PookieMD's Blog: Where Physicians Learn About the Business of Medicine

The new year brings the January slowdown, in which patients don’t come to the office for appointments because of many reasons–most of them financial.  Lots of patients have huge deductibles, and will have to pay for every bit of their health care until it is met.  Other patients are tapped out from the holiday season, and are now looking at big debt.  So how do you encourage patients to come in and get the health care they need?

For new patients, make a big deal of the first appointment.  Send out a packet ahead of time, with your bio, as well as information about your staff, office info (where to park, hours, services), and forms to be filled out.  Include  payment policies. Also include a health “tip sheet”–e.g. reminders that exercise, prudent diet, proper medical care and non-smoking offer big health dividends.  (Yes, dear readers, of course you should already have all of this on your website!)  Include your card in the packet.

For established patients, send a reminder post card, and emphasize the necessity of continued medical management for continued health.  Make the postcards up beat, and again offer a health tip.  You don’t need to do postcards every month, but January is an especially good month to get everyone started on their new year’s resolutions!  Postcards should include contact information so patients can easily make appointments!  You should always have staff call and remind patients of their appointments 24-48 hours ahead of time.  There are automated ways to do this as well.

Consider offering something free–a noon seminar on healthy eating, or ways to include exercise in a daily routine.  One of the most fulfilling seminars I did was a diabetic teaching seminar, complete with lunch and samples.  I paired up with a nutritionist, and a drug rep bought a light lunch for the group.  It brought huge kudos and loyal patients in to the office.

Make the experience enjoyable.  Your receptionist should greet patients cheerfully, your office should be neat with up to date magazines, and for pity’s sake don’t keep patients waiting!  Have the patient make their next follow up appointment before they leave the office.

Develop a quarterly newsletter.  This is a chance to send out information on medications, immunizations, new staff, and encouraging news.  Newsletters are a way of attracting the type of patients you want to see in your office–and beginning to build a practice that you love.

Make it happen!

It’s time to make the next 6 month marketing plan for my company, ExtraMD.  ExtraMD, based in Denver, is  a group of doctors that do fill in work for family practice and internal medicine practices through out the Denver Metro area.  I am the president, and run the group.  My biggest job is finding work for the 6 doctors that comprise the group.  We call ourselves a “local locums”, and our goal is to provide reasonably priced fill in doctors, build long term relationships with clients, and help their practices grow.  We have had a lot of our clients for 4+ years, as they use our group over and over. It takes about 3 months to build a relationship such that a client books shifts with us, so I have to plan accordingly.

As you may recall, I made a marketing plan back in January to combat the recession. It was made to go through June, but actually went through July.  Following is the plan for the next 6 months. 

The Goal: 60 shifts per month.  (Last January my goal was 50 shifts per month, and we didn’t make it.  However, we did get up to 40/month, double our slowest month ever, in which there was only 20 shifts.)  By the way–this goal is a “stretch goal” –it will really push the limits for me as chief (and only!) marketer.

August: postcard to potential/current clients reminding them that we provide fill in physicians when the practice is extra busy or if  a physician is on vacation.  I already did this, and did something I haven’t done previously–I reused a post card that I had sent out in June.  It was the most successful postcard mailing I have ever done, so I used it again.  Mistake:  didn’t check post card stamp rates.  They went up since June, and I mailed a whole bunch with a $0.26 stamp rather than $0.28 stamp.  Arggh! Moral: always check stamp rates as they seem to be going up rapidly!

September: email to clients on collecting co-pays.  I will do this as a blog post and recycle it in to a mailing.  My client list doesn’t seem to coincide with my blog readers, so it’s okay to reuse that content.

October: press release.  I haven’t picked a topic for the release, so will have to be looking and open for ideas.  (ExtraMD can help your practice cover increased volume of flu patients?)  I will also ask the other doctors in the group to leave business cards with the practice managers they are working with and with other people who are interested in our company.

November: Thanksgiving cards.  My company and our doctors have a lot to be thankful for! We survived our slowest 1st quarter ever, and I would like to send a gift card with the Thanksgiving card to our clients.  I have traditionally sent coffee cards, but would like to do something more healthy and fun, like coupons for stuff from Gaiam.  (I love this company, and one of my good friends is an accountant there….Hmmm…can I use that connection?)

December: email to clients on preparing for the January doldrums–the time when patients aren’t coming in because of deductibles etc.

January: a free webinar on medical practice management?  (My good friend and controller of our company, Suzanne, would have to help out with this one.)

For more on stretch goals and celebrating failure, visit Celebrating Failure.  For more on marketing, check out the Duct Tape Marketing blog and book.

I’ll keep you posted!

photo: http://www.sas.usace.army.mil/kkorner.htm

I’ve been on the PookieMD Magical Mystery Tour:  I’ve been visiting some of ExtraMD’s primary care clients to see how they are faring in these tough economic times.  These are long term clients with whom I have had a long relationship, and know the office managers well.  Here is what they have to say about the current recession and how it effects their practices.  (All are family medicine practices, with over 12 providers each.)

• One had an EMR in place, and was happy to have it, but implementation was a struggle, and their system was down when I was there.  The second was getting an EMR April 1, but was going to implement “slowly.”  The third practice felt there was not an EMR out there good enough yet, and cost was prohibitive.
• All noted an increase in the self-pay Accounts Receivable.  One practice noted that this was now 17% of their business.  (Yikes!!)
• One noted a slump in business for the first quarter, which they think is due to multiple factors, including the recession, high deductible plans and reluctance by patients to spend the copay to see their physician.  The other two practices, demographically better situated, didn’t report a decrease in patient visits, but noted the trend to longer time in AR for self pay patients.  One noted delayed payments from insurers, the others reported no change.
• All three  practices had extended hours, including weekends.  One has an attached walkin clinic that is open 7 days a week.
• All three practices used ‘physician extenders’ extensively.
• None of the practices were involved in alternative methods of revenue generation, such as aesthetic medicine, and had no plans to do so.
• All three practices did minimal marketing to attract the type of patients they wanted to see.
• One practice had decreased their health insurance costs by growing through a broker.  This same practice  joined a co-op to buy office and medical supplies.  The office manager is very interested in customer service, and will start a training program with her staff as an attempt to retain their patients.  The other two had no such plans.
• All noticed a decrease in revenues with the addition of nearby “minute clinics”, but had done no additional marketing.

So, what’s the take away?  Margins are tighter, time in AR is growing, and marketing is minimal.  The one exception is the clinic with the attached walk in clinic.  I predict they will stay afloat and even thrive.  What is your practice doing to keep the doors open?

As promised, I would set up a goal for the year, and plan to achieve it.  I had earlier noted that business for my company, ExtraMD was down for the first time in five years.  My company supplies physicians to clinics/hospitals/urgent care in the city where I live.  I am the physician owner, and feel responsible to the other 5 physicians in our group.  So, I developed a marketing plan for the next six months to bolster our shifts.  The general marketing theme was a birthday celebration, as ExtraMD is turning five.   

The goal: have 5o shifts per month for our physicians.   (This is what we usually have, but has suddenly decreased.)

Unless noted, all responsibilities for marketing are mine.

The plan (by month):

January: send an email to our clients, announcing our birthday celebration, and giving a discount of 10% off the first shift.  (Already done by our trusty office manager.)  Send out a press release announcing the birthday celebration.  (My responsibility.)

February: deliver birthday cupcakes to potential clinics with cards/brochures. 

March: build a referral tree via email.  E.g.: if a client refers someone to us that uses us to fill shifts, the referring client will get a discount off their next shift with ExtraMD.

April:  send out postcards reminding clients/potential clients of our services, focusing on how we benefit the practice when one of our doctors fills in.

May: send out email reminder for practices to book now for summer vacations.

June:  send out a newsletter with tips on practice management to our email subscribers.

Most of the marketing will be low cost.  This marketing plan was developed with help from Philippa Kennealy, a physician entrepreneur.  I also consulted Duct Tape Marketing, by John Jantsch.   I’ll keep you informed as to our progress.

So, continuing on with my tale of my little business…I left off describing how ExtraMD ( my local locums company) was going to weather these stormy economic times.  I have noticed a drastic drop in shift requests.  Over the past two years, we have typically had 10 shifts per month unfilled, almost enough for a full time physician.  However, over the last 3 months, I have seen a distinct drop, such that by December we only had 2 shifts that went unfilled.

Scary.

Next, an urgent care cancelled a shift, saying they were so far behind in their receivables, they couldn’t afford any more debt.  We haven’t yet received the money owed for work we did there.

Scarier.

In addition, a large clinic system cancelled over 16 shifts for one month, leaving 4 doctors with out work for February.  They emailed me, saying, “Good news for our clinic…we’ve hired a full time physician, so won’t need coverage.”  Bad news for us.  We do have a 30 day cancellation policy, but the clinic squeaked in at 31 days, so didn’t have to pay the full cancellation fee.

Scariest.

So, what will we do?   How will I find work for my  docs, keep my company afloat and sleep at night?

Here’s my plan:

1. Calm down.
2. Send out a post card mailing, advertising a birthday discount.  (ExtraMD is turning 5.)  Something cute and eye catching will be on the postcard,  like a birthday cake.
3. Email our clients, letting them know we have a birthday  celebration discount going on.
4. Consider taking  birthday cupcakes to our best customers.
5. Put an ad in the local medical journals.
6. Talk to the other physicians in our group about leaving business cards and chatting up the business at practices where they are working.  As the physician owner, I have done all the marketing myself, but hey, it’s worth a try.
7. Create a press release targeting the local market about ExtraMD’s birthday celebration and discount.  Let practices know that we are a  good interim solution during tough times–it’s cheaper to use us than hire another physician, especially if  a practice isn’t certain it can support another full time physician.

I’ll keep you posted as to the results.  How is YOUR practice doing in these tough times?

If only I could get paid for worrying!  I was up last night at 1:30 am, worrying about my company, ExtraMD.  I formed ExtraMD five years ago, when I left the large hospitalist group I was working for.  The hospitalist group was (and still is!) made up of intelligent, caring physicians.  I earned a nice salary, got regular bonuses and had excellent benefits.  I left because, with a young daughter, I wanted to have greater control over my time.  Exit the benefits, nice salary and bonuses.  Enter flexibility and a steep learning curve with respect to business.

I consulted an attorney, created my company, got a designer to make up brochures and business cards and declared myself in business.  I would eagerly check the emails of my new business email, waiting for work.  I was studying to recertify my boards, and so was glad to have some extra time.  I was thrilled when I got my first free lance job, working for anther hospitalist group.

I realized that the jobs weren’t just going to pour in, so I decided to market.  One of my friends is a rep for a pacemaker company, and he suggested I try the “lunch with the doc” approach.   I dutifully called several offices, got their lunch orders, and, on the appointed day, would show up with the food.  I was lucky if the physicians at the office would even come talk to me.  The office staff was always glad to see me and consume quite quickly what ever offerings I had, leaving me to clean up the office lunch room.  I did get business that way, but hated doing it.   The final straw came when I was asked to bring lunch for THIRTY.  I complied, and the office staff barely said hello as they chowed down, chatting amongst themselves as I sat alone.  The physicians never showed up.   Offices didn’t care that I wasn’t a big fancy drug company, they just wanted free food.  End THAT strategy. Besides, it was so darn expensive and time consuming.   Not to mention how it made me feel!  I now have great compassion for drug reps.

I had already sent out masses of introductory letters and brochures, and got only one job that way.  I decided to try a different approach, and created a post card mailing with snappy color graphics.  I laboriously created a postcard on Publisher, and printed it on my trusty home printer.  I created a database of local physicians by website mining, then printed out labels and got my baby sitter to stick them on the post cards.  This approach got people’s attention, and I started getting more work in primary care and urgent care, which was what I was after.

ExtraMD grew by word of mouth, post card mailings, and ads in the local medical newsletters.  Soon physicians started approaching me to work for my company.  We have grown so now there are 6 physicians, providing “local locums” service through out the metropolitan area where I live.  In the past 4 years, ExtraMD has always had more work than it could handle, and has actively been recruiting physicians.   We now have a controller, a board of directors and a virtual assistant.  Things have been going on swimmingly, with steady growth in revenues and profits.

Until this past October.  Which is why I am up worrying about “my people”.  More in the next post.

Yes, we will talk business today.  No more fluff on being efficient, knowing where the speculum is, and handing out tricolor business cards.  Let’s get to the meat of it: YOU CAN’T SEE PATIENTS IF THERE IS NO ONE TO SEE. 

Sadly, many practices have a dearth of patients.  How could this be?  Some are located in physician dense areas  ( or is it dense physicians?),  where competition is fierce for patients, others are in a location with out a lot of patients, while others have not gotten the word out.  Getting the word out will be the focus of today’s highly opinionated, some what educational post.  (In all fairness, this is not JUST my opinion.  I actually DO research these topics!)

So, here are a list of free, cheap, inexpensive and expensive marketing ideas that you should try in the laboratory of your practice.  (Yes, you need to have the Edison mindset–experiment!  You can’t build a light bulb the first try.)  I freely use examples from marketing ExtraMD, my company.  (An example of see one, do one, teach one, but hey, we’re doctors, it’s what we do.)

1. Set the tone from the moment the patient walks in, to the moment they leave.  Word of mouth is huge in the doctor business.  Your receptionist needs to actually LOOK AT THE PATIENT AND GREET THEM BY THEIR LAST NAME, before handing them 27 forms they must fill out with a scratchy pen.  (Could ya’ spring for some decent pens?)  You, dear doctor, must BE ON TIME , say the patient’s name, listen intently, and come up with an understandable treatment plan.  But wait–we are not done yet!  Your trusty assistant (or you, depending on how your office runs) must make sure the patient knows what the plan is, has the needed ‘scripts, and knows when to return.  Helping the patient find the check out desk is a nice touch.  How many times have I wondered through a labyrinth of an office, trying to find a way out, and ended up in the bathroom?
2. Avail yourselves of your friendly colleagues.  Go out and meet the docs at the urgent care clinics, and specialists at your local hospital.  While you are at the hospital, introduce yourself to the ED docs.  HINT: the nicer you are to the ED, the nicer they are back! (Really!)  Let all of these people know you are taking new patients, and hand out cards.  Introduce yourself to the hospitalists.  Just last week, I met a nice nephrologist who gave me her card.  She had a great niche in that she spoke Spanish.  Guess who I called on my very next Spanish Speaking Only (SSO)  ICU patient?  Guess whose cards I passed out to my colleagues?
3. Send thank you notes to physicians that send you patients.  Everyone likes a thank you note.  Include that fancy tricolor business card.   Yes, I walk the walk.  ExtraMD’s nifty assistant just sent out thank you cards to our clients.
4. Have a website.  It is a necessity in today’s hyper connected world.  Even the sadly computer challenged ExtraMD has one.  In this day and age, patients are savvy and will check you out on line. Make sure your website lists your hours, days, experience, the patients you want to see, which insurance you take, and has some nice pics of you and your staff.  Not to have a website is archaic.  Get with the 21st century!  You can get a website going fairly easily and at a reasonable cost if you shop around and ask colleagues who they used to design theirs.
5. Speak the language.  If you are in a community that speaks a language other than English, and YOU speak that language, make sure that’s on your web site.  Unfortunately for me, no hablo espanol, which would be a huge asset in the region where I practice.  Sprechen Sie Deutsch?
6. Make sure your hours are accessible.  What are you thinking, closing at lunch?  Have a late lunch (if any) and the working folks will love you when they can get in at lunch. They will tell their friends and so on… Also consider extended hours a couple of times per week, opening early and closing late. 
7. Get famous. Seriously, a lot of docs write columns in the newspaper, or do radio programs.  Select topics that are interesting, and applicable to your wannabe patients.  You could be the next Dr. Drew!  (Hmm, is that a good thing?)
8. Get your name on the hospital website.  Make sure your name, practice name, and practice address/info is listed on the hospital website where you have privilege’s.  Patients will search these databases to find a physician.
9. Introduce yourself to the medical staff office at your hospital.  Leave cards, brochures and chocolate.  (Don’t laugh, chocolate sells!)
10. Press the flesh. Consider doing some meet and greets at health clubs, sponsoring a kids sports team, or giving a free talk at the local senior center. 
11. Consider fliers, and direct marketing post cards.  I list this last, because this is an expensive way to go.  I must note, however, that post cards have served ExtraMD well.

Other key points: develop a marketing plan, and a budget.  Track what works and what doesn’t.  Some stuff will surprise you, other sure bets will stink up the place.  Let me know what works for you and I’ll post it here.

Good luck!  Keep doing the valuable work you do, and know that you really do make a difference in the world!!!