Chapter 11: Get Marketing “Fly”


[Understanding Old and New-Wave Patient Relationships Management]  

By David Edward Marcinko

By Gary L. Bode   

The first rule of any technology used in a business is that automation applied to an efficient operation will magnify the efficiency. The second is that automation applied to an inefficient operation will magnify the inefficiency – Bill Gates   

Most medical practitioners equate marketing with advertising. Advertising is only the most expensive, and often least effective, facet of services marketing. Internal marketing and patient relationship management, on the other hand, is the most cost effective, time effective and most dignified form of medical marketing. Internal marketing and PRM within your practice occurs continuously, even if you are unaware of it.


Patient satisfaction opens the door to internal marketing for your practice and comprises the bulk of professional medical services marketing. We all know practitioners who are only average clinically, that do extremely well.  Conversely we all know great clinicians struggling to stay afloat in today’s rapidly changing health care environment. The difference is usually patient satisfaction. 

Some patients are delighted with us despite a result we’d rather not have our colleagues see.  Other patients angrily leave us, for some trivial reason, despite a great result. Much of this paradox is attributed to the patient satisfaction aspects of internal services marketing and PRM.

Positive services marketing impacts your bottom line dramatically. Your gross fees are a function of marketing. Obviously, any other beneficial practice management programs work even better on a larger gross fee base.

Advantages of increased patient satisfaction include: 

  • Increased patient retention. Patient satisfaction increases patient loyalty. This translates into more billable services and more retail medical goods (DME) sold per year.   All practices lose patients through death, geographical relocation, etc.  Nothing can be done about it.  However, other patients defect to other practitioners or do not seek additional required treatment at all.  If no other patient satisfaction program exists, other than a best effort on a case-by-case basis, the techniques listed later can dramatically decrease that defection rate.  Retaining a patient is more cost effective than replacing one.  Note that even a 1% improvement in patient retention, an extremely low result, and can mean thousands of extra pre tax dollars available for practitioner salary.
  • Increased new patient referral rate from current patients and staff.  Not only do you retain the referral potential of the current patients not lost, but the rate and enthusiasm of existing patient referrals also improves.
  • Decreased overhead percentage rate.  The relative amount of profit increases secondary to improved staff-production, more revenue generated on fixed expenses like rent, and decreased advertising costs.
  • A fee premium for being the area’s de-facto preferred provider.  Increased patient satisfaction skews the usual price / quantity tradeoff of patient consumerism in your favor.  This is especially important in no third party covered services.
  • Decrease in the average interval between exams and purchases. An average of one-week decrease between “bi-annual” exams translates out to many additional exams done every year just from an existing patient base.
  • Decrease of time in the accounts receivable cycle.
  • Decrease in the bad debt rate.
  • Improved office morale, less stress and increased quality and joy from practicing your profession.

Internal marketing becomes especially important in a specialty where differences in practitioner skill are not perceived by the public as significant, and/or in an area saturated with other practitioners.  For example, the world’s best heart-long transplant surgeon does not have to worry about his location, office dynamics or personality adversely affecting patients.  But, a suburban optometrist surrounded by other optometrists, ophthalmologists and national optical franchises, all competing for the same patient base, does.

Another example of positive services marketing through increased patient satisfaction was AIDS anxiety almost two decades ago. Some percentage-of patients were concerned, perhaps just subliminally, about contracting AIDS in the office. If your staff is trained to point out the sterilization controls present, how the office exceeds HIPAA, MSDS and OSHA requirements and how meticulous you are, these patients relax. This “marketing” merely points out to the patient things you take for granted, and, removes one psychological barrier to full compliance. It is not bragging or manipulation. A remarkable positive cycle of benefits ensues for everyone. There is no down side: nobody one is displeased to see you maintain a clean office.

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5 thoughts on “Chapter 11: Get Marketing “Fly”

  1. Seeking Patient 2.0 and Health 2.0 Definitional Stability for P-CRM
    What is it – How does it work?

    The Internet is a constantly evolving service that continues to grow at an exponential rate, despite late adoption by some physician practices.


    Since 1995, the primary use of the internet was e-mail communications with peers, hospitals and others. Next providers linked to hospitals and managed care organizations to obtain more direct connectivity for clinical information and insurance benefits coverage.

    More recently, physicians are finding other beneficial avenues to expand their utilization of the Internet, include Customer [Patient] Relations Management:

    • Direct e-mail inquiries from patients.
    • Patient educational newsletters and links to other educational sites.
    • Continuing medical education (CME).
    • Chat room, consultations, conferences or professional presentations.
    • Nurse to patient e-mail connectivity.
    • Immediate data on lab results with high-low values to patients.
    • CPOESs (Computerized Purchase Order Entry Systems).
    • Appointment scheduling patient reminders.

    Health 2.0, Web 2.0 and Patient 2.0

    But, ever since the term “web 2.0″ was first used in 2004, there has been an inordinate amount of chatter about what web 2.0 really is and its true impact in medicine. No one’s defined it clearly, but we think the web evolution relative to healthcare essentially falls into 3 generations, as outlined in the Dictionary of Health Information Technology, and our related websites, wikis and professional blogs.

    Health 2.0 Journalists

    According to healthcare visionary and uber-blogger Matthew Holt, and similar other sources, Healthcare 2.0 may be defined as:

    “A rapidly developing and powerful new business approach in the health care industry that uses the Web to collect, refine and share information. It is transforming how patients, professionals, and organizations interact with each other and the larger health system. The foundation of healthcare 2.0 is information exchange plus technology. It employs user-generated content, social networks and decision support tools to address the problems of inaccessible, fragmentary or unusable health care information. Healthcare 2.0 connects users to new kinds of information, fundamentally changing the consumer experience (e.g., buying insurance or deciding on/managing treatment), clinical decision-making (e.g., risk identification or use of best practices) and business processes (e.g., supply-chain management or business analytics)”.

    And so, if Health 1.0 was a book, Health 2.0 is a live discussion. Furthermore, Scott Shreeve, MD and personal communication] of Cross-Over Health defines health 2.0 as:

    “A New concept of healthcare wherein all the constituents (patients, physicians, providers, and payers) focus on healthcare value (outcomes/price) and use competition at the medical condition level over the full cycle of care as the catalyst for improving the safety, efficiency, and quality of health care.”


    By now, you probably realize that Health 2.0 empowers patients and worries doctors.

    Writing for Time magazine recently, journalist Bonnie Rochman explored the ramifications of patients sharing information and tips online, an “empowerment movement” that she calls “Patient 2.0.”

    In her piece, she profiled the newly created Society for Participatory Medicine, which “encourages patients to learn as much as they can about their health and also helps doctors support patients on this data-intensive quest,” as well as, a free service which makes its money by selling anonymized patient information.



    And so, your comments are appreciated.

    1. What do P-CRM, Health 2.0 and Patient 2.0 mean to you?

    2. How would you define these terms formally, and how do you use P-CRM, Web 2.0 and Health 2.0 in your medical practice?

    3. How do you specifically use them relative to your internal and external C[P]RM activities?

    Thank You.
    Hope Rachel Hetico RN, MHA
    [Managing Editor]

  2. Medical Practice Demographics Marketing

    Collecting real patient data, that is, information on race, ethnicity and language preference, can help medical practices and clinics improve care delivery and increase market share.


  3. Health 2.0 CRM Considerations for Medical Practice
    [The Build vs. Buy vs. Outsource Conundrum]

    There are several options to build, buy or outsource a medical practice Customer Resource Management infrastructure. And, there are advantages and disadvantages to all three options. I will review them all for our readers.


    Rapid technology advances are transforming the business landscape. This makes it very challenging for healthcare organizations to keep abreast of the technologies, to train and manage resources on tools, to grapple with cross-functional, cross-departmental dynamics and build the CRM application. In addition mergers/ acquisitions and other market realities can make CRM operations complex and distract healthcare organizations from delivering excellent patient experience.
    It is very tempting for small healthcare organizations to think they can develop what they need in-house themselves. May be May be not. It is very essential to stay focused on your main business and see if the solution is available elsewhere. Figure out if you are in the business of whatever you are doing or let us say in the business to develop patient survey tool or a low-end database. It is best to get outside help wherever you are dealing with an initiative/ task that is not your core competence or where it is to your strategic advantage- be it time-to-value or cost savings.


    Depending on your business needs you can either buy CRM package solution and implement or build best of breed solutions that are suited to your business needs. You need to pay very close attention to what the software vendors are promising. Naturally they will be more interested in making the sale, than advising on whether it integrates well with your existing technologies, so the onus is on you as a buyer to ask the right questions and make appropriate purchases.


    Especially for very young healthcare organizations today, outsourcing can be an option worth exploring to de-risk technology decisions. Outsourcing de-risks marketing program – avoids unnecessary, upfront, massive capital investment and will also equip the marketers with the flexibility to ramp up or down as situation demands. Outsourcing does not mean healthcare organizations can wash their hands off the CRM function. Still it is the business that will have to provide the strategic direction and control the CRM process and outcome. There are also Application Service Provider (ASP) solutions which de-risk technology decisions.


    One of the attractions of going the hosted route becomes very clear when you have a two doctor practice marketing medical services that require 24×7 availability of information, transaction and service. They have attractive pricing that encourage “pay as you go” paradigm which is of enormous help to young businesses.

    However, the disadvantages of an ASP [SaaS] cloud model are: 1) you can’t integrate with your other enterprise systems for patient 360-degree view 2) you can’t customize to reflect your exact needs 3) you can’t work offline, which can be a disadvantage if you are mobile.

    Good Luck!
    DeeVee Devarakonda

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