Make sure you are doing it legally.

I recently attended a large DSO convention.  As I talked with many of them, I was surprised to find how many of the attending organizations never thought to invite a specialist onto the team.  So much missed opportunities.

Just think about how many referrals your generals send out to local specialists each and every day.  Especially perio, ortho and oral surgery.  Keeping that revenue in-house is a incredible revenue  builder.  

Here is just a quick example.  In 2018, one small DSO of 3 locations referred over 240 referrals to an in-house periodontist over the course of a year.  With an average of $1,300/ patient, that DSO was able to retain over $312,000 in revenue. These same statistics were seen with their Orthodontists and even Oral Surgeons. 

Think about it.  For each concentrated pod of offices, your DSO can easily bring on 3-4 additional doctors without even needing to increase your marketing.  These patients and procedures are already there and spending the money on needed procedures.  

Stop lining the pockets of doctors outside your network!

Many Corporate Organizations pride themselves with the fact that all of their GPs are trained to do all specialty procedures themselves. "We seldom if ever refer out patients!" I would hear repeated quite often.  

While that is good in theory, they still refer out quite a bit.  And besides, wouldn't it be better to bring on specialized doctors that still allow you to retain your revenue while providing the patient with the greatest quality of care available?  Why not!!!  It just frees your GPs up to do more of what they are proficient at.

That may have been true in the past, but as competition continues to grow, more and more specialists are looking to secure a day or two a week with a steady schedule.  

Not only are GPs doing more and more specialty procedures, but things like  "Do it yourself Orthodontic Home Kits" are having a huge toll. Competition will continue to grow.  Many of these specialists will want a steady stream of patients to fill a day or two each week. 

In-house referrals occur in every DSO even if there are no specialists involved.

As an example, when I worked as an associate in a corporate office, I would often see patients who needed root canals.  The office knew that I enjoyed doing root canals and the other doctor didn't.  So they would schedule the patient to see me when a root canal was needed.  Was there ever any question of legality by doing that?  Absolutely not; I was an associate and could therefore see patients who were being originally seen by another doctor.  Would it be best to inform the patient that I was going to be seeing them?  Of course.  Was it legal?  Absolutely.

Most DSOs are owned and created by a dentist. In fact, most states require each dental office to be "owned" by an actual practicing dentist.  Any additional doctor brought into the practice, comes in as a partner or employed associate.   This applies to specialists as well.  The easiest way to set up a new specialist is to have the specialist come in as an associate to the main doctor in the office.  

Here is Alabama's Referral Regulations. 

(9) Is guilty of division of fees, or agreeing to split or divide the fee received for dental service with any person for bringing or referring a patient without the knowledge of the patient or his or her legal representative, except the division of fees between dentists practicing in a partnership and sharing professional fees, or in the case of one licensed dentist employing another.

Here is Georgia's, It spells it out really well:

(3) “Fee Splitting” does not include:

   a. The payment of a commission from a dentist actively licensed in Georgia who owns a practice to any employee, associate, independent contractor or agent who is also a dentist or dental hygienist actively licensed in Georgia and working for the practice. Such exclusion applies where the dentist owns the practice through a sole proprietorship, partnership, limited liability company, or by majority ownership in a professional corporation.

   b. The sharing of professional fees between dentists practicing in a partnership or within the same practice group, where the remuneration is not based on the number of referrals within the practice or referrals required by the partnership agreement:

There are state guidelines and regulations that prevent kickbacks and fee splitting (Anti-Kickback and Stark Laws). If you aren't careful, it can appear as if you are funneling referrals to yourself. There have been many problems in the medical field (HMOs) concerning this very thing. The problem comes when referring doctors feel pressure to refer to someone just because they are in-house. It is extremely important that you make sure your GPs know and feel that they can refer to specialists they trust and feel will take the best care of their patient even if that means sending them to an "out-of-network" provider. That being said, having a referral tracking system that shows you when they continue to refer outside the practice, allows managers the opportunity to find out why the GP does not feel confident in your in-house specialist. Most of the time, it doesn't have anything to do with lack of confidence in your specialist, it's just that the GP and Specialist need an opportunity to get to know each other.  

It's crazy just how many DSOs forget that they still need to do the little things that are done outside the corporate dental world.  One of these is internal marketing.  Yes, you absolutely need to hold lunches where the GPs can meet the specialists. It would even be a good idea to require the specialist to present quarterly lunch-and-learns for the referring doctors, not only in your organization, but to the other local GPs in the area.  

Doing this will allow your referring doctors to have confidence in referring to the in-house specialists.  Not because they are in-house, but because they trust and like them.

Make sure you are doing it legally.

How to keep patients in-house.