I run growth for a healthcare practice and a large part of our practice is fed by physician referrals. While this is just one of the demand gen channels I manage, this is the most important one for me right now.

The physician liaison / field sales reps team is constantly out in the field meeting with potential referring physicians. Since I don’t quite have a large budget.. Here are some practical tips on how to run this on the cheap.. For people that aren’t given a large budget 🙂

Granted, physician liaison is a “relatively” new concept but to me, that’s super-duper important.

Let’s get the basics first so we are on the same page.

What’s a physician liaison?

You can call them practice representatives, physician relations manager..whatever you wish.. These are folks that hospitals and specialty practices employ (or should employ) for business development.

With more and more small practices being forced to sell to larger health systems, this role has become even more crucial for your independent practice / hospital to succeed.

My advice – Understand the role well, hire the perfect personalities for it and give them adequate support to succeed.

What does a physician liaison do?

Pretty simple – their sole task is to grow your referring physician base. You grow your referring physician base by keeping open lines of communications with your total addressable market of referring physicians.

So, in effect, this role includes a mix of customer service, sales, consulting..

Customer service – your referring physicians need to be happy sending patients to you. While your ops team can certainly help by giving out quicker appointments, reverting with visit notes ASAP, keeping your referring physician partners in the loop all the time.. you know that doesn’t usually happen..

Enter the physician liaison to keep the customer (referring physician) happy.

Sales – well, your physician liaison managers are knocking on physician doors and prying them open. They are visiting these providers 6-7 times (research shows it takes 6-7 attempts before someone recognizes your brand) before the provider starts sending you referrals.

Consulting – helping the referring physician office with questions they have. I have had situations where my reps went in and suggested a diabetic patient annual eye exam so these practices can increase their HEDIS scores.. I have had situations where my reps literally escorted a patient in their car back to our office for an immediate consult.. Where they helped someone troubleshoot a problem with P2POpen etc..

That’s what they do.. Understand it well.

What to look for in a field sales rep / physician liaison?

First and foremost, they need to have strong communication skills, interpersonal skills, and organizational skills.

They need to have a very friendly, outgoing personality with strong communication and interpersonal skills.

Most of the offices these reps visit are busy seeing patients and going through their daily lives.

Physician liaisons disrupt that.. And have to bear the consequences of that as well.. However, an outgoing and friendly personality helps with situations where you have to wait for 2-3 hours to see the doc or the practice manager… where you have to chat up the front desk staff as you are the 5th rep that showed up today..

The list is endless…

They need to be very well organized… more often than not, when a liaison visits a physician office, they don’t always get what they came for immediately.. Many times (in our case, more often than not), the doctor visits on specific days.. The doctor cannot see them unless it’s between 10-12 noon etc etc.. The liaison has to remember to come back on specific days, specific times .. on top of that, they have to optimize their routes to cover as many doctors as possible.. A laundry list of things to stay on top of (yes, several software can help with that.. But I will address it later)..

They need to be “relationship” kind of people… this is a relationship sale (if it can be called a sale).. Channel partnerships can only be built on relationships.. A liaison needs to be able to build a relationship with the office staff (not only the doctor).

They need to have some knowledge of the specialty – while many liaisons are just starting off without any idea of the industry itself.. The most effective ones understand the specialty they represent and can speak the lingo.

What does a physician liaison need to be able to do their job

I cannot tell you how many times practice leaders have hired physician representatives and told them.. You need to generate referrals.

From where?

……Uhh.. from the docs nearby..

OK, is there a list of doctors that I can rely on?

……Uhh.. no, just google it

Umm.. ok, is there a specific kind of doctor that I should visit? Or do I visit any PCP or specialty or… ??

……Uhhh.. just go to the docs and we prefer referrals from PCPs, opticals, Internal medicine …

OK… so how do I identify them? Is that on google?

……Uhh…

And so on..

Don’t do that. Don’t be that manager..

Arm your team with the right data and then only should you expect them to perform.

Understand that you, as a manager, are going to have to answer these questions:

  1. List of practices your physician liaisons needs to visit.
  2. How do they create their daily route plans?
  3. How do they report back their progress?
  4. How do they manage reminders to go back to certain offices?
  5. How do they (and you) track whether the office they visited did send us a referral?
  6. A few more…

There’s pretty sophisticated software (available off the shelf) to help you with several of these problems.. But here are some simple hacks I followed

Physician list building

We use one big database of all physicians that are listed in New York City area. However, since our locations are only in Bronx, Queens .. not in the rest of New York i.e. Manhattan, Brooklyn or Staten Island.. We cull them out…. Primarily because people don’t travel far from their home or office locations to see doctors and prefer to see doctors near them.

We could have bought this list but of course, even that data is not always guaranteed.. Nor is it any provider directory ever truly correct (that’s another big problem that our industry has).

This big database is created using CMS’ NPI database (http://download.cms.gov/nppes/NPI_Files.html ) . They are pretty good about it.. With monthly and weekly updates.

They were extra nice starting June 18, 2018 as the download included the following 3 new reference files:

  1. Other Name Reference File – this file contains additional Other Names associated with Type 2 NPIs
  2. Practice Location Reference File – this file contains all of the non-primary Practice Locations associated with Type 1 and Type 2 NPIs
  3. Endpoint Reference File – gives you a list of contact information for NPIs.. (web, email, connect, direct etc)

Do keep in mind that this data is NOT clean.. But at least you get a starting point..

Just filter by the state, city and entity_type code (2 for orgs and 1 for individual physicians)

Your next step is to validate these addresses against google, zocdoc / healthgrades to see how many of them are invalid. For google check up, use a simple macro in google sheets and validate the address.

If you want to get fancier with this, you can also figure out the procedures a provider bills for, the plans they accept, how many patients they see, how many times they see them.. Etc (from another database clinician utilization & individual network provider database).

BTW, this advanced information really, really helps hunting 🙂

Once you have created this “sort of” clean database of physicians to go after, here are the steps to take.

Keep in mind that this is how I hacked it.. Doesn’t mean that you have to follow the same process.. You can figure out your own as well.

Physician territory and route management

  1. Keep in mind that this is a bit of a manual process.. Again, keep in mind, I needed to hack this together and had outsourced assistants to help with this.
  2. Please do choose a tool that helps your sales reps be out in the field and check in at locations they are visiting, leave notes from those locations, mark the validity of the list you provided them etc. For us, we chose badger maps.
  3. Create a master spreadsheet of doctor offices to visit that are near the office locations of your practice.
  4. In the spreadsheet, assign offices evenly between reps (again, this is all available in CRMs).
  5. End of each week, prepare 50-60 accounts for each rep to visit the following week.
  6. Try to give reps the cleanest data possible. For each practice listed in the spreadsheet, google them to see if the address in the spreadsheet is correct or not. Trust google data more than the spreadsheet’s NPI database data. If google doesn’t show data, try zocdoc.com or healthgrades.com.
  7. Update the spreadsheet with the data you get from Google or zocdoc. Sometimes you will find google data and won’t be able to understand it unless you click on the website itself. If you go to the website, definitely copy all the locations listed there on that website and add them to the master spreadsheet. E.g. you see “THE PAC PROGRAM OF QUEENS” listed at “3501 QUEENS BLVD, LONG ISLAND CITY, NY, 111011700”.. But when you google them, you will see “Address: 7 Debevoise St, Brooklyn, NY 11206” … they have already moved and have multiple locations. So, you click on their website and find all their locations
  8. When you are preparing this data for the next week, look at other data you have prepared in previous weeks. If there are accounts that are marked with specific follow up dates of the next week, make sure that you include those accounts in this week’s account list.
  9. Once you clean this practice location data, upload them into a route map tool of your choice as accounts.. FYI, we used badger maps. Do this 1 step at a time so the accounts are assigned to the correct person (each rep).
  10. If you make any mistake with the step above, you can easily edit an account and assign to the other reps
  11. Next step is to create route maps for each rep using some kind of a lasso tool (or click/map tool)
  12. I would recommend that you don’t exceed 10-15 locations per lasso as it’s very difficult to see as many doctors per day.
  13. Hopefully your route mapping software lets you “Optimize” routes as well. Sometimes, this does suggest a faster route to the reps. Do it.

Make sure you tell your reps to enter copious notes.. doctor names REALLY, REALLY help because you can use this doctor name to match against the referring physician for all new appointments.

Weekly reporting, data cleanup, measuring sales effectiveness

  1. At the end of each week, collect the check-in report from each rep and compare against the list you gave them for that week.
  2. From this checkin report, publish a simple report that shows the following:

— Accounts assigned per rep that week

— Accounts visited per rep that week

— Productivity = visited / assigned accounts (per rep) – this helps you understand what’s hindering productivity of field reps.

3. From this checkin report, publish a simple report that shows the following:

— Accounts assigned per rep that week

— Accounts marked INVALID that week – this helps you understand how to better prepare the weekly data.

4. In this check in report there are notes that reps leave. Collect those notes and do the following in the master spreadsheet – e.g.

  • Some practice locations from the list are no longer active, so mark them as INVALID along with the CHECK IN DATE
  • Some practices tell reps that they will never send patients, so mark them as REVISIT LATER along with the CHECK IN DATE
  • Some practices tell the reps that they will definitely send patients, so mark them as FOLLOW UP and enter a follow-up date of 2 weeks from check-in date in the master spreadsheet along with the CHECK IN DATE (keep in mind that reps will keep going back to the same offices every 2-4 weeks, so each CHECK IN DATE should be recorded so you can figure out how many touch points are needed before a doc office actually starts sending patients).
  • Some practices say that they already send patients to the Jackson Heights. Sometimes it so happens that the docs write the referrals on referral pads to their patients and think the patient reached our offices, but the patient never calls the office. Go to the master patients spreadsheet and find out if a referral was received from these offices. If you find the referral patient, mark this account as CUSTOMER.. Else mark it as LOST REFERRAL. This needs to be investigated further by our front-office folks as they might not have marked the patient’s referral source. If front office cannot find any issues on their side, the reps need to tell these referring docs to use another way of referring to our offices (fax or using our referral software).
  • Some practices tell the reps to come back later or on a specific date or on a specific day of week when the doctor is present in the offices.. So, mark these accounts as FOLLOW UP and enter a specific follow-up date on that specific day of week, next week in the master spreadsheet.
  • Do as many of the same steps above in your route map tool as you can, so you have the same data on both the route map tool and also the master spreadsheet.
  • Next step is to figure out which one of the accounts/practices that said they would send patients, actually do send patients. Of course, the expectation isn’t that they would immediately send patients, so you would need to look at new patients that came to your practice locations in the last few weeks (last 30 days is a good measure). For this open up your EMR to figure this data out..
  • Most EMRs/EPMs would allow you to get reports of all appointments created over a date range (and sometimes also shows you who the referring physician of record is).
  • For us, unfortunately, front desk staff weren’t recording the referring physician names on a regular, regimented basis (not entirely their fault.. More on that later)
  • Unfortunately, our spreadsheet uses practice name and not provider name to create the sales routes.. However, appointments are created using the doctor/provider name. This is where additional information needs to be dug up for each patient that has referring physician data available. Even though there will be a few rows of data where referring physician information is present (“REFERRING PHYSICIAN/PHYSICIAN NOT SELECTED”), we go through each of the other rows and copy the patient name, then head over to our EPM to find that patient
  • Once you have found the patient, typically, you can see the attached PDFs to find out the actual referring physician information (staff usually scans and attaches a PDF of the referral to the patient record itself.
  • Now that you have the referring practice name information, go back to the master spreadsheet you have and mark the prospect/practice name record as CUSTOMER. Keep in mind that the name might not always match 100% but the fax number usually will or the address will match.
  • Go to your sales route mapping tool and make sure to mark the account as CUSTOMER (later these CUSTOMER accounts might be removed)

The steps/methodology mentioned above has given us a better handle of what we are doing and how are approaching physician liaison marketing as a regimented process. As we prove further ROI of physician relationship marketing, this would allow us to allocate further budgets towards this channel.

Again, keep in mind that there’s commercial software available to solve MANY of these problems.. Use them if you have the budget to do so.

Stay tuned for further updates