I Have to Do What to Get Your Referrals?

The Referral Marketing Panel at Medtrade presented a panel of home health care experts who discussed how they select, utilize and evaluate HME providers. The panel was comprised of a discharge planner, case manager and director of nursing, a physical therapist, a successful regional HME and a vendor with referral marketing programs.

Panelists discussed several key issues:

1. How referral sources depend upon HMEs to learn what equipment they need for their patients at home.

2. How referral sources do or don?t give patients the right to choose an HME provider.

3. How HME providers can begin to get referrals even if they have been closed out of the referral loop.

In general, HMEs cannot get referrals if they are out-of-sight or out-of-mind. In the home medical equipment industry, referrals are dependent upon one-on-one relationships between referral sources and HME salespeople. HME salespeople must be dependable and reliable and do what they say they are going to do. If an HME provider follows-through, then the referral source will keep calling them back.

Following are the panelists' comments from the two hour presentation and discussion at the Medtrade show in Atlanta.

Case Management: Linda Craiger

Linda Craiger, R.N., CCM, patient care coordinator at Piedmont Hospital in, Atlanta is responsible for both case management and discharge planning.

HME providers are always welcome at our hospital. Just call our secretary and schedule a time. Case managers are extremely busy, so lunch is usually the only available time. That means you need to bring lunch. But we do want to see the presentation and equipment you bring and learn how it helps our patients. And if you have specialized HME, do your homework first so you don't waste our time and your own time. Make sure you contact the appropriate case managers in their respective specialized hospital departments such as ET nurses to see a new lymphaedema pump so that they will attend your inservice.

Craiger explained how hospitals process referrals. "Case managers are assigned to a unit with between 15 to 21 patients. They are always multi-tasking and take the quickest road to get a job accomplished. My approach is to make a referral to the supplier that has everything, such as home health and HME. All I have to say is, Get me a generic wheelchair, oxygen tank or walker in 10 minutes, and the patient has the equipment.

The only time I go outside this referral loop is when a patient needs specialized equipment such as home IV infusion. Then I utilize the supplier that either offers it all or when they accept a referral from me they subcontract out to take care of the order for me. When we go to a patient and try to explain that one company offers oxygen and another will deliver the walker, a patient who is ill may feel overwhelmed or confused. We try to only have one provider in the home to work with a patient, and those HME providers that work with home health agencies benefit because we prefer to only have that nurse in the home.

The patient is the one who always gets first choice in choosing their HME provider. The doctor is next, although the insurance company often determines which provider we must use. If the insurance company has an exclusive arrangement, then we need to know this information first. If I am asked for a provider I always say four or five names and then recommend the one who has fewer complaints. We do keep quarterly tallies on who has X number of complaints and who has none.

We prefer HME providers who we can call on a cellphone. Whoever can answer my call the quickest and is available to talk to me right now, these are the suppliers who will get our referrals. Otherwise, I have to leave a message or page someone and when they call back half an hour later, I have already processed five more patients and can?t remember why I even called them.

How do you get my patient referrals? Simply do my work for me. Pull the patient?s file to copy their face sheet, spec and order the HME, contact their doctor directly and coordinate delivery with the patient?s discharge. I am sorry but the reality is I take the quickest route to get my work done. This way I am taken out of the loop because I know you will do the work and all I will hear are compliments about your service afterwards.

Tom Coogan, HME

Tom Coogan is vice president of Care Medical, headquartered in Portland, Ore., the largest independent HME in Oregon and Washington.

I'm not the Avis but rather the Hertz, because I will try harder for that referral business. Our slogan is: One call does it all. If we get a call at 4:45 p.m. on a Friday for an immediate patient discharge, we will have the equipment at their house before they arrive home.

We have learned that by being flexible, we over-serve until we become a preferred provider and get on their list. The result is that we currently have 97 managed care contracts. By using technique and perseverance we have been able to succeed against national companies.

To become a preferred provider, you need to take sales tools with you to the first meeting. A corporate overview of your company should include your history, number of employees, annual revenue and an outline of all of your value-added services. Insurance companies want to know if you deliver after 5 p.m. or 24/7/365. Define your on-call policies, same-day delivery processes and priority orders. Include photos of personnel showing respiratory therapists with patients, drivers at patient homes and patient intake at your store. Establish a key staff person to monitor all calls from a particular payer.

Offering referral sources a tour of your facility is one of the most important elements you can provide in order to establish a personal relationship with them. Introduce them to your staff, show them the process of order intake, and possibly take them out on delivery. They may have never seen an HME before, so they are enthusiastic about coming to your workplace because they don?t know anything about HME providers.

Be involved in your referral source community. Join the Case Management Society of America (CMSA) and you will become a state association member. Most of our relationships with payer sources have been established by attending this group?s monthly meetings. Case managers provide an excellent opportunity to network. Never give up networking.

We sponsor an equipment fair every other year and help co-sponsor an annual vendor fair for all case managers in our service area. For our first equipment fair, 110 case managers attended. We also schedule quarterly inservices with them to show new products as well as provide lunch. Case managers process paper all day long and are always hungry for education. They are very appreciative whether we have an event inside or outside of their offices.

Mary Ellen Conway

Mary Ellen Conway is president of Capitol Healthcare Group, Bethesda, Md., and works with hospitals, health care organizations, insurers, home health agencies and physician offices.

"Case managers in independent practice are a gold mine of untapped referrals for HME providers. They advertise in senior publications, work with assisted living facilities and cater to families who don't know what to do with their parents. Not only do they have the relationships with families, but also with the long-term care facilities where the patients will go. They can teach you the local market and which facilities to target.

Physician offices also must be educated about HME providers. They have never visited a provider, have no idea about accreditation, and do not understand that we hold ourselves to a higher standard. Most office managers started out as the receptionist twenty years ago and don't know about anything outside of their own offices. Sponsor a luncheon with a vendor. Focus on new hires. Build a relationship. They will be thankful you forced them out of their offices.

Orientees in health care have more time to get out and visit with you. Work with your vendors to sponsor CEU programs and health fairs. You don't have to reinvent the wheel. Nurses and case managers need contact hours and all of them need lunch.

Physicians and case managers have reps calling on them every day for drugs, soft goods and OTCs. You are just another salesperson walking in the door. Be quick and precise; don't waste their time. If you don't have a prepared presentation, they will not have the time of day to see you again.

How do you become a preferred provider? HMOs and PPOs are accredited organizations and must track their complaints. If no one complains, then a hospital won't switch. But if an HME won't deliver after 5 p.m., then get patients and doctors to send in complaints. I know an HME that inserviced doctors and then had them sign a letter saying they were their preferred HME provider. They took this letter to the insurance company and got a foot in the door this way.

Remember that not every patient a doctor sees in the hospital will be part of an insurance plan or organization. Preferred providers do have contracts with the major players at hospitals. But there will still be a large volume of Medicare or Medicaid patients that need HME.

?Focus on a niche so that you will not have to compete with the chains. Start calling of specific types of doctors or nurse practitioners. For example, if you are calling on pediatric specialists, set up an agreement or loaner closet to provide them with breast pumps, nebs or apnea monitors. If you are calling on pulmonologists, offer CPAP, oxygen and nebs for both premies and adults.

David Kreutz, Seating Clinic Coordinator

David Kreutz, PT, ATP, is the seating clinic coordinator, Shepherd Center, Atlanta, who has 20 year's experience in seating and mobility.

To become a preferred provider, have a family member or doctor act as your advocate and be adamant about using you as their HME supplier. That way you are not the only person saying that you are the best in town. Let them contact the insurance company and say they insist on using a company that they know provides excellent service. Next, speak with the insurance company directly and get them to include you in their contracts.

Our hospital once owned their own DME and now understands the advantage of not being in this business. Patients have a difficult time understanding the separation between the hospital facility and an HME provider. We continuously received calls about patients' chairs when those should have gone to the DME.

HME providers need to understand the customer and the patient. When they deliver a new chair they need to be prepared to help fit the patient. So many suppliers don't bring tools and expect the PT to make all of the adjustments for the patient and train them. But this is the provider's job, not mine. And if a patient needs a loaner chair until their custom equipment is delivered, the provider needs to have it at the hospital at discharge so we don't lose our fleet of chairs.

As a referral source, we do not control how a patient is assigned to an HME provider. This is done through an insurance contract or Medicare. We give patients a list of providers. We used to use a rotational list, but found when insurance companies specified preferred providers we were unable to continue rotating. To get on our list, an HME provider must be able to provide Medicare and Medicaid patients, provide more than one type of chair, and be certified in assistive technology.

Wes Hopper, Account Manager Apex-Carex Health

Wes Hopper is national account manager for Apex-Carex Health and a veteran inservice presenter.

"Why bother calling on your referral sources? All of your referral sources are operating on slashed budgets. They can no longer attend meetings and conventions like they used to. Discharge planners and case managers still need to learn about HME, but now you have to bring the products and inservices to them. Schedule inservices, cater lunch and you will be surprised at how receptive they are to your presentation.

Inservicing referral sources is much more effective when you have veteran salespeople to accompany you. Call your vendors. They are waiting to help you on these presentations. They have ready-made Powerpoint presentations, new product samples, educational literature and coop funds to buy lunch.

Rotation lists remove your relationship with a referral source that you have worked so hard to develop. Premium relations build over time. But a rotating list ignores this preference that a referral source prefers to use. Your best option is to be on the list and then get the referral source's verbal recommendation to a patient.

Don't let pricing be an issue. Sometimes competitors will offer tremendous discounts because they have inflated their prices by two or three times. You can fight this by showing the referral sources the legitimate MSRP. Direct them to the vendor's or distributor's Web site. Print and mail them the MSRP list that is objective, printed information that you did not create. Educate customers that they are getting a better deal with your legitimate discount off this MSRP rather than from a larger discount off of an artificially inflated price.

This article originally appeared in the November 2003 issue of HME Business.

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