August 1999 Bulletin

Marketing in an HMO market

Patient-friendly practice

Patient profile for HMO

Web site on Internet

Community activities

MD referral network

HMO staff relations

How to build a bigger practice

By Carolyn Rogers

True or false: As managed care penetration in your community increases, the need to aggressively market your orthopaedic practice decreases.

If you answered "false" you'd be right, according to two medical marketing experts.

"Many physicians believe that their days of practice promotion are over once they've joined all the managed care plans in the vicinity," says Neil Baum, MD, an author and speaker on practice management issues who is based in New Orleans, La. "In reality, you've got to market harder than you've ever marketed before."

The reasons for this, Dr. Baum says, are three-fold:

"First, even in managed care, patients still have a choice," Dr. Baum says. "That choice may be limited to five or six orthopaedists, but you want to be the one they choose. The primary care doctor and the patient will select the orthopaedist who enjoys the best reputation, the one who communicates well with patients and doctors, the one who allows the easiest access into the practice and the one who is conveniently located.

"Second, if you don't provide outstanding care, and patients complain about you and your service to a managed care plan, your contract may not be renewed. You only need to get two or three complaints in your file and they will find reasons not to renew.

"Finally, even the most penetrated communities-California, New York, Florida, Minnesota-are, at most, 75 to 80 percent managed care. That means that 20 to 25 percent of patients will be fee-for-service. These patients are looking for stellar performance if they're going to pay for it. They expect to be seen in a timely fashion; they expect courtesy over the phone; they expect the doctor to answer all their questions; and so on."

Anne-Marie Nelson, a health care marketing expert and president of Nelson and Company, Scottsdale, Ariz., agrees that marketing is more vital than ever in the era of managed care. To make your practice more attractive to HMOs, she recommends that someone in the practice initiate contact with their HMOs and attempt to develop "rewarding" relationships with them.

"Either the doctor or the practice administrator needs to make contact with the appropriate person at the HMO; the orthopaedist should contact the medical director and the practice administrator should contact the provider representative," Nelson says. "Let them know that you're available to them; talk about how you can work together."

Nelson suggests that every practice compile a profile containing all the data about its physicians, its staff members, experience, education, office hours, locations, access data, patient demographics, patient education and communications programs it has in place, clinical outcomes data, average length of stay for different procedures, etc.

"Your practice needs this data, but the information is also valuable to your HMOs-offer to share it with them," Nelson says. "HMOs want to keep those practices-particularly specialty practices-that are distinctive and essential to them. They want practices that have a reputation in the community and that have a reputation within the health plan. If you are willing to work with them on an ongoing basis, that will be remembered at contract renewal time.

"I'm not telling doctors to kowtow to their HMOs, but being resistant or hostile won't accomplish anything either."

In the end, establishing a smoothly-running, patient-friendly practice is your best marketing tool, Nelson says. "In this day and age, patient word-of-mouth is still the primary source of new referrals," she says. "Ask yourself, are you keeping waiting time to a minimum? Are you making the best use of ancillary personnel to free up the doctor's time? Do you have a friendly staff?

Once you have a well-run practice and good relationships with your managed care organizations, Nelson says there are numerous ways to attract new patients.

To become more visible in your community, speak at the local chamber of commerce, schools, libraries and other community organizations. Offer seminars on osteoporosis prevention, for example, using patient education materials offered by the Academy. The Academy's communications department also has developed prevention of injury programs with slide sets and fact sheets that can be the basis for community meetings. For more information about the programs, contact Pat Julitz in the Academy's communications department (847) 384-4123.

At least one physician should belong to the quality assurance committees for the health plans that you contract with -it's a wonderful source of referrals and of gaining prominence in the community and in the health plan, Nelson says.

"Use your staff to build relationships in the community, encourage them to join local organizations, networking groups, the PTA," Nelson says. "Whatever organizations your staff members might have an interest in, encourage them to join and, if possible, pay or partially pay for those memberships."

What about advertising? Unless you're in a very competitive market-and you really know what you're doing-Nelson claims there are better ways to spend your money.

Dr. Baum agrees. "I would discourage people from doing advertising," he says, "I don't think you get a good return on your investment."

"Most practices don't measure-or don't know how to measure-an ad's effectiveness," Neslon says. "If you make the decision to advertise, you have to know specifically what you want the reader to do as a result of that ad. Do you want them to call the office for an appointment? Sign up for a class? Be specific and you'll be able to gauge the ad's effectiveness."

Here are more of Nelson's marketing ideas:

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