PHYSICIAN PRACTICE/REVENUE
GROWTH: STRATEGIES FOR SUCCESS
A Workshop Presented By Patrick T. Buckley, President and CEO, PB HealthCare Business Solutions LLC
PB Healthcare Business Solutions LLCStrategy, Marketing, Management for Health Care®
©2009 PB Healthcare Business Solutions
LLC
The material contained herein is protected
and intended for use by clients and
associates of PB Healthcare Business
Solutions LLC, and may not be reproduced
or distributed without the expressed written
consent and permission of PB Healthcare
Business Solutions LLC.
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
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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
3The New World Of Physician Group Practice Management
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 New World Of Physician Group Practice Management 4
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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
The New World Of Physician Group Practice Management 5
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The Marketplace Is Always Shopping
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“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?”
Understanding Our Customers’ Universe
How People Choose Physicians
(primary care practices)
SOURCES
Self
Personal Endorsers
Caregivers
Organizations
30%
40%
20%
10%
7Understanding Our Customers’ Universe
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Decision StaySwitch
AWARENESS OF PRACTICE
WILLINGNESS TO TRY
Anywhere from 5 to 20% of Current Patients Are “In Play”
BRAND EQUITY/REPUTATION
SERVICE “PERSONAL BRANDS”
RELATIONSHIP MANAGEMENTASSESSMENT OF
EXPERIENCE
MARKETING STAGE
REPEAT CUSTOMER
Understanding Our Customers’ Universe 8
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Top 10 Reasons Patients Switch PhysiciansI. 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
9Understanding Our Customers’ Universe
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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 10
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Consumers Are Participating In Online Communities
Understanding Our Customers’ Universe
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Medical Group
Practice
SOCIAL MEDIA MESSAGING
Multi-directional
Immediate
All demos
Inexpensive
Easy consumer
interaction
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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?
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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?
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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 5 C’s Of Successful Medical Practice Marketing 15
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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 5 C’s Of Successful Medical Practice Marketing 16
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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 5 C’s Of Successful Medical Practice Marketing 17
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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?
The 5 C’s Of Successful Medical Practice Marketing 18
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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
19Using Marketing Information To Facilitate Revenue Generation
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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.
20Using Marketing Information To Facilitate Revenue Generation
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TABLE 2: DOCS INC. CUSTOMER PROFILE
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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%
Market Snapshot
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TABLE 1: KEY DEMOGRAPHICS OF SERVICE AREA
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Population
Characteristic
Core Area
(Zip Code
53208: Approx.
47% of patient
origin)
Secondary
Service Area
(Zip Code
53210: approx.
28% of patient
origin)
Wisconsin US Census Tract
94—Vliet
Street so.
Lloyd St. no.
N. 60th St.
west
N. 52nd St.
east (1.1
miles w-e)
Total Service
Area
(approx.
25% of
patient
origin)
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
Income
26,436 32,340 43,791 41,994 43,005 NA*
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 Bureau, American FactFinder, Census 2000)
*U.S. Census 3-digit zip code tabulation areas (ZCTA) do not track this information for 2000 census
Using Marketing Information To Facilitate Revenue Generation
TABLE 3: PRODUCTION CAPACITY AND GROWTH POTENTIAL FOR SOLO FAMILY
PRACTICE*
National average (NACS, advanced data # 365, 2003)
317.3 visits per 100 persons per year =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 service area
262,723
Estimated current market share for practice .1%
National rate applied to practice (with no increase in patients)
422 patient visits
Incremental visits needed from current clientele to achieve national visit rate
152
Incremental customers needed to reach national rate (assuming no increase in visit rate)
74
Per day patient volume capacity 10
Total potential visits based on daily volume capacity (240 days x 10 patients/day)
2,400
Proposed Target Market Share .2%
Additional visits beyond 270 to achieve market share(.002 x 262,723)
255
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*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
Using Marketing Information To Facilitate Revenue Generation
VISIT RATES FOR SELECTED DIAGNOSES
24Using Marketing Information To Facilitate Revenue Generation
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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%
Using Marketing Information To Facilitate Revenue Generation 25
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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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MEDICAL GROUP PRACTICE
MARKETING/OPERATIONS ASSESSMENTREFERRAL 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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MEDICAL GROUP PRACTICE
MARKETING/OPERATIONS ASSESSMENT
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
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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?
BRANDING YOUR MEDICAL GROUP PRACTICE:
ASSESSING YOUR EFFECTIVENESS
0=Not at all
3=Yes, but not completely
5= Absolutely
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Communications Vehicle
Description Significant Competitor Presence
Relative ROI/Cost Primary Use Best For Target Group
Recommendations
Directories Yellow PagesSpecialty DirectoriesInternet Directories
Yes Low/High Ability to locate practice Seniors Consider advertising in directories butstreamline
Website Basic web site Yes High/Med. Explain practice styleProvide description of services
All Consider enhancing the web site
Blogs and other Social Media
Personalized communications on web site
No Low/Low Communicate with patients Patients Not recommended
Internet sponsorships Google-type banner or box ads on web sites frequented by target demographic groups
No Low/Med. Used mostly by non-medical businesses
All Not recommended
Traditional sponsorships Sponsorship of speaker programs, sports teams,etc.
No Low/Varies Mostly for brand image development
Consider as it can build visibility but limit to strategic support
Collateral Written material such as brochure, display cards
NA Low/Varies Give to patients after they join practice
Patients, esp. seniors Consider as a leave behind piece
Outdoor Transit, vinyl and electronic boards
No Low/High Reminder medium and image
All Not recommended
Practice Newsletter (hardcopy or e-zine)
Monthly, bi-monthly, or quarterly.
No Medium/High Keep practice visibleStrengthen affinity with community
Consider in six months
Direct Mail Post-card, letter,CD or brochure. Use to get people to a free screening or to an open house for practice
No, but needs to be different from others so it isn’t junked
Low/Low Attract new move-ins, announce new services,
All Consider—make sure the call to action is a strong one
Special Events Holding an open house, screenings, health fairs
No High/Low To get people to experience something about the practice
All These are good “press the flesh” type settings and provide opportunities for would-be customers to ask questions directly
Advertising (print, electronic)
Ads in newspapers, magazines, radio, tv
Some Low/High Control and place the message
Certain vehicles work best with different groups
Consider as a supplement to other promotional options
Publicity Coverage in local news, medical journals, and newsletters. Eg: Metro-Parent, Milwaukee Woman
Varies High/Low Gives third party “endorsement” which is more believable than advertising
All Highly recommend
Personal Selling Housecalls, speaking engagements
High/Med
31Marketing Communications Matrix For Medical Group Practice
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.
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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
“The New Social Media For Patients and Providers”, Jason Bhan, M.D.
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Comparing The Major Social Networking SitesSocial Medium
Strengths of this Medium
Weaknesses of this Medium
To Whom This Medium Most Appeals
Relative Value ForPhysicians
Lots of good press and credibility with big playersFastest-growingCan blast messages out to many
Message must be short Baby boomersGen X’ers
Excellent for professinalnetworking and recruitment of professionals.
Not as viral as other mediaPrimarily individual career/ business people
Young and Mid-level Professionals
“Warmest” medium; likes pictures and non-commercial type infoFastest growing medium for women over 55
Friending can be awkward
Gen X’ers and growing with baby boomers
Good way to showcase procedures, present compelling stories through podcasts and video.
Still has a little of the “jackass” image with some people
All age groups
Well-known among younger generation and musicians
Not taken seriously by the older adult population
Millenials Not recommended
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Physicians On Facebook
“The New Social Media For Patients and Providers”, Jason Bhan, M.D.
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And On YouTube
• http://www.youtube.com/watch?v=-MJP37xL0gY
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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
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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
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Timely Billing
Appropriate Coding
More Effective
Collections Practices
Provide more or
enhance services
Retention Strategies
Increase Volume
Generating Top Line Practice Revenue
Optimize Payer Mix
Internal Marketing
Increased Throughput
Scheduling Efficiencies
Evidence-Based Practices
Costs
R
e
v
e
n
u
e
s
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Increasing New Volume: Best Practices
• Build The “Customer First” Brand
• Eliminate The Information Silos
• Virtual Office Solutions
• Smart Promotion Using Old and New
Techniques
• Referral Source Development
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Retention Strategies
Increase New Volume
Internal Marketing
Optimize Payer Mix
Provide more or
enhance services
Assessing Revenue-Generating Opportunities
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Retention Strategies: Best Practices
• Say “Thank You”—(Duh!)
• Manage Throughput Without Upsetting
The Customer-First Orientation
• Retain Open Slots For Same Day Traffic
• Cross-selling And Data Mining
• Stop Leakage Out Of The Group Practice
• Install An “Evergreen” Customer Service Program
Regular notification of patients waiting for
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)
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Retention Strategies
Increase Volume
Internal Marketing
Optimize Payer Mix
Provide more or
enhance services
Assessing Revenue-Generating Opportunities
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Internal Marketing: Best Practices
• Create and foster a nutritive environment
• Have a staff “meet and greet” with all physicians
• Cultivate a “servant leadership” management
philosophy and work-style
• Develop internal customer workchart
• Conduct self-image gap analysis
• Reward staff initiatives meaningfully
• Maintain weekly progress checklist
• Celebrate team accomplishments
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Retention Strategies
Increase Volume
Internal Marketing
Optimize Payer Mix
Provide more or
enhance services
Assessing Revenue-Generating Opportunities
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Optimize Payer Mix: Best Practices
• Analyze the Demographics
• Target specific promotional vehicles
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Retention Strategies
Increase Volume
Internal Marketing
Optimize Payer Mix
Provide more or
enhance services
Assessing Revenue-Generating Opportunities
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Provide More Or Enhance
Services: Best Practices
• Connections with alternative providers
• Analyze utilization patterns by diagnosis
• Focus on one or two specialty areas and
make them special
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Retention Strategies
Increase Volume
Internal Marketing
Optimize Payer Mix
Provide more or
enhance services
Assessing Revenue-Generating Opportunities
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GoalSupport
Physicians Patients/Consumers
Employees
3 X
4 X
2 X
2 X X
1 X X
3 X
1 X X
4 X
4 X
4 X
Putting Strategies Into Action: XYZ Multi-Specialty
Physicians Group
Growth Goals, Strategies, Targets
STRATEGIES TO GROW AND SUSTAIN REVENUE
Practice Development1. Assign “mentors” and role models for the
newer physicians who do not have built-up practices.
2. Provide opportunities for newer physicians to be introduced within the physician community, as well as to the public.
3. Provide scripts for the front line staff to introduce new physicians to new patients seeking an initial appointment.
4. Institute program for newly-recruited physicians to meet with office staff when they come on board.
Internal Marketing1. Develop employees service awards program
2. Infuse operational enhancements with customer service philosophy
Community Outreach/Personal Selling1. Implement physician relations program
2. Conduct visits to key referrers’ offices
Communications
1. Conduct direct mail campaign to new move-ins
Customer Service/Satisfaction1. Implement retention strategies e.g. annual
recognition letters to established patients, screening reminders, etc.
CUSTOMER DEVELOPMENT GOALS:1. To Build Unaided Awareness2. To Create A “5 Star” Service Environment3. To Increase Percentage Of Referring
Physicians Who Positively Rate Our Services
4. To Increase Overall Patient Volume External Customers Internal Customers
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