Physician Referral Rates Growing at Staggering Numbers

On January 23rd, 2012 the Archives of Internal Medicine released study that showed trends in physician referrals from 1999 to 2009 and the numbers were quite fascinating. During this time there was a 94% increase in overall referrals – rising from 4.8% to 9.3% (P > .001).   

 

The most interesting statistic was that the greatest increase in referrals came from physicians without an ownership stake in their medical practice. This group increased referrals 136% from 4.7% to 11.1% (P > .001).  If they did have ownership the number only increased by 79% from 4.2% to 7.5% (P > .001). 

 

There were no concrete conclusions drawn from the article; however, there are some hypotheses we could come up with to explain these trends.

 

1. Physicians are increasingly under pressure to see greater number of patients. Because of this, the easiest way to do increase efficiencies would involve referring anything that hints of complexity along to specialists so they can do the research and figure out what is happening to the patient so the primary care doctor doesn’t have to.
2. Patients are becoming more informed as consumers. The more educated patients think they are on a subject the more likely they are to ask for a referral to a specialist, especially if the initial diagnosis given by their primary care doesn’t concur with their research based conclusions.
3. More physicians are becoming employees of hospitals than ever before. This especially would explain the even more exaggerated increase in referrals by non-ownership based physicians. While private physicians aren’t incentivized to refer to anyone or any service generally, all hospital employees have built-in pressure and incentives to refer any patient they can to corresponding hospital employed specialists and hospital owned services. 

 

While hypotheses are based in theory, there is much corresponding evidence that points in this general direction. With hospitals reporting profits of $52.9 billion in 2010 and hospital employed physicians increasing by 34% over the ten previous years, I think its clear who is profiting from these increased referrals.

 

10 Simple Medical Practice Marketing Tips

Make Yourself Accessible

You practice has to contract with as many insurances panels as possible – especially the major players in your local market. Referring offices are looking for a one stop shop to send all of their patients, so do not be afraid to include some lower reimbursing ones as well if you receive referrals in your specialty. The second way to make yourself accessible is to offer extended or shifted hours for appointments. A good way to do this is to end the workday on Friday at 1 pm and incorporate an early day at 7 am with a late day until 8 pm or have a half-day on the weekend.

 

Address Comments

Just about every physician has a few negative comments on various medical ratings websites online. While you don’t want to respond to the specifics of a comment online, you can respond in a way that shows other patients you care. For example, “We are sorry to hear you had an unacceptable experience with our practice. Please feel free to call our office and we will be able to remedy this situation. Patient satisfaction and quality care are our two highest priorities.”

 

Reach the Community

There are great opportunities to gain exposure to the general and medical communities through presentations. These can range from community center presentations on a common symptom, to medical dinner CME’s, to business lunch and learns. Because presentations take preparation, it can often be best to roll them out in a series at several locations than to attempt one oversized event.

Know Thyself

The saying goes, “to know where we are going we have to first know where we have been.” This is especially true in physician marketing as we stress constantly on the importance of measurement. If you want to grow your patients, know how many you current see and from what sources – whether this is referring offices or by patient zip codes. You cannot be successful if you first don’t clearly define what that is.

 

Educate

Patients are becoming ever more perceptive about their medical care, wanting to know as much as possible. If you provide educational pamphlets about your specialty that truly informs patients, it adds value to both your practice and the offices that refer their patients to you. Even if you’re not a specialty physician, educational checklists about what preventative care people should complete are well received by many places, from school nurses to corporate HR departments.

 

Targeted Mailings

For 2-3 dollars per address, you could distribute your educational materials, business cards, and a call to action to attend one of your presentations to your target audience. Low conversion rates of around 1% have deterred many offices from utilizing this; however, the more value you send, the higher your conversion. This also applies for mailing to referring offices. Don’t just send business cards; send your bio, what you specialize in, your insurance list, and a direct line to your scheduler.

 

Image is Everything

Your image is not simply the materials you create with your logo, but also includes your building, your staff, and how everyone interacts with patients. Using a designer to create the right office atmosphere can provide vast amounts of marketing and public relations benefits. Couple this with professional staff who are dressed in matching attire and know the professional protocols set forward in answering the phone and interacting with patients and you have set yourself up for success.

 

Net Strategies

The Internet is here to stay so having an online presence is a must. Creating a website has never been easier; however, your website is an extension of your image. It’s sometimes better to not have a site at all than to put a site up that reflects badly on you and your practice. If done correctly and well, medical internet marketing can be the best investment you make in your business.

 

Get “Fanned”

This section isn’t about having a breeze, but instead about joining social media sites – especially Facebook as a business. The beauty of social media marketing is that it is 100% free and just requires some leg work to populate them. With the right guidance in place, you can have a booming social and online presence.

 

Utilize Existing Patients

Medicine is a market that revolves around trust since people seek your services when they are most vulnerable. Who are the best people to explain to others why you should handle their care? Simple, the existing patients who you treat and have trust you themselves. Most physicians see 2000 patients yearly, if half of them recommended two people to see you, that’s a solid equation to double your patient load.

For more information on medical practice marketing, visit MDPracticeConsulting.com.

Doctors Fear Being Rated, but They Often Score High with Their Patients

By Michelle Andrews

Physicians have long been prickly about Web sites that assign them points or letter grades or even smiley and frowny faces based on patient reviews of their experiences. Picking a physician is more complicated than buying a toaster, they say, and doctors can’t be accurately evaluated solely on the basis of whether they’re good communicators, for example, or keep appointments punctually.Now Consumer Reports, a leading publisher of, among other things, buyers’ guides for toasters and other appliances, has ventured into physician rating territory in Massachusetts. The ratings, published as an insert in the July issue for the magazine’s Massachusetts subscribers and available online as well, put 487 primary-care and pediatric practices through their paces, assigning scores from 1 to 4 in each of five categories related to patient experience.

To create the ratings, Consumer Reports partnered with Massachusetts Health Quality Partners (MHQP), a nonprofit that since 2006 has been surveying Massachusetts consumers about their experiences with doctors and reporting the data.

Consumer Reports is dipping its toe into an increasingly popular area. The organization is working with groups in Wisconsin and Minnesota to develop physician ratings in those states as well, although they won’t be focused on patient experience as they are in Massachusetts, says John Santa, director of the company’s health ratings center. Minnesota’s ratings will focus on quality of care, while Wisconsin’s will focus on preventive care.“We’re trying to learn about this,” says Santa. “For us, physician ratings is a journey, not a destination.”

There are many ways to assess a physician’s competence, but patient reports of their one-on-one experiences — whether the doctor is a good listener, for example, or spends enough time with each patient — are more than just feel-good measures, says Barbra Rabson, executive director of MHQP. “Studies show that the better the patient experience, the better the clinical outcome,” she says.

Massachusetts doctors support the project, says Richard Aghababian, president of the Massachusetts Medical Society. “We want all of our physicians to feel they should be accountable for the care they provide,” he says.

It helps that physicians say they are comfortable with the methodology behind the ratings. The Massachusetts ratings are based on surveys completed by more than 64,000 adults. To be considered statistically reliable, a certain number of responses about an individual physician had to be received, says Rabson.

More than 50 Web sites rate physicians, according to Guodong Gordon Gao, co-director of the Center for Health Information and Decision Systems at the University of Maryland School of Business. In contrast to the Massachusetts ratings, some sites allow consumers to log on and rate individual physicians anonymously. Physicians generally don’t like such sites, saying there is no accountability and no way for doctors to defend themselves against criticism.

But a recent study by Gao and colleagues found that physicians may have less to worry about than they suppose. The study examined more than 386,000 anonymous physician ratings posted on the RateMDs.com Web site between 2005 and 2010. RateMDs.com, which started in 2004, was selected because it was one of the first sites to rate doctors, has the largest number of user-submitted reviews and is among the fastest-growing, says Gao. Some 250,000 U.S. doctors have been rated at least once on the site, according to RateMDs.com co-founder John Swapceinski.RateMDs.com assigns physicians an overall rating of 1 to 5 based on patient assessments of their knowledge and helpfulness. The study found that, on average, physicians received a quality rating of 3.93 out of 5. Nearly half received a perfect 5 rating. The average number of ratings per physician was 3.2 in January 2010.

“The number-one surprise was the positive results,” says Gao. “The American Medical Association and others have said that the sites can ruin physicians’ reputations.”In a statement, the AMA said that “anonymous online opinions of physicians should be taken with a grain of salt and should not be a patient’s sole source of information when looking for a new physician.”

The study results are consistent with other types of online consumer ratings, says Ritu Agarwal, director of the Center for Health Information and Decision Systems and co-author of the study. “In studies of word of mouth in other domains such as movies and books, positive word of mouth dominates negative in online ratings.”

Physician reviews that skew toward the positive may please doctors, but for consumers they’re not particularly useful as a guide in selecting one. Experts point to the comments that people often include with their ratings, saying they can be helpful in assessing a physician, as long as people keep in mind that each is just one person’s opinion.

For example, someone might read a review that says a doctor returns phone calls on weekends, says Anne Weiss, who directs the Robert Wood Johnson Foundation’s health-care quality work; the foundation provided funding for the Massachusetts ratings project. “That might be really important to me.”

Rating sites of any sort help consumers take a more active role in managing their health and making health-care choices, say experts. And that’s important, whether the information comes from a scientifically valid survey or an anonymous online review.

“There are lots of things people could pick up that I would not call evidence-based,” says Weiss. “But even those are opportunities for people to understand their role as consumers.”

This column is produced through a collaboration between The Post and Kaiser Health News. KHN, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health-care-policy organization that is not affiliated with Kaiser Permanente. E-mail: questions@kaiserhealthnews.
org.

From The Washington Posthttp://www.washingtonpost.com/national/health-science/doctors-may-fear-being-rated-but-they-often-score-high-with-their-patients/2012/07/02/gJQAe2bcIW_story_1.html

Posted 7/2/12

Doctors Condemn Olympic Athletes’ Endorsement of Junk Food

By Emma Lester

In a letter to The Times today, doctors and teachers joined celebrity chef Jamie Oliver in criticising role models for their endorsement of unhealthy foods.

Professor Gerada said that on the eve of the Olympics, athletes should be showcasing the importance of health and fitness.

‘It might be timely to remind athletes therefore of the power that they have when endorsing junk food which contributes to our rising levels of obesity, especially among our children,’ said Professor Gerada.

Professor Terence Stephenson, past president of the Royal College of Paediatrics and Child Health (RCPCH), said: ‘The Olympic organisers should seek to renegotiate sponsorship for future games.’

The letter acknowledges that celebrity sponsorship deals are worth millions of pounds, but health professionals and teachers urge sporting role models to think about the adverse effect that their endorsements have on the lives of children.

Dr Aseem Malhotra, a cardiologist in London, said: ‘The very lucrative financial gain for these athletes is sadly at the expense of our children’s health and we shall not allow this to continue.’

The letter calls on celebrities to think of the physical, social and emotional effects of obesity that the consumption of the products they advertise is causing.

Charlie Powell, director of the Children’s Food Campaign, said: ‘It is highly disingenuous to try to present unhealthy foods in a positive light by linking them with our sporting celebrities.’

According to Dr Hilary Cass, president of the RCPCH: ‘Instead of glamorising junk food, athletes should be using their influence to inspire children and young people to become tomorrow’s top athletes by eating well and leading active lifestyles.’

‘With celebrity status comes responsibility,’ Dr Cass adds.

Steve Iredale, president of the National Association of Head Teachers, said: ‘I would ask those involved to reflect carefully on the potential consequences of their actions and instead work together to help to improve the health and life chances of those who are so vulnerable.’

From GP Online

http://www.gponline.com/News/article/1142593/doctors-condemn-olympic-athletes-endorsement-junk-food/

Posted Date 7/25/12

CMS Proposes Primary Care Raises Funded With Specialist Cuts

by Robert Lowe

Medicare would reduce reimbursement for many types of specialists to fund sizable raises for primary care physicians in 2013, according to a proposed fee schedule that the Centers for Medicare and Medicaid Services (CMS) released today.

These reductions and raises are apart from the huge pay cut — now put at 27% — set for January 1, 2013, that is triggered by Medicare’s sustainable growth rate formula, and likely to be postponed by Congress.

Under today’s CMS proposal, Medicare pay would increase by 7% for family physicians, 5% for internists, and 4% for geriatricians. Most of this increased reimbursement would result from a separate payment that Medicare would make to physicians for coordinating a patient’s care for the first 30 days after discharge from a hospital, skilled nursing facility, or certain outpatient services. The fee, which will have its own procedure code, reflects the Obama administration’s push to reduce hospital readmissions caused by sloppy follow-up care. At the same time, the administration has made it an overall priority to improve reimbursement for primary care services, according to CMS.

To give raises to primary care physicians as well as nurse practitioners and physician assistants, CMS said that it has to lower reimbursement for other clinicians to achieve budget neutrality. The biggest losers in the proposed 2013 fee schedule would be radiation oncologists, who would take a hit of roughly 15%. Most reductions, however, are less than 5%, as illustrated by the following selected specialties.

Specialty	Fee Change*
Anesthesiology	-3%
Cardiology	-3%
Interventional radiology	-3%
Neurosurgery	-1%
Pathology	-2%
Radiology	-4%
Urology	-2%
Vascular Surgery	-3%

* Change in total allowed charges under proposed 2013 Medicare fee schedule.

A number of other specialties, such as allergy/immunology, gastroenterology, general surgery, plastic surgery, and rheumatology, are slated for no change in Medicare reimbursement.

The proposed Medicare fee schedule will be published in the Federal Register on July 20. CMS will accept comments on the proposal until September 4, and the agency will issue a final fee schedule by November 1. The proposal explains the various ways in which comments can be submitted.

From Medscape Medical News

http://www.medscape.com/viewarticle/767033?sssdmh=dm1.800869&src=nldne

Posted: 7/6/12

Using Social Networks to Change Patient Behavior

by  Troy Brown

Social networks offer many opportunities to stimulate healthy behavior by accelerating the change process and reaching more people than would otherwise be possible, according to a review published in the July 5 issue of Science.

In the review, Thomas W. Valente, PhD, professor of preventive medicine at the Keck School of Medicine of the University of Southern California in Los Angeles, illustrates these strategies and discusses ways that each can be used.

“Network interventions are purposeful efforts to use social networks or social network data to generate social influence, accelerate behavior change, improve performance, and/or achieve desirable outcomes among individuals, communities, organizations, or populations,” writes Dr. Valente.

Individuals

This is the most basic network intervention, and it involves using network data to identify individuals or opinion leaders who can act as champions of the behavior change. Selection of opinion leaders can be done by counting nominations from group members or using a mathematical algorithm to identify central nodes based on different definitions of centrality.

This strategy involves identifying the people best able to influence members to adopt the behavior change and those most likely to disrupt the change process. Dr. Valente notes that group leaders might not always be the most effective agents of change because they might have a vested interest in maintaining the status quo; for this reason, bridging individuals, who have connections to people in more than one group, might be a more effective way to promote change.

Low-threshold adapters, or early adapters, can be used early on to build momentum and create an early tipping point.

Segmentation

This approach identifies groups of people who will change at the same time. “Group-detection algorithms create mutually exclusive groups and an overall index indicating how well the groups represent the overall network structure,” writes Dr. Valente. In a work environment, groups might be organized according to the roles individuals play in the organization.

Induction

“Induction interventions stimulate or force peer-to-peer interaction to create cascades in information/behavioral diffusion,” Dr. Valente explains. Such strategies can involve word-of-mouth campaigns, which are often employed to create a “buzz” about a specific product or behavior.

Respondent-driven sampling (RDS) methods use people (seeds) to recruit others (usually closely associated peers) to participate in a study (like a clinical trial) or to receive an intervention. RDS can be very effective at reaching people who would be otherwise difficult to reach, perhaps because they are in a marginalized group (like injection-drug users). This method involves identifying the number of seeds to start with, and the number of people each seed can be expected to recruit.

In network outreach, which is similar to RDS, network seeds recruit people in their personal networks to participate in an intervention as a group. It is thought that this is more effective than individual interventions because the group reinforces the behavior change.

Alteration

This strategy is different than the other 3 methods, in which the networks are fairly static. In this strategy, the network is intentionally altered to improve efficiency. Three different tactics can be used to accomplish this: adding/deleting nodes, adding/deleting links, and rewiring existing links.

Adding nodes involves bringing someone in from the outside to encourage change in the network. This approach can involve using health professionals or lay health advisors to educate the group. Support groups like Alcoholics Anonymous use this approach to add support people to a person’s network.

Node-deletion strategies identify and remove critical nodes in the network as a means of effecting change; an example of this is antiterrorism strategies designed to weaken a terrorist network.

Networks can also be altered to increase efficiency or improve performance. Teachers often do this when they divide a class into study groups and distribute skill levels evenly in the groups.

Intervention Selection

“Selecting an appropriate network intervention depends on many factors, including the type and character of available network data, the type of behavior change being promoted, and the environmental or situational context,” writes Dr. Valente.

“Network data can be derived from many sources, including archived communications (such as phone, email, text messaging, and listserve postings), participant observations, published sources (such as corporate board membership), and survey data,” Dr. Valente notes.

He explains that although there are many benefits to using social networks to stimulate positive behavior change, there are risks as well. Members might not want to be identified by the group to which they belong, or they might not want their level of involvement to be widely known.

In addition, few of the network intervention methods have been studied in laboratory or real-world settings. “By understanding how social networks can be used to improve learning, performance, and organizational outcomes, we can use the power of human interaction to improve the human condition,” Dr. Valente writes.

From Medscape Medical News

http://www.medscape.com/viewarticle/766988?sssdmh=dm1.800869&src=nldne

Posted: 7/6/2012

Impact on Finances for Medical Practices

Looking at the new direction of how independent physicians’ practices have gone recently has also lead to indirect effects on the finances of an office. As a result, hospitals have been paying their non-physician staff more, making it even more difficult for the independent doctors to compete.

For example, nearly all hospitals are paying non physician staff a more than independent practitioner, which is causing them to have to raise their pay to attract employees that they would normally lose to the hospital. This is an indirect expense the many doctors have had to absorb due to hospital policies that many people do not see on the outside looking in.

So what can the little guys do? It’s not simple, but here are some tips for doctors. The easiest solution is to start by trying to increase your revenue stream by attracting new and high quality patients to your practice by hiring a medical practice consultant to provide representation for your practice.

Other avenues that can be used to generate revenue are physician advertising and implementing internet marketing. Depending on the type of your practice, it can be extremely beneficial to get in your community to attract referrals.

Medical Practice Consulting

A new age of independent private physician practice is coming forward. In 2008, the Medical Group Management Association (MGMA) estimated that 37% of doctors worked for hospitals. It is becoming increasingly difficult for independent physicians to battle the hospital groups as they grow larger and larger on what seems to be a monthly basis. So what exactly does this mean for the little guys? To put it simply, you must become more efficient and provide some marketing for your medical practice and the best way to do that is by hiring a medical practice consultant.

A consultant for medical practices can objectively analyze your practice from a business perspective, and implement marketing strategies for a medical practice to provide sustainable increased revenue generation . An office must consider marketing at some level, getting your name to the public is crucial especially when hospitals are spending thousands of dollars per month to market themselves.

Launching A Marketing Campaign

Creating a marketing campaign for a medical practice is the first step in the right direction to seeing improved results, but what is the next step? Now you must launch the campaign that has countless hours carefully thinking through and making precise decisions. Here are some tips for  launching your medical marketing campaign.

Speak at community events and conferences.  Get out of the office and be a guest speaker at a conference or a society meeting for doctors about your expertise or specialty. Not only will you be gaining creditability between your communities, but also your peers who may decide to refer you patients after hearing something interesting you spoke about.

Ask patients for referrals.  A common misconception is asking current patients for new referrals. There seems to be a negative perception swirling around this because it makes physicians look desperate. This couldn’t be further from the truth, if a patient has had a good experience with you, why wouldn’t you ask them to assist you in marketing your practice with positive reviews to friends and family. This can be as simple as keeping a sign that says we love referrals by the front desk to having the receptionist mention something upon checkout.

Spend a day in your patients’ shoes. Take a moment to sit down and think about the services and amenities patients really want when they visit your office. Do you offer a friendly environment with entertainment like a television and current magazines that aren’t 6 months old and an office decor that doesn’t feel like an old science laboratory? Is your office staff friendly and energetic when welcoming patients, or is the office staff cold and numb, making every office visit unpleasant.  Think about those ideal offices you have visited in the past and make it your guide for a medical practice

Marketing Campaigns for Medical Practices

An effective marketing campaign for medical practices is often what separates a slow growing or receding doctor’s office with a rapidly growing one. A marketing campaign is defined as a specific, defined series of activities used in marketing a new or changed product or service, or in using new marketing channels and methods. A marketing campaign is not something that you can just put together one afternoon over a cup of coffee, and entails many strategies for medical practices.

Most successful marketing campaigns are well thought-out and have many hours of research behind them. A focused campaign starts with where you presently are in the marketplace, and ends with the specific steps you need to take in order to reach where you want to be. A marketing campaign must be specific and focused, but also offer flexibility for the future or if growth in the practice occurs.

Don’t be afraid to hire an experienced medical marketing consultant to guide your practice in the right direction. For any assistance regarding the creation or development of a strong marketing campaign, please contact  MD Practice Consulting today to speak with a trusted medical executive at 877-972-MDPC.