Basket fruit gift sending

Gaining referral sources is all about professional presence, not presents, say experts interviewed for this, the fourth in a series of articles in PT on various aspects of establishing and maintaining a successful private practice.

There's much more to successfully cultivating referrals than baskets, brochures, and friendly goodbyes at the close of patient visits. That's the message from experienced physical therapists (PTs), who say that the private practitioner who knows when to ask questions and when to share insights will have far greater success gaining referrals than will the PT who leaves fruit baskets or other tokens at physicians' offices but fails to educate and inform his or her patients and clients about physical therapy.

"Vision 2020(1) is all about our becoming a doctoring profession, with a skill mix that is separate but equal to that of other health care professionals," observes Ernie Roy, PT, CSCS. "I don't think we approach a physician provider who's a potential referral source with a gift basket of yum yums when what we're seeking with physicians is a collegial, consultative relationship." Roy, program coordinator for the physical therapy service at LRGHealthcare in Laconia, New Hampshire, has put much thought into the PT-physician relationship, even going so far as to draft a set of guidelines he's titled "Avoiding Pitfalls, Fostering Communication."

To Marilyn Swygert, PT, MHS, patient visits aren't simply a matter of providing care. They're opportunities for "letting patients and clients know that you are the person they, and their family members and friends, should turn to for the rest of their lives for treatment and prevention of musculoskeletal problems."

Sure, Swygert stocks brochures in her waiting room that describe all the services and programs offered by Charleston Physical Therapy, the South Carolina practice she co-owns. "But I also talk about the various aspects of what I do as a professional," she says. "I listen closely for what patients and clients might say about family members who have physical problems, and I suggest how physical therapy might help. I seek, generally, to broaden people's understanding of what physical therapists do."

Lynn Steffes, PT, holds that every time a PT sends off a patient or client with a simple, "Goodbye, see you Wednesday," an opportunity for future referrals has been lost.

What that PT should do at the conclusion of any patient visit, Steffes says, is thoroughly recap the session, emphasize any progress made, reiterate home program instructions, and end by saying, "The next time you come, this is what we anticipate doing." The result, she says, is that the patient's or client's "perceived value" of the visit will be enhanced-which, in turn, will foster positive impressions of the PT and of physical therapy on anyone to whom the patient or client subsequently describes the session. "Your patient isn't, then, going to limit the description to, 'She rubbed me,' or 'He made me do a bunch of exercise,' Steffes says. "Instead, he or she is going to say, 'When I first went in there, I could only turn my head this far. Then the physical therapist did this, and now I can do that. And this is what we're doing next time."

Steffes, whose New Berlin, Wisconsin-based company, Steffes & Associates, markets its own referral relations portfolio and toolkit, believes that "the first place you develop referrals is through the quality and level of communication you have with patients and their family members on a daily basis."

Ask Questions

"Ask yourself," suggests Phil Tygiel, PT, MTC, "are you just looking to drum up business, or do you want to develop a practice that you'll enjoy-one that will allow you to practice the way you want to practice?" If you're a new private practitioner and the latter is the case, the owner of Tygiel Physical Therapy in Tucson, Arizona, advises, "almost hand-pick your referrals. Look for doctors who'll appreciate your diagnostic skills, your expertise, the level of care you can provide."

The next questions are for the physician. "Don't start off trying to impress the doctor by telling him or her what you know," Swygert cautions. "Instead, ask, 'What's your toughest patient?' or 'What type of patient do you like least to treat?' Typically it's going to be that chronic pain patient, the one who keeps coming back. In that case, ask the physician to send you a patient who has chronic pain. Once you've shown that you can help that patient, other referrals will follow."

Be an Educator

Steffes sees each patient visit as a chance to address "a huge PR problem"-the fact that "a lot of patients, and a lot of people in the general public, view the physical therapist as someone who rubs backs and exercises people." It's difficult for a PT, in private practice or any other setting, to "differentiate him- or herself from massage therapists, fitness instructors, and personal trainers unless he or she explains how what PTs do is different," Steffes says.

"Too often," she observes, "we start treating someone and we expect that person to interpret what we're doing as a skilled service, without having communicated to that individual the value of what we do. PTs need to explain the partnership between PT and patient, share their impressions of the diagnostic tests, educate patients about their own care, and thank them for their participation in managing their recovery."

With co-pays and deductibles rising, "patients are not going to want to take $25 or even $50 a visit out of their own pocket unless they truly understand the skilled nature of the care you provide," Steffes says. "The physician's perception of the PT, too, is going to be that much more positive when the patient reports back the progress he or she is making in physical therapy and what's planned for the next visit."

Tygiel notes an "interesting phenomenon" that often occurs when patients return to their physicians after having received physical therapy. "The doctor is expecting the patient to tell him how he's doing, but the patient is expecting the doctor to tell him how he's doing. The patient thinks the doctor is omniscient." A danger of this "you tell me" approach on the part of the patient is that the physician may assume from the patient's lack of information that physical therapy isn't working.

"Sometimes it helps to prepare the patient," Tygiel says. "Not only should the PT provide the physician with a well-written, intelligent, typed report, but the PT might say to the patient, 'Tell Dr So-and-So this.' That can be tremendously helpful."

Document Well

Steffes has one word for PTs who characterize themselves as "people people, not paper people." The word is "Tough!"

"Payers, physicians, and case managers judge us largely on the strength of our documentation," Steffes says, "so it always must be at the highest professional level. We tend sometimes to sound like technicians: 'This measurement was this, this measurement was that.' I encourage PTs to pull their patients' charts and look at the content and quality of the evaluations by neurologists and other specialists-the assessments, impressions, and recommendations. PTs often can learn something from the way those reports are put together."

Another audience with which outstanding documentation can resonate and bring referrals is personal injury attorneys, Tygiel says.

"A good, narrative report that lays out how the injury occurred, what the impairments are and what tissues are damaged, and the recommended course of care has tremendous value in court," Tygiel notes. "PTs are uniquely qualified to tie together movement, function, cause, and effect-how an injury happened and how it will affect the patient's function. Once a PT has established to the legal community that he or she is adept at documenting all that in a clear and accessible way, that PT is going to be in demand."

Gift Sparingly

So, what about gift baskets for potential referral sources? Sometimes a good idea? Always ill-advised? Opinions are mixed. (In fact, earlier this year the APTA Board of Directors asked APTA staff to investigate the ethical, legal, and practical implications of offering gifts and other incentives to individuals who may influence referrals to physical therapy. A report, which will include information on the policies of other professions, is to be issued to the Board in November as a precursor to developing positions, policies, or guidelines for members' marketing practices.)

"I think things like gift baskets make PTs look too much like sales reps," says Swygert. "There's nothing that burns me up more than the idea of people bribing you, essentially, to listen to them." That said, however, she allows that there's nothing wrong with leaving office staff "something you baked, if you're already coming in to talk to the doctor."