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