How does the Ambulatory Referral Guide Improve Revenue Generation for Doctors?

Rey Palmares
October 30, 2019

Of the 100-million subspecialist referrals each year, only around half of these are actually completed. This has become an increasingly dire situation for healthcare. Factors such as miscommunication and ambiguity or misinterpretation lend greatly to these visits becoming losses. These dismal numbers have family physicians missing out on potential income in the long term as many patients never come back after a referral. Sometimes, they don’t even follow through with the referral.

To address this problem, the Ambulatory Referral Guide (ARG) was designed by the Institute for Healthcare Improvement in 2017. The document introduces a nine-step diagram, which addresses primary care’s problem with referral completion by circling it back to primary care. However, even in 2019, the ARG is still relatively unknown, much less implemented in private practice. We suspect it’s due to misunderstanding how the ARG can benefit healthcare practice.

is how the Ambulatory Referral Guide can indirectly help family physicians earn more while improving their practice.

Crafting Professional Partnerships – for Network and Marketing

The ARG promotes profession-based relationships. The process necessarily implies a personal warranty that the subspecialist is capable of attending to the patient. This also communicates the family physician’s confidence in the subspecialist.

This translates well for the subspecialist—but how would it help the family physician?

While referring patients to another medical practitioner may seem like letting go of revenue, it will invariably help improve revenue in the long-term through relationship-building. It is a good way to get advertising and marketing for no cost. In turn, the subspecialist can likewise direct her patients back to the family physician as the case may be. Doctors can take it a step further and organize a network of family physicians and their preferred sub-specialists.

Beginning and Ending With Primary Care to Secure Patients

It is a misconception that patients no longer need to report back to family physicians after a referral. This is a matter that the ARG expressly and directly addresses: patients must always be “kept in the loop.” After an appointment with the subspecialist, patients are referred back to the original physician. This is not normally done outside of the ARG and is therefore a defining feature of the matrix.

Contrary to public perception, the role of primary care physicians does not end after having referred patients to subspecialists. After subspecialists receive such commendation through a referral, they are invited to comply with the ARG—and issue a referral back to the primary care physician.

The takeaway here is that patients are not lost after referral and are seen by the family physicians at the end of the referral process. As such, no revenue is ever lost in an organized referral system. In fact, physicians can better secure their income with the ARG.


Writing should be one part informative and one part entertaining. It's what differentiates a generic piece of text from a well-written article. Rey Palmares dedicates much of his time to fine-tune that craft, juggling the joys and frustrations of writing with those of his law school life outside of the office. He's making it work so far.