How-To Insights For Expanding Your Practice

By John Guiliana, DPM, MS, Lynn Homisak, PRT, Richard S. Levin, DPM, Hal Ornstein, DPM, and Charles R. Young, DPM

When looking to expand your practice, there are an array of tactics you can use to help bolster your patient base. You could take a closer look at advances in technology that could either provide a new service for patients or enhance efficiency. Enhancing your Web presence is another avenue you can take. Embracing continuous quality measures is another approach. However, the consensus among practice management experts is that physician referrals are the golden nuggets of a successful practice. For maximum effect, you should target the gatekeepers at the practices of internists, general practitioners and family medicine specialists. The gatekeepers have a firm hold on the faucet of patient referrals to our offices. Establishing good relationships with these individuals will serve to change the patient flow from a dribble to a solid outpour. A supportive gatekeeper can easily create a steady flow of new patient referrals into a specialty practice. The two most effective ways of interacting in a positive manner with targeted gatekeepers are through social interactions and reciprocal referral activity. Social activities might include a sporting event, athletic competition, private club events or some other shared interest. Reciprocal referrals are extremely effective. In short, make an effort to refer patients to the gatekeeper for medical care. This demonstrates your professional confidence and helps to invite further referral activity from the target source. A third important way of influencing referral activity is to market a sub-specialty area of interest. While you cannot be everything to everyone, you can select one or two areas of interest and develop specific levels of expertise within those fields. It is then essential to market or communicate these available areas of interest to the gatekeeper in the hopes of encouraging increased referrals from his or her practice. How Your Staff Can Help Build Referrals Building referrals does not stop at interacting with other practitioners. It’s also a great idea to have your staff reach out to the staffs of other doctors via a “Lunch and Learn” session. Neil Baum, MD, an urologist who has written multiple books on marketing a medical practice, initially popularized the concept. The program runs on the premise that a significant amount of referrals is generated not by the doctor but by his or her staff. Therefore, staff runs the program for staff. Start by developing a list of target practices from which you would like to see referrals. These can be practices that you see patients from already or practices that are not currently using your services. These may include family practice, internal medicine, endocrinology, rheumatology, chiropractors, orthopedics or other podiatrists. Prioritize the list and start with the offices you know. This makes it easier for you and your staff to get started with familiar people. “Lunch and Learn” allows the staff from other offices to tour your office over lunch and learn what a podiatrist actually does. Your staff in turn will learn about what they do in their office as well. Your staff may opt to go to the referring practice with lunch if that works better for them. The DPM is not present for the program, which allows the staff to conduct the “Lunch and Learn” session on their own. As with any new program, you should coach your staff on how to run a “Lunch and Learn” session. Script out the phone invitation for your receptionist. Cover the topics you would like to see discussed during the 45-minute program. You want the visiting staff to leave with a greater appreciation for the services you and your staff provide. Maximize Your Web Presence In today’s age of sophisticated technology, it is unrealistic to think your office can expand its reach and advance to its fullest capacity without taking full advantage of the Internet. Having your own Web page can take your practice to a whole new level of marketing and expansion. Physician-based Web sites can help to provide patients with a more valuable media for not only obtaining “trusted” medical information, but also in offering physician-patient interactive services. Now, at a time most convenient to them in the privacy of their own home, patients can schedule appointments and submit prescription renewal requests with only the touch of a finger. When dealing with Web sites, content is of prime importance and your main focus should be to offer patients value. Don’t forget these tools are going to represent your office. You don’t want to stand behind something tacky and uninviting, not to mention insufficient in meeting your needs. So where do you start? You have two distinctive routes to take, each of which will depend on your financial position. You can hire a company to help you put together a Web page from start to finish, with the company only asking for informational input from you to help personalize each page. Otherwise, if you (or a staff member) have a flair for writing, one or both of you can use your imagination and sink your teeth into the development of this interesting project together as a team. In any case, your Web site layout may consist of: • location (many Web sites feature links to places like Mapquest or Yahoo to provide your patients with a tailored map and directions to your office); • photos which allow visual contact with you, your office and qualified staff; • a brief biography including your educational background; • various contacts to the office (for general or specific billing info, the office manager, HIPAA concerns, etc.); • the ability to request appointments and/or purchase supplies (if your office offers these services); • a list of treatments and services you provide (including new services such as ESWT or laser therapy or the diabetic shoe program); • a list of insurance companies that you participate in; • informational policies (such as billing or privacy); • specialized forms that patients can download, fill out at home and bring with them to the office in preparation for their visit; • an educational resource center for your patients regarding various foot conditions that they would like to learn more about; and • an archive of e-newsletters, if used, for those who want to visit past issues. Increase Your Reach With E-Mail Using e-mail can help you reach out to patients more effectively through appointment reminders and newsletters. According to a 2003 Harris Interactive survey, 67 percent of adults (140 million people) are now online, which strongly suggests that it is worthwhile to target an e-mail audience. A January 2001 survey noted 81 percent of the online population wished to receive e-mail reminders for preventive care while 83 percent of them wanted follow-up e-mails after visits to doctors. Considering this trend of e-mail growth, Internet access will surely become the standard as the preferred patient contact medium. If you are considering an e-mail newsletter, which will involve an output mail merge of information to your patients, you will want to start gathering patient e-mail addresses on your registration form and teach yourself and your staff how to manage a mail merge program. If you prefer to have someone on the outside responsible for submitting newsletters, begin researching costs (set-ups and monthly charges) from Internet service providers. Once you are set up, other considerations may involve: • brainstorming with staff and colleagues on what information you’d like to include in order to keep it new and refreshing; • directing Web site visitors on how to subscribe to receive issues on your Web site as well as how to unsubscribe should they decide to do so; and/or • compiling a target list of recipients (e.g., patients, PCPs, pharmacies, physical therapists, etc.). How An Office Brochure Can Be A Valuable Promotional Tool Another option for marketing your practice is the office brochure. If it includes much of the basic information on your practice that we suggested including on the Web site layout above, the office brochure can be an outstanding marketing tool that can produce tremendous results. Like a Web site, the practice brochure is a highly effective marketing product for most any healthcare office. It acts as your perpetual salesperson and also offers the opportunity to professionally brag about yourself. A well-done practice brochure can be completed in a cost-effective fashion and can easily become your number one practice building tool. (For more info on this subject, see “How To Market Your Practice Via The Office Brochure” on page 76 in last month’s issue.) Bolster Efficiency Via Updated Office Tools Technology can help you get the word out about your services but it can also be vital in improving the services themselves. Every day we see more and more businesses updating the look and feel of their offices and stores by employing the latest technological advances. Each practitioner should take the time to assess his or her practice’s “technology factor” and decide if it is time to pursue upgrades. Simple items like computer monitors have evolved to modern flat panel displays. Flat panel monitors are less likely to be obscured by fluorescent lighting and they take up less space. They also have a narrower viewing angle so they cannot be read from the sides, making them more HIPAA-compliant if they are placed in the right area of your office. Many small office phone systems today provide music/message on-hold features that you can update as well as voice mailboxes. Many of the new systems integrate wireless headsets that allow the staff member to receive and answer phone calls away from the base unit. This would allow your staff to multitask so they can answer the phone and process X-rays at the same time or leave their desk to find a patient chart while on the phone. Should You Consider Adding New Services Or Products? Taking advantage of technology is also invaluable in increasing the services and improving the products you offer. In your practice, this may be one of the most effective methods of expanding your patient base. In making the decision to offer a new service or product, one should consider issues of clinical relevancy, efficacy and professional availability. Let clinical relevancy be your most important consideration as you navigate through the choices you will have to make. For example, perhaps your practice could integrate a program of custom fabricated ankle-foot orthoses (AFOs) to your existing durable medical equipment dispensing program. The AFOs are excellent solutions for many patients for whom orthotic devices do not control progression of both pain and deformity. The AFOs have scientific data to support their use as well as a track record of patient acceptance. In some cases, one may judge products or services in part by testimonials of respected colleagues and empirical evidence alone. Clinical efficacy and professional availability are also valuable benchmarks in evaluating new products and services. Obviously, it’s important to keep in mind that efficacy varies in each individual practitioner’s hands and can often be less than published results. Use your previous experiences and those of known colleagues to help you judge efficacy. Professional availability is obviously a problem when a product is difficult to obtain or is constantly on back order. If you send custom fabricated AFOs to a lab for fabrication, be sure to select a reliable lab that produces a quality device in a timely fashion. Keep an eye on the shipping and handling. Not only should it take the least amount of time possible, but you should obtain a competitive price as well. Expanding your services can often be a successful means of enhancing revenue streams. Integrating services such as physical therapy, in-office dispensing and labs provide improved revenue while concurrently enhancing patient satisfaction and comprehensive care. However, this type of expansion may involve simultaneous physical expansion or an office redesign. A thorough business plan should definitely precede any expansion of one’s services. Weighing Physical Expansion Versus An Office Redesign If you opt to expand your services and it does require more space and volume, thorough planning is a must. Physical expansion involves strategic planning, which should include a detailed business plan and cost justification. Keep in mind that physicians who perform a careful analysis of existing floor space often find expansion is unnecessary. A review of daily motion studies and patient flow throughout the office may simply demand office redesign rather than expansion. In addition, common methods of cost allocation may indicate an area of weak revenue generation. Testing new processes within this area may greatly enhance its productivity. As an example, conversion of a conference room into a revenue generating area may greatly preclude the need for expansion. Attempt volume expansion only after a careful study of your practice. You must compare average revenue per patient to the variable costs associated with each new patient that comes into your practice. As volume increases, expenses often rise at a faster pace than revenue. Physicians who succeed with outstanding marketing plans often find themselves working harder for less. Once you’ve initiated an expansion, you should examine the marketing plan at least quarterly to determine its profitability. What About Quality Control? After planning, capitalization, marketing and implementation of an expansion plan, physicians often find themselves suffering from the inevitable “growing pains.” One of the more deleterious concerns of growing pains is a loss of quality. A continuous quality control program should accompany any expansion plan. (For more information on quality improvement, see “Eight Steps To Improving Your Practice” on page 55 in the September 2002 issue.) Since quality is often just as much perceptual as it is real, it has long been recognized that quality (and particularly the loss of quality) is merely qualitative and not quantitative. The failure mode and effect analysis (FMEA) is a means of transforming quality measurements (and the risks of quality loss) into a more quantitative entity. The failure mode and effect analysis proactively explores the possible reasons for quality loss within a given process and assigns a risk factor. The resulting quotient therefore quantifies the potential event, as well as prioritizes all possible failure points. Critical to the success of a quality control program is the development of a team. All key members of the staff should participate and offers insights into the plan. You should conduct monthly meetings during the initial phases of the practice expansion. Remember that continuous quality control is an ongoing process. Proactively identifying a process’s weak points often precludes loss of quality events and helps diminish the growing pains of expansion. Dr. Guiliana is a Fellow and a member of the Board of Trustees of the American Academy of Podiatric Practice Management (AAPPM), and a Diplomate of the American Board of Podiatric Surgery. He holds a master’s degree in health care management and practices in Hackettstown, N.J. Ms. Homisak is a member of the Board of Trustees of the AAPPM, the Past President of the American Society of Podiatric Medical Assistants and a team partner in Secrets of Success (SOS) Healthcare Management Solutions, LLC. Dr. Levin is board-certified in foot and ankle surgery by the American Board of Podiatric Surgery. He is a board-certified wound specialist by the American Academy of Wound Management and is a Fellow of the American College of Foot and Ankle Orthopedics and Medicine. Dr. Levin is a member of the Board of Trustees of the AAPPM. Dr. Ornstein is a Diplomate of the American Board of Podiatric Surgery and a Fellow of the American College of Foot and Ankle Surgeons. He is the President of the AAPPM and a partner of SOS (Secrets of Success) Healthcare Management Solutions, LLC. Dr. Young is a practice management consultant with a private practice in Farmington Hills, Mich. He is an Assistant Professor at the Michigan State University School of Osteopathy and an Adjunct Professor at the Ohio College of Podiatric Medicine. Dr. Young is a member of the AAPPM. Editor’s Note: For more information on “Lunch and Learn” and other marketing ideas, Neil Baum, MD, is the keynote speaker at the American Academy Of Podiatric Practice Management’s Annual Midwinter meeting in Pittsburgh, PA that will take place Feb. 27-29, 2004. For more information, contact the AAPPM at (978) 686-6185 or via e-mail at

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