Last month, Vantage was featured on the cover of PT Magazine in an article that focused on the topic of “healthcare consumerism.”  Healthcare consumerism is the shift toward the treatment of patients as “consumers” of their healthcare services, rather than simply passive recipients in their care.  As a result, the focus of many [smart] private practice owners is on the development of services and environments of care that will create loyalty and satisfaction among their patients.

Here is a link to the article - Thank you to PT Magazine for their coverage of such a relevant topic to today’s healthcare environment.

In traditional industry, says Quatre, businesses compete for customers by either lowering prices or improving product quality-say, by building a better widget. “In health care it’s much different because you can have a different service based on your training, your staff, your expertise, and so forth, but can you charge more for that because the quality’s a lot better? Your hands are tied to some extent, unless you’re on a strictly cash-based model. To compete for the customer, what you really need to do is make it an experience with which they would prefer to be involved.”

On a trip back to my hometown of Bend, Oregon from Portland this week, I had occasion to stop for gas in the small town of Madras, Oregon.  Madras is a great little stop because it’s the 45 minute mark before getting home from Portland, and because it has cheap gas.

For those that aren’t aware, Oregon law mandates that the pumping of gas is performed only by station attendants, requiring customers to sit idly by as fuel is purchased.  It’s easy to get used to, and I certainly consider it a benefit of living in the great state of Oregon.

Having the extra time to sit and do nothing provides ample opportunity to think about things like the cost of gas, your kids, and in my case - blogging.  The topic for today’s post came to me after the station attendant approached my window and asked if he could wash my window while he fueled my tank.

I should note that while it’s mandatory for a station attendant to fuel the tank in Oregon, it’s not mandatory (and it’s actually not too common) for the attendant to wash your windows.  It’s even less common for the attendant to do a good job if they wash your windows, and it’s almost unheard of for them to leave the window looking perfect.

This said, it’s no wonder that I was so impressed as the attendant began his work.  Not only did he have great technique, perfectly consistent strokes, and an almost flawless end result - but he was courteous, friendly, and engaging the whole time.  He truly enjoyed what he did, and took visible pride in his work.

Now, as the attendant was performing this work of art on my windshield and I should have been simply sitting back thinking of something entirely different, I couldn’t help but overanalyze the situation.  Was his boss working on the car next to me?  Was he training a new employee who was watching him from afar?  Was he working for a tip?  Anything I could come up with would have helped me to make sense of the situation - I mean, why on earth, in the absence of any external motivation, would this guy spend so much time and energy making my window look so perfect when he didn’t have to?

The answer to the question was in his courtesy, his conversation, and his overall enjoyment of the experience - this guy actually liked what he was doing, and because of it, he did a great - nay, fantastic - job.  He enjoyed the experience, I enjoyed the experience, and I will continue to stop at his gas station, not because of the cheap gas or the 45 minute rest break on my trip home, but because he earned my loyalty by taking care of me in a way that he didn’t have to.

I immediately drew a parallel to what we do in the healthcare field as relates to customer service.  Whether a doctor, dentist, physical therapist, or someone else in the field, we care for people - not windshields or cars.  In doing so, we are able to reap the rewards of benefiting real people who, in most cases, are experiencing difficult times influenced by illness or injury.  People don’t come to see us because we are cheap.  They don’t come to see us because we’re on the way home (patients will drive an average of 5-7 miles to see us).  They don’t come to see us because we’re a good alternative to a dinner and a movie.  People come to see us because they need our help and they want us to care for them just as they would care for themselves (better in most cases).

Not to speak for everyone who reads this blog, but if we can be won over by something as simple as a window washing at a gas station, how easy is it for us to win over our patients for life, simply by giving them all that we’ve got, and by enjoying our experiences with them?  By taking full pride in our services, smiling graciously, and conversing naturally, we’re forming bonds with our patients that are much stronger than can be broken by an insurance company, a referral source, or a patient co-pay. 

More and more I find that it’s easiest (and probably the most important) to learn from the simple experiences in life - those that can be learned from even a gas station attendant.
____________________
Tannus Quatre is a passionate blogger and writer, as well as a principal/consultant with Vantage Clinical Solutions.

Everyone loves a holiday.  Thanksgiving, Memorial Day, the Fourth of July…most of us get a day off and enjoy spending time with family and friends.  I know I do (except, of course when the family is out of town and I choose to spend the day blogging instead of watching the Fourth of July pet parade).

As cool as they are though, holidays are like just about everything else that’s good in life - they soon become taken for granted and the true meaning they were originally intended to bring soon play second-fiddle to what we’ve made of them.  The Fourth of July is no different, but today I did want to take a step back from the fireworks, put the watermelon down, and comment on the concept of freedom in America, and how, if at all, this impacts the healthcare industry (believe me, I’ll get to the fireworks and watermelon a bit later).

We often hear about “freedom” and “independence” in America, and how the “land of the free” is one of the most sacred constructs of our way of life in this country.  I agree that it is.  We are free to choose how we live, free to go where we want to go, and free to do what we want to do.  Freedom really is a pretty cool thing, and even though many of us prefer a cold beer and a hamburger on Independence Day rather than a deep discussion about our founding fathers and the Declaration of Independence, I think it’s OK as long as we’re living “freedom” and “independence” in our everyday lives, providing living testimony to the significance of our freedom.

Living “free” has many benefits, and has allowed our country to evolve into the technologically advanced and economically powerful force that we are today (Did I just say that?  Give it a couple of years, we’ll swing back around).  Living free allows us to express ourselves creatively and try new things, hoping to improve ourselves and others through an endless pursuit of the biggest, the brightest, and the best.  And while many fall down in their pursuits (I know I have), we as Americans are free to stand back up, try again, and get it right the next go around.

Now, freedom, as great as it is, is an interesting concept as related to healthcare.  In my opinion, there’s no other industry in which freedom should play more of a role - innovation, creativity, compassion, progress, and many other by-products of freedom form the cornerstone of the healthcare industry, allowing us to care for each other, improve the quality of our lives, and form the foundation for future generations of healthy individuals.  The problem is, this isn’t the way it works.

Unfortunately, the healthcare industry is far from “free.”  On the provider side we don’t have the freedom to choose the treatments that we know will help our patients because they aren’t reimbursed, we don’t have the freedom to spend the time we need with our patients because we need to see large volumes in order to keep our doors open, and we don’t challenge the system with new business models and delivery methods because of fear of professional fallout and failure.  On the patient side we don’t have the freedom to choose our providers because they aren’t part of our insurance plan, we don’t have the freedom to leave our employers because they insure our health, and we don’t have the freedom to work as a team with our providers because they don’t have the time to spend with us.  Doesn’t sound too “free” to me.

So, what’s the answer to this apparent lack of freedom in healthcare?  Well, I think it’s entrepreneurship.  I think we need to spend more time evaluating the drivers of good healthcare, and how to align the incentives of our healthcare business models with those of our patients (our “customers”).  I completely understand the argument that there are many who will fall through the cracks in a system that doesn’t provide a safety net - I get it, and I agree.  I don’t agree however that the safety net should effectively reduce the “freedom” of our best and brightest to find new, more efficient, and more profitable ways to deliver healthcare to our country - entrepreneurship as I would call it.

There’s not a simple fix to the healthcare problem in America, but I firmly believe that innovation and creativity is the foundation from which the tides will begin to turn.  Much of our freedom has been lost in the healthcare industry, but the good news is that getting it back is not as far off as one might think.  Making the decision to say “no” to insurance companies that won’t allow you to provide good care and deciding that you will find a way to be profitable using new, perhaps even untested business models in your area is a profound, but good first step.  There are many great new models of care out there that may or may not work change healthcare as we know it.  But my hat is tipped to all that are trying something new in an effort to be “free” and to improve our system through innovation, creativity, and entrepreneurship.
____________________
Tannus Quatre is a passionate blogger and writer, as well as a principal/consultant with Vantage Clinical Solutions.

I deal quite frequently with the topic of consumer choice in healthcare, and what private practices can do to be the “provider of choice” in an increasingly patient-centric business (healthcare revolving around the patient…novel concept, eh?).  If you’re interested, you can read my post from a few days ago about the Solucient HealthView Plus 2006 study on the topic of “healthcare consumerism” by clicking here.  I love the shift of decision making power to the patient as it requires that providers and insurance companies really work hard to compete for business, improving services and experiences in the healthcare sector.

Here is a great post on the same topic by Peter Lucash at the Medical Practice Business Blog which discusses the interplay between the physician, insurance company and the patient in regard to patient choice.

Consumer choice is likely to be part of the universal coverage system that will be enacted in the US. This will mark a shift in the dynamic, where the patient will be more open to a marketing approach from physician practices. This is a time to be creative, perhaps working with other groups on patient education and prevention programs that will benefit. Every fall, I climb up on my bandwagon to promote “vaccine day” – if the local drug store can do it, so can (and should) you. In short – look for ways to engage your patients and community and build relationships.

 

The evolution of healthcare in the US is evolving in some interesting ways, and we will certain major changes in the coming few years. The shift to truly portable health insurance, even where employers step in, will put more decision making in the hands of consumers. From a business perspective, position yourself front and center to the patients.

Patients are becoming savvy about their choices as related to healthcare, which is causing a shift among providers and medical facilities throughout the U.S.  I see this on a daily basis as many of the private practice clients I work with are becoming more in tune with how to “satisfy” their patients rather than simply provide them with good clinical outcomes.  I view this as good for our healthcare system as the view of the patient as a “consumer” of services, and not simply a diagnosis or statistic should ultimately support a patient-centric basis for creating and operating private practice medical facilities.

This article from The Health Care Blog speaks to the concept of healthcare consumerism as relates to consumer attitudes toward web-based healthcare, citing research conducted in order to quantify the presence and nature of this trend in the United States.

One of Dr. Safavi’s opening slides came from Solucient’s HealthView Plus 2006 data, and was focused on “Quality-Driven Consumers,” people who are “likely to research ratings information on hospitals or doctors,” and likely to change providers if the one they originally preferred received a low rating. Strikingly contrary to the conventional wisdom, this group makes up only 19%, or one-fifth, of American adults.

The other categories are equally interesting. About one in eleven of us (9%) are “likely to research” but “unlikely to change.” This group goes through the motions of investigation but won’t switch when they find information counter to their original preference. 

One-third of us (34%) lackadaisically go with the flow. They are “unlikely to research” and “unlikely to change.”

And (this is my favorite) nearly two in five of us (38%) are “unlikely to research” but “likely to change,” traits one audience member suggested be renamed to “Ignorance On Fire.”)

Business schools teach of the importance of knowing one’s competition: the strengths, weaknesses, marketing techniques, customer sources, and on and on.  Knowing one’s competition when running a medical practice uses much the same theory, and knowing about the practice across the street is just as important as knowing your own practice if you’re going to effectively spread the word about why your practice is different, if not better.

As healthcare reimbursement has evolved over the years, we’ve seen medical practice revenue models morph from primarily 3rd party payment to a mix between insurance payments and out-of-pocket cash from patients.  Many practices have moved to a completely cash based model, and you’ve seen examples of this through the development of cash pay retail clinics as well as in the rise of cash only concierge medical practices.

With this shift in revenue stream comes a whole new complexity as pertains to the “sale” of healthcare services to the public.  If a practice is now going to ask a patient to pay out-of-pocket for a greater share of their healthcare expenses (and in many cases, 100% of the payment), the service-based competition between that practice and the practice across the street becomes less relevant.  The bigger issue becomes how to compete for the dollars that patient might like to spend in the retail, automotive, or entertainment industries.

One part of the marketing equation has to do with differentiation; the how-to of making my practice look different from the one across the street.  This part of the equation is fairly easy in the case of cash based practice models.  By charging cash, service quality can increase dramatically through a smaller per-provider patient base, and often times the environment of care will be highly differentiated through more of a personalized, perhaps even spa-esque facility.

The tough part about cash pay medical practices is not competing against the neighboring practice though.  The tough part is competing against the purchase of discretionary items such as new cars, vacations, and flat panel televisions.  Unfortunately, (or fortunately, depending on which side of the coin you’re looking at), Americans view out of pocket expenditure for healthcare services to be discretionary.  For the most part, I believe this to be true, as when given the option between paying 100% cash for healthcare versus using a traditional healthcare practice that bills to 3rd party insurance, we do have a choice to keep more money in our pocket by using the traditional medical practice that will both delay and reduce our out-of-pocket responsibility.  Convincing the public to pay for healthcare, which can often be covered by insurance (or worse, not provided at all), when there is no alternative payment system that will put a flat panel TV in the home, is a challenging proposition.  To do this requires significant differentiation of the entire healthcare experience, such that patients are not merely buying an EKG or physical exam.  They need to be buying convenience, experience, and perhaps even status, when paying for concierge medical services or physical therapy sessions from a cash pay PT clinic.

Many have tried to integrate cash pay models into their medical practices.  While many have found a market and niche that works perfectly to support such models, others have come up against some of the issues discussed above.  This article from Medical Economics tells the story of a physician practice that wasn’t so fortunate, and I feel there are many lessons to be learned about how, when, and where to choose a cash pay model, and how to limit your risk along the way.

Our policy of trying to save patients money—combined with our patients’ reluctance to file claims because of the hassle—had backfired. And so, while we had more than a thousand patients, with many new ones coming in every day, few came for follow-up visits. And with receipts stagnant, the prospect that the business would somehow grow in the future was unlikely. I held on a little longer, but, five years after opening my cash-only practice, I finally sold it—lock, stock, and barrel—to our local hospital system. I’m now an employed physician, seeing many of the same patients I saw as a private practitioner. When I ask, they tell me they preferred the level of care they were getting before.

Looking back, the reality of what happened still stings. Despite our best intentions, sound financing, and perseverance, we couldn’t make our model work. That’s the message I deliver to any physician who asks me about my experience. Not only must patients value your service, but you must realize your own worth as a physician and act accordingly.

In recent years, private practices within the healthcare industry are seeing more and more appeal to the “consumer” rather than the “patient.”  This shift is likely due, in part to a number of influences; (1) increasing competition among private practice facilities require differentiation through overall quality of experience, rather than solely on clinical outcomes, (2) increasing co-pays required by patients at the time of service cause patients to be selective about where they spend their money, and (3) there are many consumer-based services and products within the healthcare industry that can command a premium (teeth whitening by dentists, for example).

Here is an example of a dental office in Central Ohio that is making the appeal to the healthcare consumer through comfort, fun, and technology.  I would go here…wouldn’t you?

Infinite Smiles’ interior features a spacious 7,800-square-foot floor plan with a warm, inviting décor, 20-foot ceilings with changing LED lights, fiber optic panels in patient waiting areas representing sunrise, sunset and a starry night, color corrected lighting throughout the office to simulate daylight to allow for optimal color matching, a patient juice and coffee bar, two stone-faced fireplaces, a 1,001-gallon saltwater aquarium, blankets and flat panel televisions positioned throughout the facility.

Established patients also are welcome to use the fully-equipped combination study and den complete with plush leather chairs, flat panel TVs, phones, faxes and e-mail access.

“Our customer-centered approach is designed to continually evolve over time. When better procedures or new technologies surface that will help our patients, they will be integrated into our practice. This will help Infinite Smiles remain one of the most advanced dental facilities in the nation,” said Dr. Patel.

Daycare for patients’ children is one example of services that will be offered in 2008 to make it easier for parents to receive dental care. Patients can even borrow umbrellas in the event of rain.

This is an interesting article on the growing trend toward consumerism in healthcare, whereby patients not only want to be made better, but they want to feel good while doing it.  Growing competition for healthcare dollars has lead to improvments in the delivery of the healthcare experience throughout the United States.

Today’s consumers expect more from their healthcare providers. They expect care that goes beyond the clinical experience and demand that it be fast, convenient and of high quality. We must continually seek ways to improve the customer experience along the entire patient continuum — from acquisition to service delivery to retention.

…”Consumers will be judging healthcare services as they would other retail transactions, expecting transparency in price and quality. And with those variables becoming easier to discern, customer service will become the key differentiator in healthcare choice,” according to a white paper from The Beryl Institute.

With reimbursement woes abound, healthcare practices are increasingly turning toward cash-based options for a portion of their revenue.  This article offers 6 tips for opening a successful medical spa.

“Medical Spas are a natural progression of medical practice expansion, having a medical doctor run them gives them the credibility and public confidence needed for their success,” says Jeff Russell, executive-director of the IAPAM. Physicians need to find a way to utilize their skills to expand the scope of their practice. The growing demand for personal attention and service in medicine may provide opportunities for physicians who see the benefit of addressing these needs.