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October 2001


Putting the Pieces Together

By James E. Glinn, Sr, PT
Prior to the past decade, a rehabilitation professional could establish a clinic, hang out a shingle, and begin a successful therapy practice with very little marketing effort. This time period was, in short, a sellers' market for rehabilitation services.

The causes behind this ease of entry into practice were twofold. Therapists were in short supply relative to demand and managed care had not exerted significant pressure toward decreased utilization. Needless to say, times have changed. The supply of rehab professionals is adequate secondary to demand in most parts of the country. Managed care (including Medicare oversight) exerts a significant influence on the rehabilitation industry as a whole.

In addition, payors, interested in both risk management and cost-efficiency, are demanding more accountability from health care providers in corporate compliance and outcomes. Such demands have certainly altered practice patterns, and created a voluminous amount of paperwork for providers. Many of us grumble and grouse at these new requirements, and sometimes may even wonder why we chose rehabilitation as our life's work.

The Other Side of the Coin
In spite of all the changes, the future for rehabilitation services is demographically bright. Our current over-65 population, combined with the Baby Boomers marching toward Medicare eligibility, ensures an increasingly important role for the rehabilitation professional. This is true both in the area of insurance-based payment for rehab services and in cash-based payment for prevention and wellness programs by the general public.

Assuring payors that your practice has an effective compliance program as well as adequate outcomes is an important marketing tool for many providers. Making other sources of business (physicians and the public) aware of your menu of services is equally integral.

Compliance plans, outcomes reporting, as well as the addition of a wellness component to your current services mix can be extremely important for private practices from a marketing standpoint.

Practice Culture: The Big Three
In spite of technology, guides to practice, carepaths, and other tools designed to create consistencies of care, unique differences still exist within and between various therapy practices. This individuality or practice culture is what distinguishes one practice from another and is often the stimulus for a customer to purchase a service from one facility rather than another.

The big three components of practice culture are ability, access, and atmosphere. Ability includes the skill mix of the professional staff, and programs created by that staff. Access is a broad category including location, hours, and days of operation; ease of parking; insurances accepted; network affiliations; price of services; time spent waiting for treatment; amount of paperwork; and type(s) of facility licensure. Atmosphere includes appearance and cleanliness as well as attitude and communication skills of staff.

Following are typical components of a marketing program for private practices:

1. Compliance-the constitution and code of conduct of an organization.
2. Outcomes reporting-user satisfaction survey, visits per patient, functional changes.
3. Wellness programs-exposes the public to your other services.
4. Practice culture-ability, access, atmosphere.

The next step is to make the right people aware of your organization and the above components. My five steps to practice growth include establishing one through four above plus creating awareness through a mix of marketing efforts.

Creating a Marketing Plan
There are four major steps in a marketing plan: assessment of demand for a service; analysis of an organization's ability to meet the demand; creating awareness of the services offered; and stimulating purchase of the services.

Demand for a service is contingent on the presence of a sufficient population with the resources, the need, and the desire to access your services. The number and quality of rehabilitation services competing in your market are other important considerations.

The analysis of a practice's ability to meet the demand is where many larger facilities are actually at a disadvantage as compared to smaller clinics because merely being able to meet the demand is often not enough to sustain a new program or service. Your practice may be able to meet the demand, but is staff willing to meet it? Moreover, is that staff eager to meet the demand? This is a major difference between the success or failure of a new program or service. Smaller practices often seem to be more eager to meet the demand than larger entities. Practice owners must distinguish between ability, willingness, and eagerness prior to new program implementation.

Creating awareness and stimulating purchase of services consist of public relations, personal selling, and advertising. Prior to expanding on the above three marketing methods, all of which are designed to stimulate a customer to purchase your service, a rather crass comment must be made. Quite simply, customers purchase a service based on fear of loss. This is true for a customer such as an insurance company that writes a contract with a provider because not doing so might lose them members and for an orthopedic surgeon who refers postoperative cases to physical therapy out of concern that optimum function may not occur without proper rehabilitation. Like it or not, effective marketing will capitalize on fear of loss, even in the rehabilitation services arena.

The Marketing Trio
Public relations is the major method of marketing used by most private practices. Basically, public relations is the management of communication, consisting of a broad range of activities such as day-to-day efforts in the clinic (internal marketing), public information seminars, and attendance at social functions and service clubs. Public relations efforts create an image for your practice in the mind of the public and other interested parties.

Personal selling consists of face-to-face or phone meetings where the immediate goal is to sell someone your program or service. Such meetings may take place over meals or at other times convenient to a potential customer.

Advertising is the development and use of visual and/or auditory materials designed to supplement public relations and personal selling efforts, as well as stand-alone components designed to create awareness of your service. Examples include yellow pages advertisements; mailings; brochures; in-house posters; exposure via newspapers, radio, television, and the Internet; prescription pads; and help-wanted advertisements.

Continuous Integrated Marketing
Continuous means that your marketing efforts never cease. The mix between public relations, personal selling, and advertising may change but marketing never stops. Integrated is the combination of public relations, advertising, and personal selling, so that these components complement each other. Everyone in the organization needs to be involved in the marketing process and the practice must always have marketing events planned, ie, sports injury seminars, osteoporosis prevention workshops, women's health fairs, or holiday social functions.

The United States is rapidly becoming more ethnically diverse. In addition, affluence, taxation, and technology have created population centers of highly educated, service-oriented professionals, as well as wealthy retirees in locations that were once based on mining, forestry, and/or agriculture industries. Marketing managers must stay keenly aware of such population changes. The rehabilitation services mix must change and adapt to meet the needs of a changing population mix. A marketing plan should take into consideration geographics (terrain, weather patterns), demographics (age, ethnicity, income), and psychographics (unique population characteristics and behaviors).

Geographics studies, for example, might tell us whether an area is likely to have a greater incidence of chronic pain and fibromyalgia (both of which are exacerbated by winter darkness and cold). Demographics studies will yield employment income and insurance information about a given population, important information as to the amount and type of industrial injuries, as well as data regarding discretionary income available for wellness or fitness programs. Psychographics studies may reveal a unique affluent population who balk at $5 co-pays for physical therapy services, but will spend $200 per month for a personal trainer.

An effective continuous integrated marketing program can mean the difference between mediocre earnings or a superior bottom line for private practices. A practice may have all of the necessary ingredients-compliance, outcomes, wellness, and an outstanding practice culture (ability, access, atmosphere)-and a marketing plan is simply how you let others know what your practice has to offer.

James E. Glinn, Sr, PT, is CEO of FutureRehab, a health care consulting firm specializing in practice development in Bakersfield, Calif. He may be reached at jamesglinn@futurerehab.com or via the Web: www.futurerehab.com.

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