With the days of automatic referrals from local physicians to radiologists a thing of the past, and in the face of growing competition, marketing radiology practices to referrers is a do or die concern. Freestanding imaging centers are competing for patients not only with hospitals and other subspecialty providerssuch as orthopedistsbut with other imaging centers as well, leaving market share sought after and margins tight.
A growing number of radiology practices are coping with these pressures by adding marketing representatives who visit the medical offices of referrers. These “physician liaisons” can play an important role in helping to establish and maintain long-term and profitable relationships.
Though marketing representatives are an increasingly common part of the current medical scene, not every radiologist sees the benefit. This was the case 5 years ago when Sarah Odom, marketing director of Baton Rouge Radiology Group in Louisiana, joined the 18-radiologist organization. About half were skeptical of the marketing notion, but the other half appreciated why marketing was necessary. The skeptics, however, are now believers. Between 2001when the practice began tracking its marketing resultsand 2003, Baton Rouge Radiology Group saw a 48% increase in the number of its referrers.
Fundamentally, marketing to referrers is simply a question of communication, and can be as easy as picking up a phone.
Prospecting for Business
There is no formula for who to call or even who to see during this initial point of contact. “You don’t know when you go into the practice who’s going to be the decision maker,” says Raymond Loy, director of marketing at Open Advanced MRI & CT, which has 10 locations throughout the Chicago metropolitan area. “It varies. For some, it’s the doctor; for some, it’s the scheduling person; it may be the front-desk person or the office manager; sometimes it’s the doctor’s wife. But you need to know all these people and you need to service them at different levels.” Prospective referrers can come from a variety of sourcesthe phone book, medical association lists, hospital directories, and notices about new physicians in local newspapers.
Every doctor wants something different from the imaging service they are using, says Andrew Morse, director of marketing for Axcess Diagnostics, Venice, Fla. “There’s an old saying, If you’ve met one doctor, you’ve only met one doctor,'” he says. It is the account representative’s objective to identify what a referrer wants from a radiology service. Efficiency, quick turnaround times, and accurate studies are common selling points.
Another effective strategy to gain the attention of referrers is to bring either a radiologist or technologist along on an office call. “The most important thing is physician-to-physician sales,” Morse explains. “Physicians will listen to a colleague.” In addition to office visits, Morse says that his practice also sponsors educational seminars, case review sessions, and open houses for consumers.
Building relationships with the staff is ongoing and can be done in a variety of ways. Odom sometimes sponsors lunch meetings, particularly during the initial visits. “Lunch is really a great tool, because you get to see everyone and you get to figure out who matters,” she says. “You get to see every party that deals with your office who might have an issue to bring back [to the radiologists].”
Scheduling a visit and grabbing the attention of a referring physician and their staff are not the end of the road for the marketing representative. The relationship must be maintained on a regular basis.
When a marketing representative leaves an office, he or she typically leaves brochures and other collateral materials such as pens and notepads. But this will not guarantee that a physician will remember to refer a patient to a practiceparticularly in a competitive market like Baton Rouge. Instead, superior, personalized service will go a long way in guaranteeing whether a referrer will send a patient to a particular practice. “Service is everything,” says Odom. “If you have the equipment and you can do the scan, but you don’t get the referring physician his report, then it doesn’t matter. That’s what they want.”
Though there are many ways a marketing representative can sell their radiology practice to potential referrers, there is one pitfall that they have to be careful ofthe federal Stark Law, which regulates physician self-referrals as well as inducements to referral. According to Max Reynolds, an attorney with Washington, DC-based McDermott, Will & Emery, under the Stark Law, there are things a practice can and cannot do when selling itself to referrers.
A practice can promise quick turnaround on a study, quick turnaround on the interpretation, quality service, and accessibility to answer follow-up questions.
What a practice cannot do is more complicated and includes:
In general, Reynolds advises that marketing representatives avoid providing preferential treatment of those primary care physicians who refer a large volume of cases. He also adds that the Stark Law is not the only legal headache marketing representatives should be aware of. “They should also be concerned with compliance with the federal health care program anti-kickback law,” he says. “Additionally, many states have kickback and self-referral laws, some of which are even broader than their federal counterparts. Violation of these state laws can result in criminal, civil, and administrative penalties.”
Loy gives his marketing representatives a discretionary fund to use in any way they like for marketing purposes. “If they want to buy pens, they can buy pens; if they want to buy bagels, they can buy bagels,” he says. “The nice thing is that it gives the marketing manager variety. They have the ability to be creative with their job and stay in front of people in different ways, so it’s not always the same approach.”
Establishing superior service can be difficult and requires a creative approach. Loy’s representatives have hit upon a unique and potentially tricky way to prove not only the competency of the practice, but its ability to service the patient and the physician. “We always say if you want to try us, send us your most problematic patient,” says Loy. “I’ve had several cases in which people have sent new patients who were somewhat troublesome, and one office called me and said, What did you do with Mrs Smith, she couldn’t say enough nice things about you. She never says anything nice.'”
For Loy and Odom, offices are visited on a fairly regular basis. Odom tries to see those clients who do not need much support at least once a quarter, and sees those with problems or concerns more frequently. Loy’s approach is more hierarchical and formalized. “You can classify your doctors into an A, B, or C category,” he says. “It becomes a juggling game of how to keep everybody engaged and involved. We have some tracking mechanisms in place, and we’re actually looking to do some other automation to help the marketing managers go through that process, so they know the last time they were [at a physician’s office] and what they did.”
Morse’s marketing managers visit their clients daily, because they do much more than leave pens and brochures. “Unlike some companies, we don’t have all of our reports faxed to peoplewe will also hand deliver films,” he says. “It’s not just about dropping off trinkets. What our marketing reps provide is support to the office staff. This means that if the staff are looking for a report, they can contact the rep; if they’re looking for a film, they can contact the rep; if they have a question about a certain exam, they can contact the rep, or they can contact the office. But we try to direct things to the rep as much as possible, so that the account feels that they have a representative who works for them.”
The Lookout Post
As the practice liaison between the radiologist and the referrer, the marketing representative is responsible for recognizing problems and seeing that they will be fixed as soon as possible. “[The account representatives] do a lot of crisis management,” he says. “If there’s a lost report, if there’s a patient who’s unhappy with something, if there’s a physician who feels that we dropped the ball on something&they handle those. Our opinion has always been that when you have a problem, it’s an opportunity to get closer to your customer.”
While the marketing representative can assist in getting the patients in the door, it is the office staff that ensures that the patient has a good experienceone that they will hopefully comment on to the referrer. “When a patient walks in, you have to have a staff that greets them in a good mood, that goes out of their way to get them a cup of coffee, that walks them down to the scanner, and that is friendly to them,” says Morse. “That staff is selling your practice when they’re talking to that patient.” This selling continues with the radiology staff’s interaction with the referrer’s staff.
This sort of service can also help to sell the practice in another fundamental way: by making the referrer see the imaging center as an extension of their own office, says Loy.
Since the position is similar to a sales job, compensation is structured with a base salary and bonus or profit-sharing schedule based on predetermined goals. In addition, marketing representatives also, typically, receive mileage and, in the case of Axcess Diagnostics, a cell phone.
The key to success is more than simple tenacity. It is passion. “They have to manage their business like it’s their own business, so you can’t just hire anybody and put them out there,” Morse explains. “You have to make sure you get people who believe in what you’re doing.”
Chris Wolski is associate editor of Decisions in Axis Imaging News.