Neurologist
We conducted validation interviews with doctors to find out their feedback and thoughts regarding Physician Liaisons. They provided insightful responses that will surely help better our services and what we can do for their practices.
Here are the questions that were asked:
1. What are the top specialties you refer out to most (ortho, OBGYN, Pain, ENT, etc), and for what (conditions/symptoms/treatment)?
2. Besides excellent patient care, when referring to a physician, what factors help you make that decision to send to that physician or practice? (examples: cell phone number, them meeting, you face to face, location, etc)
3. Is there something a physician liaison or medical rep that stands out to you in a positive or negative way, and why?
4. If a physician liaison comes to your practice to discuss building a patient-referring relationship between you and their specialists, what can they say/ do that would provide value for you or your staff?
5. What is the greatest value a physician liaison would be able to provide to your practice?
Written Validation Interview:
Dr. Saad K.
1. Pain/pm&r injections and neurology
2. Cell phone/personal contact
3. Pushy and not knowing when to back off
4. Doc's direct cell number. Often need to just talk about a patient.
5. Help me network - setup lunches. follow up on referral problems.
Dr. Robert A.
1. Orthopedics for shoulder and hip, neurology for headache, neuropathy, dementia, and post-stroke care. Pain doctors for nonoperative back pain.
2. Availability, patient feedback, and personal interaction.
3. knowledge, and availability
4. Not sure.
5. They would facilitate communication between and education about surrounding providers and how they may be able to help each other.
Dr. Olga K.
1. Orthopedics: for degenerative spine disease that needs presurgical evaluation or requires surgery
Pain: for any patient with pain that might need controlled substance prescriptions (opiate) or might benefit from injections (LESI, CESI, ganglion blocks, etc)
ENT: patients with headaches that are found to have sinusitis on brain MRI
Neurosurgery: cerebral tumors, malformation of brain and spine, hydrocephalus, etc.
Cardiology: patients with stroke that potentially can be cardiogenic, patients with refractory hypertension that causes neurological disorders
2. I only refer to physicians I know personally and can contact at any time, I am a private neurologist and have my own network I like.
The location makes no difference to me. I want to discuss the patient over the phone or texts, that can be needed before or after the visit, I do not rely on faxes or official notes, I need information beyond a consult note as I want to learn myself also or confirm my trust.
3. I need to be presented with the information I am interested in and ask for, there is lots of data and information I can get myself and already have before the liaisons come, I do not need reintroduction of the data known.
I do not like lectures by liaisons, prefer a conversation particularly to discuss existing patients' cases. I like it when I get patients' booklets or other material to have graphics that can be understood by patients and easily used by me during the visits. I had no negative experience with liaisons but I know I do not like pushy people that I know some doctors literally hide from
4. I want the names of the physicians, I can get information myself, I would want to talk to the doctors as well.
5. Answer my current questions, facilitate efficient care, provide better communications between physicians.
Dr. Mike L.
1. My main referrals are to Orthopedics (mostly hand surgeons for carpal tunnel or cubital tunnel repair), Neurosurgeons (meningioma, malignant tumors, aneurysm, spinal surgery), Rheumatologists (pain and overlapping Neuro autoimmune disorders), Vestibular Therapists for vertigo therapy, Physical Therapy (huge number of referrals for pain, gait disturbance, pinched nerve, muscle weakness, TMJ, rehab after stroke, for a functional increase in Parkinson's), Craniofacial docs (for oral appliances to treat Sleep Apnea and TMJ/Bruxism), durable medical equipment companies for CPAP and sleep devices, Cardiologists (for patients with certain types of dizziness, orthostatic symptoms, blackouts that are likely not Neuro), Pain Specialists (for treating pts who need epidural blocks, facet blocks, Neural stimulators, neural ablation), and of course testing facilities (for MRI, CT, carotid/vertebral ultrasound)
2. Reputation in the community, word of mouth from other docs I trust, prior results, them communicating back with me after referring to them, ability to get a patient in quickly if I call them, convenience/location (a bigger deal than you might think here in Atlanta), participating in pt's insurance (esp Medicare, since more and more docs, have opted out). For testing facilities, it's flexibility with payments- many of which now have a steeply discounted cash price which is very helpful for patients with a high deductible
3. Positive is stopping by periodically if there's anything new, getting me copies of new studies, etc, and being easily available. Negative is hovering too much, being pushy with my staff, and wasting my time with "educational visits or updates" that are little more than infomercials about something we've discussed previously or are irrelevant to my practice. And absolutely NO SPEAKERS, most are largely a waste of time, as my partner and I keep up on the literature and I participate in Clinical Research so know about a great many Neuro or Sleep therapies before they're approved since our center has participated in the studies leading to their approval.
4. Be honest with staff about what the content/types of docs or services they're interested in discussing, bring lunch for us and our staff, have referral forms, cards, CV, etc for us to have, DO NOT have prepared, canned presentations with graphs, charts, etc as our eyes glaze over and you may not be invited back. Be able to think on your feet and discuss and know your subject or be upfront about what you don't know or are interested in knowing from us. Ask us what we need. Be an asset in saving time and aggravation for us docs and especially our staff
5. The greatest value is to enhance our ability to function by providing new information, acting as a conduit to introduce us to new practices that are relevant, spreading our name around to practices looking for Neurologists or Sleep Medicine specialists, letting us know about new Specialty Pharmacies (which is a new niche, as they specialize in getting prior authorizations approved, saving my staff tons of time).
Dr. Ayesha V.
1. Psych for anxiety and depression, neurosurgery and cardiology
2. Ability to communicate the plan of care after being seen by the physician
3. Don’t quite understand the question
4. Easy scheduling if patient and patient being seen in a timely manner based on urgency
5. Strong communication skills
Dr. Safa N.
1. Neurosurgery for surgery, Internal medicine for internal complications and symptoms
2. Meetings
3. Personality, professional skills
4. Honesty and cooperation
Dr. Suzanne C.
1. Most frequent referrals: cardiology for investigation and management of arrhythmia and anticoagulation (I'm a neurologist who sees a lot of stroke and atrial fibrillation and PFO are heart conditions that deserve a look at by cardiology), neurosurgery (brain tumor found on imaging, complex aneurysms, spine surgery), pain (EMGs/radiculopathy, occipital neuritis, baclofen pump management, interventional pain procedures), neuropsychology for cognitive testing (concussion, dementia, ADD), psychiatry (depression, anxiety, PTSD). Therapy services are a huge referral (PT OT ST).
2. Having met someone is always huge, because you have a face to face relationship, and you feel like you know them. And that can be positive or negative. I have a lot of experience with what is truly emergent and what is inconvenient and I don't like to overuse emergent. So sometimes having a cell phone or more personal contact is nice as well.
3. I like the vast majority of my liaisons and reps, although we haven't seen much of each other since COVID started here. Positives are understanding that our meetings are always superimposed on the busiest days you can imagine. At the same time I know it's important for your VP or leads or whoever to meet me, that is not the time to also ask ten questions about why I prescribe less of your product. A better question is along the lines of what can we do better, so you VP or lead or whoever can garner info. For example, if the script always goes to prior auth and I have to touch it again later, you can write your product off with me. I already spend at least 10 hours a week on prescriptions - new renew prior auth co-pay cards, etc. If your product is a no go from the get-go then your people need to hear about it and fix it on your end.
And I know this sounds dumb, but if my day is busy and I'm behind because I always am and I've missed lunch because I always do and you show up for a two-minute chat and you have a scone or a soda or a coffee or a puppy ;) you're much more likely to get my ear.
4. Tell me how they can help me and my patients, i.e., we do authorizations so you can see more patients, we help the patient directly which saves them time, etc.
I have a great relationship with our vascular surgeons because I place a referral and they get seen within a week, which is a big deal in someone with bad carotid disease. Sometimes they're seen before I have the note done and out, which is awesome. Their office takes the referral and runs with it. What I don't want to hear is that I talk something up with the patient and they don't get called. Or I don't get anything back. Even drop me a ten-word email, thanks for the referral, we're gonna schedule surgery soon. I hate finding out later that a patient had surgery and I never knew what happened with the referral. Because I have a legal/malpractice issue with the referral, right? I have to prove that I referred 1) promptly and 2) effectively.
If there is something that a specialist would really like to have at the time of referral, I can likely order that, but I need to know what it is. Getting a massage 15 days later that they can't be seen without an "x" is a huge pain in the butt. I have to open the chart, figure out why I'm ordering it, order it, get it to the MOS for authorization, etc. It would be easier to do when the patient is in the office and I am in the chart and the MOS will be on the chart for the next couple of days. Anytime I have to go back to the chart, that is a major time-waster.
5. Be a true liaison. Understand what I do and what your physician does and how those things work together. I.e., I realize we're an ortho practice, but we do have onsite multimodal therapists, who could potentially help all of your gait problem or concussion or fall referrals or an in-group pain person, which could be an added value for me when the surgeon doesn't think you need surgery.
Or if you work for a health system ( not practice to practice but a physician to the system) make an appointment to check-in quarterly and let me know how things are going from your end and be willing to hear the same about my end.
Dr. Daniel P.
1. As a neurologist, I refer to the following specialties most often: Neurosurgery (usually for spinal surgery indications or surgical treatment of carpal tunnel syndrome), pain management (for cervical or lumbar epidural steroid injections), ENT (for sinusitis or vertigo of a non-central cause), physiatry (for musculoskeletal conditions or fitting for prostheses), and orthopedics (for shoulder, hip, or knee conditions).
2. Besides excellent patient care, the following factors are important in determining where to refer patients: past experience and reports from patients previously referred, location, whether or not I know the physician whom I am referring today, clinical reputation in the medical community, wait time, published patient ratings or surgical complications rates, reports on friendliness and professionalism of the staff.
3. The interactions with medial liaisons I remember most are those that are friendly and courteous, and those that are sensitive to tight schedules. I enjoy friendly, non-pushy, time-sensitive interactions that are beneficial for my patients, caregivers, and practice. Recently, liaisons have been very helpful in getting my patients earlier appointments with consultants, and have facilitated obtaining records from a consulting practice in a timely fashion.
4.They can be friendly, courteous, and respectful of time, first of all. Then they can tout the benefits or potential advantages my patients could get from being referred to the practice they are representing, and they could provide materials and information that would streamline the referral process.
5. The greatest value a physician liaison could provide to my practice is to provide information, resources, referrals, or some product or process that is likely to help my patients, and to improve the quality of the healthcare I and our staff are able to provide them, and by ensuring efficient delivery of said product or process.
Dr. Gabriel B.
1. Neurosurgery
Pain
Rehab
Ortho
ENT
2. Expertise
Convenience,
Proximity to Patient
3. Both have provided useful information in the past. New treatments, devices, changes in prescribing all have been reported by liaisons or reps.
4. Not sure, but it would depend if there is adequate expertise and appointments are quick. They must have some kind of affiliation or agreement with the VA.
5. Information about products, changes to products, resources for patients
