Step-by-Step Process to Drive Physician Referrals to Your Dental Sleep Practice

At the next annual sleep conference, try playing “Six Degrees of Angela Kowaleski.” She’s spent over two decades immersed in nearly every aspect of the sleep field and currently serves as Chief Physician Liaison and COO for GoTo Sleep Center for CPAP Alternatives. Angela knows her stuff, and if you turn her tips into action, you’ll see results.

—Jason Tierney

I’ve been blessed to learn from the best sleep educators and have literally worked every position in a sleep practice (except dentist, of course). I wear multiple hats, but I’ve spent most of the past five years focused on physician marketing. I used to encounter rooms of dentists who thought physicians didn’t want to refer to them because of an aversion to oral appliance therapy. While only a minority of docs fit that description, sleep doesn’t produce a strong signal for most MDs, and OAT barely registers as a blip.

My job is to change that, to raise awareness. I educate physicians and their teams about sleep. In some practices, I quash misinformation about dental sleep medicine, and then reeducate them so they understand that we’re collaborators, not competitors. Then we alloy the education and camaraderie into new patients who will realize healthier, happier lives by seeking treatment at our practice.

Education is essential in marketing. Before you start knocking on doors and telling every Dr. Tom, Dr. Dick, and Dr. Mary to send all their mild, moderate, and PAP-noncompliant patients to you, I recommend doing some prep work. Learn the science, abbreviations, acronyms, and everything in between. Commit to memory some statistics about OAT efficacy, PAP compliance rates, and other related info. Shore up any knowledge gaps by asking questions of colleagues and vendor partners, and doing some internet research.

Now that you know a thing or ten, it’s time to get your marketing materials in order. Always leave something tangible at prospect offices that includes your branding. I use folders containing our name, business cards, referral forms, prescription pads, insurance list, and patient brochures. Depending on the office’s experience and interest, I sometimes leave several relevant OAT case-study articles, too.

Here’s a valuable pro tip: Add a note at the bottom of your insurance list stating that you’ll work with the patient to maximize their benefits even if you aren’t currently participating with an insurance program.

It doesn’t hurt to bring a small treat with you. Office personnel tend to engage more readily when they see a sweet reward for their time. This can help you circumvent the gatekeeper and get the office details you need. I usually spend around ten dollars on these treats at a discount club. Once you identify a prospect office as a new potential account, you can invest a little more with donuts or baked goods.

Keep your eyes peeled when you’re commuting to a practice. You’ll be astonished by how many other prospective offices you’ll drive past. Because of this, keep double the supply of folders you think you need. You can always make an impromptu visit to one of these other offices.

Equipped with your sleep education and marketing materials, you might ask, what’s next? Start with your local sleep centers and sleep physicians. Build rapport with them. They’ll become the cornerstone of your sleep practice. Sleep centers prescribe CPAP, APAP, and other therapies, but times are changing, and the medical community’s openness to OAT is greater than ever before. There is no one-size-fits-all treatment.

When researching local sleep centers, be sure to check whether the facility is an independent diagnostic testing facility (IDTF). IDTFs are diagnostic centers only and do not have prescribing doctors on staff. Develop a relationship with the IDTF, and ask them who their top referring offices or physicians are. This information can be worth its weight in gold. Pulmonary offices also present great opportunities. Pulmonologists boarded in sleep medicine get moved up the list. Next, look for neurology offices or ENT offices specializing in sleep.

After picking the low-hanging fruit—physicians specializing in sleep disorders—look for other specialty offices. One increasingly popular example is heart and arrhythmia. An estimated 40–50 percent of patients with atrial fibrillation have OSA, and patients with sleep apnea have four times the risk of developing A-fib. Some internal medicine and primary care physicians now diagnose and treat sleep apnea, too.

This is spectacular news because it means more awareness and additional opportunities for collaboration. The concierge practice model is becoming more and more popular. In a nutshell, patients pay monthly or annual fees to see their physicians. These offices work to decrease the number of visits patients need. When approaching these offices, it’s important to educate doctors and staff on the importance of treating sleep apnea due to its impact on overall health.

Don’t forget the dental offices. Once my route is planned, I search nearby dental offices and pop in and leave our information. As you know, many dentists don’t treat sleep. Now, they’ll have your information to share with patients.

So many dentists think physicians intentionally ignore OSA and OAT. The truth is that it can almost always be traced to the lack of awareness. I can’t count the number of times I’ve encountered well-educated, well-intentioned physicians with booming practices who just don’t know much about sleep-disordered breathing. When I start making connections between sleep apnea and the health issues they see in their patients and advise how we may be able to help, the referrals almost always follow.

Details, details, and more details are key to mapping a perfect route. Calling offices in advance can help get the information needed to include or discount a new lead. Ask exploratory questions to learn more about the practice. Find out if they’re treating OSA patients, prescribing oral appliance therapy, or ordering sleep tests. Ask permission to drop off some referral materials. The answer will almost always be “yes.” Is there a specific referral coordinator to address the materials to? This information will allow you to walk into the office and ask for the person by name, once again helping you bypass that pesky gatekeeper. Since the pandemic began, more people answering phones for these offices are actually working remotely. Keep this in mind because they might not be current on everything going on at the office. If you believed initially that this office was a good one, then follow your gut.

Platforms such as Badger Maps, Sales Rabbit, and Salesforce are extremely helpful for optimizing your route, thereby saving you time and money. I just mentioned a few of the more popular options, and I’ve used Badger Maps for several years. I can input a specialty office such as “pulmonary,” and then it populates the map with all the pulmonary offices in the vicinity. Google or other search engines can also be useful in creating a sales and marketing pipeline. Consider getting a free Rxvantage.com account, which lets you schedule lunches with practices via the site. Ultimately, how you use your CRM platform matters far more than which one you use. Every prospect visited or called should be documented in your system. Include every detail you can get.

Check out websites for alternative therapies, such as Inspire, exciteOSA, and Remede. Each site includes a tab to find physicians prescribing these therapies. The listed physicians are already treating sleep patients, making them great leads for you. What do they do with patients who don’t qualify for treatment or were non-responsive to therapy? Retirement communities can also be great marketing spots. Facilities normally have a front office that can provide you with details about their newsletter, health events, and community health presentation opportunities.

Education? Check. Materials? Check. Route planned? Check. Let’s go! Communicating effectively is key to developing consistent referral accounts that feed your practice. First impressions really do matter. A lot. Preparation is paramount, and personality goes along way. What sports memorabilia is in the office? What about their families? Details you ascertain from the visit and circle back to during later conversations will impress and build trust.

I cannot stress enough how important it is to remember the names of the people at the office. I promise you that when you go back to an office and call the front desk person by their name they’ll be dazzled. Dale Carnegie was right: our own names are the sweetest sound. Get the front office person’s name and introduce yourself and your practice, and give a sincere, but brief pitch about what you do. Know when the doctors are in or out of the office. Find out whether they’re only providing telemedicine visits so you can provide a digital version of your brochure that they can send patients after visits. This may sound unimportant, but these small details can make a big difference. Be specific in your business and your mission.

Now you’re getting somewhere. Routes have been completed and referrals are coming in. Documenting encounters and consistently tracking referrals are crucial to build momentum. Whether it’s through a spreadsheet or your EHR, keep track of every referral. If patients don’t proceed due to lack of insurance coverage or some other reason, always follow-up with them. CPAP patients should be called in 30 days to see if they’re using their machine. Between the middle and end-of-year, circle back with patients who declined because of insurance issues. It’s likely they’ve since met their deductibles. Think of this information as a rolling list of potential patients.

To lunch or not to lunch? That is the question. When setting up a lunch, be sure the office is truly interested in your business. If you ask an office if they prescribe oral appliances and they answer “yes,” ask for more information. Do they refer out for an oral appliance once per year, or are they regularly sending their patients to another dentist all the way across town? How many patients are they sending each month? What does their ideal referral situation look like? Some reps like to do lunches on Fridays. The problem with that is that the weekend arrives, a new week begins, and you’re last week’s news. I prefer to do lunches earlier in the week, so staff and doctors see potential patients to refer while we’re still top-of-mind.

Personal engagement and route tips. When you schedule a lunch, be sure to have a sign-in sheet. The one I use asks for name, position, and day and month of their birthday. I’m looking for the doctor or key staff member’s birthday to surprise them with a sweet treat. Every sign-in sheet gets attached to the respective referral files and I add the birthdays on my marketing Google calendar.

After a lunch meeting, handwrite and mail a thank you card to key contacts. Follow up in person one week later to make another impression. For established, consistent referral accounts, visit them twice monthly.

Once you identify a key person in an office, try to obtain their personal cell phone number. I like to text my accounts randomly with a special cupcake delivery notice or pop-up pizza day. I try to do something relevant to the season or holiday, anything from Easter baskets to Halloween candy to donut day. I’ve created a holiday calendar with daily activities for office teams to participate in, follow our social media, and send me the daily challenge to be eligible for a special treat.

Follow-up is key. I’ve received referrals from offices on my first visit after they told me they didn’t treat sleep patients. At the other end of the spectrum, I visited one office eight times before we received our first referral. Don’t be discouraged. Be confident. You have a purpose. You’re not bothering the office; you’re offering to help their patients while building your business.

The most important thing. Always ask for the business: “Which patients can I help you with TODAY?”