The Marketing Imperative: Effectively Promoting the Hospital-based Practice

Marketing plays a critical role in hospital-practice alignment and recognition of value-added services.

Running an efficient radiology enterprise requires keeping a close eye on expenditures. In this equation, spending marketing dollars on promoting a hospital-based practice may seem unjustified. After all, a practice may ask, isn’t that the hospital marketing department’s job?

In today’s changing healthcare environment, a “not-my-job” perspective on hospital-based practice marketing may be unwise, says Deborah MacFarlane, MBA, a member of the Radiology Business Management Association’s RBMA U faculty and president of HealthEdge Consulting in Laguna Niguel, Calif.

MacFarlane has developed a new course for the RBMA U online learning community specifically on the role of marketing in hospital-radiology practice alignment. She is passionate about the topic because in reviewing more than 20 requests for proposal (RFPs) for hospital-based radiology groups, she has noticed that hospitals across the board are looking for practices that are willing to become more involved in quality, safety and yes, marketing of the hospital-based practice to referral sources.

“In every single one of the RFPs that I have been involved with, the hospital-based radiology department has either had flat [patient] volumes or declining volumes,” MacFarlane says. “Hospitals have not on their own been able to grow their market share in the outpatient radiology marketplace, and so they are now asking radiologists to participate in marketing the hospital radiology department.”

Even well established practices are at risk. One RFP MacFarlane assisted with was for a practice that had held the same hospital contract for 42 years.

It is no accident that hospitals are issuing so many RFPs now, MacFarlane explains. Three big forces are coming together to make hospital administrators examine the relationship with their hospital-based radiology groups and seek to partner with groups that will really step up their game in quality, safety and marketing. The first is that there are new Joint Commission standards specifically for the delivery of medical imaging in the hospital setting.

Secondly, payors are moving toward reimbursing based on quality metrics and hospitals need the radiologists’ involvement in tracking quality data and seeking continuous improvement.  A third factor is the emergence of big regional and national radiology services providers that can offer hospital systems subspecialty reads, around-the-clock service and the scale to be a one-stop-shop for all the system’s radiology service needs.

In this environment, a practice that cannot show increasing patient volumes and has not been diligently marketing itself to its hospital administrators, executives at the health system level and the hospital staff and referral sources, will be starting at a disadvantage, she warns. “Marketing evolved in radiology in the outpatient imaging center [setting], and hospital-based radiologists have always been of the mindset that if they sit in their dark room, it will come,” she says. “They did little to attract referrals to the hospitals and they just took it for granted that that would happen. Any sort of service levels that were involved with the referring physicians was the hospital’s problem.”

Not too late

The good news is that marketing of the hospital-based radiology practice is not that difficult once a practice commits to putting some resources behind it. MacFarlane advises starting with good old-fashioned relationship building with the hospital staff and administrators. If members of your practice hold directorships within the hospital, help your radiologists leverage these positions into posts of true leadership where they begin to advance initiatives instead of passively reviewing ideas brought to them.

Schedule meetings with hospital staff and administrators. Ask for honest feedback, listen thoughtfully and then develop action plans for the top problems identified. If referrers complain that the radiologists are hard to reach, for example, set up a single number they can call in order to quickly get their questions answered, MacFarlane says.

Finally, remember to reach out to the hospital marketing staff and support their initiatives, she advises.

“That hospital marketing person is your friend,” MacFarlane says. “You need to embrace them and go out and talk to them. You also have to be willing to participate in the hospital’s marketing efforts. If in October your hospital is making a big splash for breast cancer awareness month, you have to be willing to step up and maybe give lectures and do other things that are supportive of what the hospital marketing people are trying to achieve.”

Engaging patients through marketing

While internal marketing to referral sources, administrators and the hospital staff is the most important aspect of marketing the hospital-based radiology practice because you are there at the discretion of the staff and administrators, you can also do co-branded marketing to improve patient awareness of the role of the radiologist if you have established trust with the hospital marketing department. This can aid the hospital in the difficult job of raising patient satisfaction scores — an area of concern for many hospitals now that CMS publishes quality metrics online and uses them to issue comparative star ratings for hospitals.

MacFarlane says she has, for example, seen practices work with hospital marketing departments to put videos in the radiology waiting rooms or reception areas to explain that there are highly skilled physicians behind the scenes reading CT and MR exams. Even a simple attractive display of professional photos of the radiologists and their credentials can head off satisfaction issues later due to patients getting bills for the radiologist’s professional services and not recognizing the name as a physician they saw.

“In every hospital there is a patient waiting room or patient registration/reception area, and we need to turn these into our patient education areas,” she says.

Successful examples abound

The precise form of the marketing of a hospital-based practice will of course vary depending on a host of factors and there is no one-size-fits-all solution. However, two groups that MacFarlane cites as doing an exceptional job in the marketing of their hospital-based practices are Columbus Radiology in Columbus, Ohio, and Radiology Associates of South Florida in Miami, Fla.

Columbus Radiology’s marketing grew out of its decision to set up its own call center nearly 10 years ago instead of relying on a fragmented system of various hospital call centers. Last year, it handled 180,000 calls.

“[Through the call center] we were getting this feedback on the radiologists and it made us wonder what else we were missing,” says Charles McRae, chief executive officer for Columbus Radiology and an RBMA member. 

The practice hired its own referral source marketing person who could call on its referral sources and identify any service problems. In doing so, it quickly realized that while the hospitals it worked with had marketing people to manage relationships with referrers, this was no match for having someone dedicated exclusively to the radiology business who would know the questions to ask to get useful feedback.

For example, a Columbus Radiology marketing person visiting a referral practice  discovered that the physicians in that group believed the MRI machine at the local hospital had been lost in a flood a few years back and never replaced.

“Guess why they hadn’t been referring!” McRae says.

The biggest reason to have your practice spend time in front of referring physicians and not rely solely on the hospital marketing department is that it is much better to have referrers tell your people about what you are doing right and what you are doing wrong than to have them tell the hospital or not tell anyone at all, McRae advises.

“We can take that voice of the customer back to the hospital and make changes that will impact the care cycle and processes and, ultimately, the financial end,” he says.

Columbus Radiology works closely with hospital marketing departments to coordinate messaging and materials. It typically takes the lead on marketing efforts because the practice has the clinical expertise necessary to communicate effectively with referring physicians.

“We have co-branded marketing materials with our logo and the hospital’s logo on them that we take the lead in developing because we better know the medicine,” he says.

For example, when one hospital purchased a new SPECT-CT device, Columbus Radiology selected the photographs and helped craft the written content for the referral-source marketing materials announcing the new service line, even though the hospital had the greater financial need to ramp up volume quickly.

“We had a lot less risk in that because it wasn’t our one and a half a million dollars into the equipment,” McRae says. “But we also benefited, because obviously we were reading the studies.”

The situation is a bit different if you own the equipment or you serve other hospitals and imaging centers that compete with the first hospital. In these cases, be cautious, McRae advises. “You can’t market with the hospital and compete against them,” he says. “Then there is an inherent conflict of interest. The question will always be in the hospital’s mind, ‘Who are you really trying to benefit?’”

The annual report as marketing vehicle

Another form of marketing that radiology practices may wish to consider is the issuing of an annual report highlighting their achievements. Ricardo Cury, MD, president and chief executive officer of Radiology Associates of South Florida (RASF), says this has helped further RASF’s relationship with Baptist Health South Florida and its seven hospitals and 13 outpatient centers in the Miami-Dade County area.

During a planning retreat, the RASF radiologist leaders had identified a lack of referral source awareness of all of its achievements. The tenth largest private practice group in the nation, RASF had a great deal to share about the benefits of its 13 subspecialty areas of expertise and its ongoing efforts in quality, service, physician satisfaction, patient satisfaction and safety (including Image Gently and RADPEER involvement) that there simply was no way to communicate it all consistently through traditional relationship building with referral sources, meetings, conversations and presentations.

The first report covered 2011 to 2012 and was an immediate success. The practice mailed the report to all of its referring physicians, but the real surprise came when Cury received an email from Brian Keeley, CEO of Baptist Health of South Florida. Greene congratulated him on the report and then asked for 250 additional copies so that he could send one to every board member for every hospital within the Baptist Health system.

“That was a very nice email to receive,” Cury says.

Although one would like to think that hospital administrators are aware of all that their hospital-based radiologists are doing to enhance quality of care, the reality is that they are very busy and often unaware of what individual departments and groups within the hospital are up to, Cury notes. An annual report will ensure that when you do need to negotiate a contract or make an argument for expansion of particular services, you are negotiating with administrators who already know and understand the value you bring to the organization.

“It is hard to build a case [for your value] when you are negotiating a contract,” Cury says. “It is a lot better to do that beforehand.”

Costs for the annual report were kept low by having the physicians help develop much of the content and by working with a local printer who could also do the design work as well as the printing.

Direct-to-patient marketing

Building on the success of the annual report, RASF launched a bi-annual patient magazine in 2014. The group prints 10,000 copies and places them in waiting rooms as patient education materials. Included in each issue are articles by the radiologists and photos of all of the RASF radiologists. This helps patients understand that they are being cared for by highly educated and qualified physicians who are constantly working to advance quality of care and the methods for getting the best possible images.

Marcia Weingarden, RASF’s director of public relations and practice development, manages the production of the magazine in addition to her other duties. Baptist Health’s marketing department reviews and approves the publication before it is printed since it is distributed through Baptist Health facilities.

While hospitals can understandably be concerned about protecting the reputation of their own brand and presenting a unified “one-organization” image to patients, once they trust that your publication will reflect positively on them, they are likely to welcome the effort. In RASF’s case, the quality of the patient magazine was so high that after the first issue, the marketing department began to help Radiology Associates of South Florida underwrite the cost of printing in exchange for having Baptist Health ads appear in the magazine.

“In a high-level view, they see us as a win-win situation because if you are marketing the imaging and the doctors, you also are marketing the hospital,” Cury says.

Marketing and contract negotiations

Medicine has a culture that looks askance at self promotion, but it is risky to simply assume that if you provide excellent service to referral sources and have short turnaround times, satisfied referring physicians, dose reduction efforts and other quality measures you can forego marketing yourself, MacFarlane says.

 “If you actually step up and you do all of these things, you have to get credit for it,” she explains. “You can’t just quietly do these things. You need to make people aware of what you’ve been able to accomplish.”

McRae agrees and says that while it can be tricky to measure a specific return on investment for hospital-based practice marketing, you should still do it.

“It absolutely pays for itself,” he says. “How can you not do it? This is an added value to the hospital, yes, but it is also an added value to the practice. It is one piece of what we present to a hospital system in how we are providing value, and they recognize that we have got a vested interest in being successful. Our success should be aligned with their success.”

Likewise, Cury quickly acknowledges that there is a cost to employ your own marketing people and to print annual reports and patient magazines in addition to everything else that you may already be doing, like maintaining a website and social media presence plus offering educational opportunities to hospital staff. However, he agrees that the effort pays for itself.

“Yes, it is a cost, and it is hard to quantify the benefit, but it definitely helps in many ways to solidify our reputation, to solidify the added value things we are doing,” he says.

The big lesson, MacFarlane says, is that hospital-based radiologists can no longer afford to be just “the guy in the dark room.” Marketing is now a key component in an effective hospital-radiology practice relationship, and learning about it is important if you wish to be successful.