Strategies for Growing Patient Volume: 4 Gastroenterologists Discuss
Question: Where are the best opportunities for patient volume growth in 2014?
Spencer Dorn, MD, MPH, MHA, Vice Chief, Division of Gastroenterology and Hepatology, UNC School of Medicine, Chapel Hill, N.C., in connection with The Expert Institute: Though it may be tempting to answer new technologies such as deep enteroscopy or Barrett's ablation, the best opportunity for patient volume growth is to increase appropriate use of screening and surveillance colonoscopy. Colonoscopy remains underused by many, including many who are at increased risk for colon cancer.
Lawrence R. Kosinski, MD, MBA, Managing Partner, Illinois Gastroenterology Group, Elgin.: The main source of patient growth is still based on relationships — with primary care providers — with existing patients. Focus on maintaining high patient and PCP satisfaction, this will continue to drive your brand. This means attention to their details, not yours. There may also be opportunities for growth through participation in narrow network health plans generated from the Affordable Care Act. These will be for discounted rates but will push volume.
Mark Noar, MD, Endoscopic Microsurgery Associates, Towson, Md.: I think the best opportunity for growing patient volume is incorporating new procedures and technology that will bring additional patients into the practice. These things should also save time and money in the long run. There are a lot of new technologies available beyond the standard endoscopy; for instance, the Stretta procedure will be a huge way to grow patient volume because it will attract a large and never ending subset of patients.
At the same time, ancillary procedures that are needed when treating these patients will generate a nice income with relatively high return on investment. These procedures are typically performed by a nurse or a technician and have huge earning potential.
Q: What are a few of the biggest challenges when working to drive patient volume to GI centers?
Dr. Dorn: One main challenge is overcoming patient resistance to screening and diagnostic procedures. Many patients are apprehensive about undergoing GI procedures, perhaps due to concerns about safety, pain or frank embarrassment.
Additionally, though the Affordable Care Act eliminates direct out-of-pocket costs for screening colonoscopy, there are still significant out-of-pocket costs for other procedures, and almost all procedures require patients and their accompanying adult driver take time away from work.
Dr. Noar: A huge challenge facing us now is the health insurance system. This year is the first year we saw huge out-of-pocket copays from patients. Traditionally, copays are in the range of $100 to $500 out-of-pocket, but this year we saw more like $2,000 to $4,000 because employers are trying to reduce costs by providing plans with higher copays.
Additionally, we usually see a slow time during the first few weeks or month of the year as patients wait to meet their deductible before undergoing diagnostic or elective procedures. This year, our slow period lasted three months and we are anticipating the same for next year. The smart practices will recognize this as a threat to cash flow.
We're planning to bring in our Medicare patients for the first three months of next year to keep volume up until the patients with private pay insurances have met their deductibles.
Q: How has hospital consolidation impacted your patient volume?
Whitney Jones, Midwest Gastroenterology Associates, Louisville, Ky.: We have had a major consolidation of networks and hospitals, and a strong move towards primary care physician employment. Networks are getting very competitive, and they are trying to prevent leakage or cases going outside network. So we have to work extra hard to keep referrals from the primary care physicians because they are under pressure to not let cases go outside network.
One thing GI physicians might think about doing is considering a joint venture between their endoscopy center and some of the bigger networks.
Q: What are a few of the best direct-to-patient marketing strategies to boost GI center patient volumes?
Dr. Jones: We have really been pushing our web-based presence and we are also allowing patients to schedule online as well as call directly for appointments. We have done mailings to the community that surrounds the center and we have told them that they can come in and do direct access screenings, that is they don't have to come in for an office visit beforehand, they can come in and go straight into procedure. We've done some media, for example, some TV infomercials.
It is a very cloudy time to try and see the future, but I think there will be opportunities and part of those opportunities will be informing the public about the life saving benefits particularly related to colorectal cancer screenings.
Dr. Kosinski: One of our best strategies was to create a set of small business card-sized digital tools that we then placed in our PCPs' offices. Remember, they are busy and see five to six patients per hour. They also may not know the intricacies of a colonoscopy. We provided them a simple tool that they could give to the patients. These were digital business cards for our practice and our ASC. It spurred growth.
Q: Are all marketing strategies based on having an online presence in this day and age?
Dr. Noar: I believe there are many avenues you can use to attract patients, but the tried and true methods of word-of-mouth are the most effective and cost-effective ways to market. The reality is you can spend a ton of money advertising on external sources, but your return on investment is usually very small. Instead, educate your employees and patients about what you do, and that internal marketing will be beneficial.
For example, a few years ago, I incorporated hemorrhoid treatment technology into the practice and once patients saw it was painless and worked really well, they recommended their family, friends and co-workers. For every patient that has that procedure, they refer another 10 to the practice within a month. When you start telling patients you can find and fix their disease and make a significant impact on the way they feel, that internal marketing easily pays for itself.
More Articles on Gastroenterologists:
Physician Leadership in EHR Implementation: Q&A With Gastroenterologist Dr. Patrick Takahashi
Drs. Richard Fedorak, Haili Wang Develop Urine Test for Detection of Colonic Polyps
Dr. M. Babitha Reddy to Practice at New Mercy Family Medicine Clinic
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