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AAOS Now

Published 5/1/2012
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Bill Champion

Build Referrals with Nine Milestones in Patient Care

What does your patient experience communicate?

Patient growth in an orthopaedic practice is influenced by several variables including, but not limited to, competitors, payer networks, and health system arrangements. Although these external forces are influential, critical choices in personnel, management, physician commitment, and adaptability determine whether or not the practice effectively communicates leadership, brand superiority, and market preference.

Patients and referral sources rarely need more choices. They need help choosing. To provide your practice a competitive advantage in the marketplace, focus on the patient experience, which can be broken down into nine milestones, or triggers, that influence patient choice.

These nine milestones comprise “the Power of 9” and provide practices the opportunity to make good choices, manage differently, and execute at a level that generates more patients from what should be a practice’s largest referral source—current patients.

I—Incident of injury
A patient starts down the path to musculoskeletal care with the incident of injury. Incidents may be acute or nonacute, and each of these takes a different path.

For acute injuries, the primary driver of choice is location. For nonacute injuries, the path is far more complex and takes into account numerous influencers.

II—Decision to seek care
Several triggers influence the patient with a nonacute injury to either hold off or seek care. Recent economic times have unquestionably had a negative impact on patient decisions to seek care, due to the patient’s employment or insurance status.

Some drivers, however, will trigger patients to seek care even in less-than-ideal economic conditions. These include increasingly severe and more frequent bouts of pain, continual lack of sleep, interference with work or sport, and lastly, passion. The first three are relatively obvious, but surveys of patients will find a sizable number who identify an activity that is of personal interest, or passion, that is being hindered by a musculoskeletal condition. These patients are looking to solve a problem and get back to their passion. For them, it isn’t a knee injury; it’s a problem that is keeping them from gardening or jogging.

III—Choice of a provider
The choice of an orthopaedist is as complex as any consumer decision and in many cases more so. In any given month, roughly one percent of the potential patients in a practice market will need musculoskeletal care. This single percentage makes reaching prospective patients in a way that is both effective (produces documented appointments) and efficient (requires the least amount of resources) challenging at best. Add in the complexities of insurance, primary care networks, and competitive influences, and it is no wonder that practices struggle to allocate resources effectively.

On average, practices get 40 percent of their referrals from primary care providers and an additional 40 percent from previous patients. As health care becomes more consumer-driven, this breakdown will shift toward previous patients and self-referral, presenting challenges to practices as the number of target audiences grows and what prospective patients are looking for changes. Today’s patients are not looking for an orthopaedic surgeon, but a hand surgeon, spine specialist, or knee expert. Through the Internet, patients have access to ever more information to help them determine what they need and who is an appropriate provider.

As recently as 10 years ago, an orthopaedist would have a loyal source of primary care physicians and a percentage of patients who influenced referrals. Today, those discussions are being conducted online through social networks and are influencing decisions about where “the best care” can be had.

Although advertising can be effective for some practices in the right market, using the right medium, and using a clear, differentiating message, in most cases, it does not generate a return on the investment. Advertising’s appeal is that it is so easily executable. For most practices, writing a check delivers messaging into the market that physicians are able to see and hear. This strategy is reinforced when patients or acquaintances mention hearing or seeing the ads.

Awareness, however, is rarely the problem. On average, practices have an awareness level that exceeds the number of people that choose them by a multiple of four. The objective should be to make it easier for people to choose your specific practice.

No other milestone is more complex and challenging; it’s difficult to allocate the right resources in the right manner to influence choice.

IV—Making an appointment
At this milestone, a prospective patient has already made a conscious choice of a practice, yet many practices make it so difficult for patients to actually make an appointment that some patients may take two steps back to their decision to seek care and look for another provider.

I would contend that the three A’s (Affability, Accessibility, and Ability) are more important today than they have ever been. When evaluating this milestone in your practice, call and make an appointment, or ask a trusted friend, family member, or colleague to do so. Was the process easy and enjoyable? If not, patients may be choosing you, but your appointment process is sending them elsewhere.

V—First visit
Some previous patients may refer more patients to the practice than some primary care referral sources, even through these “raving fans” are the least clinically qualified to do so. Their referrals probably aren’t based on clinical expertise, but on their overall experience with the practice—the staff and you as their orthopaedist.

Patients can experience more than 15 different touch points as part of an orthopaedic visit. Each of these touch points either adds to or detracts from their overall experience. And that experience is not being compared to similar experiences with other orthopaedic providers. Instead, it’s being compared to the service experience they had at the restaurant they visited or the store where they shopped. Practices should have a plan to soften any sharp edges and create an experience that will make a patient’s visit the best part of his or her day instead of the most frustrating.

VI—Last nonsurgical visit
This milestone reflects the last visit a nonsurgical patient might have with your practice. Every patient should have one key message by this point: that he or she came to the right place for treatment of his or her condition. It is “how” patients are treated that drives patient growth far more than the “what” they are treated for.

VII—Surgery
Good clinical care is the bedrock of any good practice. Yet, without documented outcome studies, patients use the information they do have—perhaps a referral from a neighbor or the cleanliness of your office—to determine quality. Because they do not have good data, patients rarely choose an orthopaedist on the basis of clinical care.

The most important aspect of the surgical milestone is how the surgical experience reflects on the surgeon. Whether the experience was exceptional or not, it almost always reflects on the surgeon’s practice.

This milestone starts at the last preoperative appointment and ends at the first follow-up appointment. Remember, the patient’s experience is less represented by what happened during surgery and more dependent on the hassles prior to surgery and the challenges afterwards. These experiences should be managed to create promoters versus detractors of the practice.

VIII—Follow-up visit
Follow-up appointments provide a practice an opportunity to reinforce a patient’s choice of care provider. Postoperative patients are an orthopaedic practice’s most credible referral source. These patients have been engaged with the practice at a unique level. They know how, for what, and why someone should seek care there. Don’t underestimate how important this appointment is to the practice. The first impression is important, but the last impression is equally as important.

IX—Post follow-up
A good patient experience shouldn’t end at the last appointment. A patient experience can and should continue through to the next incident of injury for the patient or a loved one.

Practices have numerous opportunities to communicate using traditional media. Some practices support unique patient events to differentiate themselves and engage patients at a level beyond traditional efforts in the market.

In closing, the nine milestones identified in this system provide orthopaedic practices numerous opportunities to communicate something more to what should be the practice’s best referral source—its patients. These patients are looking to reinforce their reasons for choosing a specific practice and are often looking for even better reasons to refer the practice to their friends, family, and coworkers. Being a good provider of musculoskeletal care is rarely enough; focusing on the entire patient experience is necessary for success.

Bill Champion is the president of the Orthopaedic Marketing Group in Omaha, Neb. He can be reached at bchampion@orthopaedicmarketing.com