Marketing of the Bariatric Surgical Practice at an Introductory Level

| June 11, 2014

by Paul B. Wizman MD, FACS, FRCS(C), FASMBS, and Rita Wizman, MBA

Paul B. Wizman, MD, FACS, FRCS (C), FASMBS, and Rita Wizman, MBA, are from Bariatrix Florida in Margate, Florida.

Bariatric Times. 2014;11(6):12–13.

Abstract
As physicians, we have been trained in the science of medicine. Once we graduate, we discover that it is not only a science, but also an art and a business. We have had little formal training in the way of business and, therefore, marketing can seem intimidating at first. In this article, we discuss a marketing strategy at an introductory level.

We will define the target client/patient, set a system for tracking each patient, define a budget, and discuss the combination of available tools best suited for your type of program. We will discuss branding, reputation, and networking as well as traditional versus internet marketing for the bariatric professional.

Introduction
Before putting together a marketing strategy, it is important to identify your practice for business purposes. You will want to ask yourself, “Is it is a hospital, university, or a private program?” A hospital and university program must obey the physician self-referral law (commonly referred to as the “Stark Law”) and, therefore, cannot promote private physicians. A university program may attract more complicated cases (e.g., revisional surgery, super obese, and Medicare populations). A private outpatient band practice may attract a less morbid population. You will also want to ask whether the practice specializes solely in the bariatric field or other specialties as well. Each practice is different and will have different patient demographics and different marketing budgets. Where a hospital program may have a fixed marketing budget and certain marketing plan, a private physician may entertain a more flexible marketing strategy and spending. Your first task is to identify the origin of your client. Oftentimes, physicians’ staff will fail to track the source of new patients (e.g., internet search, physician referrals, insurance plan referral, previous patient) If you do not track the source of every new patient, you will never be able to determine the effectiveness of each of your various marketing tactics.[1] So, before you spend money on a marketing strategy, it is important to implement a system of tracking each and every patient from the very first call into the office.

The State of Obesity and Bariatric Surgery
In the United States, we are currently performing about 170,000 bariatric cases per year; 40 percent sleeve gastrectomy and 30 percent Roux-en-Y gastric bypass (RYGB) and laparoscopic adjustabe gastric bands (LAGB) with other procedures, such as duodenal switch, making up the other 30 percent.[2] Fifteen percent of the United States population has a body mass index (BMI) greater than 35kg/m2.[2] This means that our penetrance is less than one percent. There was a steady rise in the number of cases from 2000 to 2006; however, the rate leveled off a few years ago and may now be decreasing.[2]
Despite the enormous number of adults with obesity in the United States, bariatric practices face a challenge in increasing the number of new patients. Some challenges include the following:
1.    Insurance companies interfering with access to care (submission requirements, dietary programs, patients’ increased financial responsibility)
2.    Unawareness of the laypersons, particularly due to an ongoing prejudice of the primary care doctor
3.    Lack of education
4.    Negative misconceptions and myths
5.    Lack of family support.

Given these challenges, we can estimate that the pool of potential clients is much smaller than the 15 million Americans with obesity and may be closer to 200,000.[2] Given these estimates, we must target our marketing efforts in a more focused fashion to this small subset of potential patient/clients.
United States Small Business Administration recommends that small businesses spend 7 to 8 percent of their gross revenue in marketing. Keep in mind that your marketing program is a revenue center rather than a cost center. Rather than focusing on how much a certain marketing vehicle costs, consider the return on investment.

Hospitals and physician practices are discovering that it is no longer enough to deliver good quality healthcare to remain competitive. Today’s health consumers, especially younger patients, consider the reputation and patient experience before physician referrals. While bariatric patients of older generations listen to the doctor’s recommendations and follows the referral from his or her primary care physician, younger patients (including baby boomers) have turned into a so-called generation of e-Patients. The letter “e” does not only stand for electronic communication, but also for equipped, enabled, empowered, engaged, emancipated, equal. This generation will search the internet for information on bariatric surgery, compare the reviews of hospitals, and research surgeon reviews as well as testimonials from previous patients. The days when physician options and suggestions were never questioned are over, and patients are taking their healthcare into their own hands.[4]

Branding, Image, and Reputation.
Word of mouth is one of the most effective marketing strategies. Patients are much more likely to choose a certain healthcare provider based on their friends’ advice and previous experience. On the other hand, one bad outcome can spread to thousands. Some of us might have heard, ”I love the doctor, but his staff is difficult.” Therefore, be aware of how your patients are treated on the phone and face-to-face during their appointments. Each communication with a patient or one of the peers should be perceived as an opportunity to network and gain influence.The importance of customer service cannot be emphasized enough.

Networking
A hospital, surgical program, and surgeon must maintain close camaraderie with the community. For a hospital, this may mean health fairs at local malls, free informational meetings, and perhaps even allowing coverage of bariatric surgery or discounting the cost to employees. For surgeons, this might entail presence at local and national meetings, in-services, community educational classes, and visiting the primary care, gynecology, orthopedic, cardiology, pulmonary, sleep, and ENT specialists in the community.

Traditional marketing is still an important part of the marketing strategies for healthcare providers. While putting together your marketing plan, consider radio, print advertising, direct mailings, public relations, TV, billboards, and brochures/flyers. The cost of each vehicle will vary significantly, but so will results. For small businesses, traditional marketing may be cost prohibitive, while hospitals and larger franchises may find this useful.

Internet Marketing
According to a national survey conducted by the Pew Research Center’s Internet and American Life Project, 72 percent of internet users looked for health information online, including searches on serious conditions, general information, and minor health problems. The survey found that patients are less likely to choose the healthcare provider solely based on geographic location and that potential bariatric patients are willing to travel a longer distance to receive care. This decision might be based on a surgeon’s reputation, previous experience of a family member or a friend, better price, or even better reviews on physician review sites.

Basic internet marketing tools include the following:
1.    Bariatric practice website with current information. Your practice website should have relative and unique content that will help in the organic position of the website. It must also be honest and educational.
2.    Physician review sites. Staying on top of review sites, such as obesityhelp.com, bariatricpal.com, vitals.com, healthgrades.com, and others can be time consuming; however, it is important to read them and address them periodically. Make sure that the basic information about the your practice is correct. You should also complete free profiles, add your website links, and add images. Google Alerts is also a very useful tool to track what is being said about you and your practice online.
3.    Local business listings. Managing your local business listing on Google, Bing, and other sites will not only help your patients find you, but also establish a better presence in the search results.
4.    E-mail marketing. E-mail marketing is a great tool to engage with previous bariatric patients, keep them on track in the post-operative period, and inform them about upcoming events. Be sure to use an e-mail marketing service, such as Constant Contact or  Mail Chimp, so that you do not violate an anti-spam law and patients can opt out of the emails.
5.     Engaging in social media. Social media sites, such as Facebook, YouTube, and Twitter, will establish better online presence, build relationships with patients, and help with reputation management. Be careful not to respond to specific health inquiries online to avoid violating the Health Insurance Portability and Accountability Act of 1996 (HIPAA).
6.    Free marketing tools. Be sure to take advantage of free marketing tools. Companies like Apollo Endosurgery, Covidien, and Ethicon offer various free marketing tools. For example, Apollo Endosurgery lists physicians who perform Lap Band® surgery according their zip code, so be sure to edit your profile, add your website address, dates for your Information Sessions etc. (www.lapband.com). Take advantage of patient education materials (brochures, posters, digital images).
7.    Mobile marketing. Mobile marketing plays an important role as 85 percent of United States adults own a cell phone, and of that group, 31 percent have used their phone to search for health or medical information.[3]

There are numerous marketing tools available. Be sure to reach out to marketing professionals who can provide advice and help you with implementing your marketing plan. Choose what works for you—set a budget, build strategy, and be consistent. Be prepared for change as it is the only constant force in business.

References
1.    Gandolf S, Hirsch L. Healthcare How to avoid the 7 deadly sins of healthcare marketing. 2013 http://www.healthcaresuccess.com/education/7-deadly-sins. Accessed February 19, 2014.
2.    Roslin MS. Bariatric procedures decline despite rise in obesity and diabetes. General Surgery News. 2013;(40)10:6–9.
3.    Smith and Jones Healthcare Marketing. The Mobile Health Revolution. 2013. http://smithandjones.com/journals/healthcare-marketing-white-papers/. Accessed February 19, 2014.
4.    Smith and Jones Healthcare Marketing. Socializing Medicine. 2013. http://smithandjones.com/journals/healthcare-marketing-white-papers/. Accessed February 19, 2014.

funding: No funding was provided.
disclosures: The authors report no conflicts of interest relevant to the content of this article.

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