Judy Capko and Laurie Morgan presented a webinar on "Marketing for Medical Practice Profitability" sponsored by Kareo last week. If you missed out on the chance to join in, Kareo very kindly makes all their webinars available on their website at: http://www.kareo.com/resources/webinars -- this one should be available by the end of the day on Friday, March 29.
For those of you following the Healthgrades situation we've been working on -- i.e., hospitals 'claiming' individual physicians' listings without the physicians' permission, rebranding the pages with hospital logos and information, and diverting calls to a call center for the benefit of the hospital -- here is an update. On the plus side, Healthgrades did respond to our request to remove the hospital branding from our doctors' listings -- they referred to this as removing the hospital 'module.' The listings now show with the physicians' numbers only, and the hospital-branded wallpaper and other artifacts have been removed. Regarding our questions about why Healthgrades allowed this takeover of listings to happen in the first place, the response from them was less satisfactory. They asserted that "just like Facebook," they "own all the content" and "have a right to sell advertising against it." I pointed out that Facebook -- despite all the privacy criticism it generates -- does not actually do anything approximating diverting people to a third party's phone center. (!) Additionally, when I asked them why this was done without the physicians' permission, their answer was that "the hospitals all contacted the physicians" -- but, I know for a fact this is untrue. And, if Healthgrades "owns all the content," then why would it be the responsibility of an advertiser to validate Healthgrades' content? As an aside, I do have some personal experience that is quite relevant to this situation. I worked in media for more than 15 years, and even owned and published a yellow pages-style directory. It's simply not the case that diverting a prospect who is looking for a particular person or business to a call center for the benefit of a third party (or the directory) is typical revenue-generating practice in media. It is one thing to take public information to build directory listings -- that's acceptable and reasonable, and if the physician gets extra exposure and awareness from it, that's a good faith type of trade-off. But, leveraging the physician's own awareness generating efforts and referral pipeline development to drive callers to a hospital's call
The Wall Street Journal had a thought-provoking opinion piece by Scott Gottlieb, MD, on Friday entitled "The Doctor Won't See You Now. He's Clocked Out." Gottlieb asserts that the ACO model ObamaCare encourages is basically handing hospitals a monopoly in many markets, and encouraging them to buy up practices to take advantage of higher, 'facility' reimbursement rates from Medicare. And he adds that, once employed, physicians are less motivated to take ownership of the full spectrum of patient care (e.g., because they hand their patients off to another hospital physician at the end of their shift). The overall picture is higher costs and less productive physicians. As someone who's studied economics, I find it hard to argue with Gottlieb's analysis of the effect of market power: hospitals will inevitably use their monopoly (or quasi-monopolistic) positions in many markets to drive higher prices. I wonder, though, if that won't -- at some point -- create opportunities for more entrepreneurial doctors. To the extent that hospitals and other larger systems raise rates, that should make working with smaller, more nimble, and less expensive independent practices more attractive to payers. And, that may ultimately enable more entrepreneurial physicians to find a path to keeping their practices open and profitable, and even developing new models (as occurred with, for example, ASCs in the past).
Today I stumbled upon an intriguing, although somewhat troubling, blog post from last fall entitled, "Disrespect ... is the Elephant in the Hospital." The post referred to two academic papers by Lucian Leape of the Harvard School of Public Health that closely examine how a hospital environment that tolerates disrespect -- whether from doctors to nurses, staff to patients, administrators to clinicians or physicians to patients -- leads to all kinds of bad outcomes, including very demonstrably increasing medical errors. Tolerated disrespect isn't just a hospital problem -- it can happen in organizations of any sizes, including private practices. And, the potential consequences aren't just clinical. If a manager or physician creates the sense that staff aren't respected contributors to the team, it stifles staff contributions. Team members who are in a position to observe operational problems will be discouraged from pointing them out -- and so the practice misses out on an opportunity to improve. And, of course, the daily grind of disrespect will eventually cause your practice to lose its best employees. Once a pattern of disrespect is well-established, it can be tough to break. If a practice manager seems to treat staff dismissively or is demeaning to them, corrective action by the physician(s) he or she reports to is imperative. If a physician seems unable to interact with staff without condescension or bullying, an intervention (perhaps with the help of an outside coach) is needed, and it may be necessary to carefully structure how he or she works with staff. Above all, the first step to repairing an office environment that has become hostile is to provide the means for staff to confidentially (anonymously) provide honest feedback, without fear of retaliation. For a small practice, it may be helpful to work with a neutral outside party to gather employee opinions in a "safe" manner, and summarize them so that management can take corrective action.
My new column this month gave me a chance to share some anecdotes about really interesting, high-performing medical practices that have achieved their success by breaking a few rules! One of my favorites, because it's so much fun to think about how these doctors and practice managers inspired us and taught us quite a few new tricks. Repertoire Magazine
Practice managers and physician owners might look at the media attention focused on Yahoo! CEO Marissa Mayer's decision to end work-from-home at her company and think, well, that doesn't apply to me. And it's true, with only a few exceptions (say, billing), medical practice staff members are unlikely to be able to do their work from home -- not just because they need to be where the patients are, but also because of the privacy risks of bringing documents out of the office. That doesn't mean, though, that the controversy and discussion that Mayer's decision engendered (and now Best Buy CEO Hubert Joly's as well) are completely irrelevant to physician practices. Because even though working at home is an option that won't often make sense for medical office staff, the media frenzy about one company's HR decision does illustrate how challenging it can be to make management changes without unintended consequences, even when the need for the change seems obvious. Change sparks fear One of the theories that immediately emerged about the Yahoo! telecommuting ban was that Mayer was simply implementing "backdoor layoffs" -- i.e., that she'd determined that forcing everyone into the office would be an easy way to encourage telecommuters to quit to achieve needed cost reductions. Naturally, this theory provokes fear in all staff -- what if there aren't enough quitters to bring costs down, and my job ends up on the chopping block? There are mixed reports of how the end of telecommuting is actually playing with Yahoo! employees -- despite the ongoing outrage of bloggers, there are also reports that many current Yahoos understand the need for and actually support the change. But, certainly the situation is a good reminder about how important it is to communicate effectively with employees, to help prevent unnecessary fears from taking hold -- otherwise, you risk losing your most valued employees, who will begin job hunting in earnest when they sense trouble. (I have seen changes as small as eliminating free coffee to save a few bucks lead to swirling rumors that bankruptcy is imminent! When communication is missing,
Today I dug further into the Healthgrades/hospital listing hijacking issue. I tested the phone numbers for two of the practices we've worked with on listings, one in Southern California and one in Northern California; both of these practices have had their listings heavily branded by local hospitals (without consent or even notification from the hospital or Healthgrades to the practice). In both cases, the practice's phone number was replaced with a referral line number. My experiences testing these numbers out illustrates why it is so problematic for the practices and so wrong for it to have been done without their consent. ===== Test #1 -- SoCal Dial number ... recorded greeting, "please hold for the next available agent" [AGENT?] Operator: Hello? How can I help you? [Not even the lame, generic "doctor's office" you usually get with an answering service] Me: Oh...er...I thought I was calling my doctor's office? Operator: Oh, I'll have to transfer you. Are you an existing patient? Yes: Okay, please SPELL your doctor's last name, so I can make sure I transfer you to the right place [Spell? Really? Didn't I just call his office?] ===== Test #2 -- NorCal Dial number ... same recorded greeting, "please hold for the next available agent." Hold for 25 seconds. Operator: Hello, can I help you? [Again, not even an indication you're calling a doctor.] Me: Oh, whom have I reached? Operator: Um, you've reached a call center for XXXXX Health. [That's the hospital system] Me: Oh, I thought I was calling a doctor's office? Operator: Oh, um, XXXXX Health is using us to verify patient information -- can I update your information? [Really? How do you know I'm a XXXXX patient?] Me: So, I haven't reached the doctor's office. I've reached someone from XXXXX Health? Operator: Well, XXXXX Health has us gathering patient information and tracking calls from HealthGrades. Operator: So, are you concerned about this? We've been getting a lot of complaints. [Wow! That was fast. I didn't think I'd indicated a complaint yet. They really must be getting a fair number.] Operator: I can pass your information on
Those of you who check in here regularly or have heard me speak on online reputation management already know that I'm an advocate for working with the major physician directories and taking advantage of their high profile rather than hiding your head in the sand. I've long appreciated the ability these sites offer to easily identify yourself as a physician or practice administrator and correct and customize your listings on Vitals and Healthgrades -- which is not just beneficial but really crucial because these sites are so well-optimized on Google, it's likely that some of your prospective patients and even current patients will end up landing there looking for contact information and other details. I've never had trouble with claiming or managing listings on behalf of a client until this past fall, when I ran into some really frustrating difficulties that are still not resolved, despite numerous attempts to contact both sites' customer service people through multiple channels. I'll describe what's happening here both in the hope that practices can benefit from this as it unfolds, and in the hope that perhaps some individuals from these sites will see this posting and provide some assistance. Starting with the most shocking problem: Healthgrades and the hospital listing hijack incident. Last fall, I attempted to claim two additional listings for a private practice we work with that just added two new docs. (I had previously claimed the physician owner.) There were all sorts of unanticipated technical problems in the process -- including the system failing to delete an obsolete address (2500 miles away!) for one of the doctors. I was also unable to de-link myself from another practice I'm done working with, so that they could take control of their own listings; the problems seemed to be technically related. I wrote in again and again -- about ten times! -- for help to support. Generally, I got no answer. On one occasion, I was told that they were having system problems that might take weeks to resolve, but that they would take care of all the changes for me if I would document everything that was