Physician Sales and Increased Utilization: A New Approach
To say healthcare is a complicate system is a practice in the art of the understatement. At times, it feels like there is too much to take in for there to be an actual curve involved in the learning. Any effort to simplify part of the time of action is extremely welcomed.
There is pressure these days for healthcare systems to add sales personnel as a way of increasing the utilization of their facilities. The daunting task of approaching a physician’s office with the purpose in mind to get them to change their current referral patterns is a road filled with barriers. Not only must the liaison clarify the “what” part of the sales course of action, but also he or she needs to clarify who needs to hear about the hospital. Often, liaisons in addition as administrators make the mistake of targeting only the physicians. Experience shows that practice managers and the schedulers are also meaningful people to target. A structured approach to addressing these individuals and any obstacles to employing your facility can make the time of action more obtainable in addition as assessable. However, for the purpose of this article, we will focus chiefly upon the physician.
When approaching physicians about system utilization issues (i.e. why the physician should use your hospital versus another), there are a few important things to first consider. Knowing how much the physician refers to your system is a good start. This information should be reviewed prior to each office visit. Presenting this data to the physician increases his/her awareness and opens the discussion as to possible usage barriers. At the very least, the presentation of this data gives the hospital liaison a place to begin prioritizing what they would like to see the physician realistically increase. Depending upon the sets your system offers, a shared continuum to consider might be for the physician to increase his/her imaging situations, lab studies, sleep lab patients, rehab patients, direct admits, surgical situations, referrals to system loyal specialists or move their complete practice.
Recently, one of the liaisons at Northlake Medical Center, a 120-bed acute care hospital in Tucker, Georgia, identified a decline in the number of imaging situations they were receiving from one physician whose practice is located in medical office building connected to the hospital. Upon further investigation, the liaison found that the physician was recommending the patients for an MRI or CT examine as usual, then, he would pass the patient off to the scheduler. In this case, the scheduler was new to the practice and loyal to the competing hospital. She independently made decisions to send the patients there instead of Northlake. In this case, ensuring that the scheduler was made aware of the hospital sets was basic to increasing the utilization of the facility.
clearly, part of the success of the facility depends upon setting appropriate utilization targets. Once these goals have been established, a system to classify where each targeted physician is with their motivation to use the facility would be useful. At Northlake Medical Center, the staff has implemented a system to not only clarify where each physician is with their motivation to change, but they have developed specific strategies to help the physician move toward greater utilization of the hospital sets.
The approach that the Northlake staff is using comes directly from the Transtheoretical form. This form is a psychological theory developed by James Proschaska, and Carlo Diclemente. When Proschaska was in graduate school, he found there were over 130 schools of thought regarding how people change their behavior. He conducted a comparative examination on these theories and identified five stages of change. Proschaska and Diclemente first began to apply their form of change when working with smoking cessation patients. The Transtheoretical form has since been used to assist patients with various other addictions, cancer patients, stress management, diabetes and other forms of illness.
Since increasing hospital utilization involves changing physician behavior, the Northlake staff felt the Transtheoretical form would provide a structured framework in our approach. clearly, the “patient” in this case would be the physicians and possibly their staff. The “therapist” would be the physician liaison. The goal of this approach is to help the physicians themselves come up with their own ideas about how advantageous your system would be to their practice.
What makes this form of change so alluring from a physician relations standpoint? This form begins by calculating where the person is in their motivation to change instead of assuming readiness to change. With this kind of therapy, the therapist’s job is not to change the patient but to arouse questions in the patient about the need to change his/her behavior. Using this approach, the therapist assists the patient with initiating the idea to change their behaviors. Given this, people rarely argue with their own ideas which considerably reduces most resistance to change behaviors. It is important to understand that this kind of interaction is not about strength games or manipulation. Rather, this form details an interactional style that challenges the physician to look at what does and doesn’t work with their current situation.
The beginning phase of this form is called precontemplation. Physicians in this phase of change may or may not be ready to change any aspect of his or her referral patterns. There may be a without of awareness regarding your hospital or any other alternatives for their patients. Many hospital systems have to continue with misperceptions regarding their sets or branding issues. Based on this, the physician is clearly not ready to make any changes that would be popular to your hospital.
A physician liaison meeting with a precontemplative doctor will find the interaction lukewarm at best. It is important to be prepared when addressing this kind of resistance to change. Some strategies include basic education about the sets that your hospital offers. Since most physicians do not want to hear lectures about your sets or have time to read brochures, it is helpful to find creative ways to educate the physician. Asking probing questions about referral patterns may arouse defensiveness; however, asking a question like “If the top 5 physicians you refer patients to the most won the lottery and quit, how would you find replacements?” may help acquire the information needed to educate the physician about your specialists.
Some of the questions that the liaison can ask might tap into some of the most basic emotions. Fear and pain tend to motivate people more than anything. A liaison might ask, “How is your practice keeping up with the lowering reimbursement rates?” or “How do you know if your patients are dissatisfied with the facility or physicians your refer them to?” These questions may tap into some of the most basic fears of a physician or practice manger. It is important to tailor your questions in such a way so as to point the physician to the strengths of your facility. These questions also aim at gathering information about the strategic plans of the practice so that you can position your hospital as a resource.
Another strategy that a liaison can use to gain insight into the practice is the “Who do you use” game. The liaison directly asks which local specialists the physician refers to in order to get a feel for the level of satisfaction for these doctors. In many markets, physicians divided between several hospitals. This line of questioning can help educate the physician or practice manager on which physicians also have privileges at your hospital. Helping the targeted physician clarify which physicians come to your hospital can allow you to teach them about the sets of your hospital. One pitfall to be mindful of, however, is that many times, a referring physician will not specify where he or she wants the patient to have a procedure done. If the physician receiving the referral has privileges at your competitor’s hospital, that physician may take the case to the other hospital. In this case, the physician liaison may end up working for the competition. The liaison needs to clarify the issues with the physician and work to provide creative solutions to try to keep this from happening.
The liaison may choose to utilize a variation of the “Who do you use” strategy. This involves asking the physician “Which specialties do you have the hardest time getting patients in to see?” Again, the goal of this question is to position yourself as a resource for the physician or practice manager.
Recently, a Northlake staff member called on a local dominant care physician and asked this question. The practice manager responded that she had a difficult time getting their patients in to see cardiologists. Since the liaison has a good working relationship with the practice manager of the cardiology group at his hospital, he gave the practice manager his card with his cell phone and asked that she call him the next time she has a cardiology patient so that he could help get their patient a prompt appointment. Once the practice manager called the liaison to let him know they had a patient that needed a cardiology appointment, the liaison contacted the cardiologist’s practice manager and asked that he call the dominant care practice. In this case, the liaison needs to follow up in a few days to make sure the two practice managers connected. This kind of goodwill can motivate the physician and his practice manager to begin consider using your facility.
The next stage of this form is called contemplation. At this point, the physician is aware of your hospital and has considered referring patients. But, he or she may be ambivalent about your hospital for a variety of reasons. The physician may have meaningful issues with the facility he or she is currently using but may not be fully aware of other options. clearly, it is a tremendous risk to shift referral patterns thoroughly, but this is an opportunity for the liaison to increase hospital utilization.
One strategy that can be useful for a contemplative physician is to review the risks and rewards associated with sending patients to your hospital. Exploring the risks first allows the liaison to clarify and possibly clarify any misperceptions the physician has about your facility. This course of action also allows for further education along the way. Following up with a review of the rewards of sending a patient to your system sets the tone for overcoming any remaining barriers and will pave the way for the physician to begin changing his or her current referral pattern.
The meaningful to the “risk/reward” strategy is to arouse enough doubt with the physician around the current referral system so that you can begin positioning your facility as the solution. All information should be factual and create realistic expectations. All questions to the physician should be aimed at the most pertinent issues the practice faces which differ with each individual physician. Tailoring the questions to each physician’s needs is a challenge. Once these needs are discovered, the liaison can work to plug their hospital in as the identified solution.
Getting a physician over to your facility for a tour is an excellent tool to increase utilization. This tactic is especially useful with physicians in the contemplative phase. Preparing for the tour could include arranging meetings with meaningful possible referral supplies, fleeting introductions with hospital administration and board members in addition as directors responsible for areas of the hospital concerning the targeted physician’s specialty. Touring the physician allows time for adequate discussion about the assets of the facility in addition as the limitations. Since patient access to the facility is such a strong asset to Northlake, our liaison recently asked a touring physician, “How does your practice measure patient satisfaction and where does patient access fall in the rankings?” This physician felt access was extremely important and was very impressed by the layout of the facility. Describing the hospital layout on a physician call would not have nearly the same impact.
The next phase of the stages of change form is preparation. A physician at this point is clear that he or she wants to begin making changes in their referral patterns and is actively seeking information. The physician may have already sent a few test situations to the hospital and is working to estimate the experience. This is a basic time for the liaison since the physician’s main referral patterns are nevertheless with his or her current facility.
By the time a physician reaches the preparation phase, it is shared for the liaison to have already established a relationship with that physician. Given this, the physician should already have everything he or she needs to refer to the facility (i.e. imaging pads, proper phone contacts, etc.). If the physician has not toured the facility however, this would be a good time to do so. At this point, the liaison needs to begin scheduling meetings between the prospective physician and the medical leadership of your hospital. easing these meetings is vital to the success of both the inbound physician in addition as the hospital. It is also important to look for ways to “wow” the physician in this phase with good customer service. Always overestimate deadlines slightly so that you can get the job done early. This sets the physician up for a pleasant surprise. At Northlake, we often tell the prospective medical staff member that the average time it takes to come on staff is three months. In actuality, our average time for processing an application is less than sixty days. With physicians in the preparation phase, it is also important to regularly measure their perception of your sets. Asking them “What are some ways we can enhance our sets?” will assist in overcoming obstacles to further utilization.
When a physician is actively using your system, he or she can be classified as in the action phase of the form. The physician may or may not be on the hospital medical staff, and there can nevertheless be possibilities to increase utilization. clearly, it is important to review the utilization data on physicians that you have in this classification.
The meaningful strategies involved with physicians in the action phase revolve around integrating them further into your system. This course of action is twofold. First, the physician liaison needs to assist with initiating introductions with possible referral supplies. Inviting them to the physician’s lounge at times when you are aware that meaningful referral supplies will be there is one approach to help develop referral patterns. Second, the liaison needs to conduct regular visits to the physician’s office to ensure they have everything they need to utilize the facility. This also presents as an opportunity to solve various problems as they arise.
The final phase of this form is the maintenance stage. At this point, the physician is using your hospital sets as much as possible. There are few obvious opportunities to increase usage of the facility within that physician’s specialty.
The goal for liaisons at this stage is to monitor utilization data and mirror these numbers back on a regular basis. Many organizations truly provide “report cards” that are posted publicly. The thought behind this is that posting the data contributes healthy competition among the physicians. The liaison needs to continue to visit the physician and trouble-shoot any problems that arise. Once a physician reaches this level in the system, he or she becomes an excellent resource for incoming physicians.
As mentioned earlier, this form provides a structured framework for approaching physicians to integrate them into your medical system. The main goal of this form is to help the physician arrive at the idea that they need your system in order to be successful. A physician liaison using this approach must be ready to guide physicians and often their staff members by major changes in their practice patterns. Making quick assessments as to which stage the physician or staff is in, being knowledgeable about the current utilization trends and using these two information points effectively are all part of the success of this form. The liaison must be willing to weather a physician fluctuating back and forth by the stages for various reasons. The form is not linear; consequently, the strategies can overlap at times and be interchanged.
What makes the Transtheoretical form so alluring is that it addresses all three aspects of behavioral change- the cognitive, emotional and behavioral. This form has been empirically proven to be effective in producing behavioral change. Given this, we think it can be a powerful approach to changing physician referral patterns.