Memphis BioWorks ZeroTo510 Program

I truly believe that Memphis, Tennessee is the best city for medical devices. The medical device community here is expansive but close-knit; there are always former colleagues and friends to be found working on new and exciting ventures.

HandMinder Co-Founder Yu Liu, MD, PhD, shows off an early
prototype of the device. Photo courtesy Commercial Appeal.
Last week, the Memphis BioWorks Foundation hosted their ZeroTo510 Investor Day, where 6 start-ups presented their novel technologies and launch plans. The ZeroTo510 program is the first of it's kind in the nation; yet another reason why I think Memphis is THE place to be. (You can read more about the ZeroTo510 program on their website.) I was thrilled to be a part of the program, and had the honor of introducing one of the young companies, HandMinder, at the event.

I initially became involved with HandMinder as a marketing advisor, but find myself becoming more and more personally invested. The team designed a patent-pending device that to easily and cost-effectively rehabilitate stroke patients who suffer from hand dysfunction. It's a groundbreaking technology platform, and the team has a truly mind-boggling amount of neuroscience research experience. It's the beginning of an exciting partnership - they truly have much to teach me, and in return, I hope to teach them a bit about branding and launching not only a product, but an entire business. Very exciting stuff indeed.

What is an "appropriate" referral?

One of the cornerstones of my business is the concept of generating appropriate referrals, as opposed to just getting more butts in waiting room seats. Uninformed or ill-informed referrals are counter-productive for everyone involved: specialists waste time seeing patients that do not truly need their services, patients waste time seeing specialists, and the cost of treating the patients' non-surgical condition increases.

But how does one determine which referrals are appropriate and which are not?

The authors of a recent article published in The Foot Journal evaluated foot and ankle referrals based on whether or not the condition directly led to surgical treatment. (Hewitt. A prospective audit of referral patterns to a dedicated Foot and Ankle surgical service. Foot. 1 December 2011 (volume 21 issue 4 Pages 166-171)  They determined that only 65% of referrals were appropriate based on this criteria. I found it interesting to note that 13% of the referred patients had a condition that warranted no treatment at all from the specialists.

In an ORTHOSuperSite summary of the above journal article, Dr. Carol Frey published an interesting perspective. She argues that surgical rates are not an accurate measure of referral appropriateness. "The best way to judge an appropriate referral is by the outcome," she writes. "Since managed care does not have disparate charges for similar levels of care, it seems that any referral that can obtain a good outcome, is appropriate. Another way to judge an appropriate referral is by cost savings. One recent study in California pointed out that 59% of referrals for foot and ankle care were to podiatrist (as opposed to an orthopedic foot and ankle specialist), and although they cost less per individual treatment, they had significantly more treatments, procedures and visits associated with treatment."

Regardless of the criteria on which we judge appropriate referrals, I think we can all agree with the study authors: "Referral pathways could be improved by greater communciation between [general practitioners] and foot and ankle service with the construction and implementation of referral guidelines which would enhance the referral and treatment pathway to the service.”

Improving Patient Communication

Patient communication. It's a hot topic for hospitals these days. The American Hospital Association places such emphasis on the matter that they have developed materials specifically to help hospitals improve their patient communication (link here). It is emphasized in med school and residency programs, discussed in countless articles. But is it top of mind for you and your practice?

Lest you underestimate the importance of patient communication, consider this: According to a Journal of American Osteopathic Association article, "patients who understand their doctors are more likely to acknowledge health problems, understand their treatment options, modify their behavior accordingly, and follow their medication schedules."(link here) Moreover, as discussed in previous posts, effective communication is directly linked to patient satisfaction.

The JAOA link above has some great tips for improving your own patient communication. In this post, I want to focus on resources that your practice can provide to improve your patients' understanding of conditions and treatments, and thus their overall experience.

1) Printed materials. Certainly this category is not a ground-breaking one. Everyone from the NIH to the AMA provide patient education brochures and handouts. It's not difficult to get one's hands on some free materials, but I want to remind you that free does not necessarily equal effective. Put some thought into the materials that you are providing to your patients. What are you trying to communicate? Are the materials specific enough to each patient, or do you try to get away with 2 or 3 generic brochures that cover many conditions? I particularly like these tips and tricks for evaluating and creating effective materials from the folks at UC Davis. Additionally, if you take the time to develop some proprietary materials for your own practice, you can take advantage of the opportunity to brand and market your practice.

2) Web resources. Is your website a good resource for patient education? Is your content educational and unbiased, free from unsubstantiated claims or marketing overtones? I am all for differentiating your practice and promoting cutting edge therapies, but there is an appropriate place for those messages. Your patient education web page is not it. Your web resources should be thorough, covering all reasonable treatments for a condition. If necessary, provide links to articles both for and against any experimental or controversial treatments. By all means, leverage the abundance of free content on the web. The beauty of the web is that you can easily link to quality resources from your page - just make sure you have the appropriate permission to do so. Make good use of the opportunities that the web affords; animations and videos are particularly informative, and are media that don't translate to a simple pamphlet. Finally, make sure that your patient education section is easy to find from your home page, well-organized, and easy to navigate.

3) Get social. One of the best ways to help patients understand their condition and the benefits (and potential downsides) of a particular treatment is to connect them with patients who have gone before them. Medical device companies are beginning to understand the importance of developing patient communities - one of the best examples is Nuvasive's Better Way Back program that enlists "patient ambassadors" to help set expectations and soothe nerves of new patients. By putting new patients in touch with veteran patients, you are giving them the opportunity to understand the condition and treatments on a very personal level, free from medical jargon and any pressure that you and or staff may unintentionally impart. They may feel more comfortable asking basic questions about things like anesthesia and recovery, helping them to enter into any therapy with realistic expectations, thus improving the chances of a satisfactory outcome. Patient networking can be as simple as maintaining a phone list of patients that don't mind "mentoring" other patients, or as complex as establishing message boards on your website. Get creative!

Referral Sources Part III: Community Referrals

As we continue our discussion of key referral channels, we would be remiss to neglect mentioning the patients that show up at your clinic sans referral. Particularly in this age of technology, many patients are taking matters into their own hands, doing their own research, and foregoing the traditional physician referral pattern. Of course, this is dependent on insurance - but many patients have health coverage that does not require a referral in order to see a specialist.

Reaching these patients requires a completely different approach. Generally speaking (and this depends on your market and your particular strategic plan), I advocate spending a larger portion of a practice budget on the aforementioned referral channels (Physician, Patient) for one big reason. If you "convert" a local primary care physician, he or she will refer to you for years to come. You've reached one physician, but hundreds of patients. When marketing directly to the community, you're trying to reach individual patients. It's the needle in a haystack phenomenon. That being said, improving your reputation in the community can have a great intangible impact on your practice, and can help fill those clinic appointments. Here's how.

-  Improve your online presence. Patients aren't calling a practice out of the blue. They are calling after having looked up "Memphis Spine Surgeon" on Google. They have checked out your website and find it to be professional and impressive. They have looked up your location on Google Maps and find it to be relatively convenient to their home or work. They have read reviews on Google,, or a related site. Even my parents do most of their research online, and they are smack in the middle of the target audience for many of you.  Make sure your online information is accurate and consistent with your practice's brand - in other words, does your website "say" what you want your patients to hear?

- Generate community awareness. That's a nice way of saying "advertise." Traditional advertising methods can improve name recognition and ensure that your practice is top of mind for many potential patients. If you don't have a marketing person on staff, enlist a consultant or agency to manage your advertising campaign which may include TV ads, newspaper ads, etc.. Also important (and cost-effective) is great PR. Make sure the local media knows about your cutting edge procedures and heart-warming patient success stories. Offer to serve as a medical expert on local news shows or be interviewed for articles. As with advertising, it is helpful to hire a Public Relations expert as they have media relationships that prove invaluable.

- Educate. If you know what types of patients you want to attract (a "must" prior to launching any marketing plan), you can provide related educational opportunities for the community. For example, partner with your hospital to host an educational presentation on hip replacement. Advertise the event to your "target market" and offer free screenings to attendees. Have a member of your office staff available to schedule appointments for indicated patients right there at the event. A great way to fill appointment slots with patients that can benefit from your therapies!

There are countless other ways to generate community awareness of your practice. I'd love to hear from you all - what has worked for your practice?

Referral Sources Part II: Patient Referrals

Jump in as we continue a series of articles about key referral sources and how to reach them.

Patient referrals

In today's environment, referrals from past and current patients are some of the most powerful referrals a practice can ask for. Good outcomes and happy patients are obvious keys to encouraging patient referrals, but those alone don't guarantee that a patient will refer friends and family to your practice. Here we discuss how to develop patients into ambassadors for your practice.

The power of "word-of-mouth" marketing

In previous posts, we have discussed that many patients are inherently wary of physician referrals. However, if their brother's neighbor's friend's dog-walker recommends a particular physician, they are likely to heed the referral. Why? Because patients are suspicious of the healthcare system (especially pieces that they don't fully understand), but trusting of their personal network. Tapping into that personal network can be very beneficial for your practice. Here's how to do it.

1. Happy patients, happy practice. I know, I's not possible to have 100% improvement in every situation. There will be patients that can't benefit from surgery, patients that are unhappy you won't operate on them, patients that refuse to lose weight, or stop smoking, or whatever the case may be. But continually go out of your way to explain the situation, educate your patients, and tune into how your patients are feeling - emotionally. 

2. Keep your practice top of mind. In the best cases, patients resume their lifestyles and their previous discomfort fades from memory. So when their colleague mentions he or she is having a similar problem, they may be less likely to dig up your contact information and pass it along. Consistent communication with patients can refresh their memories. My favorite way to do this is via e-newsletter. Collect email addresses from your patients at registration and send a quarterly newsletter with interesting medical news, case studies, practice changes, and so forth. Not only does this keep your practice top of mind, it also provides an easy way for patients to refer: if they come across an interesting article, they merely have to hit "send" to forward to a friend. (Note: I would be remiss to leave out the importance of social media here. Check out my previous post for my thoughts on Facebook applications for healthcare.)

3. Put patients in the spotlight. When you have a "home run" case, ask that patient if she would like to use her experience to help other patients. Many patients jump at the chance to share their story. I like to write up a patient experience and include before and after images in each aforementioned e-newsletter. You can also use case studies on your website, in printed brochures, and in advertising campaigns (I especially like advertorials, which are sponsored pieces that are written like an editorial article). Some practices are surprised to find how cost-effective video production can be. Interview patients, include before and after pictures or video, and post on your own YouTube channel.  Lastly, consider having a list of "patient ambassadors" that new patients can contact to candidly discuss their concerns. 

Physician Referrals and Patient Compliance

Continuing a series of articles about key referral sources and how to reach them...

Physician referrals (Continued)

This first referral source may seem a bit obvious - we all know that primary care physicians refer patients to a specialist when necessary. What is less obvious, however, is how physicians select the surgeons and practices to which they refer. Even less obvious is understanding how physicians decide which patients to refer for surgical assessment, and when. And finally, when a patient is referred to a surgeon, does he or she comply? Why or why not?

Today, we'll answer the final question on physician referrals: when a patient is referred to a surgeon, does he or she comply? Why or why not?

Studies have shown that up to 1/2 of patients are non-compliant when it comes to following their doctor's instructions, and visiting a surgeon is really no different than filling that prescription. It's safe to assume that for every 3 patients referred to your clinic, 1 opts out. But why?

We could spend days discussing patients' objections to seeking treatment from a specialist; I won't pretend that this blog post is exhaustive. However, here are a handful of objections that we actually have the power to impact.

1. Lack of knowledge about the condition and available treatment options. To some, the act of visiting a surgical practice is the same as signing him or herself up to undergo massive surgery. He or she may be unaware of less invasive or non-surgical options, and may wait and wait until symptoms are unbearable before seeking treatment.

2. Suspicion regarding PCP's reasons for referral. I'll admit it. This is me. If my physician refers me to a specialist, I don't blindly call up that particular doc and make an appointment. Rather, I'll get online and do some research to find a specialist that seems highly qualified. There was one exception to this rule, however. My son's pediatrician referred us to an asthma/allergy specialist. Our pediatrician explained to me that he preferred this particular specialist because he has a great deal of experience with kids, and is phenomenal at communicating with the referring physician, making it easier for the pediatrician to effectively manage the patient's care. This helped me to understand the referral (and trust that it wasn't just his med school buddy) and we complied.

3. Patient's choice to visit a different surgeon. Similar to #2, this patient is well-informed. He or she may choose to research specialists online, and may opt to visit a different surgeon based on his areas of specialty, website and reputation. We see this commonly with surgeons who perform minimally invasive surgery - in spite of a referral to another surgeon, patients may seek out a surgeon who performs what they perceive as "cutting edge" procedures.

Referral Sources Part I: Physician Referrals (Continued)

Continuing a series of articles about key referral sources and how to reach them...

Physician referrals (Continued)

This first referral source may seem a bit obvious - we all know that primary care physicians refer patients to a specialist when necessary. What is less obvious, however, is how physicians select the surgeons and practices to which they refer. Even less obvious is understanding how physicians decide which patients to refer for surgical assessment, and when. And finally, when a patient is referred to a surgeon, does he or she comply? Why or why not?

Today, we'll answer the second question: how do physicians decide which patients to refer for surgical assessment, and when?

First, a disclaimer. I'm generalizing. Every physician considers different factors when deciding who, when, how and where to refer. Physicians have varying levels of expertise, and differing areas of interest. Some may be well-versed in spinal conditions, others expert knee evaluators, and yet others cardiac specialists.

But that's exactly the point. A primary care physician cannot be expected to be an expert in everything. It's not realistic, and it's not their job. I would argue that it's YOUR job (or my job, as the case may be) to ensure that the referring physicians in your area have a good understanding of surgical indications and other reasons for referral.

In the absence of educational initiatives and valuable references, which patients get referred? Let's take patients who present with back pain as an example. As you all know, back pain is notoriously challenging to diagnose, and a very small percentage of back pain patients will actually benefit from surgery.

Primary care physicians are likely to refer:

A) The squeaky wheel. The patient who has visited and complained about their chronic back pain for 2 years straight. Referral is the only way to appease the patient.

B) No one. Spine surgery has a bad reputation. Many primary care physicians will only refer patients as a last resort.

B) Everyone. New studies show that physicians feel obligated (legally, financially, or otherwise) to treat patients aggressively. Better to be safe than sorry. Hope you like spending ALL your time in clinic, because that's where you're going to be for the next 5 years. Only a handful of these referred patients are surgical candidates...

If you're with me, none of the above options are all that appealing. However, you do have control over your referrals. By partnering with and educating the referring physicians in your area, you can ensure that the appropriate patients are being referred for the appropriate treatment (PT, pain management, surgical assessment) at the appropriate time. Additionally, you can increase the percentage of patients that you see in clinic that are actually surgical candidates - meaning you spend more time in the OR and less time screening patients in clinic. It's a win for the primary care physicians, a win for the patients, and a win for the surgeon.

P.S. Need help developing a strategy to educate the referrers in your area? Drop me a line.