This is the city….Seattle, Washington. An established practitioner, in an effort to increase his new patient load, decides to allocate more money towards his existing marketing budget this year. In doing so, he makes an unsupported decision to distribute the funds via the only method he knows…the Yellow Pages and newspaper advertising, and as a result, he burns up these reserves with not a penny to spare. What a crime! While some practices claim these types of standard marketing techniques work best for them, the basis for this particular doctor’s decision was not rooted in any substantial analysis of his individual practice statistics. Nor was it based on monitoring the return on his marketing investment to determine if there were more cost-effective options available to him.
 
Harvard University conducted an interesting study years ago that reflects on the importance of repetition in a marketing plan.  If you doubt the power of repetition, just ask yourself (or anyone over the age of 30) to list the ingredients of a Big Mac. Convinced?
 
Based on this concept, Harvard decided to attach meaning to this information and determined that you need to make a conscious effort to market your message at least nine times in order to make a substantial impact on your (potential patient) audience; however, you can expect that two out of every three will go unnoticed. That now changes the magic number from nine to 27 which, if pursued, would more sooner (than later) end up depleting whatever marketing funds were designated for the original nine-time arrangement, and then some. This doctor’s crime of not weighing the cost of these extended dollars against the value they provided was adversely impacting his practice revenue.

In an attempt to rectify this crime and lead him down a different path, we knew we had to approach it from a more practical standpoint. After conducting both geographical and statistical analyses of his practice, his need for a more cost-effective strategy was clear. Based on his current location and the types/ages of patients he was seeing, he needed to take the leap from the road of familiarity onto the “information superhighway.” It was time he considered new internal/external marketing approaches via the use of the Internet and set new goals for his practice. 

Overcoming Fear of the Unknown
At first, the thought of the “unknown” prompted many questions. He admitted having a one-dimensional knowledge of the Internet (allowing him only to send and receive e-mail). That, combined with the idea of facing new uncharted territory, left him skeptical and fearful about how to get started. Some of his concerns revolved around several issues:

* the cooperation of his staff (would they be willing to accept or add to their current job description?);
* cost (including the training time necessary for staff to learn to use it productively);
* his return on investment (would the effort be worthwhile?) and lastly,
* the effect that it would have on practice efficiency and his quality of patient care. 

All legitimate apprehensions and still, we were certain that by maximizing some simple Internet features, we would significantly increase his visibility while keeping costs down.  The first phase included the construction of his own practice website.

Benefits of a Website
The benefits of a website can vary according to the amount of time and effort you are willing to invest into it. Those that do not reap rewards are generally the ones who do not take advantage of all it can offer or just “can’t be bothered.” Of course, knowing what those benefits are, before blindly free-falling into the development of a website, provides a much better understanding of its overall value. 

According to Glenn Lombardi, President and CEO of Officite, a web-design company servicing almost 7% of the podiatry market (or approximately 1,000 podiatrists), there are four key advantages to keep in mind: 

* The attraction of new (high value) patients. This is based on the fact that Internet users are typically from a higher income bracket (68% make $50,000 or more) and are determined to find the best, newest treatment out there. Thanks to on-line research, this not only includes researching what types of treatment are available, but who in their area offers it. 
* An opportunity to offer increased podiatric education and product information.
* Increased Office Efficiency – via on-line personalized directions to your office, new patient orientation and “24/7” downloadable access to practice forms.
* Enhanced image and uniqueness of your practice.

Lombardi also addresses the cost-effectiveness of having a website as compared to other traditional methods of marketing. A recent survey of his clients revealed that on average, websites receive between 300-1,000 visitors a month, indicating that the pattern of website visits is rising. Lombardi’s survey also showed that one new patient can generate anywhere from $300-$500 in initial services.
  
Accordingly, if you get only one new patient a month, your ROI can be achieved in 6-12 months. It is important to keep track of your referral sources (see example), so you can make a calculated decision for future marketing plans based on which one brings in the biggest return.

I can speak to figures regarding website visitation from my own experience of working in an active practice. The average number of visits to our website has more than tripled over the past year (from 18/day to 58/day); much of that exposure is due, in part, to new strategies we put in place. We look for every opening to send patients to our website in an effort to continue the efficiency it has created in our office. Not a piece of mail or e-mail correspondence (statements, recall letters, welcome to our office letters, referral letters, etc.) leaves our office without inserting a different podiatric “tip of the month” message for our patients tucked inside the envelope. These always direct patients to our website for more detailed information.
 
Separately, all new patients are directed there when they call to make their appointments. They are encouraged to fill out registration forms prior to their initial examination, get directions to our office, “surf our site” to get more information about our practice, staff and doctor (through the posting of pictures office hours, types of insurance we accept, etc.), and view the various types of conditions we treat along with the newest methods offered to treat them.
 
These new “educated” patients arrive at the office with paperwork completed, allowing us to start them immediately and maintain a smooth flow of patients throughout the day. Patients are not only cooperative and willing to do this, they thank us for making things easy for them!

Our established patients also go to our website on a regular basis to obtain copies of instructional forms or more routinely, to communicate with staff regarding their upcoming appointment or recent statement or to schedule a return visit. Some may even pose a question to the doctor regarding their treatment, which we are able to intercept and respond to at the doctor’s direction. 
 
The staff finds it far more efficient to link to insurance company websites for benefits information, because unlike a phone call, it does not interrupt a patient concurrently being discharged at the front desk. Patients consistently voice their preference of receiving an e-mail over a telephone call.
    
E-Mail vs. Telephone
With e-mail, patients have the ability to express themselves more clearly, will not be put on hold and can reply at their convenience. Conversely, staff can respond to patient e-mail with detailed, sometimes catalogued answers, focusing on the accuracy of their response. This communication can be tasked during down times or light patient loads. An added plus is that you have an immediate record/documentation of all correspondence. 

Because of the increased popularity of e-mail, we now ask for our patients e-mail addresses right on our registration forms.  Additionally, they are asked to make their preference known with respect to having appointment reminders via e-mail or a phone call. Not surprisingly, more and more are choosing e-mail.

One of the most rewarding payback structures in connection with the Internet has proven to be the development of a new patient recall system.

After a brief learning curve involving how to mail merge all or certain names from your database, you can easily generate general or diagnosis-specific patient recall letters, allowing an even greater standard of quality care for your patients. You can either create labels to mail a batch of letters at one time or, if you record e-mail addresses, minimize the cost associated with mailing, physical labor (stuffing and sealing envelopes) and supplies by e-mailing your letters on a monthly basis. It also is a value-packed way to make contact with PCP’s or other specialists in your area to build new relationships and/or distribute electronic practice newsletters. Your recipients get personalized, individual letters even though they are all transmitted together with only several clicks of a button. 

VOIP
The next phase of technology which is expected to have a tremendous impact on practices is VOIP (Voice Over Internet Protocol). According to Lombardi, this system is one which will allow you and a patient on your website to carry on a live conversation right from the computer, via a talk button on the site. Currently cost-prohibitive, Lombardi expects this system is probably no more than about 12-18 months away.

Increase Productivity
Of course, the increased productivity factor is directly related to finding the right person to perform this task. Perhaps you already employ a staff member looking to branch out into a new direction in your practice, who also attains excellent computer skills to help take this program to the next level. It is no secret that when people truly enjoy what they do….they do it well. Capitalize on matching job skills to the right person and match the effect it can have on improved outcome and productivity. 
 
In the end, this doctor was quick to learn that it’s no crime to be efficient and cost-conscious at the same time. With the use of valuable innovative tools and a computer-savvy staff, you too can move your practice in a profitable direction. Keep in mind that Google and Yahoo are replacing the Yellow Pages every day, and, in fact, Lombardi points out that 30% of all searches on line are now local. “People want more information about a doctor when choosing medical care,” he says. “A properly built website will be optimized to come up high in both search engines when a patient searches in one’s area.”

So go ahead, let your fingers do the walking….and remember, getting them tangled in the web can be exactly what the doctor ordered!

Lynn Homisak, PRT, is a team partner and practice management consultant with Secrets of Success (S.O.S.) Healthcare Management Solutions, LLC and a member of the Board of Trustees of the American Academy of Podiatric Practice Management (AAPPM).  She has lectured internationally to both doctors and assistants on motivational and management-related issues and has published numerous articles on associated topics. Lynn, a licensed Podiatric Radiology Technologist (PRT), is currently employed as an office manager in Sammamish, WA.