When marketing to physicians, think like an entrepreneur, not a clinician

Direct mail increases annual referrals, revenues by $100,000

It was not a sight to inspire confidence in your mission, admits Southern Home Care executive director Lorraine Waters. "When I started [about three years ago], there was this one doctor who’d shake his index finger at me every time he saw me in the hospital parking lot."

That single gesture warned her of the daunting task that lay ahead in marketing the agency, a department of Clark Memorial Hospital in Jeffersonville, IN. The physicians whom the newly hired director planned to target for referrals either had low opinions of home care or, like most of the hospital staff, didn’t even know Southern Home Care existed.

"I’d say over 80% of the staff in the hospital did not know there was a home health agency here," she recalls.

So, Waters, BSN, CNA, did what any savvy manager would do: She listened closely to the doctors’ concerns, educated the hospital staff, and gave away lots of pizza.

The strategy worked. Her hospital-funded marketing efforts have heightened staff awareness of home care and improved relations with doctors. A direct-mail campaign, launched in late 1995, so far has brought in 56 more patient referrals than the previous year and $100,000 in additional revenue.

Why market? You can’t just go for hospital referrals

Should you market your agency to physicians? Sales likely isn’t part of your job description, and why should you have to sell your agency, anyway?

"If you don’t, your competition will," says David Baker, director of Home Care Services at Sisters of the Third Order of St. Francis Health System in Peoria, IL. "Don’t just go for hospital referrals."

But seeking new sources of business will require a shift in thinking. Baker says hospital-based agency directors dig a hole for themselves by thinking like department heads, and not entrepreneurs.

Consultant Kevin O’Donnell, chairman of Lewisville, TX-based Health Care Resources of America agrees. He says agency directors place themselves at a disadvantage because "they talk the Medicare language or the home health language. That has nothing to do with marketing a business."

The market has changed, O’Donnell reminds clients. Managed care and consolidation have cut hospitals out of being major sources of referrals to home care. He urges home care directors to seek other sources of business. (See Hospital Home Health, August 1996, pp. 78-79.)

O’Donnell suggests that agencies align themselves with other outpatient procedures and home care providers in the community instead of waiting for Medicare business to come their way.

Karen Carney, a home care marketing consultant and publisher of The Home Advantage marketing newsletter in Andover, MA, has a similar opinion. "I can’t tell you how many stories I’ve heard about home health agencies not getting referrals from their own hospitals."

Most likely, that’s because the hospital staff didn’t know there was a home care agency, as in Waters’ case. Sometimes, Carney says, "Hospitals don’t always understand home care and how it fits in, or the agency isn’t sure where it fits in, either."

The hospital advantage

Being based at a hospital can have its advantages, though. The resources available make agencies appealing for "one-stop shopping," says Cathy Frasca, RN, BSN, FACHCA, executive director of South Hills Home Health Agency in Homestead, PA. "And you can let the hospital market your services along with all the other services."

"The fallacy," says Waters, "is in thinking you don’t need to market your agency because you’re part of a hospital. You have to market."

Here’s how she did it:

To overcome the internal identity crisis, Waters first met individually with hospital nurses, case managers, and discharge planners to tell them about her home care services; then she and her nurses held a series of presentations for larger numbers of staff, again offering an overview of what the agency could do. At the same time, she secured space in the hospital newsletter and each month runs a story about home care.

A few months later, she faced members of her target group, the referring physicians. Waters picked doctors she knew were the least happy with home care and, assisted by two other home care coordinators, met with them individually. The team asked what the doctors didn’t like about home care and then promised to fix it. And what if the doctor had to leave the meeting? "We still had the office manager," Waters says.

Waters targeted about 140 physicians, mostly local ones who used the hospital but also a few who had practices across the Ohio River in Louisville, KY.

She recalls a recurring complaint: "Some doctors had had the experience that once the agency got their patients, the doctors never saw them again. We pledged not to do that, and we don’t." Waters says that her agency makes sure any patient who is able to get to the doctor’s office for tests, goes.

"Doctors are sometimes between a rock and a hard place," explains Larry Burnham of Walker and Barnhardt, a home health marketing firm in Concord, NC. "They sometimes get orders for procedures ex post facto on patients they don’t see, and they feel vulnerable. They think, ‘When I get a patient in home care, I lose control, and I’m at high risk.’"

Waters says that some doctors complained "they didn’t get paid as well as we did, so we had to explain to them, ‘Yes, we can charge $95 a visit, but we don’t get that. Medicare only pays us for our actual costs.’"

The key to her program’s success has been communication. "Nobody was listening to the doctors," she says.

"At first the doctors were skeptical, but in six months we did it. That was the turning point."

Direct-mail campaign works

Referrals began to increase, but Waters, who came to Southern Home Care from a private-duty agency, wanted to do better. She asked the hospital public relations department for help, and they contracted with a local marketing company. Then came the pizza luncheons.

"This gave us a golden opportunity to meet with three or four doctors at one time," says Waters.

The marketing firm designed five diamond-shaped postcards to be mailed separately over a period of several weeks, each card briefly explaining in words and images why the physician should consider Southern Home Care for his patients. They read:

1. "We’re well-connected."

2. "Our staff stays current on the nuts and bolts of home care."

3. "We value your time."

4. "We know when it’s time to let your patient move on."

5. "You’re always in control."

The pictures on the cards were of an electrical extension cord, a machine bolt, a clock, a parking meter, and a TV remote control.

The doctors were to initial and save each card. When all five were collected, the cards could then be returned to Southern Home Care to win a free pizza lunch for the physician and the office staff. Lunch money came out of the agency’s budget. And who delivered the pizzas? You guessed it. Lorraine Waters.

"This gave us access to the doctors who were not referring," she says, "and we could ask them, ‘What do you want?’"

That showed Southern Home Care ways it needed to improve. "It helped us build up our IV services," Waters adds.

One of the things Waters believes helped her cause was "the fact that we used the hospital pharmacy. The doctors were comfortable with it because they knew them."

The free lunch program began in November 1995 and continued until June 1996, and the agency still reaps benefits, though not all of them are directly related to referrals. Remember the doctor who wagged the disapproving finger? He’s president of the Southern Home advisory board.

"He’s been such a help," Waters says.