Marketing and Public Relations
With the average American family moving every five years, even a healthy practice may expect attrition of 10 to 20 percent each year. On top of this, managed care produces an additional challenge, since the shifting of contracts among competing plans can cause sudden and unexpected surges or drops in patient population. To offset these uncertainties and stabilize growth, you must carry out a carefully managed program to stimulate patient demand.
The starting point is a clear understanding of the practice's referral dynamics. Begin with the basics: note all referrals in the patient's chart, including the name of the patient who made the referral, or the specific managed-care plan through which they access your practice. Make it a point to personally thank patients for referrals.
Beyond this, virtually every practice benefits greatly from a more structured referral acknowledgment system. The reinforcement you provide depends on the number and quality of referrals (for example, a thank you card on the first referral, a call from a nurse on the second, a personal letter on the third, etc.)
You should consistently work to involve more patients. An advisory board of influential patients builds a sense of ownership on their part, and is an excellent tool for encouraging referrals in targeted patient groups.
If you participate in a managed-care plan, don't fail to capitalize on its advantages. For example, many managed-care companies will put you in contact with the benefits managers at employers they have signed up, to arrange for prevention lecturing with the group. Identify particular managed-care programs that best match your practice goals, and launch an organized effort to reach their patients, either through the plan's marketing department or through direct mail. Dignified direct mail to targeted geographic areas also produces results.
Make use of your staff as practice ambassadors. Give them business cards and titles; it not only boosts morale, it helps broaden your referral base and increase patients' perception of value in the practice.
Hone your own professional image - both in dress and demeanor - and ensure that your staff follows your lead. Then launch a program to increase your visibility through public speaking, either through your hospital's speakers bureau or by offering health lectures directly to local libraries, community centers and health clubs.
For additional networking opportunities, and to further polish your skills, join an organized speakers group, either on a local or national level, depending on your particular specialty and practice goals. Also look into professional speaking courses and sales or customer-relations courses through local institutions.
One of the best books ever written in this area is Dale Carnegie's How to Win Friends and Influence People. There are some 40 million copies sold worldwide and it's been translated into more than 30 languages. An excellent read if you're looking for practical insight into developing personal relationships and contacts.
You can also expand your practice by making unexpected telephone calls. Call back one patient every day. Your staff should choose the patient who would most appreciate a call from you, and it should be done on an unexpected basis. Research shows that this patient will tell at least six others that he or she got a call from you. It's a tremendous practice-builder. We also recommend that each staff member call three people daily. This is a way of connecting with patients in a way that really matters to them.
Greeting cards are a low-key way of keeping in touch. Consider Thanksgiving cards. They're non-denominational and it's a logical time to express our thanks to all the people who have supported us. Birthday cards are another way to go, but be sure your patient list is up-to-date. We all know of physicians who ended up with disaster when they inadvertently sent a card to a patient who had recently died.
One of the best patient pleasers involves giving patients information on their own condition. The Mayo Clinic gives each patient a comprehensive letter describing their condition, history and everything that happened. This is tangible evidence of value.
Look at your visual presentation, as well. Develop a practice logo, color and style. Hire a professional design firm for this. Don't try to design a logo yourself. If a professional design is out of your budget or just not right for your practice, then keep things simple, clean and professional. Effective marketing and public relations in a medical practice depends not on a slick presentation, but rather on your ability to develop relationships with referral sources.
In the health-care environment of the future, you'll need to keep on top of what managed care plans are doing. But place more emphasis on honing patient relations and practice-building techniques. This will increase your patient population more effectively than concentrating on dealing with contracts.
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"Marketing! Not in my practice!" The word marketing in medicine elicits many images and emotions, mostly negative. Yet, every day more and more medical practices are understanding and utilizing marketing techniques to build successful practices, increase patient compliance, and positively affect future practice and patient care outcomes.
Renowned medical clinics are writing marketing plans, hospitals are appointing marketing directors, established physicians are retaining public relations consultants, and now physicians are conducting market research studies before setting up practice.
Over a period of six years, a pediatrician in a midwestern town found that his patient load was declining. Fortunately his wife, who was studying geography at a local university, decided to focus her demographics project on selecting a location for his practice. After doing some extensive market research, she found that her husband had located in an area where the population under 18 was declining rapidly. A study of the regional area indicated that the new families with young children were locating in a different sector of the region. Based on this information, the pediatrician relocated his practice and is now doing well.
A Boston OB/GYN found that the predominant part of his practice was primary care OB/GYN. His marketing objective was to change his patient mix from 75 percent primary care OB/GYN to doing more specific gynecological problems, or complicated OB cases.
The problem was that he was then working at full capacity because he had built his practice on primary care. To change midstream was not easy.
To make the transition he developed a patient information booklet detailing his new point of view. He also changed his policy of seeing only patients who were referred by another physician.
In addition, he designed a questionnaire to enable his assistants to screen patients before accepting them into his practice. New patients needing primary care were not accepted. The screening techniques ascertained beforehand whether or not the patient had complicated problems that required his attention. Up to this time he had not been doing any screening whatsoever. Over a period of three years, his patient mix changed to meet his goal of reducing his primary care load to 30 percent.
St. Claire Hospital in Denville, New Jersey, learned that its older patient population found it hard to reach the facility. As a solution, the staff set up a mental health center on wheels which provided the services of a mental health nurse, counselor driver and social worker, on an informal basis. Besides mental health counseling, the service provided hypertensive and audio metric screening as well as information and referral services for the elderly.
The program increased awareness of St. Claire Hospital's services, and the mobile center proved to be a valuable resource to the patient population.
If you follow the marketing discipline, it will benefit your patients and your practice. Remember, it's a philosophy and a tool. Use it well.
The theory, principles, techniques, and philosophies of marketing are the same whether you are in solo practice, partnership practice, small group, or part of a large practice. Here are some specific tips to help you in assessing marketing opportunities in your area:
1. Pay very close attention to patient complaints about medical services in your region. Make sure they are not prevalent in your own practice.
2. Assign someone on your staff to treat every patient complaint in your practice as if is a number one priority. Call the new job "Patient Relations Coordinator".
3. Understand your population shifts and spending habits. Go to your library and Chamber of Commerce to examine Federal Census and demographic studies.
4. Look to see what physicians in large and successful practices are doing. Perhaps they are filling a special need that you could fill too.
5. Look for practices with new and innovative ideas and apply them to your practice.
6. Survey your patients for their feedback on your practice procedures. The Department of Practice Management, American Medical Association, will send you an example of a survey questionnaire.
Advertising: A controlled method of communicating your practice's viewpoint to patients with the intent of influencing them to use your services. Typically, you pay for your message, control its content, and select the media - i.e., yellow pages, radio, direct mail, television, or billboards.
Public Relations (P.R.): An indirect method of promoting your practice's positive achievements or viewpoints to patients. Public relations tends to be "news oriented" in the media, and inexpensive, since it is not paid for, and the practice does not have control over the final message. P.R. takes the form of news releases, statements to the media, public speaking, appearing on talk shows, and so forth.
Market Research Identifying the Need of Medical Services: An organized analysis of information which helps us. The purpose of market research is to isolate specific patient demographic information so that you can respond appropriately. Market research helps you focus in on the best ways to deliver your services.
Exurbia: Areas beyond the suburbs which are still accessible to major city services. More patients are moving into these areas.
Market Share: A mathematical calculation which
determines precisely the number of patients of a particular type
under your care. If the drawing area for your practice is 40
miles,* the estimated number of diabetics in your area is 1000,
and your practice has 100 diabetics, then you have 10 percent
market share.
*This would be true if it were 50 miles or 60 miles.
Market Penetration: Your practice's share of a particular market - usually expressed in terms of percentage.
Media Mix: Planning the coordination of advertising and promotion, using newspaper, radio, television, and other means to present a message. It is usually presented in budget form.
Metromarket: Central city plus suburban areas from which a clinic may draw its patients.
Profit Squeeze: Generally caused by severe price competition or by increased costs (e.g., the 78% increase of malpractice insurance in New York State) which cannot be passed on to the patient in their entirety.
Test Market: A means of trying out a new idea or service on a limited basis (such as asking for payment at the time of service) to gauge patient reaction. If the reaction is positive, then implement the program. If poor, do not proceed. Many new services or products never make it through the test market phase.
Direct Mail: A promotional mailing to patients, used exclusively for practice-building or in conjunction with other advertising.
Consumer Analysis: Usually part of the market research function which specifically identifies your patients' demographics and their affect on your practice and future needs.
Target Marketing: A family practice resident was very specific about the patient mix he wanted - namely he wanted a good combination of geriatric patients, children and adults. He targeted (his practice) on an ethnic group whose sociological background was such that three generations lived close to each other. By so targeting, and doing his socioeconomic demographics, he had the practice of his choice.
Market Segmentation: An analytical approach which segments a particular patient population through demographics and analysis, to assist you in targeting your market.
Selling: Is the best purpose in medical practices to achieve patient compliance. Whether a patient is trying to quit smoking, lose weight, or cope with a particularly hard method of treatment, he or she needs to be motivated. The effective practitioner is able to convince the patient of all the benefits of complying with a particular course of action. That's selling.
Cost Pricing: A method of determining the total cost of delivering the service - rent, utilities, staff costs - plus a reasonable amount of return for the physician's time.
Competitive Pricing: A method of determining the charges based on what other physicians in the area are charging for a particular procedure. This assumes that patients are price sensitive.
Ability To Pay Pricing: A very prevalent practice in the medical sector. For example, in many practices Medicare and Medicaid patients pay less for the same service than private patients.
Value Pricing: A pricing method based on the relative task and complexity of a procedure performed. This method of pricing is utilized by many surgeons and sub-specialty areas, such as for new procedures.
Fixed Pricing: Another form of pricing utilized mainly by Health Maintenance Organizations (HMOs). In this type of pricing, an actuarial calculation is taken of what the cost would be to deliver medical care on a long-term basis. Patients are quoted a fixed monthly price, regardless of whether they receive the required treatment or not.
Base Price and Extras: Means a base price for the office visit, and the patient is charged for extras, such as, laboratory tests, X-rays, suture removals, and the like.
Skimming the Cream: A pricing technique used by those who offer a medical service that is new and unique. For this service, the charges are high. As volume increases, many times the price is then lowered. A typical example might be a new open heart surgery or surgical transplant technique.
Level-of-Service/Product Strategy: Means gearing the service and the fee to the socio-economic status of the patients. A high-volume, low-fee Medicaid practice differs greatly from the low-volume, higher-fee practice in an upper middle class suburb. Obviously, the level of service in the Medicaid practice would be "no frills," with functional reception furniture, etc. The higher paying patients in the second practice would dictate a second product strategy.
Positioning Strategy: Means promotion, scheduling, and service that caters to busy executives who would conceivably need special services. A good example of a positioning strategy would be an executive health clinic. Even though the clinic will see patients who are not executives, the clinic in an affluent suburb, positions its medical services for executives in the nearby corporate head offices.
Loss Leader: A service delivered near or below cost to bring patients into the practice. Examples of this are the $5 dental check-up, and free health screenings to uncover other major problems which need to be treated.
Before you plan promotional activities, consider what the American Medical Association has to say about the ethics of it. The official position places no restrictions on advertising by physicians, except to protect the public from deceptive practices. The AMA's official position, as quoted from the American Medical News, January 23, 1981, is as follows:
"There are no restrictions on advertising by physicians except those that can be specifically justified to protect the public from deceptive practices. A physician may publicize himself as a physician through any commercial publicity or other form of public communication (including any newspaper, magazine, telephone directory, radio, television or other advertising) provided that the communication shall not be misleading because of the omission of necessary material information shall not contain any false or misleading statement, or shall not otherwise operate to deceive. The form of communication should be designed to communicate the information contained therein to the public in a direct, dignified and readily comprehensive manner. Aggressive, high pressure advertising and publicity may create unjustified medical expectations. And advertisement or publicity, regardless of format or content should be true and not misleading.
The communication may include: (a) the educational background of the physician; (b) the basis on which fees are determined (including charges for specific services); (c) available credit or other methods of payment; and (d) other information about the physician which a reasonable person might regard as relevant in determining whether to seek the physician's services. Testimonials of patients, however, as to the physician's skill or the quality of his professional services should not be publicized. Statements relating to the quality of medical services are extremely difficult, if not impossible, to verify or measure by objective standards. Claims regarding experience, competence, and the quality of the physician's services may be made if they can be factually supported and if they do not imply that he has an exclusive and unique skill or remedy. A statement of cases involving a particular serious ailment may imply that a physician has cured or successfully treated a large number certainty of result and create unjustified and misleading expectations in prospective patients. Consistent with federal regulatory standards which apply to commercial advertising, a physician who is considering the placement of an advertisement or publicity release, whether in print, radio, or television, should determine in advance that his communication or message is explicitly and implicitly truthful and not misleading. These standards require the advertiser to have a reasonable basis for claims before they are used in advertising. The reasonable basis must be established by those facts known to the advertiser, and those which a reasonable, prudent advertiser should have discovered.
As used herein, reference to a "physician" applies also to information relating to the physician's group, partners, or associates. Any communication or message within the scope of the opinion should include the name of at least one physician responsible for its content."
Public relations are activities which are designed to enhance the practitioner's image without directly soliciting patients for the practice. They increase prestige and visibility by building positive relationships with the practitioner.
Most local papers periodically carry a column titled "Ask the Doctor" or something similar. These may be syndicated; but, as often as not, approaching your local newspaper will elicit their interest. They are always looking for local content, and a weekly column from a resident physician will serve their interest (they also like the fact that you'll write for free and syndications cost money.) Such articles invariably carry a footnote such as "Dr. Smith's practice has been established in _______________ for 20 years, located at 23 Wayside Drive."
A note of caution; you may be asked to write about subjects not of direct interest to you, simply because the paper has received requests from its readers. But the prestige inherent in being accepted for publication is significant and can influence the practitioner's standing in the community and with his patients.
As with writing a column, merely being asked to participate in local panel shows on radio or TV implies that the practitioner enjoys a certain position in the medical community; and often all it takes is a letter to the local station stating your availability and interest in a particular subject. Sometimes, your letter can actually be enough to result in scheduling a local program on your topic.
First off, getting involved in the activities of your local AMA branch or county medical association increases the medical practitioner's exposure to his peer group. For specialists relying on referrals from other practitioners, such exposure is very important. Furthermore when such activity eventually leads to holding professional office, the frequency with which the physician's name is exposed to the public increases; interviews are sought, charity sponsorships are solicited, etc. Such activities invariably lead to increased recognition and esteem on the part of the public.
These can be effective prestige builders provided that they are truly public service and not specifically tied into the individual practice.
Flu season is approaching and a new effective... ... is available. We urge you contact your physician for further information... ...Presented as a public service by Family Practice Associates."
This type of ad exposes your name to the public, is a valuable public service, and serves to enhance the image and relationships of the practitioner or practice.
Practice communication includes a variety of activities that use various forms of direct communication to keep your name before the public, enhance your professional image and/or stimulate action on their part. We will briefly describe various methods of approach and discuss the advantages of each.
Each new patient should receive a practice information brochure outlining your procedures. Besides listing office hours and phone information, a good brochure will contain other important information:
Informing a patient of what is expected in dealing with your practice enhances professionalism and avoids future conflicts. When a brochure is revised or updated, it should be sent to the entire patient register. It presents an excellent opportunity for an additional contact.
The handing out of business cards is one of the most basic forms of image building and promotion. Everyone uses them, and they can even be given out socially without giving offense. We have some specific suggestions for their design and use.
Each patient and all members of the patient's family should be given a business card and asked to carry it for easy referral in case of emergency. We recommend a fold-over design which can provide a wealth of information promoting the practice. The psychology of the fold-over card is that curiosity will not allow the recipient to leave it unopened; and once opened, the text will be read! Your message will be passed to anyone receiving your card.
Business cards should also be supplied to all professionals who may have an opportunity to refer patients to you. The printing of a new card provides an excellent opportunity to contact referral sources, thank them for past courtesies and remind them of your availability. Your card should also be enclosed in any direct mail solicitation.
Medical charities, pharmaceutical companies, insurance companies and others routinely provide pamphlets on a wide variety of medical subjects. Providing a rack of such literature in your office is a valuable service to your patients, costs nothing, and keeps your name in front of the patient. (You will, of course, have stamped each brochure with your name and address.)
Newsletters provide an excellent vehicle for routine, non-specific contact with your patient register; they maintain a high profile for you while providing an additional service that patients appreciate. The physician can choose a monthly, bimonthly or quarterly format, and can either create his own using abstracts or articles from medical journals, or use several bulletins available from commercial sources. You may wish to incorporate individual messages specific to your practice.
The important thing is that you are maintaining continuous contact with patients, reminding them that they are valued and are receiving "special" treatment.
For the specialist dependent on referrals from family practitioners and others, a professional newsletter is an effective way of presenting a capsule version of developments in your specialty. Recipients will appreciate keeping up-to-date without greatly increasing their reading load, and once again your availability and gratitude for referrals is subtly underlined.
Direct mail has several distinct advantages as a method of obtaining new patients; it is professional, individualized, can be minutely targeted and need not conform to a rigid timetable. These advantages more than outweigh the relatively high cost per contract of this method of solicitation. There are many sources of mailing list available.
Thus, if you want to contact affluent families in your community, it is fairly easy to obtain lists by ZIP code, family income, occupation of head of household, etc. Having obtained such a list, a professional letter can be sent out. This type of letter is low-key, professional and does not smack of commercialism. To maintain this professional image, the direct mail letter should be:
There are printing houses that provide such individualized mailing services, or your office staff can send out 5-10 letters a week as time permits.
One factor that reduces the cost of direct mail is that a list can be used over and over again. Once having targeted your market, several letters can be sent at intervals to the same people. There is a cumulative impact which may eventually stimulate action.
Mr. J. L. Lewis
123 Main Street
Anytown, USA 45678
Dear Mr. Lewis:
"A stitch in time saves nine." Like all platitudes, this one is based on fact. The best guarantee in a healthy future lies in avoiding problems.
Here at the Executive Health Clinic, we specialized in the care of busy executives, such as yourself. The most up-to-date diagnostic equipment is available at our offices. Our downtown location and special hours make it easy to fit health care into your already full schedule.
If you have not had a check-up in awhile, may we offer you our services? Please call us for an appointment. We look forward to adding you to our list of health conscious executives.
Thank you for your consideration.
Sincerely,
A. B. Smith, M.D., Director
Executive Health Clinic
ABS/lw
enclosure
Some general comments are appropriate before discussing individual media. The right of professionals to advertise their services is being accepted, and court litigations have upheld the use of this form of promotional activity. However, there is still considerable resistance within the medical profession to the entire concept of advertising. The practitioner who embarks on any form of media campaign should be prepared for the disapproval of some of his peers, and the degree of opposition may very well be a key factor in deciding whether or not to embark on a campaign.
In addition, the content of professional advertisements must be limited to providing information about practice and/or general image building. Qualitative claims and comparisons with other practitioners, either directly or by inference, are unprofessional and will create unwanted enmity among peers. Also, such claims are unprovable and leave the advertiser open to legal action. In general, subjects that can be included in medical advertisements include:
Yellow page ads can be very effective simply because they are seen by prospective patients actively looking for medical services. We recommend both an alphabetical listing and a display ad, as well as a listing (where available) in a section which classifies physicians by specialty. Thus, an individual could be listed under:
Costs are relatively low, and response can be significant.
Billboards are effective for long-term name exposure and recognition, but rarely stimulate immediate action. Location is critical since the nature of the viewership is a least as important as the number of viewers. Since they are viewed "on the move" they are inappropriate for long detailed messages. Cost can be high, depending on location.
Public Transportation. As with billboards, bus and train ads do not generally stimulate immediate action, but if creatively used can be highly effective. For instance, an ad on a commuter train promoting "Special hours for the commuting professional" could have interesting results. Costs are modest and the audience is "captive", so ads will be read.
Newspaper Advertising. Local newspapers provide an excellent, moderately priced medium for getting your message to the public. This vehicle provides several distinct advantages:
Radio is the only medium that relies on the auditory senses to transmit a message. Ironically, this unique characteristic provides it with both its greatest advantage and disadvantage. While its message can be absorbed by those doing something else at the same time (cleaning house, driving home), radio is used as "background" noise by many, and your message may be completely overlooked by lack of concentration. It is also an "immediate" medium, that is, if you're not tuned in when the message is sent, it's gone forever. This means that radio ads must not only be repeated frequently, but at different times of the day to assure they are being absorbed.
Radio can be closely targeted by choice of station, program and time. Highly accurate listenership data is available covering all stations and programs. Messages can be changes frequently and at moderate cost. Air time can be expensive, depending on program selection, and often the most advantageous "time slots" are taken up by commitments to national advertisers.
This medium should only be considered if you are prepared to maintain a substantial budget over a prolonged period, and if you can obtain guarantees from the station that your ads will be aired at the time you want.
Television. Ninety percent of all households own at least one set, and average viewership now approaches five hours per day. Using the industry standard of "cost per 1000," the numbers may look very reasonable. Unfortunately, for the individual practitioner or practice, the deck is stacked against you. Costs on major network affiliates are so high as to put them out of the reach of most practitioners. The only reasonable exposure is available on local, unaffiliated stations. These stations normally have much more limited viewership than the network affiliates. Production costs are high because professional talent must be used to produce as, thus limiting the number of messages that can be reasonably produced. Messages cannot be easily changed; to recoup costs, each ad must be shown repeatedly.
While we do not wish to slough off this very effective advertising medium, for all but the largest group practices in major metropolitan areas, TV campaigns are simply too costly for consideration.
Premiums and Incentives. In general, we do not recommend the use of premiums and/or incentives to promote the medical practice. Frankly, the general image of the "giveaway" is too commercial and conflicts with the dignity expected of the medical practitioner.
However, there is one exception that is noteworthy. An excellent source of new patients is families moving into the community. These families normally look for a doctor early on, especially if there are children in the household. With this particular group, a physician can position himself on the inside track through the use of an organization existing in most communities, the Welcome Wagon. Welcome Wagon normally provides new residents with an introductory packet of information which includes various incentives and discounts from local merchants. A letter from your practice, welcoming the family and offering a first visit and examination at half your normal fee could very well direct them right to you. Remember, the chances are they know of no physicians in town. Why shouldn't they hear about you first?
Why practice representation? The medical practitioner may well ask this question. When, by accident of demographics and geography, there are "enough patients to go around," the role of the practice promotion may indeed be diminished in importance. But the situation today is that, in most areas there is an overcapacity in medical service availability, a condition that is likely to accelerate in the future.
Overcapacity places the physician in a position of having to compete
for patients; and having a wide range of choices, patients must
be given good reasons for choosing one practice over another.
Practices that do the best job of representing themselves will
find their patient registers growing while those that neglect
these important activities will inevitably be left behind. Each
choice made against your practice represents a loss of income
and growth potential.
Copyright 1997 International Council for Quality Care, Inc. All rights reserved. Boca Raton, FL Voice: 561-241-4331
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