Make your referrals count

2008 07 03 14 58 17 239 Referrals3

You finish up with a new patient exam, and it's clear that additional work is needed. Maybe it's a mandibular implant or cantilever bridge. Maybe it's aggressive periodontitis or a malocclusion that indicates the need for braces.

In any case, it's time to bring in a specialist.

Standard procedure is to hand patients several referral cards and encourage them to contact at least one of the names on those cards. But what if you knew that only half the patients you referred will follow through?

Are you liable? Even if you aren't, what could you do to ensure your patients get the extra care they need, without running the risk of losing them in the process?

A new study from Kelton Research finds that of the 53% of Americans who are referred to a dental specialist, 46% of those referrals go unfulfilled. This trend costs specialists anywhere from $1,000 to $5,000 per patient, according to Kelton. But the impact goes much deeper than that, affecting general dentists as well, according to Irving Lubis, D.M.D., a former Boonton, NJ, periodontist who now works as a marketing consultant for dentists (

The study, which surveyed 534 patients (original sample size: 1,000; margin of error: 3.1%) who had received one or more dental referrals, also revealed that younger Americans (ages 18-49) are more inclined to disregard dental referrals than those age 50 and older (50% versus 39%).

Web-based referrals keep patients and dentists in touch

Another solution to the "referral crisis" is to use the Internet.

Michael Zerivitz, D.D.S., of Deltona, FL -- who commissioned the Kelton Research report -- recently created a Web-based referral system,, that launched this month. The site is designed to create an easily accessible yet secure form of communication among general dentists, their patients, and specialists.

"I saw a problem that has been plaguing dentists for decades: that it is difficult to refer patients to specialists and know that they actually got there, that the information the specialists need to do the treatment gets there in a timely manner, and confirmation that the patient actually made the call," Dr. Zerivitz told

While other programs offer dentist-to-dentist communication, they also require each user to have the same software, he added.

"I created a system that is cross-platformed so that it doesn't matter which software program you use. All you need is an Internet connection. There are no downloads, no annual support contract, none of that."

Another Web-based referral system, ddsWebLink, was launched in March by DDS Ventures, a San Diego-based dental services company. According to the company, the system enables dentists, dental specialists, and dental laboratory professionals to more efficiently track and manage inbound and outbound patient referrals and laboratory cases, plus associated images, documents, and case files. Like PatientsCount, ddsWebLink offers users a secure, platform that is compliant with the Health Insurance Portability and Accountability Act (HIPAA).

"Our Web-based tool has the ability to process referral inquiries and laboratory work requests from inception through completion and manage online all of the collaborative requirements of any given case," the company stated in a press release.

"I couldn't agree with this report more," Dr. Lubis told "Younger Americans are not quite as serious about their health as baby boomers. People ages 50 and up are much more apt to follow through and get the problem fixed. The younger generation thinks they are going to live forever. And if they aren't worried about dying, why should they worry about their teeth or gums?"

One reason patients don't follow through on referrals is because in many instances they are handed two or more referral cards, he noted. He cited a recent member survey conducted by Dentaltown in which 33% of 455 dentists said they refer their patients to one periodontist and 45% said they refer to two or more periodontists.

"Patients are not given a report or a letter of recommendation detailing what needs to be addressed," Dr. Lubis said. "They are handed the referral cards with virtually nothing but the contact information. This places the onus on choosing a specialist with the patient, and many times the patient is not comfortable with having to make the decision so they do nothing."

Part of the problem, he added, is the misconception that offering your patients multiple referrals will protect you from potential lawsuits. In fact, the opposite is more likely, Dr. Lubis said.

"In checking with legal sources at the ADA and elsewhere, there is no legal validity to the notion that dentists are more legally protected if they make multiple referrals," he said. "The truth is if the patient doesn't go and there are problems down the line, the patient will come back and sue the dentist for not making a strong enough referral."

The Kelton study also found that 65% of patients would be more comfortable seeing a dental specialist if they knew that the specialist was familiar with specific details of the case. For example, 29% said it would be helpful if specialists called ahead of the appointment, while 60% said they would appreciate it if the specialists had their x-rays and records in hand before the visit.

Making this information available to all parties involved -- the dentist, the patient, and the specialist -- is critical to improving referral rates, Dr. Lubis said.

"Leaving the responsibility for referral information transfer in the hands of the patient is not very smart," he said. "If nothing else, the general dentist should provide a referral form to the specialist, preferably in triplicate: one copy for the patient, one for the specialist, and one kept by the general dentist. It should detail what the dentist identifies as the problem and what the possible solutions might be. The patient should be included so they are aware of the urgency of the problem and the need for getting it taken care of."

If patients do follow through on a referral, they should be copied on any subsequent reports from the specialist back to the general dentist. This will reinforce the importance of the specialist's findings and additional treatment, if indicated.

"The chances of the patient going on with treatment are higher if they are in the loop than if they are not," Dr. Lubis said. "This applies to all progress reports and case completion reports as well."

With a copy of the referral report in your files, patients can't come back and accuse you of not having provided the proper treatment or treatment recommendations.

Dr. Lubis offers other tips for improving the success rate of referrals and improving your bottom line in the process:

  • General dentists should provide patients with literature about their condition or problem. This information should be provided to the dentist by the specialist, but is also available from organizations such as the ADA.

    Specialists should also provide brochures about themselves, Dr. Lubis said. "In my [periodontal] practice, I would have a promotional résumé, a nice information piece about me that would give all my background and practice information and education and a photograph, plus a business card," he said.

  • If you choose to refer to more than one specialist, give the patient one referral at a time rather than all of them at once.

  • If possible, contact the specialist, while the patient is still in your office. Patients followed through on 90% of such assertive referrals in a study conducted by Vincent Connor, a Colorado Springs, CO, practice transition specialist, Dr. Lubis said. When the patient was handed one card and asked to make the call themselves, the percentage dropped to 60%. And when the patient was handed multiple referral cards and asked to make the call, the percentage dropped to 30%.

The bottom line, according to Dr. Lubis?

"The stronger the referral, the more chances the patient is going to go for the needed examination."

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