Practice Marketing

TEMP

New patients that are referred to your practice by established patients is a positive sign.

Patient referrals are usually a sign that patients feel comfortable with office staff and

believe they are receiving high quality care from their physician. If you are not receiving

a significant number of referrals from patients, consider surveying them to determine

how satisfied they are with the services your office provides. (See “Patient Satisfaction

Surveys” below.)

Office staff should be equipped to refer patients to your practice by carrying business

cards and distributing them to anyone who asks about the practice. In some practices,

financial incentive programs or bonuses based on the number of individual referrals or on

the overall growth of the practice help to assure that office staff are promoting the

practice and its services. Incentive programs and bonuses should be reviewed by legal

counsel to ensure compliance with health care laws, such as the anti-kickback statute.

Reviewing referrals from other physicians, and the income generated by providing

medical care to these patients, is another area that should be closely evaluated. You may

discover that some physicians only refer patients with particular health insurance

coverage. Discovering these trends, both positive and negative, and making attempts to

change the disadvantageous trends before they become widespread is worth the effort.

As you review the data from your practice, look at the number of new patients that you

anticipated from your participation in particular health plans. Determine if the contracts

you signed are allowing patients to continue treatment that might have otherwise had to

leave your practice. Also, determine if participation in these plans has altered the pattern

of your referrals to other physicians.

Local businesses may be another important source of referrals for your practice. You can

encourage these referrals by providing services to one or more companies, such as

employment physicals or safety lectures, to encourage employees to visit your office for

additional treatment. Distributing a brochure about your practice to the human resources

department is also helpful to give your practice added visibility and explain the services

that you can offer new employees.

Patient Satisfaction Surveys

Measuring patient satisfaction is a process that should be carefully planned to include

both the survey design and the implementation of system changes once the results are

tabulated. Patient satisfaction surveys typically cover: access, communication between

the patient and office, courtesy and helpfulness of the office staff, and physician-patient

interaction. The physical environment of your office can play an important role in the

satisfaction of your patients as well. Asking patients about a few specific items may

encourage them to suggest other improvements for your practice. The MMS is also

working with the Massachusetts Health Quality Partners (MHQP) on a statistically

significant “Patient Experience Survey” that will evaluate patient satisfaction in practices

across the state. For more information on this topic, review the PPRC Resource on

Patient Satisfaction Surveying at:

www.massmed.org/pages/pprc.asp

.

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Another way to assess patient satisfaction is to survey the patients who have left your

practice to determine why they left. You could try contacting patients that ask to have

records sent to another physician. If they are simply moving out of your area, which is

common for many patients requesting records, you have an opportunity to wish them well

in their new location. If they are changing practices because of new health insurance that

you do not cover, you might consider a new contract with this health plan.

Office Staff Evaluation

In many practices, office staff spend more time with patients than physicians. Patients

respond to all of the treatment they receive, not just the physical examination and

consultation provided by the physician, so it is important to assess how well office staff

are performing their duties. Asking staff to rate themselves on their service to patients is

a good reminder of basic patient relations. You may discover differences of opinion that

are worth discussing at future staff meetings or performance reviews.

Another way to find out how well you are doing is to ask your staff to anonymously

assess your practice and suggest ways that it could be improved. Ask office staff to

assess their personal capabilities, the services of the practice, the building and working

environment, and the overall strengths and weaknesses of the practice. It is also helpful

to allow office staff to make suggestions on how to make improvements in these areas.

Financial Analysis

A financial analysis gives a practice an indication of how well it is doing, helps identify

strengths and weaknesses, and begins to define problems and opportunities that might be

addressed in a marketing strategy. Conduct a financial analysis that reviews the

practice’s profit-and-loss statement, tax returns, accounts receivable, billing records and

insurance claim files. Your accountant may recommend additional ways to collect or

organize important financial facts. If your billing system is computerized, much of the

information you need should be readily available in routine reports.

Run reports using your billing system or manually record the sources of payment for

services. In general, your patients should come from a mix of health plans so that you do

not become reliant on reimbursement from one payer. While it is not easy to restore

balance in a practice that has become dependent upon a few sources of reimbursement,

this analysis will help identify if there is a potential financial danger that could be

improved by seeking a different mix of patients.

Your accountant may also help you look at the profitability of individual procedures and

help determine if new services could be added or existing services discontinued.

Although profitability is important, other factors must be taken into consideration as well

because you may offer services that do not produce direct revenue, but increase patient

satisfaction and new patient referrals that enhance the overall profitability of the practice.

If overall practice growth appears to be the key to long-term financial success, a

campaign to attract new patients may be your goal. On the other hand, if providing more

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services to existing patients will meet your objectives, you may want to build a marketing

strategy around adding and promoting a new procedure. Determine what your population

wants and needs from your practice and plan an information campaign to let them know

how you can serve. In most cases, the marketing strategies will include retaining

patients, improving services to them, and growth.

Marketing to Patients

Even in today’s complex health insurance marketplace, physician recommendations from

family members and friends are vital to the success of a medical practice. Generating

word-of-mouth referrals requires a commitment from your entire office to provide your

current patients with efficient and friendly service. The difference today is that

physicians must contract with the same health plans that their patient populations use.

Your success is also dependent on health plan provider directories, so be sure your

practice is accurately listed on the Internet and in all print directories. Once these health

plan details are in order, you will be more accessible to new patients.

Patients are increasingly pressuring physicians to consider quality of care initiatives for

their practice as well. For this reason, it may be useful to participate in the AMA’s

Physician Consortium for Performance Improvement, which aims to provide performance

measurement resources for practicing physicians to facilitate implementation of clinical

quality improvement programs. By participating in The Consortium, you will obtain

performance measures that represent a consensus of experts in clinical and research fields

and include those measurable activities in which physicians can participate to

continuously improve quality of care and outcomes. To learn more about The

Consortium visit

www.ama-assn.org/go/quality

.

Physician-Patient Communication

Your thoroughness in explaining the patient’s illness and treatment plan is one way of

demonstrating your knowledge and your personal concern. Whenever possible, take time

with patients because patients that leave your office with unanswered questions are more

likely to be dissatisfied with the service received, even if their condition improves. When

communicating with patients try to maintain eye contact and listen carefully to what they

have to say. When you explain diagnoses and treatment plans talk in laymen’s terms so

patients can understand what you are saying. If you are concerned about the perception

that you are rushing too much, you might consider asking your staff to help you identify

these situations. This is helpful when dealing with patients that do not ask questions

because they believe they would be imposing on your busy schedule.

If you are treating a patient with a chronic disease, you can provide them with

educational materials related to their illness and treatment options at the end of office

visits. This will reinforce that you want to work collaboratively with them and care about

their recovery. For some practices, providing patient education is an important part of

treatment so their reception area, examination rooms, and practice website are vehicles

that are used to communicate the practice’s commitment to disease prevention and health

promotion.

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A practice newsletter is an excellent way to provide information and news about various

illnesses, treatments and disease prevention tips that are of particular importance to your

patients and their families. It is also a good way to inform patients about changes in the

practice, such as new staff, and events that affect the services of the practice. Each time

the newsletter is mailed to patients, the name of the practice gains greater visibility. If

your practice collects patient email addresses, send the newsletter via email. If you have

a website, also consider sending a message to all of your patients with a link to the most

current newsletter that has been posted online. This will increase the likelihood that

patients will visit your website and discover something new about your practice. You

may also be surprised to learn that existing patients are sharing your newsletter with

family and friends that could become new patients.

Take every opportunity to send personal communications to your patients, especially

promptly notifying patients of test results, even if they are normal. Other ideas for

personal communications include: sending birthday cards to established patients, mailing

welcome letters to new patients that include a brochure about the practice, sending

follow-up notes to remind patients of the need for physicals, immunizations or checkups,

and sending thank you notes whenever a patient refers a friend or family member to you.

Office Policies and Accessibility

Practice location, access to physicians by phone or email, timely appointments, short

waiting times, and easy access to the office are all part of operating a practice that is

convenient for patients. If many of your patients are elderly, be sure that your office

building has good access for patients using wheelchairs, and that the seats in your waiting

room have arms and are high enough so patients can sit and rise easily. If many of your

patients find it difficult to schedule appointments during traditional office hours, consider

offering early morning, evening or weekend appointments on some days of the month.

Work with your staff to see how the appointment schedule might be revised so that

patients can get an appointment within the same week that they call and not have to wait

more than 15 minutes after their scheduled appointment time in the reception area.

Shorter wait times are also a good way to attract new patients that do not have a

relationship with you or your practice. Keep a list of patients who want to be seen as

soon as possible and call them when a cancellation occurs. You might also consider

adopting an open access (same day) scheduling system, which will require careful

planning and several weeks to implement, but has many potential benefits for you and

your patients.

Investigate the feasibility of opening a satellite office so that you will be accessible for

patients in multiple geographic locations. Careful planning should be done before taking

on the added expense of another office, but the added patient base could make it a

worthwhile investment. It may also be possible to share or switch offices with other

physicians who would like to have more than one office location.

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Establish a system for reminding patients of the need for follow-up visits. A

computerized recall system based on age, condition and a recommended physical

examination schedule can send emails to patients automatically or simply produce a list

of patients who need to be sent appointment reminders. If you do not have a practice

management system, have your office staff maintain a list of patients to be recalled. If

you need to see a patient for a follow-up appointment in six months, put their name on a

list to be reminded in five months. Some practices give patients a postcard as they are

completing their office visit and ask them to address it to themselves. The card is pre-

printed with a message that says it is time to call the office for an appointment. The

office staff retains the post card and mails it at the appropriate recall date. Doing so takes

very little time, builds the practice, and reinforces the need for continuing care.

An area that is often overlooked is the answering service or machine that receives your

after-hours calls. Most patients prefer to talk to a person, but this is not always possible.

An answering machine could ask people to call during regular hours for an appointment,

indicate a specific time that your practice is available for urgent care visits, or provide the

number of the answering service or emergency department to call if it is an emergency.

Patient parking at your office should be free and have copies of schedules and routes

available for patients who may need public transportation. It may also be beneficial to

partner with other practices or businesses to provide a free shuttle from public

transportation terminals, or nearby parking lots.

Provide patients a copy of your payment policy in your welcome letter or during their

initial visit. When payment, credit and collection policies are carefully explained, it will

reduce the severity and quantity of billing related problems for your office staff.

Unexpected or unexplained policies and procedures are likely to be a source of

annoyance to your patients. Request copayments and payment of outstanding balances at

the time of service by accepting credit cards, giving patients a stamped envelope to send

their check to your office, or work out a payment plan while the patient is in the office.

This will minimize administrative costs and avoid misunderstandings over the phone.

When you do send patient statements out, be sure to itemize all charges and fees to

minimize any misunderstandings. When appropriate, notify patients of disputes with an

insurance plan as early as possible. This can drastically improve collection rates and

avoids confrontations with angry patients that receive bills months after the date of

service because your office has exhausted all efforts with their health plan.

Contacting Employers

If you want to increase access to potential patients, try contacting the people who employ

them and pay for their health insurance. By contacting local employers your practice will

gain visibility and develop opportunities for potential patients to familiarize themselves

with your practice. Deciding which companies are worth contacting may require a little

research. Determine which types of health insurance local companies are offering to

employees and confirm that you are contracted with these plans. Have one of your staff

members contact employers to explain the services you provide, and leave brochures and

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literature behind for posting on bulletin boards and distribution to employees by other

appropriate means. It may also be helpful to meet with the company’s human resources

manager and other staff that are responsible for the health and safety of employees.

These individuals are often tasked with referring patients who become ill or are injured

on the job.

You may also consider meeting with the management of a company to fully understand

their needs and convey your commitment to keeping their employees healthy and on the

job. During this meeting it is also helpful to explain that while your main concern is

serving the firm’s employees, your practice does not over-utilize services and is

committed to practicing cost-effective, quality medicine. To interact directly with

employees, you might consider offering periodic on-site events such as blood pressure or

cholesterol screenings, or seminars on various health-related topics. If your office is the

closest health care facility to an employer, you may also want to volunteer your services

in emergency situations to show your commitment to the health of the community. As

appropriate, encourage the employer to refer patients to you for employment and ongoing

physical examinations, treatment of work-related injuries, and rehabilitation services.

Marketing to Health Care Providers

The key to maintaining collegial relationships is to constantly be in contact and show

your appreciation for every referral within the confines of the law. To build new

relationships make a list of people to call or visit in person. Commit yourself to a

measurable goal, such as one contact each day, to increase your visibility to professionals

who can refer patients to you.

Ask your staff to keep a referral log with a section for each referring physician and list

the patients that the doctor refers. Review the log every few months to determine if it

shows an increase or decrease from a group or individual physician. If it appears that a

physician is not sending you as many referrals as in the past, contact them to see if there

is anything you can do, within the confines of the law, to encourage additional referrals.

Your referring colleagues often attend the same meetings that you do, so review your

referral log ahead of time so you can thank them for a referral or remind them of the good

service that you provide. A satisfied patient is your best advertising with other

physicians. Patients who have been treated well usually tell their referring physicians and

a good referring physician will usually ask.

If you are a specialist and depend heavily on referrals from colleagues, target specific

primary care physicians from whom you would like to receive patients and build an

organized campaign to get their support. Call these colleagues to explain your specialty,

credentials, experience, hospital affiliations, and the services offered by your practice.

Follow-up with them every few months and thank them for any patients they send to you.

When you receive a referral, keep the referring doctor informed of the patient’s progress

by sending reports and/or information on the treatment that you provided as soon as

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possible. If your collegial referral system is crucial to your practice, plan to talk with

physicians when you are on rounds, in the hospital lounge or cafeteria, during social or

recreational events, as well as regular hospital and medical society meetings.

Another important area to concentrate on is maintaining a good rapport with the nurses,

physical therapists, social workers, nutritionists, and clergy who treat or regularly visit

patients in the hospital. Pharmacists in your community are another potential source of

referrals that should not be ignored. If you distribute a patient newsletter, be sure to send

a copy to these health care providers as well. Remind these people of your name and

specialty, and the name(s) of recent referrals that they sent to you.

Remember that anything you do to enhance your medical reputation in the eyes of your

peers, including teaching, speaking, or publishing, is likely to help your referrals.

Consider writing a letter to the editor of your local newspaper when a health issue is in

the headlines. Then let your colleagues know what you have done through your

newsletter with a special letter citing recent educational programs that you have attended

and how that education might serve their patients. Send copies of appropriate articles

that you have written, including copies of letters that you have written to editors, with the

intent of informing your colleagues and not boasting about your success.

If your practice is highly dependent on referrals, keep some time slots open on your

appointment book for them just as you would for urgent visits. It is also important that

you don’t steal patients, so when your treatment of a patient is complete, they should be

returned to their PCP at a clinically appropriate time for subsequent care. Try to avoid

assuming responsibility for any treatment that is not related to the immediate problem

that the patient was referred to you for without first consulting with the referring

physician. If you want to encourage referrals from other physicians, find out if they have

internal policies for patient referrals and do everything you can to work within that

framework. If you must see a patient that was referred to you for multiple visits, provide

the referring physician with information about the diagnosis and treatment plan when

appropriate. Finally, be sure to inform a PCP before referring a patient to another

specialist, as some health insurance plans may require another referral.

Provide colleagues with a self-addressed, postage-paid form so they can easily tell you

the reason for the referral, prior treatment, insurance coverage, etc. If there are new

physicians entering your community, welcome them to the area and let them know what

services you offer by sending them a copy of your patient brochure or any other

information you typically send to referring physicians. Offer to conduct a staff meeting

with the office staff of referring physicians to tell them about your specialty, what

patients can expect in your office, financial policies and any other information that might

simplify the referral process for their office staff. A business lunch arranged for the

receptionists in both of your practices is another way to improve referral relationships

and improve business for both practices.

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Marketing to Health Plans

Health plans play a major role in determining the physicians that a patient may see, which

is drastically different from the fee-for-service environment of years ago. While patients

are mostly concerned about the quality of care they receive, health plans are always

looking to control costs while providing access to care for their members. If you want to

be accepted into health plan provider networks it is helpful to understand what is required

of physicians to be properly credentialed and enrolled.

Most health plans are looking for quantifiable evidence of the quality of care you provide

to patients. They are also required to meet certain standards for accreditation, such as

NCQA. To control costs, health plans may prefer to contract with physicians that are part

of a risk unit or other group network model. In addition, plans typically look for board

certification and other physician accreditation sources as a measure for quality of care. If

you have received positive patient satisfaction results, you may choose to share them with

health plans as well.

If you are entering a market saturated with physicians in your specialty, you may try

taking the time to meet with the medical directors or other health plan representatives to

stand out from the crowd and explain your practice. Any presentation should be carefully

planned, keeping in mind that the main objective is to convey your commitment to

provide efficient, cost-effective care with high levels of patient satisfaction. If you are

unable to meet a representative in person, mail the medical director information about

your practice and follow up a week or so later with a phone call. This correspondence

should include:

Practice name, office location(s) and area served. Also include a mission statement or

a statement of objectives, including your commitment to quality care, etc.

Special practice characteristics, such as extended hours, convenient locations, in-

office ancillary services, and patient education techniques that reduce excessive

patient visits.

Physician CVs or resumes.

Names of all office personnel and their certifications.

A list of referring physicians in the plan, if you are a specialist.

Evidence of treatment patterns following published protocols or guidelines, outcome

studies, or information demonstrating your practice’s quality and efficiency.

Patient satisfaction survey results and indications of improvement over time.

Once you have signed a provider agreement, be sure to maintain personal contacts with

health plan representatives and appropriate medical directors to strengthen your

relationship and help you down the road.

Enhancing Practice Visibility

Practice Web Sites

The importance of practice websites has grown considerably in recent years, particularly

with improved health plan sites that include provider directories online. New health plan

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enrollees are increasingly choosing their primary care physicians using online directories.

If only a handful of the practices in a town has a link to their web site in the directory, a

new patient is more likely to investigate these practices first. Knowing as much as

possible about a new physician is very important for new patients and helps improve the

physician-patient relationship.

There are multiple ways to create a practice web site including: free services, such as

Medem (

www.medem.com

); lower cost solutions, such as hiring a student to design your

site; and finally outsourcing the project to a professional firm specializing in web design.

A practice web site can be as simple as providing the practice name and address or as

complex as providing online scheduling software and secure email messaging for

patients. For example, Medem offers online consultations that allows physicians to

securely communicate online with patients and receive payment for their work. Medem

also allows office staff to communicate online with patients, other health care providers

and trading partners through a simple, secure, eRisk and HIPAA-compliant network.

Regardless of the exact mechanisms used, it is important that the style of the practice is

properly communicated through a web site.

Once you have attracted patients to your site, it is important to have information well

organized that communicates the philosophies of practice. Some items to consider

posting on your web site include: Names and specialties of all physicians and support

staff, the specific services offered, health plans that are accepted, directions to your

office, recent health news, a practice newsletter, and information on the practice’s

policies. Hyperlinks to clinical information that you feel is useful can enhance the

content of your site and improve patient relations. However, it is equally important to

continuously update the content on your site so your patients receive the most current

information. If you are providing incorrect or out-of-date information on your web site, it

may actually deter patients from your practice, as well as create some legal liability, so

you need to be cognizant of the message the site is sending to prospective patients.

Once your web site has been created, be sure to register it with the major search engines,

such as Yahoo and Google, and inform your health plans so they can create hyperlinks

from their online provider directory to your site. Finally, put your web address on all

letterhead, new patient correspondence, brochures, business cards, and any printed

materials that you distribute.

As the importance of your web site begins to grow, you might consider adding additional

services online to increase patient satisfaction levels. Some practices are adding secure

email messaging to their website to increase office efficiency and provide improved

service for patients. Clear policies on how patient email will be handled must be

developed, but the results can enhance the appeal of your practice. Other practices are

scheduling appointments, processing prescription renewals, and streamlining a number of

administrative functions by using interfaces on their website to improve patient

satisfaction and practice workflow simultaneously.

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Community Involvement

Being active in your community by joining local medical organizations, volunteering

with community groups, regularly attending a place of worship, and joining service

organizations increases your visibility and enhances your practice. If you are a good

public speaker, contact local civic, religious, and other organizations and offer to speak

on a variety of medical topics. Contacting your local television and radio stations and

suggesting specific health topics for talk shows is another idea worth considering.

Relationships between the media and physicians do not occur overnight, but the long-

term payoffs in practice visibility can be worth the extra effort. Newspaper and

television reporters work in a fast-paced environment driven by deadlines, so be sure to

promptly return phone calls and be prepared to take 15 minutes out of your afternoon

schedule to speak with them. The demand for health related information is rapidly

increasing and as a physician you have a great opportunity to educate the media and the

public, while simultaneously promoting your practice. If you are interested in public

speaking or working with the media and would like additional information, contact the

MMS Communications Department at 800-322-2303 ext. 7102.

If public speaking is not your forte, you can write a health column for local newspapers

or volunteer to write an employee newsletter column for a local business. Keep the

language simple and choose subjects that are of general interest or are timely such as

water safety in the summer or receiving flu shots in the fall.

Organizing a health screening at a community center, shopping mall, or nursing home is a

great way for you and your office staff to meet potential patients. Hosting an open house

in your office is another way to meet members of the community. Creating a theme or

celebrating a particular event, such as Breast Cancer Awareness Month, ten years in

practice, or introducing a new partner, bring added attention to the event and your office.

Publicize the event well in advance with local newspapers, community groups and

schools and inform all of your established patients by giving them a special invitation.

Traditional Advertising

Although paid advertising is increasing for larger health care organizations, its

appropriate use for physician practices is still debated. An advertising campaign is

expensive and requires staff time, but is often used to announce new developments in a

practice or provide public education. Physician practices typically advertise in the

Yellow Pages, however only a few purchase a slightly enlarged ad in the physician

listings to stand out from others. Some practices also believe using bold type or a box

about the size of your business card will make your name more prominent. If space

permits, use your logo and identify special characteristics that set your practice apart,

such as weekend office hours or board certification status.

A practice brochure is another traditional marketing tool that can explain your specialty,

services offered, and describe how your practice operates. Keep in mind that a brochure

is only an introduction to your practice, so only provide enough information to entice

patients to contact your office for an appointment.