Successful Collaboration Means More than Referral: Make the Most of Your Primary Care-Specialist Relationship

Tips on how to coordinate with emergency care and referral hospitals for better patient care and better cooperation.

In a human healthcare environment, if a primary care physician didn’t refer a patient to a specialist if indicated, it could be considered malpractice. In our veterinary environment, it’s often just another day at the practice.

by Robin Brogdon, MA

With 22 recognized veterinary specialty organizations comprising 41 distinct specialties, it’s no exaggeration to say that specialty care has grown substantially over the past 20–30 years. Today, there are approximately 13,500 board-certified specialists, about one-tenth the number of veterinarians in the United States, according to the American Veterinary Medical Association.

So why don’t most pet owners know veterinary specialists exist, and why do so few patients get referred for advanced care?

The answer is complex and yet simple at the same time. It starts with primary care veterinarians (PCDVMs), who, by their very nature, are generous, protective, and practical. They truly want to help everyone who comes in their door. The problem is, many pet owners can’t afford optimal care, and many more don’t seek any care at all. This sets up a scenario where plenty of veterinarians are not even offering referrals, as they believe their client cannot afford it or don’t want to be perceived as incapable. But do we really know what a pet owner will do to help their ailing companion? In some cases, not even offering the option to seek the expertise of a specialist is a disservice. Educating the pet owner, giving them a choice, and then helping to facilitate access to advanced care, including financial resources if appropriate, is also part of the veterinarian’s responsibility.

That’s the simple part of the answer. The more complex answer stems from old habits of “doing it all,” not seeing the value in the additional expense, an unwillingness to acknowledge a limit to their skillset, geographic barriers, fear of lost revenue, and even the belief that most of what a specialist provides can be delivered at the primary care level, barring some of the sophisticated equipment and training.

Add to this the fact that not all specialists are as open to discussing cases or as communicative as they could be to demonstrate a willingness to collaborate. This can come in the form of referral letters trickling in days or weeks after the referred patient was seen or slow response to returning calls. These behaviors certainly do not lay a foundation for productive dialogue or nurture a trusted relationship.

 

Shifting Norms

In a human healthcare environment, if a primary care physician didn’t refer a patient to a specialist if indicated, it could be considered malpractice. In our veterinary environment, it’s often just another day at the practice. But change is happening.

As veterinary specialization has become more prevalent, recent graduates are accustomed to seeking the guidance of a specialist. Lacking the confidence of a more seasoned PCDVMs, this group of practitioners is apt to turn to a colleague for help managing a case. Their ego is less easy to bruise, simply because they are not expected to have the experience to know how to handle just about anything that comes their way at this stage of their career.

Two or more veterinarians . . . serving the pet and owner
as a unit, make for a deeper, more thoughtful approach
to care and treatment.

Just as specialty care has advanced, so have the choices for paying for care. As a profession, we have not done a very good job of discussing finances with pet owners, so many lose out on the opportunities available. And while not all pet owners will take advantage of the additional financial options, we need to make them aware of what’s out there. From wellness plans to pet insurance, healthcare credit cards, and third-party billing, not to mention online crowdsourcing, a little planning and creativity can net needed resources.

Plus, technology today affords nearly every veterinarian the ability to seek consult from a specialist, even if there are no referral practices nearby. PCDVMs can still provide some advanced care through telemedicine by consulting directly with a specialist. While it can be argued that it’s certainly more advantageous for the pet and owner to visit the specialty hospital, if that is not possible, expertise can at least be sought to provide some level of care. The specialist can charge for the consultation if a referral is not practical, and the PCDVM can charge the client. Technology also enables real- or near-real-time electronic access to patient information between practices with a host of new tools and apps. Using these resources reduces the barriers to collaboration and provides a much more efficient and convenient way to remain connected to your patient.

Collaboration Helps Everyone

The truth is, collaboration—not just referral—is good for the entire profession. How, you may ask? Well, look no further than a retrospective cohort study (published in the Journal of the American Veterinary Medical Association in July 2016) by Bonnie Lefbom, DVM, DACVIM (Cardiology), et al. that looked at “impacts of collaborative care on survival time for dogs with congestive heart failure and revenue for attending primary care veterinarians.”

The study’s objective was to assess the effects of in-person collaborative care by PCDVMs and board-certified veterinary cardiologists on survival time of dogs after onset of congestive heart failure and on associated revenue for the attending PCDVMs.

Dogs who received collaborative care had a longer median survival time (254 days) than did dogs who received care from the PCDVM alone (146 days), the study showed. A significant positive correlation was identified between PCDVM revenue and survival time for dogs who received collaborative care (i.e., the longer the dog survived, the greater the PCDVM revenue generated from caring for that patient).

Recent trends show collaboration is on the rise. That’s good, because it helps not only the pet but all stakeholders in the profession, financially and emotionally.

The researchers’ conclusions suggested that collaborative care provided to small-breed dogs with congestive heart failure by a board-certified veterinary cardiologist and PCDVM could result in survival benefits for affected dogs and increased revenue for PCDVMs, compared with care provided by a PCDVM alone.

What the study demonstrated is the exact premise behind the formation of Veterinary Specialists Outreach and Awareness Project (VetSOAP), a nonprofit organization formed in 2012. After conducting research patterned after Lefbom, et al.’s study, using the hypothesis that there is a correlation between the health of companion animals and the frequency and timeliness of collaboration between PCDVMs and specialists, progress is being made. In fact, VetSOAP was recently renamed the Collaborative Care Coalition, to better reflect the integrative nature of working together and its true benefits to all stakeholders, most notably the animals.

On the surface, collaboration makes perfect sense. Two or more veterinarians, with the primary care practitioner as the nucleus of the triad-of-care relationship, serving the pet and owner as a unit, make for a deeper, more thoughtful approach to care and treatment. Through regular communication and a shared vision, the team of veterinarians can guide the pet owner through the process and offer support along the way. Everyone experiences value when working in this manner.

In veterinary medicine—as in human medicine—working in silos is counterproductive to achieving the best possible patient outcomes. Whether you are a PCDVM or a veterinary specialist, forging referral relationships with other veterinarians in your service area is a best practice that research affirms can deliver real benefits, including:

  • Helping the animals you care for live longer and better—Objective data proves that pets whose health is comanaged by PCDVMs and specialists do better than those managed by PCDVMs alone.
  • Building a more loyal client base—When pets receive optimal care and live longer, clients are grateful and feel more bonded to their veterinarian.
  • Strengthening your practice’s bottom line—When pets live longer and their owners are loyal to your practice, it translates into increased revenue for the practice.
  • Changing the conversation—When PCDVMs educate clients about all the care options that are available for their animals, conversations about their pets’ health shift from a focus on finances to one of providing optimal care and position the primary care practitioner as a trusted resource who puts patients first.
  • The entire industry wins, too—When pets thrive, practices do well—and so do all the companies providing veterinary products and services. Collaboration is good medicine—and good business.

But true collaboration means more than making a referral or receiving a referred patient. Collaboration means an investment of all parties to honestly experience the benefits. For an industry built with introverts, extending oneself to build relationships and identify clinical resources you can trust is what it takes to feel confident in your recommendations and gain compliance from clients. Advances in technology can help here, too. No longer is the telephone or face-to-face communication the only vehicle to establish and nurture these relationships. This can all happen digitally, the preferred method for so many younger professionals.

Here are a few recommendations to enhance collaboration:

PCDVMs can:

  • Be open to learning from the specialist and their approach to specific cases
  • Be willing to refer sooner if you don’t have the experience with a particular condition
  • Consider that referral may actually save your client money if a definitive diagnosis is made quickly and appropriate treatment can begin
  • Take responsibility for seeking out and developing relationships with specialists to have resources you can trust readily available

Specialists can:

  • Be approachable, encourage learning, and communicate to educate and inform
  • Welcome collaboration in all its forms (in person, in writing, electronically)
  • Acknowledge timeliness of referral, quality of case workup, and prereferral care where appropriate
  • Show appreciation for referrals on a regular basis, in a meaningful way

Recent trends show collaboration is on the rise. That’s good, because it helps not only the pet but all stakeholders in the profession, financially and emotionally. Supporting each other through collaboration results in healthier patients, profits, and people.

Robin Brogdon, MA, is chief executive officer of BluePrints Veterinary Marketing Group. She is the author of 101 Veterinary Marketing Questions Answered (AAHA Press, 2011). She is also a member of the board of directors of the Collaborative Care Coalition.

Photo credits: ©iStock.com/Ridofranz, ©iStock.com/simonkr, graphic courtesy of Robin Brogdon, ©iStock.com/hedgehog94

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