The Great Practice Makeover: Clarity of Vision

When Mark Davis originally appealed to Physicians Practice for help, he was embroiled in a battle with a ridiculously slow-paying insurer and worried about building his newly acquired practice. In the months since, Virginia Medical Acute Care (VMAC) has come a long way on its own, thanks in no small part to the efforts of practice administrator Carolyn Granderson.

Granderson translated her knowledge of the state’s prompt-payer law, along with help from the state insurance bureau, into more favorable reimbursement time frames. VMAC no longer needs a makeover on this score, as Granderson now takes advantage of relationships she’s built with individual insurance company staffers. She says she’s found that “once they realize you’re digging your heels in, [payers are] more likely to step up to the plate.”

The practice, which sees walk-in patients only, has also landed corporate contracts that capitalize on its acute-care capabilities (Davis was an ER physician for 16 years). These firms make VMAC their preferred provider for their work-related healthcare needs, like on-the-job injuries and drug screenings, by entering into a binding contract for a set fee and period of time.

This arrangement makes for a great networking tool, with employers and payers sending other companies VMAC’s way. As Granderson says, “Word of mouth does wonders.”

Metropolitan Washington, D.C., and Virginia, where VMAC is located, doesn’t yet have many such urgent-care facilities. According to Davis, the area is “not exactly a hotbed for occupational medicine.” He’s carved out this niche in the two years since he bought the practice from his former employer, a large group averse to taking risks. VMAC now holds “a good chunk of the market,” Davis says.

As is often the case, start-up headaches have been replaced by new ones, but Davis and his staff naturally hope to move past the arduous trial-and-error process that got them this far. The practice’s biggest challenge is strengthening its market position; VMAC needs to make sure patients know about the office and its services.

Cognizant of his dual audience of corporate clients and patients, Davis intends to “make a deliberate foray into some serious marketing.” To be successful, he will need to develop specific, targeted approaches to increase both patient visits and revenue. The practice competes for ambulatory patients with the area’s few - and much larger - urgent-care facilities, which are attached to Inova Health System, the local healthcare Goliath. Physicians Practice recommends that VMAC more narrowly define its patient pool.

Building the patient panel

Several of VMAC’s payers - and not necessarily the slow ones - pay far less (by up to two-thirds) than the others, Granderson says. Assessing which payers are the worst offenders (assuming they don’t constitute too great a portion of the practice’s income) and either dropping them or renegotiating their contracts are two obvious solutions.

But Granderson feels the practice basically has to accept every corporate client. “If we don’t service a particular sector just because of their insurance, we lose a lot of business,” she says, again mentioning word-of-mouth. But the fact remains that it doesn’t pay to welcome a large number of patients on which the practice will lose money. A large system, such as Inova, can better absorb such losses.

The practice does not necessarily have to turn people away; rather, it should build business from other sources. That focus ties into branding the practice, one of the keys to an effective, integrated marketing plan. And of course, once the cash is pouring in, more charity care can be provided.

As would be expected, VMAC doesn’t get many “repeat customers.” Aside from the obvious necessity of a good location on a busy street and large, easy-to-read signs - Davis is working on that with the building’s management - a few simple steps can further help the practice market to walk-in patients.

Davis could establish relationships with local primary-care practices that might be happy to reduce their own providers’ call burden and instead divert after-hours patients to VMAC. Making sure area pharmacists are aware of the practice may be worthwhile as well.

As Davis points out, the psychology of obtaining care in his specialty differs dramatically from that involved in scheduled patient visits. “There are an awful lot of people within two or three blocks who don’t even know we’re here because they haven’t had the need,” says Davis. “What do I hold out to those people so that when they do need us they’ll remember us?”

Marketing tactics such as direct mail and coupon books may be ineffective because people don’t think about the possibility of seeking urgent care in advance and won’t save such materials, Davis says. He thinks patients might hop online to look for options, and he thus intends to have a new practice Web site up and running soon.

There are other low-tech options. A postcard sent to moms in the neighborhood could bring in pediatric patients; young children frequently need urgent and after-hours care. A targeted mailing of this sort wouldn’t necessarily end up in the junk drawer before it served its purpose.

Neighborhood newspapers might welcome a regular column on health issues written by Davis. Such articles provide a community service by informing the public about common summer injuries or flu prevention, for example, and it’s also an opportunity to market the practice. Highlighting your brand in this way may sound difficult, but you needn’t be the next Hemingway to get ideas across effectively. Much of the benefit to the practice comes simply from increased name recognition among potential patients.

And speaking of names, urgent-care providers in other areas of the country are using names like MinuteClinic that instantly explain their purpose. Not everyone will get the idea behind “acute care” or understand that they don’t need an appointment. Why not “Care Now” or “Quick Care” on that new sign, with smaller letters explaining “no appointment needed”?

Mission, vision, and culture

Whatever marketing tactics Davis chooses should support explicit objectives. He wants to “put together the idea of quality medical care and excellent customer service,” but many practices now like to say they’re in the customer service business. Setting discrete and measurable goals will help VMAC define its long-term aims and the strategies needed to achieve them.

A good mission statement is succinct, with details that distinguish the practice from others. When it comes to setting down a vision, Davis should skip the high-minded “motivational” language and instead concentrate on what his practice can offer patients.

For example, he could offer physician care in less than 10 minutes to walk-in customers, a concrete way of separating himself from local emergency rooms. For VMAC’s corporate arm, he talks about providing “front-to-back care” for employees, but he’ll have to spell out as simply as possible the ways in which his practice is better than its competitors. Faster workers’ compensation paperwork? Flu shots or executive physicals at the employer’s site? Davis needs to decide what he wants to achieve, focusing on the details after defining specific goals.

Ideally, VMAC’s mission and vision will guide its staff in daily decision-making, an important consideration for the practice in the near term. Right now, Davis feels that patients come to the office to see him; he’d like that focus to shift to the facility itself. “If it were up to me, what I’d really like to do is a little less patient care and a little more pushing the business along to evolve - because while I’m doing both, everything goes a little slower.” Davis needs to impart his desired culture, which he’ll have to work to clearly define, to his employees.

Simply setting up a formal training program - and making sure all staff are aware of it and take part - is the first step. Continuing education will be required, and culture discussions should become a regular part of the practice’s operating procedures.

Davis could, for instance, hold quarterly culture lunches. In advance of meetings like this, physicians should solicit anonymous staff questions or comments on trouble spots in the practice’s work flow. When Davis ultimately opens satellite offices, it’s a good idea to start all new employees off in the original site so they soak up the vibe. Another tactic is to create a “culture manual” that lists everything from the practice’s mission statement to details on how the facility expects staff to respect patients. Even the preferred steps for internal conflict resolution have a place in culture discussions. Physicians can hold a kickoff meeting to introduce the material and then give a copy to each new hire.

Processes that are imbued with the practice’s culture help staff deal with headaches and quickly move on to more rewarding tasks. In spite of her hard-line - and so far effective - attitude toward payers, Granderson still cites dealing with them as her biggest daily hassle. And Davis calls insurance companies “a constant source of irritation for everybody” in the practice. “The lack of efficiency and accuracy on their part is incredible,” he says. “If they were the ones practicing medicine, there would be dead bodies everywhere.”

One specific challenge involves patients who receive incorrect information from their insurance companies about whether they need a referral to receive urgent care. The practice feels caught in the middle when patients whose insurers have told them they don’t need a referral are later billed for an appointment. A related nuisance is after-hours verification. “Patients only know that they have insurance; they don’t know the type, the parameters,” says Granderson. She sees these obstacles as the responsibility of insurers to better educate their clients and believes it’s up to patients to follow through.

Unfortunately, though, neither of those things is likely to happen - patients will likely never understand their benefits as well as practices would hope, so VMAC needs to train its front-desk staff to educate them. Having all patients sign a printed financial policy before seeing a physician will make it very clear to them that they may be responsible for payment.

Obtain verification and benefits information quickly by using payers’ online services. After bookmarking these Web sites, staff will find it shouldn’t take too long to verify patients’ coverage as they walk through the door. The SSI Group and others offer tools like bar-code scanners that read patients’ insurance cards and automatically connect to the Internet to initiate the verification process.

Tech enabled

In addition to making smart process improvements like this, VMAC must become more tech savvy before it can achieve its expansion goals. Davis has a vague notion of transitioning “to electronic practice,” but when asked about the practice’s plans for EMR adoption, Granderson reveals she’s not even sure whether systems are available for individual practices.

A good EMR (and clear policies for using its features) can take VMAC to the next level by automating many tedious tasks and performing some marketing activities. The practice could, for instance, automatically generate a coupon mailing to patients who’ve just been seen. (Even if they don’t use the coupon themselves, they can be encouraged to pass it on to friends and family.)

Online resources like Physicians Practice’s EMR Guide can serve as a starting point. (Visit www.PhysiciansPractice.com, and click on Electronic Medical Records under the Buyers Guide menu.) Davis might also consider personal education opportunities like attending the Medical Group Management Association’s annual conference. Granderson’s proven ability to educate herself could make her a great internal advocate for VMAC’s tech-adoption efforts. Those shopping for new office technology for VMAC should look at how specific software products might be integrated into that new Web site.

The subject of VMAC’s own site relates back to a plainly defined practice vision. As mentioned, Davis hopes “to get a good, interactive Web site going” in the near future to prompt potential patients to think of VMAC when they require its services. He’s already thinking about how to brand the site and believes a tag line like “Nobody knows better than you when you need to see a doctor” will help increase traffic. Again, though, applying an even more specific practice vision throughout the site may be most useful for acquainting patients with VMAC’s character. A Web site is an opportunity to introduce a practice’s culture, which VMAC should aim to make consistent across every encounter a patient - or corporate customer - has with the clinic.

The impact of a new Web site on patient volume is debatable. VMAC’s potential patients are probably already feeling quite bad and may not be surfing the Web for help (although their loved ones or parents certainly could be). If they are, they may be looking for remedies to try at home, which Davis certainly could offer, also explaining when it might be necessary to see a doctor - if symptoms worsen or intensify, for example. Offering such information can help a practice generate a good reputation among potential patients. Davis could buy local ad space on Google, tying links to his site to keywords like “flu,” “sprain,” or other complaints that send patients to urgent-care clinics.

What is clear, though, is that a Web site is a must for many small businesses. Davis first needs to determine the purpose of his site. In addition to listing essentials such as location, hours, phone numbers, and services offered, a Web site can showcase providers, preferably with photos and descriptions of their background and interests. Many practices also include links to patient-oriented healthcare sites the physician respects - but they should be sure to use buffer pages so it will be clear when patients are entering sites beyond a practice’s control.

Today’s healthcare consumer expects more than just a brochure from a physician’s online presence, and practices can dramatically improve work flow by making the most of their site’s capabilities. Davis says patients coming from corporate clients often arrive with the wrong set of forms, so VMAC might clearly categorize all its new-patient forms online for corporate clients to download. Another option for Davis to consider is to create separate areas within his site for patients, referring physicians, and corporate clients.

It’s wise to consult a healthcare attorney before building a Web site - and definitely before going live. For starters, HIPAA mandates certain levels of security for communication via the Internet; notice of a practice’s privacy policy should appear on its site as well.

Davis’ father and uncles were in business for themselves, so he’s always been interested in the nuts and bolts of medical practice operations, and he is naturally an advocate for the little guy. “I get too itchy to just let it flow,” he says. “I want to take the next steps, to take medicine as a business as far as it’ll go.” He says VMAC is able to provide urgent care at half the cost of an emergency-room visit, so his practice model may be able to take him quite a long way when it is informed by a clear vision.

Laurie Hyland Robertson, is a managing editor for Med-IQ, the parent company of Physicians Practice. She has been in the medical publishing field for nearly 10 years, working editorially on both clinical and management topics. She can be reached at lrobertson@med-iq.com. Pamela L. Moore, PhD, is senior editor, practice management, for Physicians Practice. She has been writing for physicians on practice management topics for eight years, and she is a recognized speaker and commentator on healthcare management. She can be reached at pmoore@physicianspractice.com.

This article originally appeared in the September 2006 issue of Physicians Practice.