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By Stephen W. Earnhart, MS
President and CEO
Earnhart & Associates
A major bone of contention between hospital-based ambulatory surgery centers (ASCs) and freestanding joint-ventured facilities is how each area markets its services to the physicians.
Discussed in depth at the Same-Day Surgery conference recently held in Atlanta, that issue received mixed reviews. The statement was made that for-profit ASCs tend to market to physicians, while hospital-based centers concentrate more on patients. Those of us experienced in both areas will, like it or not, validate that statement.
The focus of marketing in a for-profit ASC is, for the most part, physician acceptance and usage. The surgeon brings the patient to the center and, as a result of that referral, provides jobs, job security, and income for the ASC staff.
Unlike the not-for-profit hospital system that often serves as the entry point for all patients into the organization (including the ambulatory surgery department), the for-profit, independent, or hospital/physician joint-ventured surgery center must rely on internal marketing to steer the referral. Often, the not-for-profit hospital will draw the patient into the organization via the emergency department, patient outreach programs, internal and/or external marketing, and TV, radio, print, or billboard advertising. This can be very expensive advertising that the majority of for-profit ASCs cannot or will not pursue; hence, most focus on internal physician marketing.
Friction and bad will can be the result for administrators or department heads when a hospital has an internal not-for-profit facility and an external for-profit ASC in a joint venture arrangement with local physicians. Clearly, the joint venture would like to be included in the hospital patient marketing and advertising; however, regulatory barriers such as Stark legislation and anti-fraud and kickback regulations prohibit much (if not all) of that activity. Physicians often resent the exclusion of their ASC from such activity. Further, staff of the hospital outpatient surgery center often are upset that the ASC touts claims of "catering to the surgeons," when the hospital managers think they serve both camps equally well.
How do for-profit centers’ marketing efforts to physicians differ from those directed at hospitals? Turnaround time between cases is a major marketing tool. This efficiency of operations is the No. 1 reason physicians use, invest in, stay in, or stray from one organization to another. Most hospitals cannot compete with the efficiency a typical ASC can provide. This level of activity, especially coupled with prompt operating start times, is one area in which the for-profit ASCs excel. Does it offset the intense marketing and advertising of a hospital outpatient surgery center? Most physicians would probably say it does.
Many people do not equate staff incentives with marketing to physicians. Actually, it is an effective and oft-overlooked marketing tool. One area that inflames many busy surgeons is staff turnover. The time, effort, and money consumed to train a skilled nurse or tech is not inexpensive. To have that valued employee leave the facility for a better opportunity, pay, or a work environment, especially when the surgeons cannot prevent it, is a major disincentive and inconvenience to an active surgeon. Never underestimate the value of satisfied employees to the surgeon.
Cross-training of the staff is a way to retain good staff members. Surprisingly, some staff members will resist cross-training vigorously, screaming into the night. This resistance baffles many of us. The bottom line is this: If you have staff members who are not willing to expand their value to the organization by learning new skills, it might be time to replace them. Time is too short to waste valuable resources with those not receptive to cross-training.
Lastly, if you want to hold onto your surgical staff, you need to ask them what they need. Ask your staff, in their opinion (and that is really all you should care about), how they can cater to the physicians’ needs in your department. I am often shocked by staff nurses who tell me they are "here to take care of the patient — not the surgeon." The staff can get angry when you try to explain that, while the patient is the most important person in the process, you no longer can ignore the influence of the surgeon who brings them to the center.
The surgeons have more choices today than they ever have had in deciding where they can go. If you want them at your facility, market to those patients . . . or let someone else do it.
(Editor’s note: Earnhart can be reached at Earnhart and Associates, 5905 Tree Shadow Place, Suite 1200, Dallas, TX 75252. E-mail: firstname.lastname@example.org. Web site: www.earnhart.com.)