Don’t Send Your Physician Liaison Into Battle Unarmed

I just got off the phone with one of our loyal readers, who is both very smart and brand new at her job as a physician liaison. Due to confidentiality reasons I can’t tell you her real name, so let’s just call her Amy.

In case you aren’t familiar with the term, physician liaisons – also known as practice representatives, physician relations and business development personnel, generate referrals from doctors for their hospital or practice.

This highly specialized position is becoming more and more prevalent at both hospitals and medical practices.

In this case, Amy works for some radiologists who have seen a decline in the practice, and just saw their best referral source defect to an arch competitor – and that happens a lot these days.

The good news is that they knew they needed to hire someone to build referral sources, but the bad news is that they 1. Expect her to know how to do everything, and 2. Aren’t willing to spend any money to support her efforts.

Let’s take these problems one at a time.

First of all, the physician liaison position is a SALES position. Good physician liaisons are worth their weight in gold, because they can build RELATIONSHIPS with referring offices. Now I am not talking about dropping off bagels quietly – I am talking about people who can really engage doctors and staff at referring or admitting practices.

However, problems arise when doctors or hospital executives expect their “marketing person” to be good at both selling and creative skills, like building websites or writing brochures.

Marketing is a world made up of specialists, just like health care. For example, when it comes to the Internet, there are designers, programmers, writers, strategists, pay-per-click specialists, search engine optimization experts, media buyers and more.

Therefore, asking someone to do both sales and create websites will yield poor results. First of all, no one is talented at everything. Secondly, even if you somehow could find – and recruit – the one out of a thousand who could do both, their time would be better spent in the field developing referrals.

So remember, there are sales people, and there are marketing communications people.

The second problem was the owners’ unwillingness to invest money to properly arm the physician liaison with even the most basic materials, like a brochure and a good website.

Now I understand no one likes to spend money. I don’t either – just ask my Partner and staff.

But there are EXPENSES that COST you money and INVESTMENTS that MAKE you money. She’s not asking for the world – she just wants the bare essentials to do her job. Keep in mind that everyone else who shows up at referring practices has proper materials – from device manufacturers to pharmaceuticals to competing physicians liaisons.

Amy asked me for advice.

I recommended she remind her boss that a professionally done brochure and website from our firm (for example) might cost around $12,000. One additional regularly referring doctor EVER would make that limited investment wildly profitable, especially for a radiology practice.

Now I know radiology has had some reimbursement challenges lately. But still, the economics of building doctor relationships are undeniable for any specialist or hospital.

The analogy I often use in our seminars is, don’t buy a racehorse but then cheap out on feeding it. That goes for new capital equipment like MRIs, new associates or new physician liaisons.

I hope Amy is able to convince her boss. Not because we need to do another brochure and website – but because I already like her. I want her to be successful in her new job.

At the same time, I am sure their archrivals would be positively THRILLED to know that Amy’s practice is unwilling to invest in supporting her with even minimal marketing materials.

As a final remark, Amy is not alone. We see this kind of thing all the time.

So if you are a physician liaison, feel free to forward this blog post to your boss. And if you are a hospital executive or practice owner, please don’t send your physician liaison into battle unarmed.

That’s it for now. Let’s talk if you need me.

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Healthcare Marketing Costs Time or Money. (Or both.) You Choose.

I am flying home from the Society for Healthcare Strategy and Market Development (SHSMD) conference as I write this, and one of the many conversations I had in Chicago is particularly relevant to our readers.

This particular hospital’s Director of Marketing has spent a lot of money on branding this year, with virtually no impact on the bottom line. Next year’s budget is in question.

She asked for advice.

First I told her that while branding has its place, I’d recommend focusing next year on strategies that can deliver actual patients, rather than activities that solely “feel good” or build her hospital’s image. I also told her that she’d likely rebuild her skeptical CEO’s confidence by showing him some tangible results.

My newfound pal wholeheartedly agreed. However, once she has a budget, she’ll still need to decide where and how to spend it, particularly in lieu of her limited internal resources.

So, I grabbed a napkin and sketched out a diagram we sometimes use at our medical marketing seminars to help people think more clearly about choosing from among various strategies and tactics.

The vertical axis represents financial investment required. The higher up on the line, the more a given tactic or strategy costs. Conversely, the lower on the line you go, the lower up front costs are required.

Keep in mind that the cost line simply illustrates up front costs – NOT return on investment (ROI).  In other words, just because a given strategy costs a lot, that doesn’t mean it is necessarily bad. Is $100,000 a year for strategy “X” expensive? Not at all if it delivers $500,000 in trackable revenue.

Of course, if you don’t HAVE $100,000, then strategy X disappears from consideration very quickly.

(Note: Before putting down that kind of cash for a given strategy, we usually recommend starting with a reasonable investment, and then growing the level of commitment as warranted based upon results.)

The horizontal line represents time requirement, starting from very little on the left, to a great deal on the right.

The next step is to fill in the quadrants with various tactics or strategies under consideration. Now, here’s why this simple exercise is so valuable.

Some clients (doctors, hospitals, manufacturers, etc.) have more time than money. Others have more money than time.

Likewise, some strategies and tactics require a lot of time, others require a lot of money, and some require both. (The only thing I can think of that requires zero time and zero money is Santa Claus.)

Of the hundreds of things you could reasonably do, it is easy to get overwhelmed, and underestimate either the time or budget constraint.

Let’s take yellow pages for example. Now, I know you probably HATE yellow pages, but until recent years, many of our clients quietly “cleaned up” with them. (That is after we got them past the gag reflex.)

Dentists and many “consumer-direct” medical specialties like plastic surgeons did particularly well. So well, in fact, that we helped create hundreds of million-dollar-plus practices over the years with this ugly, unpopular strategy.

Now to be sure, yellow pages has its own set of rules, and you need to know how to play by them or you’ll get killed.  But if you choose the right combination of variables (size, book, section, ad creative, etc.) you could (and sometimes still can) do quite well.

But ROI wasn’t our only consideration when we recommended yellow pages. We especially liked it for time stressed providers. Why?

Because once we got past developing the strategy and ads, the whole endeavor would become passive for a whole year. Aside from answering the calls, clients didn’t have to do anything again. If our yellow pages test worked, we’d do it again the following year. If not, we’d cut our losses and move on.

Meanwhile, internal strategies were (and are) especially good for clients who have lots of time but little budget. Just keep in mind that while everyone loves internal marketing, most underestimate the time requirement and results are usually more of a “slow burn” rather than explosive.

The chart below is a hypothetical example, though the placement of specific strategies will change based upon your own situation.

For example, building doctor referrals (physician relations) can require time, money or both.

If your doctors are good, willing “schmoozers,” they can invest time and not much cash to build relationships with other doctors. However, most doctors are either unable or unwilling to schmooze. Plus, the opportunity cost of their time can be quite expensive.

(We often hear things like, “My children would have to be starving before I’d go out selling myself.)

On the other extreme, hospitals sometimes deploy a dozen full time field salespeople to build relationships with admitting doctors. Obviously, those salaries and expenses can really add up.

Another example would be office signage. It can cost a lot to get an outdoor office sign installed the first time, but after that it becomes an almost cost-free, 100% passive recruiter.

Community events are fun, feel good and everyone loves them.  But elves don’t put them on in the night – you and/or your employees will have to invest time into them.

My last example here would be search engine optimization (SEO). You can outsource all of it, or you can do much of it yourself. Either way, there is a time versus money consideration.

Of course, you’ll need to consider your internal capabilities. You may rather spend time than money on SEO, but you will 1. Need employees who know HOW to do it, and 2. Not have more productive things for them to do with their time.

Finally, you’ll also need to consider projected ROI too.

However, as you consider your marketing options going forward, this simple exercise can help you remember to realistically consider both your investment of money and time for various alternatives.

Unless you have a special “in” with Santa, you are going to have to invest in one or the other.

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When Experience Turns Into Complacency, Watch Out

A few days ago I was traveling with my family, en route to South America. Having logged over 2 million miles (I am “Platinum for life” on American Airlines), I know my way around airports as much as George Clooney’s character Ryan Bingham in the movie, “Up In the Air.”

Knowing that our gate was only a few feet from the Grand Hyatt at DFW where we were staying, I told my wife and kids to take their time. The trouble was, when we finally made it to security, we discovered the entrance was closed (it was 5 am). By the time we finally found an open security entrance and made into the terminal, the departure gate had changed to the opposite side of DFW.

My wife and two school-aged daughters kept up valiantly as I led the way, vaulting up the escalator to the train, then dashing through the airport until we arrived in our seats with only a couple of minutes to spare.

So, because of my vast experience and assumptions about what to expect, we almost missed our flight.

Of course, sometimes complacency leads to far more severe consequences. The Titanic’s Captain Edward John Smith is said to have ignored warnings about icebergs in part because he had never experienced any problems before during his 40-year + career. In the book, “The Checklist Manifesto,” Dr. Atul Gawande recounts many examples of disasters and near disasters in the operating room due to stupid, avoidable mistakes.

What does all this have to do with healthcare marketing?

A lot.

We meet new healthcare clients all the time who are very confident because their business, hospital or practice is doing “fine.” The trouble is, once we look a little deeper, at least half of them turn out to be wrong.

For example, almost every day we get a call from a hospital, group or practice that has been taking its referring doctor base for granted, but now is suffering from defections due to new competitors, mergers and/or alliances.

Worse, big problems like those are typically very difficult to fix after the fact.

So today, stop and take a few minutes to identify where YOU might be overly complacent because of your past successes.

Are you taking care of doctors who refer to you? Are your new patient counts going in the right direction? Are you wasting significant portions of your marketing budget? Are serious new competitors emerging? Are you vulnerable to broader changes in healthcare reimbursement?

By doing some homework and being proactive rather than reactive, you have a much greater chance of ongoing success, now and in the future.

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Billionaire’s Advice: Take Perceived Risks – Not Actual Risks

I saw billionaire Wilbur Ross, Jr. on Charlie Rose tonight, and something he said struck me like a thunder bolt. He talked about how his holding company bought bankrupt Cleveland steelmaker LTV for cents on a dollar, and later sold it for billions in profits.

He shared his secrets during the interview:

“We’re in the business not so much of being contrarians, deliberately, but rather we’d like to take perceived risks instead of actual risks. And what I mean by that is that you get paid for taking the risk that people think is risky. You don’t particularly get paid for taking actual risks… We basically spent $90 million for assets on which LTV had spent $2.5 billion in the prior 5 years. And our assessment of the values was that if worse came to worse we could knock it down and sell it to the Chinese. Then we also bought accounts receivable and inventory for 50 cents on the dollar. So between the combination of things, we frankly felt we had no risk…The joke was right when everybody was saying  this was too risky,  it will never work, the big debate within our shop was should we just liquidate it and take the profit, or should we try to start it up. That’s how sure we were that we weren’t actually taking risk.”

What does this have to do with marketing success? Well, too often people assume that successful people take big risks. Actually, more often they do everything they can to mitigate unnecessary risk. Then, once they have done everything they can to cut their risks, they are willing to step up to the plate and try.

That is why direct response marketing principles appeal so much to me. Start with an honest assessment, learn from the experience of others before you, invest a limited amount, test, track and adjust, and then roll out if your marketing hypothesis turns out to be correct. If you guessed wrong, cut your losses, regroup, and try something else. Eventually, you’ll find a formula for success.

I remember being in Las Vegas with a now deceased friend of mine who was a high stakes poker player and businessman. He put down $15,000 to open in blackjack, while I put down $250. He had money to burn so for him it was fun.

However, for me, I told him that while I am happy to invest thousands on a marketing idea that can work, I can’t do it while gambling. The difference is that even if he had a good night, the next night he would still have to start at zero.

On the other hand, once I invest in a marketing strategy, it will either work or not. If not, I stop right away. But if it does work, it will bear fruit oftentimes for years, sometimes for decades.

So as you think about marketing, remember to follow the principles of learning from the experience of others before you, invest a little after you have done everything you can to mitigate risks, then “double down” if successful.

So let the other guy either freeze out of fear about marketing or blow it all in risky endeavors.

Your goal will be to take risks that are either zero or limited – and capitalize big time when your assumptions turn out to be right.

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Photo-Pug Creative Idea For Kodak’s Blog

Listening to a webinar today and one of the presenters is Jennifer Cisney, head of social media for Kodak. She shared an anecdote of one way she got creative with her blog, and put a camera on her pub to get a “dog’s eye” view of the world. It turns out the dog looks a lot at her and his food bowl. Full post here http://1000words.kodak.com/post/?ID=310439.

What does YOUR dog look at all day?

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About the public’s skepticism toward modern healthcare

Here is an excerpt from a book about  public distrust in general, by Mark Lilla, The Tea Party Jacobins, New York Review of Books, May 27, 2010:

But as the libertarian spirit has spread to other areas of our lives, along with distrust of elites generally, the damage has mounted. Take health care. Less than half of us say that we have “great confidence” in the medical establishment today, and the proportion of those who have “hardly any” has doubled since the early Seventies.12 There are plenty of things wrong with the way medicine is practiced in the United States, but it does not follow from this that anybody can cure himself. Nonetheless, a growing number of us have become our own doctors and pharmacists, aided by Internet search engines that substitute for refereed medical journals, the Food and Drug Administration, and the Centers for Disease Control.

The trends are not encouraging. Because of irrational fear-mongering on the Web, the percentage of unvaccinated American children, while thankfully still low, has been rising steadily in the twenty-one states that now allow personal exemptions for unspecified “philosophical and personal reasons.” This is significant: the chance of unvaccinated children getting measles, to take just one example, is twenty-two to thirty-five times higher than that of immunized children.13 Americans currently spend over four billion dollars a year on unregulated herbal medicines, despite total ignorance about their effectiveness, correct dosage, and side effects. And of course, many dangerous medicines banned in the United States can now be purchased online from abroad, not to mention questionable medical procedures for those who can afford the airfare.14

Americans are and have always been credulous skeptics. They question the authority of priests, then talk to the dead15; they second-guess their cardiologists, then seek out quacks in the jungle. Like people in every society, they do this in moments of crisis when things seem hopeless. They also, unlike people in other societies, do it on the general principle that expertise and authority are inherently suspect.

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Savvy healthcare advertiser’s true confession

Quick note – Just got an email from a client that absolutely is consistent with the spirit of my past two posts. I have taken out the specifics to keep it anonymous.

“I talked with the President of a big competitor this week and he said on behalf of his company, ‘We don’t believe in marketing.’  I was a little speechless, particularly because he couldn’t understand why our  program was so successful, while his had been a disaster.  Go figure. Anyway, I am happy he doesn’t believe.”

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Your Competitors Are Rooting for You to Stay on the Sidelines.

I know competition is not a topic for polite conversation in health care, but I thought I would follow up my last blog post with a true story.

Awhile back I was contacted by the leader of a large group who was alarmed about an aggressive new competitor who had appeared on the scene.  Like many of my new clients, she and her partners had never given marketing much thought – until now.

What’s more, they had been caught flat-footed, and were still reeling from this unexpected assault on their livelihoods. Even worse, their very best referrer had defected entirely.

It turns out that their new competitor had certainly done his homework. He’d hired professional salespeople, armed them with first-class branded materials, and immediately went about building relationships with all of my new client’s most important referral sources.

Because my new client had not previously done any marketing or proactive relationship building, their referring doctors were  naturally open to “spreading referrals around a bit.”

Be forewarned. Playing catch up is really tough. If you have been ignoring your referrers, any efforts you subsequently make in response to your competitor can look insincere.

“Oh, NOW you are willing to pay attention to me after all these years.”

Fortunately in this case, while my clients had been a little lax with their relationships, they had not been rude. (Those who are rude often never recover once a smarter, better communicating competitor arrives on the scene.)

So my first step was to build a “Referral Marketing Plan” for my new client. It detailed exactly what they needed to do to turn things around, including time lines, goals, strategies and budgets.

Because they had never spent a dime on marketing, some of the partners were taken aback when I suggested they’d actually have to invest some money in order to protect their livelihoods. (Some were still in denial that their “free ride” was over.)

After endless deliberation amongst themselves, one of the partners looked at me and said, “Stewart, what do you think?”

After a dramatic pause, I told him, “If your competitor were here in the room looking over your shoulder, do you think he’d want you to take my advice and get back into the game, or would he rather see you end this meeting deadlocked and ultimately do nothing?”

The biggest detractor sat up in his seat, looked at his partners and then said, “OK, where do we sign?”

The good news: They DID turn things around, and with my suggestions even won back their most important referral source.

The bad news: They could have prevented the whole mess by taking action BEFORE they had to.

I urge you to be proactive now, rather than try to react to competitors later.

When I teach our medical marketing seminars, I always remind attendees to, “Take care of the people who take care of you.”

In fact, those who are really tight with their referring base can actually PREVENT a competitor from moving in.

So think of marketing and referral building strategies as an insurance policy.

It’s a lot better to prepare appropriately than to rely on a miracle, come-from-behind victory in the fourth quarter.

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Are Your Competitors Quietly “Cleaning Up” While You’re Not Marketing?

Just before my speech at a recent association meeting, I sat down for a cellophane-wrapped turkey sandwich at one of the countless circular tables inside the enormous exhibit hall. (Been there before?)

One of the attendees at my table noted my “speaker ribbon,” and asked about my topic. When I told him “marketing,” he reached into his pocket for a business card.

With pride and more than a hint of condescension, he exclaimed, “See this card? I told the printer to make it as plain as possible, with no logo, no bold nor anything else that might seem like marketing.”

Now I have been in medical advertising and marketing for nearly twenty years, so his attitude didn’t surprise me. Quite the contrary, I have heard every reason NOT to market more times than you can imagine. For example,

  • “The only providers who market in our area are the bad ones.”
  • “It feels like begging.”
  • “It is so… unseemly.
  • “I wish it were illegal.”
  • “Our colleagues would think less of us.”
  • “It’s expensive.”
  • “It doesn’t work.”
  • “It’s unethical.”
  • “It’s beneath us.”

Today, more than 30 years after marketing was deemed legal for professionals, the anti-marketing culture still persists at hospitals and healthcare practices nationwide.

Meanwhile, those providers that embrace marketing often quietly “clean up” due to the resulting void in the marketplace. What’s more, they typically capture an inordinate share of the most lucrative and desirable cases.

In fact, the head of one aggressive group privately confided to me that he and his partners were positively gleeful that their competitors willfully stayed out of the marketplace due to various misgivings. I should note that this particular group enjoyed over 60% market share for the lucrative cases they were targeting – while everyone else had to fight for the leftovers.

That’s not to say that the majority of providers who market are “cowboys.” Rather, it’s usually the opposite.

Most of our clients, for example, are quite conservative. They demand – as we do – that their marketing be ethical and tasteful. Many even refer to marketing as a “necessary evil.” (I promise it doesn’t hurt my feelings!)

What’s more, far from “having to beg,” they are often “best in class” in their given fields.

“So,” you might ask, “why do they market then?”

While motivations vary widely, they oftentimes want to…

  • Counter aggressive competition.
  • Get the recognition their group or hospital deserves (aka enhance their reputation).
  • Counter the ill effects of the recession.
  • Counter declining reimbursements.
  • Prepare for healthcare reform.
  • Counter a drop in volume.
  • Build volume for expensive capital equipment.
  • Ensure the success of a new facility.
  • Fill the schedule of one or more new providers.
  • Target cases that are fulfilling or reimburse well.
  • Target specific insurances.
  • Grow revenues and profits.
  • Alert the community about the solution to a widespread health problem.
  • Stand out from the pack in a positive way (branding).
  • Stop being the “best kept secret in town”

Whatever the original motivation, many clients also find unexpected benefits from marketing.

Beyond the obvious patient volume and revenue growth, their quality of care and reputation often improve as a result of their marketing.

Colleagues notice their marketing and make positive comments like, “I had no idea you have such great credentials.” Patients can feel honored to be part of such a great institution. Staffs rise to the occasion to be worthy of the high expectations set by the marketing.

We see it all the time, and these things are all possible for you, too. But, you’ll never realize any marketing benefits as long as you continue to sit on the sidelines. So…

Are YOUR competitors quietly cleaning up while you’re not marketing?

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