Physician Practice Revenue/Growth: Strategies For Success

PHYSICIAN PRACTICE/REVENUE
GROWTH: STRATEGIES FOR SUCCESS
A Workshop Presented By Patrick T.
Buckley, President and CEO, PB
HealthCare Business Solutions LLC

©2009 PB Healthcare Business Solutions
LLC
The material contained herein is protected

PB Healthcare Business Solutions LLC
and intended for use by clients and
associates of PB Healthcare Business
Solutions LLC, and may not be reproduced
Strategy, Marketing, Management for Health Care® or distributed without the expressed written
consent and permission of PB Healthcare
Business Solutions LLC.

2

Topics For Today’s Workshop
• The New World Of Physician Group
Practice Management
• Understanding Our Customers’ Universe
• Using Marketing Information To
Facilitate Revenue Generation
• The Interdependence of Marketing and
Operations
• Marketing Communications
• Managing Cash And The Revenue Cycle
• Revenue-Generating Opportunities
• Putting Strategies Into Action
• Summing It All Up
Strategy, Marketing, Management for Health Care®

The New World Of Physician Group Practice Management 3

Increasing Pressures on Physician Practice Income
• Inadequate reimbursement
• Higher malpractice premiums
• Increasing administrative/overhead
• Longer receivable cycles
• Displacement of income-generating procedures through new
technologies
 Imaging advances have replaced need for some higher-
reimbursed procedures and surgeries
• Competition from retail clinics and “lifestyle enhancement”
alternatives
 Health clinics and quick care centers (e.g Walgreens’ Take Care™,
Minute Clinics)
 Patients are becoming more involved with programs that
eliminate or reduce pain (pain centers, chiropractors,), improve
well-being/quality of life (fitness centers, massage centers), and
improve their appearance (vein centers, cosmetic surgery, weight
management programs)
 Employers are becoming more active in health promotion
 Move toward new health management models (medical home,
integrative medicine)
 Consumers are engaging more pre-actively in their health care
diagnosis, treatment, and health maintenance


The Equations They Probably
Didn’t Teach You In Medical School

Greater number of patients + Less Time To
Interact With Patients + Impaired Cash Flow
=
Major Stress!

Excellent Service + Efficient Operations +
Customer Satisfaction
= Opportunity For Profit


The Doctor of the Future:
• The doctor is online
• Half man, half machine
• A diagnostic search engine
• In two places at once

Article location:http://www.fastcompany.com/magazine/135/the-doctor-of-the-
future.html
May 1, 2009
Tags: Innovation, Technology, Leadership, doctor

Understanding Our Customers’ Universe 6

The Marketplace Is Always Shopping

“I need to control my out- of- pocket”

“Will this fit my
family’s schedule?”

“I want to be treated with courtesy
and respect”

“Can my doctor diagnose quickly and
prescribe the right treatment?”

“Help me help myself”

“Does my doctor relate to what it’s
like to be a patient?”

“Will I get enough time to go
over all my issues?”


How People Choose Physicians
(primary care practices)

10%
30% SOURCES
20%
Self
Personal Endorsers
40% Caregivers
Organizations



MARKETING STAGE

REPEAT CUSTOMER

Switch Decision Stay
ASSESSMENT OF RELATIONSHIP MANAGEMENT
EXPERIENCE
SERVICE “PERSONAL BRANDS”
WILLINGNESS TO TRY

AWARENESS OF PRACTICE BRAND EQUITY/REPUTATION

Anywhere from 5 to 20% of Current Patients Are “In Play”


Top 10 Reasons Patients Switch Physicians
I. Poor Communication
II. Practice Style (Rushed Or Slow)
III.Insurance Plan Dictates Who I Can See
IV. Inconvenience Factors E.G. Location, Parking
V. Scheduling Issues
VI. Long Waiting Times
VII.Doesn’t Always See The Same Physician
VIII.Lack Of Confidence In Ability To Treat
IX. Doesn’t Seem To Listen Or Remember Key Details
X. Insensitivity Or Paternalistic Attitude

Source: PBHBS focus groups



Top 10 Reasons Patients Keep Physicians
I. Switching Costs Are High
II. Helpfulness And Respect Of Office Staff
III.Physician Communicates Well
IV. Person Is Not Rushed
V. Professional Competence
VI. Convenience And Amenities
VII.Scheduling Options
VIII.Reasonable Waiting Times
IX. Continuity In Care
X. Understandable Bills And Payment Flexibility

Source: PBHBS focus groups

Understanding Our Customers’ Universe

Consumers Are Participating In Online Communities

Strategy, Marketing, Management 11
for Health Care®

12
SOCIAL MEDIA MESSAGING

Medical
Group
Practice

Multi-directional

Immediate

All demos

Inexpensive

Easy consumer
Strategy, Marketing, Management for Health Care® interaction

13

Using Marketing Information
To Facilitate Revenue Generation
• Auditing The Practice:
What is the potential for further growth, and what
areas do we want to grow in?
Can we handle any incremental growth without
compromising service standards?
Who are our best performers and how do
we leverage them?
Are we doing everything possible to satisfy our
customers, and to give our staff a supportive
environment?


14

Assessing Your Marketing Prowess:
The 5 C’s Of Successful Medical Practice Marketing

The 1st C: Clinical Knowledge and Experience
▫ Are patients able to get unbiased information on the performance
of the physicians?
▫ Does the physician or group practice have a reputation for clinical
excellence?
▫ Does the practice maintain data that demonstrate how it
performs with respect to quality measures?
▫ Are data on the number of procedures performed and their
outcomes made available to patients in an easy to understand
format?
▫ Does the group foster a practice style that encourages patients to
ask their physicians questions?

The 5 C’s Of Successful Medical Practice Marketing 15

The 2nd C: Customer Service and Convenience
▫ Are evening hours, weekends, or walk-in appointments available?
▫ Are physicians keeping to their appointment times with patients?
▫ Is the reception service courteous, helpful, and responsive?
▫ Does the office follow-up with patients after the office visit?
▫ If the practice uses electronic record management, are patients
given the opportunity to review the accuracy of information prior
to leaving the office?
▫ Is patient privacy maintained throughout the patient’s visit?



The 3rd C: Cultivation Of Patient Trust And Practice Relationship
--Does the practice maintain strong consultative and referral
relationships with other specialists and subspecialists?
--Does the practice provide amenities for seniors, such as
facilitative chairs, reading materials, and assistance with
transportation?
--Does the practice schedule multiple consults if needed for patients
during the patient’s visit?
--Does the practice employ integrative health coaching?



The 4th C: Communications
▫ Does the practice provide educations information for its patients
in print, electronic, and internet-based media?
▫ Can patients access their personal physician via e-mail?
▫ Does the practice have a cogent brand message?
▫ Are communications consistent with respect to tone, look, and
feel?
▫ Are communications materials, such as collateral and magazines,
kept organized and up to date?
▫ Do the physicians speak at community health forums and events?
▫ Do the physicians participate in healthcare prevention
screenings?



The 5th C: Costs and collections
▫ Does the practice provide consumers with sufficient information
prior to the visit regarding pricing and collection?
▫ Are billing practices comprehendible?
▫ Are the physicians in the group practice in most consumer health
care plans?


Using Marketing Information To Facilitate Revenue Generation 19

CASE STUDY: “DOCS INC.”

Service Area Description

 Doctors Inc. is a family practice medical group located in a gentrifying neighborhood of Milwaukee (see map 3).
 The area immediately surrounding the practice is re-vitalizing with residential and new small business
developments.
 In this area, residents are primarily white (86%), followed by African American (7%), and Hispanic (5.7%).
 About 5% of housing units are vacant, a figure that compares favorably with the nation rate of 9%.
 Approximately 2.5% of residents are foreign-born and 10% speak a language besides English.

Map 1: Total Service Area Map 2: Core Area Map 3: Census Tract


Market Snapshot
Customer Profile

 Over 50% of the practice’s patients are between the ages of 18 and 44.
 The top five reasons for patient visits are well woman visits, well child exams, well
man exam, upper respiratory infection, and hypertension. Other diagnoses are
distributed among several categories.
 The practice has twice as many female patients as males. About half of the patients
reside in the core area (zip code 53208). Approximately 20% live in the secondary
service area (zip code 53213), and the last third live within nine zip code areas that
contribute 5% or fewer of the practice’s volume.
 Patients average approximately 2 visits per year, which is below the national average
of 3.2 patient visits per patient per year.


Market Snapshot 21

TABLE 2: DOCS INC. CUSTOMER PROFILE
Zip code Male Female Total
<18 18-44 45-64 65+ <18 18-44 45-64 65+
53206 1 1 1 3
53207 1 3 4
53208 3 13 4 2 8 19 9 3 61
53209 1 2 3
53210 1 1 1 4 4 11
53213 3 7 2 12 1 1 26
53214 1 2 3
53216 1 1 1 2 2 7
53217 1 1 1 1 4
53218 2 1 1 4
53223 1 1 1 3
53224 2 1 3
TOTALS 9 26 8 2 15 47 20 5 132

Age Percent
<18 18.1%
18-44 55.3%
45-64 21.2%
65+ 5.3%

TABLE 1: KEY DEMOGRAPHICS OF SERVICE AREA
(U.S. Census Bureau, American FactFinder, Census 2000)

Population Core Area Secondary Wisconsin US Census Tract Total Service
Characteristic (Zip Code Service Area 94—Vliet Area
53208: Approx. (Zip Code Street so. (approx.
Lloyd St. no.
47% of patient 53210: approx. 25% of
N. 60th St.
origin) 28% of patient patient
west
origin) origin)
N. 52nd St.
east (1.1
miles w-e)
Total Population 35,150 30,509 5,363,675 2,489 821,015

Median Age 27.7 26.6 36.0 35.3 34.4 33.1
Age 65+ 6.7% 6.1% 13.1% 12.4% 10.1% 12.9%
Avg. Hshld Size 2.68 2.91 2.5 2.59 2.18 2.42

Owner-Occ. Units 33.5% 44.7% 68.4 66.2% 55.2% NA*

College or Higher 18.8% 18.5% 22.4 24.4% 35.1% NA*

Median Hshld 26,436 32,340 43,791 41,994 43,005 NA*
Income

Per Capita Income 13,018 13,908 21,271 21,587 22,419 NA*

Families < Poverty 29.5% 22.3% 9.2 1.5% NA*

*U.S. Census 3-digit zip code tabulation areas (ZCTA) do not track this information for 2000 census


TABLE 3: PRODUCTION CAPACITY AND GROWTH POTENTIAL FOR SOLO FAMILY
PRACTICE*

National average (NACS, advanced 317.3 visits per 100 persons per year =
data # 365, 2003) 3.2 visits per person per year
Practice rate 2.045 per person per year

Population in total service area 821,015

Total estimated patient office visits from 262,723
service area
Estimated current market share for practice .1%

National rate applied to practice (with no 422 patient visits
increase in patients)
Incremental visits needed from current 152
clientele to achieve national visit rate
Incremental customers needed to reach 74
national rate (assuming no increase in visit
rate)
Per day patient volume capacity 10

Total potential visits based on daily volume 2,400
capacity (240 days x 10 patients/day)
Proposed Target Market Share .2%

Additional visits beyond 270 to achieve 255
market share
(.002 x 262,723)

*Visit rates are assumed to stay constant at 3.2 per patient. Estimates for additional visits are based upon the most recent
NACS national norms, which may not be reflective of actual utilization characteristics for the service area in 2008


VISIT RATES FOR SELECTED DIAGNOSES



ESTIMATING SPECIALTY CARE OFFICE-BASED MARKET SHARE
Cardiovascular Specialists, SC

Yearly patient office visits for
cardiovascular services…………………………….30,500

National average (National Ambulatory Care
Survey, Advance Data No. 374, June 23, 2006)…8.0 visits per 100 persons per year

Population in service area………………………… 1,400,000

Total patient visits in the service area estimate….112,000

Market share estimate…………………………… 26.7%


26
MEDICAL GROUP PRACTICE
MARKETING/OPERATIONS ASSESSMENT
CLINICAL PRACTICE PROFILE
• Describe the group practice’s scope of services with respect to:
 Diagnostic
 Preventive
 Therapeutic Care
• Describe the special capabilities of individual physicians
• Describe any newer methods of clinical care, e.g. minimally invasive procedures
• What are the group practice’s strengths and areas for improvement?
MARKET REVIEW
• Describe the marketplace dynamics with respect to market position, competitive challenges, and growth
opportunities for the practice.
• Is your primary competitor’s business steady, increasing, or decreasing? Why?
• How does your practice compare to your competitors’
▫ In length of time in business?
▫ In patient volume?
▫ In size and number of employees, suppliers, and support staff?
▫ In similarities or dissimilarities?
• On what basis will you compete for patient volume?
▫ Clinical uniqueness
▫ Patient Convenience
▫ Service delivery
▫ Price
▫ Technology/innovation
▫ Other

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REFERRAL SOURCES
• What are your principal referral sources?
• Who among the group practice have “rainmaker” capability?

GROUP PRACTICE GOALS
• List three primary marketing goals for the group practice. Think in measurable terms; e.g., maintain current book of
business, grow patient volume by 5 percent.

PRACTICE OPERATIONS
• Describe the opportunities for patient/provider interactions—how they happen and how well they are performed:

Initial call by consumer to make an appointment
 Can the caller “break through” voice mail protocols?
 Is the call handled promptly and courteously?
 Is the caller given a choice of physicians?

Reception/Waiting
 Is the signage easy to follow?
 Is the patient greeted in a welcoming manner and are voices kept down to assure privacy?
 Is the patient kept apprised of his or her status at least every 15 minutes?
 Is the waiting room big enough to accommodate all patients during peak hours?
 Can expectant mothers wait in an area away from pediatrics?
 Are reading materials up to date and nicely organized?
 Are there readily available waste receptacles for patients with coughs and respiratory problems?


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In The Exam Room
 Is the patient seen within five minutes of entering the exam room by the physician?
 Is the exam room equipped with everything it should have?

MARKETING COMMUNICATIONS
• Does the group practice have a dynamic web site?
• Can patients get information on the physicians—their training, experience, volumes of procedures
and outcomes?
• Does the group practice have a e-newsletter or hard-copy newsletter?


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Marketing Communications

Enlivening Your Brand
Traditional and Social Media
Internal Marketing
Guerilla Marketing


30

BRANDING YOUR MEDICAL GROUP PRACTICE:
ASSESSING YOUR EFFECTIVENESS
SCORING KEY QUESTIONS IF NOT A “5”, WHY NOT? ACTION TO BE TAKEN: WHO,
WHAT, WHEN

Has the practice developed a
positioning platform to guide its
internal and external communications?
Does the name of the practice provide
sufficient information so that
consumers immediately know the
practice’s purpose?
Does the positioning platform express
a specific attribute or attributes for
which the practice wants to be known?
Is the brand identity (look, tone, feel of
communications) creating a sense of
cohesiveness for the group practice?
Does the group know its brand image?
Are consumers’ perceptions of the
image consonant with internal
perceptions?
Do the operations of the group and
fulfill the brand promise?
Has consumer perceptions research
been conducted on a systematic basis
to determine awareness and
preference gains?
Is your brand message strong and
does it reflect the brand image you
want people to have about you?

0=Not at all
3=Yes, but not completely
5= Absolutely

Marketing Communications Matrix For Medical Group Practice 31

Communications Description Significant Relative ROI/Cost Primary Use Best For Target Recommendations
Vehicle Competitor Presence Group
Directories Yellow Pages Yes Low/High Ability to locate practice Seniors Consider advertising in
Specialty Directories directories but
Internet Directories streamline

Website Basic web site Yes High/Med. Explain practice style All Consider enhancing the
Provide description of web site
services

Blogs and other Social Personalized No Low/Low Communicate with patients Patients Not recommended
Media communications on web
site

Internet sponsorships Google-type banner or box No Low/Med. Used mostly by non- All Not recommended
ads on web sites medical businesses
frequented by target
demographic groups

Traditional sponsorships Sponsorship of speaker No Low/Varies Mostly for brand image Consider as it can build
programs, sports teams, development visibility but limit to
etc. strategic support

Collateral Written material such as NA Low/Varies Give to patients after they Patients, esp. seniors Consider as a leave
brochure, display cards join practice behind piece

Outdoor Transit, vinyl and No Low/High Reminder medium and All Not recommended
electronic boards image

Practice Newsletter Monthly, bi-monthly, or No Medium/High Keep practice visible Consider in six months
(hardcopy or e-zine) quarterly. Strengthen affinity with
community

Direct Mail Post-card, letter,CD or No, but needs to be different Low/Low Attract new move-ins, All Consider—make sure the
brochure. Use to get from others so it isn’t junked announce new services, call to action is a strong
people to a free screening one
or to an open house for
practice

Special Events Holding an open house, No High/Low To get people to experience All These are good “press the
screenings, health fairs something about the flesh” type settings and
practice provide opportunities for
would-be customers to
ask questions directly

Advertising (print, Ads in newspapers, Some Low/High Control and place the Certain vehicles work best Consider as a supplement
electronic) magazines, radio, tv message with different groups to other promotional
options

Publicity Coverage in local news, Varies High/Low Gives third party All Highly recommend
medical journals, and “endorsement” which is
newsletters. Eg: Metro- more believable than
Parent, Milwaukee advertising
Woman

Personal Selling Housecalls, speaking High/Med

32

Physicians Are Collaborating Online
In Ways Never Before Possible

• Learning in real time from peers across geographies
and across specialties

• Sharing ideas and discussing new practices

• Accessing collective insights and experience from a
broader group

• Disseminating information more quickly and more
efficiently
“The New Social Media For Patients and Providers”, Jason Bhan, M.D.

33

Physician Collaboration Through Social
Media
• Accessing the collective wisdom of your peers
▫ Asking Questions
▫ Social Bookmarking
▫ Case Presentations
▫ Wiki Collaboration

• Networking
▫ Know who you are collaborating with
▫ Build a referral base or network


Comparing The Major Social Networking Sites 34

Social Strengths of Weaknesses To Whom Relative
Medium this Medium of this This Medium Value For
Medium Most Appeals Physicians
Lots of good press Message must be short Baby boomers
and credibility with Gen X’ers
big players
Fastest-growing
Can blast messages
out to many

Excellent for Not as viral as other Young and Mid-level
professinal media Professionals
networking and Primarily individual
recruitment of career/ business people
professionals.

“Warmest” medium; Friending can be Gen X’ers and growing
likes pictures and awkward with baby boomers
non-commercial type
info
Fastest growing
medium for women
over 55

Good way to Still has a little of the All age groups
showcase procedures, “jackass” image with
present compelling some people
stories through
podcasts and video.

Well-known among Not taken seriously by Millenials Not recommended
younger generation the older adult
and musicians population

35

Physicians On Facebook



36

And On YouTube
• http://www.youtube.com/watch?v=-
MJP37xL0gY


37

Five Basic Criteria For A Physician Practice Web
Site

Searchability

Can the consumer quickly find the web site directly or via the major search engines?

Navigation

When on the site, can the consumer move easily within pages? Is there a consistent navigation structure? Is the navigation intuitive to users
and user friendly?

Content

What information is provided?
What information should be provided, and what should not?
Is there a role for frequently asked questions (FAQ)?
Are links related to site provided?
Is the content being updated on a regular basis?
Is the information informative?

Design

Does the home page draw the user in?
Are the content and navigation buttons displayed on each page?
Does the site layout enhance the user’s ability to gain information easily?
Does each page fit coherently in the site?
Do the design and look of the site convey the right feel or message?
Are colors consistent across browsers?
Is there design integrity within the page and from page to page?

Interactivity

Can the consumer take action on the site, such as sign up for lunch with the Doctor, send e-mailto a faculty member, ask questions about
current research?

Source: Physician Entrepreneurs: Marketing Toolkit, by Patrick T. Buckley MPA, ©2008 HCPro

38

Medical Group Practice Marketing Plan

The Marketing Plan Should Include These Elements:

I. Market Situation
II. Target Market Segments
III. Strengths, Weaknesses, Opportunities
IV. Positioning for the Medical Group
V. Goals and Objectives
VI. Strategies and Tactics
VII.Assignment of Accountabilities
VIII.Provision of Resources
IX. Monitoring, Evaluation, and Control


39

Generating Top Line Practice Revenue
R
C
e
o v
s e
t n
s u
e
s

More Effective Increase Volume
Collections Practices

Timely Billing Retention Strategies

Appropriate Coding Internal Marketing

Increased Throughput
Optimize Payer Mix

Scheduling Efficiencies Provide more or
enhance services
Evidence-Based Practices
Recruitment of key
providers

Assessing Revenue-Generating Opportunities 40

Increasing New Volume: Best Practices
Increase New Volume

• Build The “Customer First” Brand Retention Strategies
• Eliminate The Information Silos
Internal Marketing
• Virtual Office Solutions
• Smart Promotion Using Old and New
Optimize Payer Mix
Techniques
• Referral Source Development
Provide more or
enhance services



Retention Strategies: Best Practices
Increase Volume
• Say “Thank You”—(Duh!)
Retention Strategies
• Manage Throughput Without Upsetting
The Customer-First Orientation
Internal Marketing
• Retain Open Slots For Same Day Traffic
• Cross-selling And Data Mining
• Stop Leakage Out Of The Group Practice Optimize Payer Mix
• Install An “Evergreen” Customer Service Program
 Regular notification of patients waiting for Provide more or
enhance services
 physician
 Attentiveness at reception desk
 Fix problems on spot before escalation
Note: 43% of customers who leave a business leave because of a service issue and 77% of the
service issues are due to employees’ attitude or behavior (Maritz Market Research, 2008)



Internal Marketing: Best Practices
• Create and foster a nutritive environment Increase Volume
• Have a staff “meet and greet” with all physicians
• Cultivate a “servant leadership” management
philosophy and work-style Internal Marketing
• Develop internal customer workchart
• Conduct self-image gap analysis Optimize Payer Mix
• Reward staff initiatives meaningfully
• Maintain weekly progress checklist Provide more or
• Celebrate team accomplishments enhance services



Optimize Payer Mix: Best Practices

• Analyze the Demographics Increase Volume
• Target specific promotional vehicles

Internal Marketing

Optimize Payer Mix

Provide more or
enhance services



Provide More Or Enhance
Services: Best Practices Increase Volume

• Connections with alternative providers Retention Strategies
• Analyze utilization patterns by diagnosis
Internal Marketing
• Focus on one or two specialty areas and
make them special
Optimize Payer Mix

Provide more or
enhance services


CUSTOMER DEVELOPMENT GOALS:
1. To Build Unaided Awareness
Putting Strategies Into Action: XYZ Multi-Specialty 45
2. To Create A “5 Star” Service Environment Physicians Group
3. To Increase Percentage Of Referring
Physicians Who Positively Rate Our Growth Goals, Strategies, Targets
Services External Customers Internal Customers
4. To Increase Overall Patient Volume
Goal Physicians Patients/ Employees
Support Consumers
STRATEGIES TO GROW AND SUSTAIN
REVENUE
Practice Development
1. Assign “mentors” and role models for the
3 X
newer physicians who do not have built-
up practices.
2. Provide opportunities for newer 4 X
physicians to be introduced within the
physician community, as well as to the
public.
3. Provide scripts for the front line staff to 2 X
introduce new physicians to new patients
seeking an initial appointment.
4. Institute program for newly-recruited 2 X X
physicians to meet with office staff when
they come on board.
1 X X
Internal Marketing
1. Develop employees service awards program
3 X
2. Infuse operational enhancements with

1 X X
customer service philosophy

Community Outreach/Personal Selling
1. Implement physician relations program
4 X
2. Conduct visits to key referrers’ offices

Communications 4 X
1. Conduct direct mail campaign to new move-
ins
Customer Service/Satisfaction
4 X
1. Implement retention strategies e.g. annual
recognition letters to established patients,
screening reminders, etc.
©Copyright 2007 PB Healthcare Business Solutions LLC

46

Strategy, Marketing, Management for Health Care™

773-458-8662
www.pbhealthbiz.com

Physician Practice Revenue/Growth: Strategies For Success

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