Marketing, Promotion, Public Relations

Marketing Your Practice: Know the Legal Risks
Fujifilm and NBCF Provide Free Breast Cancer Screenings
RDI Rolls Out the Skeleton Van

Marketing Your Practice: Know the Legal Risks

By Cat Vasko

W. Kenneth Davis, Jr, a partner at Katten Muchin Rosenman LLP, Chicago, specializing in health care issues, delivered some advice to practice managers at the annual Radiology Summit of the Radiology Business Management Association (RBMA), Fairfax, Va, held in May in St Louis: When marketing your practice, be aware of the legal risks. Axis Imaging News spoke with Davis on some of the issues covered in his talk.

W. Kenneth Davis, Jr.

IE: Why is this topic an issue right now?

Davis: I wouldn’t say that it’s a new issue per se. The legal risks associated with marketing have always been there. What has changed is that the business significance of marketing is even greater now than it has been in the past. The bottom line is that there’s only so much you can do to manage your expenses. The revenue side, due to DRA 2005, has been dramatically reduced. So you’ve got to do what you can to drive the revenue side. You have to do more marketing to get more revenue, and when you start doing more marketing, you need to be better focused on constantly being aware of the legal implications.

IE: You touched on issues in advertising, which aren’t exclusive to the radiology industry. What are some of those issues?

Davis: Well, in the area of advertising you have to be concerned that you’re not engaging in any sort of false or misleading advertising, or advertising that is hyperbolic in nature. On the one hand, you certainly want your marketing to be effective, attractive, and flashy, and to communicate the value proposition that you present. On the other hand, you don’t want to disparage your competitors, engage in false or misleading advertising, or make claims that you’re clinically incapable of meeting.

IE: Is that a problem you’ve been seeing?

Davis: No, I’d say that’s actually one of the lesser areas. People are very cognizant of not engaging in any false or misleading advertising, because in most states, if you look at the Medical Practice Act, there’s typically a provision that lists unprofessional conduct. Sometimes there will be 30 or 40 things in there that it will name as unprofessional conduct. False and misleading advertising and disparaging competitors are frequently deemed to be unprofessional conduct, and you can get sanctioned or potentially lose your license.

IE: What were some of the issues the audience raised?

Davis: The common issue people asked about is the $300 nonmonetary compensation exception under the Stark [laws]. That tends to get the greatest focus, because the reality is, if you’re an imaging center and you convey remuneration on somebody, it probably creates a compensation arrangement under Stark. Unless you can fit that compensation arrangement under an exception, they can’t send you Medicare and Medicaid patients. So that’s the question we always get—what exactly does that mean? Do I literally need to be monitoring every single thing that we convey on somebody? And my advice to folks is yes, you do. That’s the easy textbook answer. If you’re a 30-doctor practice, presumably you’re going to have the kind of infrastructure necessary to track that sort of thing. If you’re a three-doctor practice, you may not. You clearly need to monitor it. That’s a legal obligation. But the larger you get, the more important it is to have formalized policies and procedures to track this kind of stuff.

A lot of it boils down to common sense. Generally, there’s not copious guidance. I tell people, have a reasonable position, live by it, make sure you implement it consistently, figure out whether it passes the smell test. If you step back and take a look at it, does your approach pass muster? Would you be able to defend it? People ask, if we give physicians the ability to log in to our PACS/RIS, and that’s all we’re giving them, just a pass code of some sort, does that somehow create a compensation arrangement? There’s just no clear-cut guidance. If that’s all you’re doing, I believe there’s a reasonable position that that does not constitute remuneration. All you’re doing is providing service. You’re doing what presumably the regulators want you to be doing, providing a high level of service with state of the art capabilities. On the other hand, you don’t want to be doing so much for someone that it stops looking like it’s a service-driven matter.

IE: PACS vendors certainly want everyone to believe that that’s just a benefit of their system.

Davis: Exactly. And like I said, I think there’s a very good argument that if all you’re giving them is the opportunity to get in and take a look at the image, that’s not conveying remuneration.

IE: Where does the argument lie that it is conveying remuneration? If you’re only doing it to select, preferred physicians?

Davis: That’s exactly where you start to get into problems. Anytime you start doing too much for heavy referrers and don’t do the same thing for other physicians, at a minimum, the optics are bad there. On the one hand, you want to be as effective as possible in your marketing; presumably you don’t have an unlimited budget, and so you want to be somewhat focused in your efforts. I’m not saying you can’t do that, but there’s also no question that merely focusing your marketing efforts on just your heavy referrers is much riskier than diversifying your efforts across all your referring physicians. If you were in a gray area as to whether a particular benefit, such as a really nice wine and cheese party, had exceeded your dollar threshold, if you were doing that for only your top five referring physicians, the practical implications are more significant. If you’re doing it for all your physicians, that gray area becomes less problematic.

Fujifilm and NBCF Provide Free Breast Cancer Screenings

By Cat Vasko

On May 7, 27 women over the age of 40 received a free mammogram at PS 149 Sojourner Truth School, New York. The mammograms were provided as part of the Images of Health: Mammograms for a Million Moms campaign, sponsored by Fujifilm Medical Systems USA Inc, Stamford, Conn; additional funding came from the National Breast Cancer Foundation (NBCF), Frisco, Tex, and the mammograms were performed by the American-Italian Cancer Foundation (AICF), New York.

(From left to right) Andy Vandergrift, Joanne Scott-Santos, Courtney Kraemer, and Randy Nagel of Fujifilm Medical Systems, USA.

“It is critical that all women have the opportunity to participate in preventive health care, such as breast cancer screening,” said LeShawn Hodge, a parent coordinator at PS 149. “We recognize the importance of early detection and were delighted to be able to give the mothers and grandmothers of our students, as well as women throughout the neighborhood—women who otherwise may never get screened—the opportunity to receive a service that could potentially save their lives.”

In addition to funding the mammograms, Fujifilm donated $2,500 to the school to support its art program, and will also provide one dollar for every mammography pledge card returned up to an additional $2,500.

The Images of Health campaign, launched in October 2006, was established to raise awareness of the importance of mammography in the detection of breast cancer. The campaign is also helping to raise money for the NBCF through the sales of Fujifilm’s pink QuickSnap 800 one-time-use camera; to date, NBCF has received more than $20,000 from sales of the cameras, as well as contributions totaling $300,000 and two Fuji digital mammography systems.

“We are excited to bring the Images of Health campaign to the next level by taking action and providing women with free mammograms,” said Randy Nagel, director of corporate communications for Fujifilm Medical. “The campaign has been a tremendous success to date in raising awareness of the importance of early detection. We look forward to continuing our efforts to motivate women to take better care of their health and to help provide the means for them to do so.”

RDI Rolls Out the Skeleton Van

By Cat Vasko

Radiology and Diagnostic Imaging (RDI) of Owensboro, Ky, offers its patients a unique service: A free shuttle, equipped with a motorized wheelchair ramp, that will pick up any patient, regardless of the circumstance, and transport them to and from the imaging center. But how did a simple van become an advertising tool worthy of a Quest patient marketing award from the Radiology Business Management Association (RBMA), Fairfax, Va? A little creativity, says Sara Macke, director of marketing and physician/patient relations at RDI. And a lot of paint.

“In 2001 we were talking about getting a van,” Macke told Axis Imaging News. “We wanted to use it to transport patients, because no-shows and cancellations were beginning to become a problem. Patients couldn’t get themselves here, didn’t want to use a taxi or public transportation, and sometimes even family and friends may not be as dependable as we hope. We wanted to make sure that everyone was getting to their appointment, the space that we’d allotted for them, so we decided to pick them up for free.”

At the time, RDI was working with an ad agency, and went to them with the van idea. “We really wanted to do something crazy, so we gave the project to the agency and asked them to give us some ideas,” Macke explained. “Everyone just figured that it would be something incorporating our logo, but since it was going to be a traveling billboard, they gave us a few different ideas.”

That’s how the skeleton van was born. “It’s an x-ray of who would be in the van,” Macke said. “On the back there’s even an x-ray of someone reading the newspaper. It also has our contact information—the Web site and the number to call, and it says ‘Free Courtesy Shuttle.’ When people see it driving down the road, they definitely turn their heads.”

The skeleton van makes “anywhere between one and 15 runs a week,” Macke said. “Not as many as you would think. But we let people know that it’s available if they do need it. They say, I’d prefer to drive myself, and we say, that’s fine—but even if your car breaks down and you need a ride, call us.”

When the van isn’t in action, it still works as a marketing device. “When it’s not in use, it’s just sitting out front so that people can associate our name and the skeleton van,” Macke notes. “And, of course, they do. We also take it to all the health fairs, and any time there’s a trick-or-treat in the park or any other event where there are going to be little kids, we take it and show it to them. We take it to all the senior fairs, too, to show people what it’s like.”

Now RDI keeps its appointment slots full, provides a unique service to its patients, and cleverly advertises itself to the community. “People think it’s really cute and funny,” Macke said. “It’s a really good recognition thing for us, and it’s a service we’re proud to provide.”