The Message Is Quality

There are few practices that mention marketing as a primary strength, but at Cardiovascular Associates (CVA), of Birmingham, Ala., the practice's image and ability to differentiate itself in the market are sources of pride. Now in its 55th year, CVA is one of the largest private adult cardiology practices in the country. "And we are successful in part because of the way we market," says practice administrator William F. Cockrell. "We don't do specials on CABG. We don't offer coupons or discounts. But we are very effective at getting our name out in the public and tying our marketing to education."

For example, the practice is a sponsor of the American Heart Walk. It also produces and airs "infominutes" on local television featuring practice physicians explaining various aspects of cardiovascular care. And participation in community events is a big part of the marketing effort, Cockrell says.

"We are one of six or seven cardiology groups in the area, and are the biggest by far," he notes. "And we always put ourselves out there as experts." Cockrell knows the efforts are paying off: In the past, if the local newspaper needed a quote about cardiology, reporters called the university. "Now they come to us at least as much as they go to the university. We have successfully established ourselves as a leader in quality and technology."

In-house strategy

CVA initially used an outside marketing firm. "They did a decent job, but what they concentrated on was 'plain Jane' name recognition," notes Cockrell. "There was no message behind the name. Now our message is quality."

Part of the practice's success stems from bringing the marketing function inside. Greg Bryant, the marketing director for CVA, joined the practice four years ago. "I thought the agency had good, quality creative [ideas], but they were out of touch with what the physicians needed," says Bryant. "The agency was more image-oriented than quality- and education-oriented. And the physicians are much more comfortable when you market prevention and education rather than fluff."

Bryant has also taken charge of the practice's electronic presence and has created a Web site that is chock-full of information for patients. "The site was project number one and it has gone through several iterations," says Bryant, including a current effort to further strengthen content for patients. "We view it as a patient resource and will tailor it more for them," he says. In the future, patients will have personal Web pages that focus on their specific educational needs.

The practice is well established and has plenty of customers, Cockrell says. There might even be murmurings among physicians that marketing is foolish when the practice is full. "But when we market, we aren't just talking to patients. We are also talking to referring physicians and to payers. We have to get the word out to a variety of people," adds Cockrell.

On a quality mission

Funding an effective marketing effort requires a healthy cash flow, and getting billing in order has been a top priority, says Cockrell. A billing director, LeJeana Hammond-Wood, was hired about four years ago and has brought CVA's accounts receivable average days out to below 30. "We do a great job of getting charges entered and turned around," says Cockrell. "It doesn't hurt that we have fewer payers in Alabama than in states like California, but we still have to get those bills processed."

Having a leader in the department who can evaluate systems and make the most of the practice's technology has allowed the practice to link the marketing and billing efforts. "When we hired [LeJeana], her first job was to be sure we knew how to use our billing system to the utmost of its capabilities. Most offices have billing systems, but only use them to process charges. Now, we also use ours for other tasks, like demographic and marketing support reports."

CVA has also made quality improvement part of its mission and hired a coordinator for quality improvement to spur the practice forward. "We have an in-house quality assurance department that looks at issues like patient satisfaction, but also at processes," Cockrell says. For instance, the practice is studying ways to reduce variations in the treatment of hypertension.

"When you have physicians who trained at different times, in different places, and practice on different campuses with little contact with each other, you have a lot of variation," Cockrell says. "We try to identify best practices and eliminate variations so that patients will go through the same protocol no matter which office they are in."

Sharing is caring

The practice has more than 200 staff members and a turnover of about 10 percent -- something Cockrell would like to lower. But CVA president Jerry Chandler, MD, says the turnover is relatively low and a source of pride for him. "We do a great job of trying to support everyone within the group and keep morale high," he says.

Keeping turnover low is one reason that the practice hired a group of psychologists last year to offer free counseling to any employee and his or her family for any professional or personal problems. "If they are happy, they are efficient," says Chandler. "And any employee is hard to replace."

Among the physicians, keeping the troops happy involves one element unusual in a practice of CVA's size: equal income sharing. "We emphasize the importance of everyone's work," says Chandler. "We are less interested in the money someone generates." Every time the subject is broached to include some productivity formula in the compensation package, the idea is scrapped.

"We study it and we don't go there. If we did, it would require people to do things they aren't best at. We like to see our interventionists doing surgery and those who are best at office visits doing that," he says.

Even with this model, according to Medical Group Management Association (MGMA) data, CVA ranks in the 75th percentile nationally for income -- in a state not known for high income, notes Cockrell. "We must be doing something right."

Planning and growing

Discussions of issues like compensation come up at the practice's annual retreat, where one- and five-year plans are addressed. "We have written plans that direct our path without wandering," Chandler explains. "Our goal is to have university-quality cardiology in a private setting that is user-friendly."

Last year, a big item on the agenda was the practice's new research department. Now up and running with six full-time research staff, the department has already started 20 projects. The latest retreat included discussions about partnering with area hospitals to establish and build centers of excellence. "The cardiology center at Montclair Baptist Medical Center is in the early stage of organization," Chandler explains. "But they have been a great partner, and we want to expand the concept to several other hospitals."

Planning for cardiology may be easier than in other specialties, says Cockrell. The population is aging, and younger people tend to be more overweight and less physically fit -- therefore less likely to have healthy hearts. "Demographics show we will have a lot more need in the future. But there are only 700 cardiologists for 3,500 national vacancies. We'll probably make more use of nurse practitioners and physician assistants."

There will be other challenges as well. Cockrell is concerned about keeping up with clinical and nonclinical technology. "I am always asking myself what new systems we need," he says. "Like electronic medical records: we don't have them yet, but we need to. How will we do that?"

For Chandler, there are different worries. "It's a continuous challenge to maintain a good level of income while trying to achieve high quality of life for physicians and excellence in patient care," says Chandler. "Balancing that is hard in a day of diminishing reimbursements. We have had success by improving processes, and our per-individual billing has gone up as a result of being efficient. But maintaining that will be hard as reimbursement is squeezed."

Lisa Jaffe Hubbell can be reached via editor@physicianspractice.com.  

This article originally appeared in the January/February 2002 issue of Physicians Practice.