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The Single Cause of Most Every Medical Marketing Failure

& the 3 Simple Steps to Fix It

I am in-network, have referral pads and a medical marketer, but no referrals.

Where did I go wrong?

· medical marketing,referring physicians,referral pads,referral forms,practice failure

Dr. Patel recently opened his own medical practice.

Dr. Patel is a gastroenterologist who recently left a large healthcare system to open his own practice in a city nearby. He has attended several networking events with the local medical society and has learned that local primary care providers are excited that he's in town. There are several other gastroenterologists in the city, but they are so busy many of them aren't even accepting new patients. Depending on a patient's insurance, the average wait time to get a new patient appointment with a gastroenterologist was running anywhere from 2-6 months!

He is in-network with major health plans,

Dr. Patel started his contracting and credentialing early, so he is already in-network with Medicare, Medicaid, Aetna, Blue Cross and Cigna. His credentialing administrator is now working with the health plans that required him to have Medicare or Medicaid before applying, as well as several marketplace plans, a local capitated network plan, and UnitedHealthcare.

and has ordered referral pads.

He ordered referral pads from, and within 2 business days had a custom referral form that ultimately transformed his practice. "We had referral pads at my former health system that marketers used as a tool to let referring providers know who we were, but otherwise they weren't that useful. Why didn't they ever think of creating referral forms like this?" was created for healthcare, by healthcare. This simple difference makes all the difference. See how Dr. Patel's $249 design was the best money he ever spent.

Dr. Patel's Referral Form

"On the front, the referral form has a list of the most common symptoms and medical diagnoses referred to my practice. A checkbox next to each one makes it quick and easy for providers and Medical Assistants to refer the patient as they're seeing them. The information fields on the front include every piece of data my staff needs to register a patient; and they're even labeled just like they are in my EMR. There's also a checklist for the Referral Coordinator listing the patient records I'd like them to send before the patient comes to see me.

"The back of the form is completely geared toward the patient. It explains what a gastroenterologist does, the main reasons a patient is referred to a gastroenterologist, and even shares a few personal details about me. It also lists all of the insurance plans I'm in-network with, explains that we have several more in process and refers patients to our website for the most up-to-date list. There's a map to our location, a checklist of items to bring to the visit, an overview of what to expect, and even a list of next steps.

"This checklist has made the Referral Coordinators job so much easier. I wish people knew how much time healthcare staff have to spend just trying to get medical records. Unfortunately, the system is so cumbersome I usually only get to see a small picture of a patient's health. Since using the referral form and process recommended by the team, I have truly been able to improve the quality of care I deliver. Great healthcare takes more than just a great doctor. Great healthcare requires having access to the right information at the right time, being able to work collaboratively with the other doctors on the patient's care team, and being able to get patients the information and resources they need."

He hires a medical marketer,

Dr. Patel hires Sally, a medical marketer, to bring referral pads to nearby primary care and urgent care providers. Sally is a great networker. She goes out and introduces herself to all of the referral coordinators at nearby medical practices. She gives each of them one of Dr. Patel's business cards and one referral pad. She does a great job following up with front desk staff and referral coordinators and develops a relationship with each of them.

but still isn't receiving many patient referrals.

After several months in business, Dr. Patel still isn't receiving many referrals. He attends a medical society luncheon and runs into several of the primary care doctors he had previously met. He was a little nervous to ask them why they hadn't referred any patients. He knew Sally had been to their offices. Luckily, he didn't have to ask. Dr. Miranda, one of the busiest primary care doctors in town, came right up to him and said, "Dr. Patel, I really wish you would send your office manager or medical marketer over to my office. I know you've probably been slammed with new patient referrals from other doctors in the city, but my patients could really use you." Dr. Patel was furious. Had Sally not gone to the offices after all?

That afternoon, Dr. Patel called Sally into his office. He explained to her what happened earlier at the medical society luncheon. Sally was confused. She knew Dr. Miranda's referral coordinator by name and had just visited with her last week! So Dr. Patel and Sally decided that they would go visit Dr. Miranda's office together the following day. Sally called Claire, Dr. Miranda's referral coordinator, and confirmed a time.

The medical marketer had clearly done her job,

When Dr. Patel and Sally arrived at Dr. Miranda's office the following day, Dr. Patel could tell that Sally had done a great job developing a relationship with Claire. Claire knew exactly who she was and welcomed her in. As they were walking back, Dr. Miranda saw Dr. Patel and immediately walked up. She said "Dr. Patel, thanks so much for coming by. You didn't have to come out here yourself, but I'm glad you did. Let me introduce you to my staff." As she turned around she could immediately tell that Claire and Sally knew each other.

She was so embarrassed. Dr. Patel's referral pad had been on Claire's desk for over 2 months and they hadn't sent a single patient. She tried to not show her frustration as she asked Claire, "Why haven't we referred any patients over to Dr. Patel?" Claire innocently replied "Gosh, Dr. Miranda, no one told me!"

as had the referral coordinator.

But it was immediately clear that the problem wasn't Claire's fault either. Claire had not only prepared herself by creating a quicklist in the EMR for managing the records she'd need to send over with the referrals, she and Sally had made sure Dr. Patel was properly registered in the EMR and sent a test patient to make sure they had a fluid process in place. Claire had even worked with one of the providers to create a gastroenterology referral template and had pushed it out to all of the providers in the EMR.

So whose fault was it?

All too often, the finger of "fault" is pointed at medical staff members. So staff members work harder and longer to try to do more. Unfortunately they are often overworked, stressed, and still fail. But why?

The healthcare industry is filled with dedicated and diligent staff. It is also filled with an abundance of requirements, regulation, and data. Electronic medical records and computer systems make managing some of the data easier, but they often make connections and communication much, much harder. We are so buried in Quicklists and Tasks that we fail to ever clearly define, connect and communicate the processes that are fundamental to medical operations. We can see the problem very clearly in this case.

The problem wasn't a person.

The practice had a great referral form. It was not only a huge improvement from anything Dr. Patel had ever seen, it met the needs of its three users who all had very different needs - the referring practice, his practice, and the patient.

Sally, the medical marketer, did a great job developing relationships with the staff at surrounding primary and urgent care practices. In many cases, Sally even met the providers themselves! These introductions and relationships are essential for connecting patient care across the large number of complex and interrelated medical disciplines and specialties, and there's no way providers have time to do it all themselves. But connecting providers is only part of a medical marketers job. Just as important is understanding the clinic flow at referring provider practices and providing solutions that work fluidly within that process.

The problem was the process.

If Sally had let Claire show her around the primary care clinic and explain how they do things, it would have been easy for Sally to see why just leaving one referral pad for Claire wasn't a good idea. There were 12 providers in the practice, 3 concurrent shifts, and 20 exam rooms! When the practice was smaller all of the patients checked out at the front desk. As the practice had grown, they added shifts and began having Medical Assistant's check out patient's in the exam room at the end of the office visit. This not only improved clinic flow, it saved time for everyone and maximized use of overhead. The Medical Assistant knew why the patient was there and was often in the exam room when the provider ordered labs or recommended to the patient that they see a specialist.

Finding in-network specialists was so cumbersome,

When the provider didn't know a specific specialist in town they would simply write up a referral order within the EMR for the patient to see that specific "type" of specialist, print out the Clinical Summary with the recommendation, hand it to the patient and push it over to the digital patient portal. They then would encourage the patient to call their insurance company and find a specialist within their insurance network. This is what was happening across the practice for gastroenterology consults.

and staff so overwhelmed,

"Quite frankly, we're too busy to look up specialists anymore and then develop an efficient process to get patients there. Further, you really have to know the provider's subspecialty expertise to make sure you refer them to the right doctor. So we find ourselves recommending that a patient simply go see a certain specialist "type". We've tried using insurance websites and some of these new online programs that match referring doctors, but they really don't work - they sort by payor and general specialty. Medicine is a lot deeper than that; and a lot more personal. That's why we were so excited to meet Dr. Patel.

We know that Claire keeps a list of specialists at her desk, but these days most of Claire's time is spent trying to get paperwork to specialists and helping patients navigate insurance questions. It's scary. We're noticing a trend that the patients aren't visiting specialists because the process is cumbersome and unclear to them too, but we don't know what to do about it", said Dr. Miranda.

everyone just did the best they could.

If the provider did know a specialist that they could recommend, they'd refer the patient through the EMR. Claire would see the referral in the EMR, call the specialists office to make sure they were in-network with the patients insurance, and then call the patient. Claire spent a lot of time explaining to patients over the phone what specialists did and how to get to their office. "Dr. Patel's referral pad explained it all for me - I really began to see the whole picture," exclaimed Claire. "It was the first referral form I had ever seen that had everything I spent so much doing! The entire back of the referral form explained to patients what a gastroenterologist does, gave them information about Dr. Patel, had a list of health plans that he was in-network with, had a map to his office and even explained to the patient all of the "next steps" to expect! I was so excited to be able to just tear off a form and see the relief on a patients face."

The solution

The team decided to sit down and create a solution together. Dr. Miranda really didn't have the time but her patients needed a gastroenterologist and something about the way she ran her clinic wasn't getting them there. The problem clearly wasn't Sally and Claire - they had both done their jobs. So they started by writing out the typical flow of each patient through the clinic, where each "step" happened, and who performed it. It took less than 5 minutes.

  1. Patient registration, information updates & check-in | Lobby - Front Desk Coordinator
  2. Vitals | Triage Room - Medical Assistant
  3. Exam | Exam Room - Doctor & Medical Assistant
  4. Lab Test & Imaging Orders, Specialist Referrals | Exam Room - Doctor & Medical Assistant
  5. Checkout | Exam Room - Medical Assistant

was to make patient "touch" points simple

At this point, the solution was simple to create. The practice would start keeping referral pads for the types of specialists they referred to the most in every exam room. If they didn't know a specific specialist, they would create a template with information about that type of specialist. Since this was where the provider was when determining that a patient needed to see a specialist, having the information right at her fingertips made Dr. Miranda's job much easier. Having it on paper made it simple.

She could simply tear off a referral form from the pad and point to the part on the back that explained what a gastroenterologist does as she was explaining to the patient why she was referring them. The Medical Assistant could do a quick check of the insurance right in the exam room since he had both the list of in-network insurance providers and the patient's insurance right there. If everything checked out, the Medical Assistant could simply write the patients name and date of birth on the front of the referral form, scan it into the medical chart, and send it via note right over to Claire.

and personal,

At the end of the office visit, the Medical Assistant could now provide patients with a personalized package that would clarify understanding of their diagnosis and next steps right at checkout. He could not only let the patient know that the information would always be available to them in their patient portal, he could make it personal, accessible, and actionable by providing it on paper right then and there. The package included

(a) a Clinical Summary of their visit with Dr. Miranda that contained their clinical diagnosis and test results,

(b) copies of any new prescriptions or test orders and why Dr. Miranda had ordered them, and

(c) a referral package providing the patient with the information and knowledge they needed to confidently take action and easily secure an appointment with the right specialist at the right time for the right reason.

put checklists in the perfect place,

Claire would then start the referral, using the checklist Dr. Patel provided on the front of the form to make sure the referral was sent with all of the required fields for patient registration, as well as the prior lab tests and imaging studies the specialist needed. Dr. Miranda could then easily open her EMR checklist, access the referral, attach her progress notes from the visit, write a note to the specialist about the reason for the referral, and send it off.

then define, refine & scale the process.

They spent a few more minutes writing up the process. Once they did this, Dr. Miranda said they would pilot the new process in her pod, make adjustments until it was fluid, and then launch it across the practice. If this worked, they could follow the same process for every referral. It would save time, connect patient care, and dramatically improve patient follow up with specialists.

The Single Cause of Most Every Medical Marketing Failure stems from ill-defined or undefined processes that are disconnected and individually managed.

The 3 Simple Steps to Fixing (and avoiding) Medical Marketing Failure:

  1. Make touch points simple and personal - people and paper communicate many things better than technology.
  2. Define who is involved in every process and make sure the documents you create serve that users specific needs. Putting checklists and key information right on the referral form optimized, informed, and connected healthcare. 
  3. Define, refine & scales processes - spend time writing out the processes and hand-off points of the processes that make (or break) your medical practice. Use them. Refine them. Share them. 

Healthcare is complex. Your medical practice is a business with the fiduciary responsibility to stay solvent so that it can provide for you and your staff. Your practice is accountable for delivering quality patient care. Seek solutions that are created for healthcare, by healthcare - this supports the industry, drives down costs, and protects you, your patients, and your business. This article was brought to you by Cynex Healthcare Business, a leader in creating affordable tools that ease the business burdens of medicine. The more you support us, the more we can support you.

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