Simione™ Healthcare Consultants

Referral Management: Insights & Exercises for Effective Implementation

While all home care and hospice organizations have processes and staff supporting their admissions and sales efforts, many do not closely evaluate and monitor referral management for the significant opportunities that exist to help rise above the competition.  “The vision for becoming the ‘best’ agency in your market or state requires clinical superiority, operational excellence and differentiated growth,” says Kara Justis, MBA, Director, Simione Healthcare Consultants, “and these key ingredients must be fueled by an ongoing effort for enhancing customer service and improving the entire referral process.”

According to Justis, it is common for an agency to possess good “basics” in referral management but lack consistency with practice and processes, as well as definitions and methodology for tracking and improving results.  An agency in this situation typically may not know its number of “missed referrals”, but has many opportunities for increased customer, staff and patient satisfaction.

As part of an initial assessment, Justis recommends that agencies document who answers the referral call during normal business hours.  For example, what number and percentage of calls are handled by a clinical manager, intake coordinator, office manager, administrative assistant or other staff member?  She also recommends that agencies then research and chart the average time between when each referral is received and when a team member meets with the patient/family for possible admission (i.e., less than 24 hours, 2-4 hours, 4-8 hours, 8-24 hours, 24+ hours). 

Since there is variability in the practice of referral management, mystery calls made to the agency can further identify opportunities for improvement in the process and customer service.  A few of these opportunities include:

  • Offering follow-up to call the doctor or arrange a visit
  • Giving callers more reassurance
  • Expressing more care and concern
  • Asking how the caller heard about the agency
  • Handling barriers and overcoming objections

“While no process magically improves overnight, you can start to enhance your referral management efforts today,” explains Justis.  “The sooner you start, the sooner you will see results. Simple modifications, whether they be in the staff’s use of language or in the use of your technology, can move the needle in the right direction.  Be sure to develop a plan for both short- and long-term improvements to engage your team for big results!”

In her extensive work with home care and hospice organizations, Justis often shares five themes for changing the mindset for sales and referral management:

  1. Recognize that every call is a referral
  2. Remember, it’s not about us…’s about them
  3. Make it easier for the caller/find ways to minimize hassle
  4. Offer to help, especially with consumer calls
  5. Develop accountability = hold onto the ball

Working with all members of the team, Justis recommends assessing the “referral to admission” process, first using a program focus, then a customer focus.  In short, she suggests that agencies examine every aspect of the people, process and metrics involved in their referral management efforts:


  • The right people in the right positions, with the right training, are critical to your success.


  • Processes drive efficient referral management, a customer-centered focus, technology maximization, and adherence to compliance standards.


  • Inspect what you expect.
  • Key measures are identified and used to monitor the processes and people, and to identify areas for adjustment.
  • Measures should be easy to understand.

How Does Your Agency Define a “Referral”?

In its most basic form, a referral is any inquiry about your agency’s services, Justis says, but working with various team members, you can explore the many instances when they encounter an opportunity to complete a referral. Help them to recognize the expectations in these and other scenarios:

  • An inquiry about services that includes a name and phone number
  • An provider inquiry (e.g., physician office/hospital discharge planner)
  • An inquiry with sufficient information to process insurance verification
  • An inquiry that includes a verbal or written order
  • An inquiry with validated eligibility for services
  • An inquiry which results in admission

It’s a Referral, Now GO!

In developing a customer service approach, be sure to:

  • Process/enter all new referrals
  • Track every call, fax or electronic communication
  • Get info into the Electronic Medical Record (EMR) immediately, regardless of anticipated outcome
    • Staff need the capability to enter information into software while taking the referral, eliminating as much paper as possible, but don’t let technology be a conversation barrier
    • Gather as much information as possible for verification of benefits, authorizations, prior benefit periods, etc.
  • Develop and maintain exceptional customer service and phone skills
    • Always confirm the caller’s name and contact information
    • Always say “thank you for your call” (consumer) or “thank you for the referral” (provider)
    • Ask “Is there anything else I can help you with today?”

Tips for Working the Referral

Every agency should designate staff for those referrals that require clinical expertise prior to admission.  These staff will expedite provider referrals with their clinical focus, triaging medically complex cases, handling verbal orders, and serving as a clinical connection with physicians, discharge planners, and other referral partners.   They should be reserved for clinical matters, with other staff designated for referral management activities that do not require clinical training.  However, all staff need to have essential resources to:

  • Enter all referrals into the CIS immediately
  • Start process to obtain verification and/or authorization
  • Understand the referral process
  • Understand the caller’s needs
  • Own the referral until the patient is admitted; this may include scheduling and follow-up

Admission to home care and hospice requires a sense of urgency, because patients need our help.  This is where problem-solving skills and a calm demeanor among staff members will hasten the process to help alleviate concern and obstacles patients and families.  “Beyond help to ensure clinical eligibility, reassure them by turning loose ends and uncertainty into feelings of confidence and contentment,” Justis says.

Pointers for Handling Consumer Referral Calls

The approach for consumer referrals differs from health professional/facility referrals in that there is typically no protocol behind a call from the community.  The caller needs help, and that’s what you need to provide,” explains Justis, “You want to remember that it’s about them, not you.  Even if the caller says he or she is just looking for information, it is still a referral. Get their name and contact information, explore why they are calling, and empathize and reassure them.  If you can engage first and schedule second, your results will improve.”

Key Insights on Call Techniques

Ongoing efforts to improve skills on the telephone will help staff convey the benefits of your services to the caller, providing families with comfort, relief and a sense of security.  Justis recommends an emphasis on:

  • Repeating the caller’s name
  • Reinforcing the caller’s decision to call
  • Handling barriers and overcoming objections to moving forward
  • Finding out how the caller heard about your services
  • Following up on the call all the way through (hold on to the ball!)
  • Documenting the call well for measurement and evaluation

“Callers want help with decisions,” Justis explains, “so comments that reassure they are making a good decision will help facilitate action in the best interests of the patient. Help them make informed choices and make the decision easier by suggesting the next step.  For example, ask specifically for a time that would be convenient for the patient to be evaluated or visited.”

Every action should facilitate a move forward toward the timely admission of a patient for services and care.  The culture in achieving this mindset supports overall quality, and quality efforts begins when the phone rings!

Monitoring & Measuring Your Referrals

When considering goals for referral management, conversion rate is not the primary measure agencies should focus on,” Justis says.  Instead, focus on three areas:  number of referrals, number of admissions, and time from first call to admission. These areas help the team concentrate on “how many people we can help, how many people we are helping, and speed of service as a differentiator for better customer satisfaction,” she adds.

For more information about Simione’s capabilities to support your sales, marketing and referral management goals, call 800-949-0388 or email[email protected].  

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