One of the keys to a strong brand is the ability to connect, or identify with a customer.  A brand that stands for something positive, has a nice [aesthetic] image, and attracts others like ourselves can be very successful in developing a strong following.

This is, of course, true of consumer brands such as Starbucks, McDonald’s, and Budweiser, but is also very true of professions such as medicine, osteopathy, physical therapy, acupuncture, and dentistry.  With regard to consumer goods, you probably know people (maybe even yourself) that would NEVER go to Starbucks, ALWAYS prefers Budweiser to Coors, and would NEVER be caught at a fast food giant, namely McDonalds.  Now, NEVER and ALWAYS are strong statements, which illustrates the power of the brand to help consumers identify with a good or a service.

A brand stands for something.  It’s a promise of a certain experience, a certain expectation, a certain way of doing things.  Because a brand represents something greater than itself, it can have much power over an audience to influence feelings, emotions, and behaviors - even to the point of making consumers ALWAYS or NEVER do something.  Pretty powerful.

The same is true of the healthcare professions.  Healthcare professions, while looking different than consumer brands, have all of the same attributes and are used in the same way.  Consumers (i.e., patients) identify with certain healthcare professions, and not with others.  I know people that will ALWAYS seek a physical therapist and NEVER a chiropractor.  I know others that would ALWAYS seek a medical doctor prior to seeing an osteopath.  Now, is this because a chiropractor is unable to help someone that needs physical therapy, or would an osteopath necessarily take a patient down the wrong path compared to a medical doctor?

No, not at all.

This is the power of branding.  By identifying with a certain consumer group or patient segment, healthcare professions, like other consumer goods and services, can influence behavior to the point of the ALWAYS and NEVER statements illustrated above.

So, how does this impact my healthcare practice you ask?  It impacts your practice and your profession (whatever it might be) because it is the brand conveyed to your target patient population that will drive whether or not you are successful in attracting patients in your area.  Whether or not patients in your community identify with your practice or your profession is a critical piece to the overall success of your practice, and it is wise to consider this as part of your overall marketing strategy and communication plan.

Make sure that your practice and your profession are finding ways to identify with your target patient population, and you will find yourself on the receiving end of the ALWAYS statement mentioned above.

In football, each offensive play is preceded by a quick huddle.  In the huddle the quarterback communicates the offensive plan to 10 other players who then go out and execute to the best of their abilities.  If the quarterback is a good leader, and all players can execute the plan well, the potential exists for a successful outcome - perhaps a first down or even a touchdown.

Now imagine if there were no quarterback and no huddle.  What if the best 11 players from the team simply went out and played to the best of their abilities.  We’d probably see some hard hits once in a while, some pass completions, and a few good carries now and again.  If good athletes were involved, the chances of seeing some “magic” here and there would be good…but not great.

Without a leader and a tactical plan in place, the “magic” would be few and far between compared with what could happen with proper planning and leadership.  We’ve all seen underdogs that were given no chance of succeeding against larger, stronger, and faster teams (look no further than last night’s Oregon State upset over #1 USC for my inspiration for this post).  And I’d argue that when this happens it is only through sound leadership, delicate coordination, and tactical execution that this happens.

The same is true in healthcare.

Our system needs strong quarterbacks.  When we go out to tactically execute the diagnosis and treatment of illness or injury, often requiring a team approach, it requires someone to be in charge and communication to take place.  A plan must be outlined and executed well if we are going to see the “magic” take place in our healthcare system.

Now, we kind of do have quarterbacks in healthcare, and who they are depend on the environment of care we are talking about.  For most healthcare needs, the primary care physician calls the plays and coordinates the execution of the plan of care - our most popular quarterback.  We also see quarterbacks in physical therapy (the direct access model is catching on and continues to show much promise), dentistry, and a number of other autonomous healthcare disciplines.  The problem in healthcare is that there is no consistent quarterback for each incidence of care, allowing us to often get too few or too many involved (not to mention that our execution often starts from the line of scrimmage rather than from the huddle).

Much of this is economy and policy driven, leaving our healthcare quarterbacks without the time to develop, communicate, and run the plays necessary to provide the best care.  I’d argue that the 7-10 minutes that is often allocated to a patient would look something like a 3 second play clock between downs on the football field.  How well would your favorite team execute under those circumstances?

The other part though, is that there lacks a cohesive infrastructure that allows our primary care physicians and other healthcare quarterbacks to effectively and efficiently communicate and transfer information and knowledge to the other parts of the team.  The information systems, payment schemes, and overall operations within healthcare often allow us only to see the yard marker in front of us, not the endzone that we’re striving for.

The Florida Times-Union published an article today on the topic of healthcare coordination as relates to the priority of healthcare reform by our presidential candidates.  It is a good look into the four areas necessary to effectively coordinate the care of our healthcare system, much the same as we will continue to see our college quarterbacks coordinate and execute plays on football fields across the country this fall.

Are you actively planning for your retirement or will you “work until you drop”?  Healthcare practice owners are no exception to the habit of business owners (and people in general) in delaying the planning of their own retirement.  Many just have enough time in a day to take care of patients, address a few management issues and go home to live their personal lives.  There isn’t much time for long-term planning - especially something as distant as their own retirement.  We all read the frequent stories about the number of individuals in their 60’s that have no savings and are forced to continue working to be able to survive.  Again, healthcare practitioners are no exception to this.

Why [do] doctors do such a bad job planning for retirement? I haven’t found a good answer to this anywhere, but as usual I have a few theories:

1. We are average Americans, and we suffer from the same “oh-well-I’ll-cross that-bridge-when-I-come-to-it” mentality as average Americans.
2. Unlike people who work in other professions, I think we also suffer from the traditional image of Marcus Welby, M.D., who never retired. Heck, he never took a day OFF! There is still an idea out there that doctors don’t really retire until their health no longer permits them to do the job. Even doctors of my generation, who don’t want to work until their bodies give out, haven’t caught up with the notion that they have to plan for the day when they stop working and, consequently, stop earning.
3. We don’t have time to plan our financial future, or at least we don’t think we have time. In truth, we don’t have time to waste and we should be planning right now. Many physicians hire accountants and financial advisors to do the planning for them, but this is an expensive business and doesn’t solve the problem of becoming an informed investor and steward of your own future.

This recent post on ruraldoctoring.com not only lists some theories as to why it might be difficult for healthcare practitioners to work on retirement planning but goes on to give practical steps in actually creating a good plan for the future.  Check it out…it is not too early!

We understand the business of healthcare.  Well, at least we think we do.

From our perspective, “business” has a role in healthcare, and we believe that in today’s healthcare arena we can’t stand around and expect things to get better unless we contribute to the solution ourselves.  At Vantage, the particular tool we use to effect change within our scope of influence is pretty simple…it’s entrepreneurship.  There’s not a single way we do it, not a perfected process that we share with the world, and we often don’t even use the same ideas twice.  Entrepreneurship doesn’t work like that, at least not around here.

To us, entrepreneurship is always a unique process, but it does involve three common elements: (1) the recognition of opportunity, (2) the acceptance of the risk required to take advantage of the opportunity, (3) and the enjoyment of the rewards that [may] follow from entrepreneurial endeavors.  By involving these elements in the development of private practice business models within healthcare, practice owners will find a way to navigate through whatever the economy, government, or corporate America throw our way.

The trick is not knowing how to “fix” the healthcare system.  There isn’t a single fix.  The trick is being creative, innovative, and entrepreneurial in our approach to today’s healthcare environment, and with this, being willing to experiment and learn about what works and what doesn’t. 

There are many business models in development today (and many that have been in development for years) that might, and might not change the face of our healthcare landscape.  But, in the same way that the creation of some of our most valuable inventions and most successful business models of today started with nothing more than a few visionaries willing to accept some risk in order for the chance at some future reward, so our healthcare industry exists as well.

On The Healthcare Entrepreneur and at Vantage Clinical Solutions, we look first to encourage entrepreneurship within our industry, and second at the merit of the ideas that come our way.  Bad ideas can be refined into good, but ideas that are never brought to the table can do nothing to help our current healthcare situation in America.

In a recent post on the Health Business Blog, David Williams also acknowledges the role of entrepreneurship within healthcare, and provides examples of entrepreneurs within a variety of areas within the healthcare industry.  It’s a great post and a quick read, so take a look.

I’d like to suggest that entrepreneurs and private industry more generally are underappreciated assets in the health reform debate –and that just possibly some entrepreneurs are already in the process of helping the country turn the corner on key dimensions. If that’s true, the role of policymakers –and voters– becomes clearer and more achievable: to create the conditions under which entrepreneurs can thrive.

Healthcare providers work hard to care for their patients. Providers always want to spend more time with patients. The requirements to meet patient expectations, complete the documentation required and submit billings sometimes leaves little time to make sure that the payments from payers are timely and accurate. A recent study by the AMA grades insurance companies, focusing on their ability to process and pay claims appropriately. It is worth spending the time to insure accurate and timely payment.

 “The goal of the AMA campaign is to hold health insurance companies accountable for making claims processing more cost effective and transparent and to educate and empower physicians so they are no longer at the mercy of a chaotic payment system that takes countless hours away from patient care,” William A. Dolan, an AMA board member, told the Chicago Tribune.

 

One of the most fundamental tenets of economics is the law of supply and demand.  I love it myself because it’s pretty darn simple, and makes sense to just about everyone…that is, if “everyone” doesn’t include the healthcare industry.

At the most basic level, you’ve got two components: supply and demand.  There is an inverse relationship between the two, so independent of external factors, when one goes up the other goes down, and vice versa.  This allows business owners who have properly positioned themselves in high demand industries or niches to reap the benefits of increased demand for their products or services.  The benefits usually come in the form of increased profits, and one must look no further than the oil industry for an example.

As the [perceived] supply of oil drops, demand increases, and with it - prices.  This is where the free market brings equilibrium into the equation, because as prices increase in response to rising demand, the demand will eventually taper off as consumers find substitutes or decide to live with less of the products and services they’re buying.  With oil it’s slightly tricky as not only do we all need it - we have a hard time living without it.  Whether we’re driving to work, flying across the country, or buying groceries, oil is responsible for most aspects of our lives, and therefore remains in high demand - kind of like healthcare.

So, using oil as an example of how rising demand due to decreased [perceived] supply works, one might assume that this would apply to other important areas of our lives such as retail, commodities, manufacturing, and healthcare.  The answer to this is, true, true, true, and…you guessed it - false.  The same doesn’t actually apply to healthcare, at least not primary care - and this is why.

Our system of reimbursement in healthcare is such that we pay for procedures, not “brain time.”  Sure, we want the smartest doctors, brilliant physical therapists, and the best dentists…there’s no argument there.   We just don’t want to pay for the thought processing.  We want to pay for procedures, much like we’ll pay an auto mechanic to “fix” our car - not to tell us what’s wrong with it.  So, what happens is we have patients who demand primary care services, but it’s not really their voice that matters.  If it’s not demanded by the payers, and isn’t associated with a corresponding increase in price for services (which ties directly to physician wages), we don’t really have a working supply and demand relationship that results in pricing and supply equilibrium in the healthcare marketplace.

Interestingly, supply and demand works pretty well on the provider side of the equation, where the price for services is a clear driver of doctor supply.   Doctors entering medical school today see what’s going on in the industry bright as day and they realize that if they aren’t going to get paid adequately in primary care (i.e., increased price doesn’t provide incentives to meet the growing demand) they will shift away from the specialty, hence further decreasing the supply.  This is, in part, the reason for the burgeoning of mid-level providers such as family nurse practitioners (FNP’s) and physician assistants (PA’s) throughout private practices and retail health cinics.

On the patient side, where the care is being demanded, it would be great if rational economic forces existed to drive up the price for healthcare services in the primary care specialty (hence, bringing supply and demand back into equilibrium), but this doesn’t happen because the patient and they payer aren’t one in the same.

Looking closely at our 3rd party payment system it is quite clear that we’re in this situation because we’ve created it by destroying the laws of economics as relates to the primary care specialty, creating an absence of incentives to enter the profession.  With a lack of adequate incentives in the educational system to encourage primary care physicians to enter the profession by forgiving loans, and without providing substantial subsidies for those starting primary care practices in underserved areas, we are left with a growing shortage of physicians willing to staff the entry point of our healthcare system, the primary care practice.

The University of Missouri recently released a study indicating that the United States could face a shortage of 44,000 primary care physicians by the year 2025 if incentives are not put in place to bring equilibrium back into the healthcare system.  So, it looks like we either create a system that is funded well enough to pay for all healthcare services for everyone (and figure out a way to keep providers incentivized to work hard, innovate, and progress - and also figure out how to prevent overutilization by patients), or we stop considering “business” and “economics” dirty words in the healthcare industry and allow physicians, physical therapists, dentists, and optometrists to enjoy the benefits of entrepreneurship, competition and free market incentives.

By 2025, the wait to see a doctor could get a lot longer if the current number of students training to be primary care physicians doesn’t increase soon, according to a new University of Missouri study. Jack Colwill, professor emeritus of family and community medicine in the MU School of Medicine, and his research team found that the U.S. could face a shortage of up to 44,000 family physicians and general internists in less than 20 years, due to a skewed compensation system that rewards specialists increasingly more than primary care practitioners. The researchers are more optimistic about the future supply of general pediatricians.

The rising cost of health care, slumping economy and increasing numbers of uninsured Americans continues to bring health care issues into the spotlight.  In addition, the upcoming presidential election feeds the rhetoric for health care reform.  As policy changes are discussed and decisions are made it’s important to remember that “more” is not always better. A post by Niko Karvounis discusses several studies which indicate that “more” does not mean better quality, improved outcomes or increased patient satisfaction when it comes to health care.

Finally given the results of the JAMA study regarding spending and patient satisfaction, one can’t help but wonder: Is it the patients or their families who are demanding more care at NYU?  How many patients really want to be poked and prodded by ten or more specialists? How many ask to die in an ICU?

I’ve been reading more in the press about the use of remote technologies used by physicians to communicate and monitor patients.  The technology exists, so using it for this purpose makes perfect sense.  I’ve even learned of some companies building this type of technology into their core business models which I believe to be a very exciting development in medical care (more on that in a future post).

In this post from Peter Lucash at the Medical Practice Business Blog, Peter reports on the use of wireless networks and video communication for just this purpose, and draws a very good parallel to the introduction of a now standard piece of office technology to the development of improved communications between physicians and patients in the 1990’s: the fax machine.

Wireless networks have the ability to carry voice, data and video. The latter becomes particularly interesting when we realize that a camera can be brought to the patient, regardless of where they are. This very portability is what makes this technology so powerful. In rural parts of Japan, nurse practitioners are using cell phones to transmit fetal monitor tracings to Ob’s at the nearest hospital (in one case, 200 miles away) for review and guidance before moving a patient several hours. AT&T offers a service dubbed “AT&T Video Share” where users can take and send live video from their mobile device – allowing another mobile phone user to see exactly what they are seeing.

Here is a great post from a physician who asks the very valid question: Why don’t we pay more for better service in the healthcare? 

Whether defined by more experienced physicians, better bedside manner, or increased time spent trying to figure out exactly what’s wrong, better quality doesn’t affect the bottom line in a medical practice - physicians get paid the same even though they’re acting different.  This poses a natural barrier to incentive which doesn’t favor improved care in the U.S.

The solution isn’t simple though.  In a system that already lacks for enough to go around (money AND physicians), how do you pay better physicians more and still subsidize those in need…

How we pay physicians creates problems.  We have a totally irrational payment structure, which discourages thinking and encourages doing.  We have a payment structure which drives physicians towards speed and away from careful consideration.

Unless we recognize the importance of the payment system and revamp that system, we will continue to get what we pay for - quick, incomplete visits - too many procedures - unwillingness of physicians to communicate with emails and phone calls.  And just remember not to blame the physicians.  They are making economically rational decisions.  If you design payment as Medicare has, you will reap the weak seeds that you have sown.

Those that read this blog regularly will probably understand my perspective on private practice healthcare - it has to be run like a business in order to survive.  If run properly, healthcare practices can be in a position to provide excellent care and community benefit with resources to spare for those in need.

So, in an effort to run a medical or dental clinic like a business, wouldn’t it make sense to know what the odds are of getting paid for services?  You can bet that those selling cars, credit cards, and mortgages want to know the likelihood of payment before they sign their end of a payment contract.  A default 6 months ago on an auto loan might make it difficult to finance a new mortgage as there is a higher associated risk with those who have demonstrated bad credit history.

Enter healthcare.  Should the same rationale apply?  Does a defaulted loan mean that a patient is less likely to pay their medical bill on time?  My natural intuition tells me that this could be the case. 

This begs the question - should medical practices use credit history in their analysis of their patient base?  The hospitals are saying that this information simply helps them determine which patients will qualify for financial assistance, but I would also wonder if in some settings this information could be used to determine which patients to accept and which to refer elsewhere.

In a March 18th post at the Wall Street Journal Health Blog, Jacob Goldstein discusses this very topic and illustrates how hospitals are beginning to use information from Equifax to determine which patients are likely to pay their medical bills, providing hospitals with much valued information about their patients’ financial status.

To figure out which patients are likely to pay their bills and which ones are best written off as charity cases, hospitals are peering into patients’ financial records.

Some are using traditional credit scores that are used for things like car loans and mortgages. Others are buying reports specially tailored to predict the likelihood that a patient will pay a big medical bill, the WSJ reports.

Hospitals say it allows them to figure out more quickly which patients qualify for financial assistance programs, and makes them less likely to hound people who can’t or won’t pay. Some consumer advocates warn that the process could lead hospitals to deny elective procedures to patients unlikely to pay. Hospitals say that isn’t happening. Advocates also warn hospitals might push people to tap high-interest lines of credit to pay for medical bills.