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Here is a single-question pop quiz: List three of the most important groups of customers your hospice serves.
Patients. That one is pretty obvious.
Caregivers. They often need as much spiritual and emotional care as patients.
The third group is . . . physicians. Did it take a little longer to come up with the last group? That by itself may be an indication that your hospice is not doing enough to nurture its relationship with physicians.
There is a tendency, perhaps, to view physicians as colleagues or partners in treating dying patients. But, in fact, they are customers who must be cultivated and nurtured through various forms of marketing. While efforts won’t include mass media campaigns one would normally associate with marketing, physicians do require a host of customer service-related approaches to ensure overall satisfaction following the referral of a patient.
Hospice of the Valley in Youngstown, OH, takes the business of physician marketing seriously. In the past year, the hospice was able to increase its referrals by 30% as a result of its multifaceted physician outreach program, says Bridget Romeo, RNCG, director of community education for Hospice of The Valley.
Romeo insists that hospices can achieve similar results if they think of physician marketing as a discipline that requires the simultaneous use of several different approaches. Traditionally, hospices have used low-key approaches that don’t require the budget-strapped organizations to spend too much. Hospices focused mainly on physicians and hospitals by sending out volunteers to tout the value of hospice and preach the hospice philosophy.
The marketing strategy now employed by Hospice of the Valley assumes that marketing hospice services in a competitive health care marketplace requires more than a jar of cookies sent to physician offices and handing out black-and-white brochures at a local health fair. The goal for hospices is to increase referrals significantly and to ensure the referrals are made in a timely fashion. That’s done through a combination of physician relations, support, and education.
Hospice of the Valley is a typical hospice, experiencing the same challenges that face other hospices around the country. One of the hospice’s greatest challenges is to increase admissions in each of the three counties it serves.
In the year since the hospice adopted its global marketing strategy, admissions have increased in all three of the surrounding counties it serves, including a 50% increase in Columbiana County and a 30% increase in its base market, Mahoney County, where it was once thought to have saturated the market.
Setting aside the cookies-and-brochure approach to gain referrals, Hospice of the Valley treated physicians as if they were as much a customer of hospice services as patients and families themselves.
Like patients and families, physicians have a set of expectations regarding their dealings with hospice and hospice staff. According to Romeo, those expectations include the following:
Most hospices may think they are regularly doing the things that encourage physicians to refer patients to their hospice. But the only way to find out whether or not those needs are being met is to actually ask physicians if they are satisfied with the care provided to their patients and with the support given to them.
Officials at Hospice of the Valley start by tracking referrals by physician. Using a computer spreadsheet, referrals of about 300 physicians are monitored. "We watch for trends," says Romeo.
The trends Romeo looks for are physicians whose referrals have dropped off from month to month or over the course of a year. "If they aren’t using us as much as they used to, we need to know why. It could be that they just have not had as many dying patients as before. If not, we need to know if we dropped the ball."
If the hospice’s tracking system identifies a physician whose referrals have decreased over several months, a Hospice of the Valley representative is dispatched to speak with the physician to find out why this is so.
There is nothing terribly sophisticated about Hospice of the Valley’s tracking system. Each time a physician makes a referral, the date of the referral is entered into a spreadsheet program. This allows hospice workers to search the database by physician to determine the number of referrals made during a given time period.
The hospice also tracks the length of service of each referral by physician. If a physician’s referral resulted in an unusually short stay, it prompts a visit by Romeo, who emphasizes the need for earlier hospice admission.
Another low-tech approach is the use of questionnaires. Physicians who refer patients to Hospice of the Valley are sent quarterly surveys that contain brief, pointed questions to help determine whether communication and services are meeting physicians’ needs. The questionnaire seeks physician opinions about perceived communication between the hospice and physician and the timeliness of its on-call service.
In addition to tracking referrals and physician questionnaires, Hospice of the Valley builds upon its physician communication efforts by providing a quarterly newsletter. The newsletter is intended to be a forum for new information, such as changes in payer requirements and protocols.
Other physician marketing approaches used by various hospices include the following:
Under this approach, each member of an administrative team is assigned to a group of referring physicians. The team is responsible for establishing a working relationship with doctors or key members of their staffs.
How the team communicates with each physician is determined between staff members and the physician or physician’s staff. Communication revolves around patient care issues and physician/patient needs, relates new program ideas, and reinforces established guidelines. Each month, team members report their findings to an operations committee.
Provide clinical and administrative staff with feedback from all referral sources, such as changes in managed care policies and procedures, physician feedback, and updates on changes in the marketplace. The purpose is to help staff realize that referral sources are important to the program.
When families send letters of appreciation to the hospice with information such as "we wish we were referred sooner" or "hospice really helped," send copies -- with the family’s permission -- to the physician who referred the patient, or to referring physicians generally, to not only encourage more referrals but more timely ones as well.
One of the obstacles to good physician-hospice relationships is the glut of phone calls from staff requesting various things, ranging from orders to signatures. By assigning a case manager to referral sources, the number of phone calls between physicians and nurses can be dramatically reduced. This practice can also help develop mutual understanding of practice patterns and increase physician loyalty.