How to Effectively Market Your ASC

Successfully driving patients through both internal and external marketing means.

BY DAWN CAVANAUGH

Fifteen years ago, I was hired to be the regional director of an ambulatory surgery center (ASC) corporation. I clearly remember meeting the national medical director of the largest ASC in the country who looked at me and asked me point blank, "Who is your customer?"

At the time I was fairly new to the ASC arena and my first thought was to say the patient, but I quickly realized the answer could not be that easy, so I reluctantly spoke up and said, "The surgeon?" At that, he turned to me and said, "The motto in the surgery center business is see one, do one, teach one. But don't ever forget, without the surgeon, you have no surgery center business!"

During the course of my tenure with that organization, we quickly gobbled up market share through relentless planning, preparation, discipline and execution. By the time I left to explore an opportunity with a startup, this division had become the largest freestanding surgical center in both the country and region, with annual revenues of $60 million a year. Sounds fantastic right? Unfortunately, the story has an unhappy ending.

Approximately 2 years ago, this large entity began to unwind due to mismanagement, poor decision making and the fact that they had simply forgotten to take care of their customer. Sound familiar?

Trouble Brewing

I have told the above story for many reasons. As administrators and surgeons, we can learn from the past mistakes of others as well as their successes. This story is so important because I have begun to see the first signs of a pending tidal wave destroying freestanding ASCs again and again all over the country.

For the last 15 years, I have evaluated ASCs country-wide, all of them performing the same number of cataract procedures as ours and other high-volume ASCs, but whose net profitability resembles an EKG printout. Some of these ASCs actually lose money each year and others net as high as 50% prior to amortization and depreciation. So, for those of you who are interested, one of the pearls that I have mastered is how to drive patients through both internal and external marketing means.

Marketing Strategies

Marketing your surgery center is the same as marketing your surgeons. The refractive practices have mastered this discipline for the last decade and appear to be ahead of the other ophthalmic specialties. Successful refractive practices are able to brand the name of the clinic, surgeon and product, as well as the delivery of their surgical services.

Unsuccessful marketing strategies include mismanaged marketing as it relates to devaluing the worth of a surgeon's skills. For example, advertising LASIK for $299/eye, or worse, using bait and switch tactics. A common bait and switch tactic is to woo the patient into a surgical practice with low fees and then attempt to up-sell what was originally promised at a lower price point.

All in all, these strategies just don't work toward establishing a healthy net profit. As an industry, we have the opportunity to learn from the mistakes of other providers and begin to re-establish for-profit protocols when it comes to managing both our practices and our ASCs.

Accommodative IOL technology has given us the opportunity to turn silver into gold. In order to capitalize on this opportunity, you must take the time to ask yourself some questions that you feel you need to know the answers to in order to drive patient satisfaction — which is internal marketing at its best. In our clinic, we have created patient-satisfaction questionnaires that help us to improve in all areas of the patient experience.

Patient Questionnaires

For those ASCs that already have questionnaires in place, a few questions to ask yourself; when is the last time you updated your questionnaire? And when is the last time you took the data from the questionnaire and used it to address problem areas in the ASC?

The first time I presented to the partnership my concerns about the satisfaction survey, they asked me why I was concerned when the patients all appeared to be satisfied. "Because we need to hear the good, the bad and the ugly," I replied. If you are consistently getting answers indicating that everything is perfect in your ASC, revisit your satisfaction survey to ensure that you are asking the right kinds of questions and that they are not slanted in their wording.

First, learn from Fortune 500 organizations that look at both the top 5% to 10% of satisfied customers and the bottom 5% to 10% of unsatisfied customers and use this information to become even more successful. Next, actually spend the money and mail the updated questionnaires to your patients and review and tally the results. Later, meet with your team and board to review the results and then reconfigure your system to address complaints. Remember, in the real world, processes will only get better through hard work and dedication to the end result. In our organization, we utilize these surveys to tell us what we need to hear, not what we want to hear. Something as simple as a patient not being able to read a staff member's name tag needs to be addressed. As I am known to tell our team, "This is not Kansas, where you can simply click your heels and things will get better. You need to work on improving each and every day!"

In order to make it easier for our patients to respond to the questionnaires and make it more cost effective for us, we have recently set these surveys up via e-mail. Patients are assigned a passcode to access the survey and the data can then be captured both electronically and in real time. This allows us to receive feedback the same day the service was rendered versus a week later.

We recently adapted one of the pearls that we learned from the refractive surgery business into our own ASC. We now utilize the Internet to allow our cataract patients' family members to view their surgery online real time. Our pre-operative RNs also have access to this technology, allowing them to keep one step ahead of the OR by having the next patient ready on time. This is a huge plus for patient satisfaction, as it keeps the patients' wait time to a minimum.

Market Outcomes and Experience

I have found that the most successful entities market their outcomes and experience — not their technology. I usually get a few laughs each morning on my way to work as I flip through the radio stations to listen to the latest airway battles stating, "We now have ‘x’ technology or we are the first to have ‘y’ technology, or our surgeon was the first to do ‘z’."

It appears that even vendors within our own industry are telling us to market technology, while our outcomes continue to be the ultimate driver of volume. Isn't it time to get back to the basics and focus on what patients really want? If you are targeting and marketing to patients who are active boomers, the answer, most likely, is that they want to keep their active lifestyles and most want to be free of spectacles. If they could, they would likely tell you they are in search of the fountain of youth, as these boomers give no indication that they are slowing down. So, having said that — when is the last time you evaluated the type of patients you are bringing into both your practice and your ASC?

Recognize Your Value

In my position, I have turned down offers from multiple insurance companies to participate on insurance plans that pay less than Medicare. What amazes me is that practices are accepting these lower payments. This is happening all over the country and most surgeons are not concerned about it, either in their practice or their ASCs. You simply cannot participate on a plan when the expenses exceed the revenue.

I remember a surgeon telling me 10 years ago that he could make more as a taxi driver than he could performing cataract surgery at his own center. This surgeon and his practice were consumed with the case count and not the revenue being generated per case. Their goal was to participate on every plan, rather than plans that they could afford to participate on. In order to change these scenarios, both management and partnerships need to take a stand with managed care. They need to explain what they need in form of payment, and in turn, the services that will be delivered to the patient. If you market your services as the cheapest in town, then your patient base will be the cheapest in town.

Let's face it, payments for ASC services follow Medicare guidelines for the most part, so when Medicare payments decrease, so do other payors. Operational expenses fluctuate based on multiple variables, the strongest variable being the lack of experience of those making decisions for your ASC. For those of you who remain on top of the marketing segment, patients come to your practice because of the following: they were referred, the practice participates on their insurance plan and/or their friend had a great surgical outcome.

Referral Base

How many of you have a spouse-tracker program and/or dual-eye tracker program in place? As we learned in the refractive arena, happy patients tell their experiences to friends and family — so how are you effectively following up internally with these patients?

We have observed over many years that most female patients typically go first when it comes to surgery, and once they have received a superior outcome and are happy, their spouse is usually next in line for an evaluation and/or surgery. However, if you don't follow-up with these patients when they are in your lanes, they can be lost to the segment of the population that we classify as fearful and/or procrastinators.

In addition, a huge satisfaction booster and an action that requires very little time is that our surgeons call all patients the evening of their surgery. This scores big points with both the patient and the family.

A Warning

Please be cautious when throwing all of your eggs into the largest basket, for they do not always net the largest returns. Everyone is jumping on the retina bandwagon without the resources and/or volume to accommodate these procedures and we are just starting to see some of the large financial blows transpiring.

When Larry Patterson, M.D., practice owner of Eye Centers of Tennessee, Crossville, Tenn., first called me 10 years ago to gain some insight on how to handle his current ownership structure with a large multispecialty ASC, I immediately realized that this particular partnership had already devalued his large monetary contribution towards net profitability and that he would be better off owning 100% of his own ophthalmic ASC. In other words, they had forgotten that he was their largest customer.

When most surgeons venture out into opening their own ASC, it becomes one of the largest investments of their career. Dr. Patterson became actively engaged in all levels of decision-making so that when the ASC was open, he was intimately familiar with all steps up to that point. Fast forward 10 years, and he is now enjoying his surgical life in a center that he knows is effectively managed, efficient and can execute strategy.

A few of the pearls that are exhibited in his ASC is (1) He understands the cost per procedure and OR efficiency better than most surgeons throughout the country. (2) He meets with his team on a regular basis and is one of the most efficient cataract surgeons that I have ever seen in the OR. (3) His patients come to him because he takes the time to answer their questions and then deliver superior results in the operating room. (4) His administrator keeps the financial pulse of the ASC on track, without jeopardizing quality of care and (5) The center is managed by relentless planning, preparation, discipline and execution of strategy.

Prior to opening our ASC, I sent both Dr. Pepose and our director of nursing, a 25-year veteran in the OR to observe Dr. Patterson's ASC. I asked them both to be open to change, since this was by far the most efficient ASC that I had observed during my career as a consultant. They both returned with a new outlook as it relates to OR efficiency. After all, seeing is believing. "See one, do one, teach one."

We are fortunate that our industry has developed both state and national organizations to assist in our benchmarking quest. However, it would benefit us ten-fold to have more discussions on successful marketing strategies during national symposiums. OM

Dawn Cavanaugh is COO at Pepose Vision Institute, Chesterfield, Mo. She also sits on the board of Care Credit and consults for Bausch & Lomb, AMO-VISX and Alcon. Prior to joining Pepose Vision Institute, she worked as a consultant for both ophthalmic practices and ASCs for 10 years, as well as holding the position of COO country's largest vitreoretinal clinic and ASC. She may be reached at dcavanaugh@peposevision.com.