Marketing Your ASC

Marketing Your ASC

By Kathy Dix

CONSTRUCTION IS COMPLETE on your ambulatory surgery center (ASC). Physician partners and investors have been recruited and are bringing their own patients to the ASC. However, you would like to improve upon your current numbers by providing care to more patients. How do you market your facility to referring physicians and the community at large?

Certain characteristics may attract a physician to your facility — good quality and high patient satisfaction, for example. Low infection rates may also be an attraction. Quick recoveries and returns to work and other normal activities are another plus, and being approved as a “Center of Excellence” is an additional draw.

A very “public” profile is crucial for getting the word out about the quality and benefits of your surgery center. AmSurg Corp., for example, at its dozens of ASCs, makes a point of getting its surgeons on television and in other health forums.1 Personal contact is the key. The centers claim better outcomes, higher patient satisfaction, and better referral service than competitors, and may measure satisfaction of the referring physician to ensure they stay up-to-date with those physicians’ needs. To reach the patients directly, AmSurg makes use of advertising, direct mail to patients, and emphasizing any accreditation the facility holds.

Lauralee Krabill, RN-C, CNOR, MBA, consultant for the Krabill Marketing Group, suggests marketing to both physicians and patients. “Physicians will direct patient care to your facility, but patients can request the surgery center to physicians because they’ve heard about it. For marketing to physicians, we do a couple of different things. In one facility, we provided candy dishes to all the physicians’ offices in our area. Then every month, you can supply candy to fill those dishes. Therefore, the director of the surgery center or the business office people from the surgery center can be in all the doctors’ offices, providing them with food, and food always works,” she quips. “As the physician’s office gets on board, then you are in constant contact with them, and as things continue to get better or as they do more surgeries, you don’t have to be there as frequently.”

“All of my marketing at all of my centers is concentrated on the physicians and their business staff, because the patients will go for the most part wherever the physician directs them,” adds Beverly Kirchner, BSN, CNOR, CASC, president and CEO of Genesee Associates. “However, they will ask about surgery centers now, and it’s important to have Web pages [about your center], especially in the big communities. And if my competitors are hospitals, I make sure that my centers are Joint Commission-accredited, because if I’m telling a patient that they’re going to get equal care or better than what they’d get in the hospital, I need to be able to tell them that I’m accredited by the same organization that accredits the hospital,” she adds.

Kirchner sets up appointments at least once a quarter, not just with the physician partners, but also with every physician in the area. She will ask them if they’re using the surgery center, and if so, what they’re doing well and what they’re not doing well. “If they’re not using us, I ask what we need to do to get them to try us. Then, if they give me any specific issues, the No. 1 rule for me and for all of my administrators is that you have an answer back to them in 24 hours, and you personally give that to them on every issue so that you build trust with them,” she explains.

Some issues the physicians list might be the lack of equipment to provide certain procedures, or the physician may not be a partner, and therefore has an issue with sending a patient there. “Often, physicians who are not partners don’t like to use ASCs that are physician owned, because they feel they’re greasing other physicians’ pockets in the community,” says Kirchner. “That is really seen in a rural community, because there is a limited number of physicians, and if you have not been invited into the surgery center as a partner, you don’t want to hand your competitors money.”

The solution? “Invite them into the partnership; it generally works,” Kirchner adds.

There is some reliance on name recognition and word of mouth within the community; however, these should not be the only means of getting patients to utilize your surgery center. There will be an abundance of people in the municipality who will not hear about the center from their friends, family, or coworkers.

“You need to get people that wouldn’t set foot in an ambulatory surgery center there,” Krabill emphasizes. “You can do that by working with the American Red Cross and having a bloodmobile, for example. You can offer evening programs on healthcare topics, with the physician being the primary source of information. Even giving kids a stuffed animal with the name of the surgery center on it works.

The more you get the name out in the community, the better, because they wonder what is behind those closed doors. You can do an open house occasionally, but I don’t know that those are valued as much as an educational topic. For example, breast cancer awareness takes place in October, so have a physician who does breast reconstructive surgery [be the expert] and provide an evening program [for the community]. The members of the community can have their blood pressure taken; then you can offer them a card that shows their numbers, so they can keep it with them in a wallet or purse wherever they go. Then take them on a tour of the facility at the same time.

“Some of our centers work with the school systems to tour children on the off-hours through the surgery center, so they can see what surgery is all about. It shows children that the area is not something to be frightened of if they have to have surgery, and they go home and tell their parents about the experience they’ve had. Remember, the woman of the house still is the No. 1 decision-maker on care for the family,” Kirchner says.

“Our philosophy is to be a good community neighbor,” says Tracy Edwards, senior vice president of corporate communications at Cirrus Health. “Marketing budgets for ambulatory surgery centers can be quite snug, so we try to do the most we can to be a good neighbor, like sponsoring sports programs, the local high school, things that really touch the community’s heart. We’re always involved with the local business organizations such as chambers of commerce because we feel it’s important to be actively involved in the communities where our ASCs are located.

Because of tight budgets, we have to be very selective with those community funds, but we do allocate and build a marketing campaign to target becoming a community neighbor,” Edwards adds.

Health fairs are built into the marketing campaign. The ASCs host health fairs and offer tours of the facilities, as well as health screenings and exhibitions of the surgery center. “It’s the patient education as well — educating the community about the fact that we’re a facility dedicated to excellence, we’re convenient, and we’re good neighbors. That’s a critical message that surgery centers need to capture — that we want to be a good neighbor, a part of the community. We’re not just this ASC sitting on the edge; we want to be a source of healthcare information,” she says.

“We have found the most productive campaigns are community sponsorships, business sponsorships. When we open a facility, we do the ad campaign to let people know we are there. We also might do some direct mail campaigns, saying that we’re new in the neighborhood, and it is in a radius around that facility.”

Having staff follow up with potential patients is key to promoting the center — if they call the patient long before the procedure, they have the opportunity to develop a relationship with them. “We encourage them to come for a tour beforehand, to come in and do pre-work if possible, so they already are familiar with the names and faces assisting them throughout their procedure,” Edwards explains. “That is a huge marketing tool most people don’t think about, to be able to send that message to physicians and the public to a degree, that you’re with the same nurses, and when you’re put under for your procedure, that same face you see is the one you will see when you are waking up.

That creates a comfort level for patients that I have heard about time and time again from staff and patients. Patients say, ‘I had my procedure done at that surgery center, and it was a wonderful experience.’”

That word of mouth is priceless — in many communities, positive comments from patients using the center have spread like wildfire through the community. “It’s surprising how effective it is,” Edwards observes. “We recognize word of mouth is the No. 1 advertisement, because people trust their friends who say, ‘I had my surgery done there.’ Patients can hear about it from their friends, or can ask their physician, ‘I’ve heard of this surgery center; can I get my surgery done there?’ That’s the full cycle we need to recognize, that marketers can utilize in their marketing pieces.”

“The other change that is coming down — and I haven’t quite figured out how I’m going to tackle this — is transparency. Eventually, we are going to have to be able to post our pricing [for comparison with the competition],” says Kirchner. “To do that, we’re going to have to work harder at developing charge masters based on actual cost to provide the care. Transparency is going to change how we market.

“This, then, will be marketing to patients, so it’s something we’d put on a Web site. Consumer groups may be putting our information on Web sites. This is happening in southern California already — there are consumer groups posting hospital and surgery center pricing on their Web sites. I think patients are more and more going to go to Web sites and browse. The other result of transparency will be revolutionize all of our pricing. If you look at a hospital that is 30 years old, when is the last time somebody went CPT code by CPT code and figured out the actual cost and updated that charge master?

As they’ve added new procedures, they’ve just gone across the board and made overall adjustments to cost. A lot of times, we will say at the first of the year, ‘There’s been an inflation rate of x, and supplies are up x, so we will take our base charge up x.’ We put that percentage into the computer and it updates every price, but that doesn’t really tell us what the procedure is costing us. That’s where transparency is going to change a lot. We’ll have to be more astute on what things are really costing down to the penny. It’s going to give some consultants a lot of business,” Kirchner concludes.

Referring physicians are generally the best route to directly affect your center’s numbers.

“I am of the school of thought that espouses marketing focus on physicians,” says Joni M. Steinman, managing principal at AUSMS Healthcare Consultants. “That is their target market. Certainly in this day in age for drugs and hospitals and procedures, you do have a certain amount of patient and family involvement in decisions to do with where one might have a surgical procedure. Your primary focus should be on the physician community, both primary care physicians as well as the surgery referral community. If your budget is an issue, as it may be for most of the smaller centers, I would suggest that you focus on the physician community before the patients or the public community.”

Referring physicians may be impressed by a center that offers specialization in one particular area of medicine. “There are always benefits to organizing your facility so you are, in fact, really excellent at something in a procedure cohort, at a specialty, maybe a type of service like women’s services or pediatrics,” says Steinman. “Find something that you can legitimately claim as an excellence, or develop an excellence in, through improved clinical protocols or enhancing nursing and technical staff, or by bringing on a new physician who might help bolster a particular area you’re good at already, but need an additional expertise in. It becomes a focus in your marketing plan as you execute it. Even if you tout women’s services as an excellence at your facility, it’s not as if you’re only going to market to women, but because you have an excellence and can demonstrate it, you are now getting women to think about that surgery center when they do have to consider having a procedure for themselves, or for a family member. Women make over 70 percent of decisions for healthcare in general. Having this area of excellence becomes an entry point. It doesn’t mean that’s the only thing you’re going to market, but it becomes the ‘crown jewel’ of your marketing program,” she adds.

Differentiation is always important, and is one of the most difficult things to do by the small surgery center provider, she points out. Differentiation is often easier for group or corporate providers. But, Steinman observes, “Like politics these days — ‘all politics is retail,’ ambulatory surgery is retail. Yes, there is a way in which some of the larger systems have an advantage in terms of marketing, but truth be known, local people look to local physicians and local providers for a place to go for surgery procedures.

Collaborating on marketing efforts also can prove beneficial, she adds. Making friends of your competitors can be advantageous for all the parties involved.

“Sometimes you can be good at something and the local hospital can be good at something else,” says Steinman. “This might be a way for you to find a happy medium, where both the surgery center and the hospital can come together to co-market one another in a way that might benefit both of you.”

In other words, the surgery center should position itself as strong in one particular area, and the hospital can position itself as strong in a related area. Together, the ASC and the hospital or health system can provide a very strong and broadly construed base of services for the consumer. “It’s an idea that works in selected settings, but is one that we ought to start thinking of more, rather than keeping competitors at arm’s length,” she adds. “Bring them a little closer. It’s time to start to find ways we can work together.”

“I believe in competition, I think it’s healthy, but sometimes we spite ourselves by not creating or forcing relationships, creating relationships where they are legitimate and helpful to both parties, founded and maintained. It is surprising how much we can share with each other while managing to not step on each other’s toes — taking a cooperative tack instead of ‘What’s good for us vs. what’s good for the hospital.’”

Thus, the selection of media and the means of reaching both physicians and the community at large must be a function of how those who you’re focusing on normally respond.

“If physicians are your primary target market, then I would say that using media like radio, TV, etc., is probably not a good expenditure of the dollar,” Steinman stresses. “You would do much better hiring somebody whose job is to bring the message of the surgery center to the physician community personally, someone whose job is to develop ways that the physician can become more knowledgeable with the surgicenter’s programs, and to solicit feedback as to what makes it more likely for them to bring patients over to you. It is a better use of marketing dollar than advertising. Advertising is an expensive way to go, and is tough for smaller centers truly to get the word out. It’s better to go directly to the physician, to go in to their offices, to work with their schedulers, office managers, or head nurses, identifying with them what services they’re now using. Are they using competitive facilities? Are they not using ambulatory surgery centers at all? Always remember that identifying a vacuum or gap is your best bet, because a surgery center is more likely to respond to filling a gap than to a bigger, more complex organization such as a hospital.

“There’s a real advantage to pounding the pavement,” Steinman emphasizes. A marketing coordinator can help make recommendations for the physician as to where they are taking patients for particular procedures, whether the ambulatory surgery center offers them a block scheduling opportunity or an equipment opportunity.

“You may even be able to offer them the ability to bring a particular nurse in as first assistant. There are just a myriad of ways to go about this. That truly is a better expenditure than traditional advertising.

“Beyond that, if you build concentric circles around your primary marketing efforts, you should go for community-based activities to present yourself as a valuable healthcare resource, as interested in healthcare for the public, not just surgery. That might put you in a position at a health fair or something similar.”

In California, for example, some ASCs make their names known to the public by showing up at art shows held outdoors. They will offer information about the surgery center, but the focal point is vision testing, blood pressure screening, or some other health-related screening for a medical condition. This condition might be treated in a number of ways, but one of those methods might be a surgery offered by your center. If, for example, your surgery center has a bariatric program, the health screening or presentation might have something to do with weight management. A surgery center could offer a mini stress test.

The whole point, Steinman says, “is so the public can identify that there’s a resource here that might help me with a problem. That’s a good role for surgery centers to play, because we are, for the most part, independently owned and operated. But even the large surgery centers have close to a majority of investors who are local community leaders, and that’s a good way to show they really feel themselves to be a local resource.”

Naturally, when delivering candy or offering meals to a potential physician referrer, the surgery center must ensure they are carefully falling within regulations, but there are multiple ways to present the benefits of your surgery center to a physician, perhaps in conjunction with an equipment vendor to demonstrate a new piece of equipment and capability that translates into procedures easily identified by the physician’s staff as something they are looking to have available for patients.

“You’re being educational, showing yourself as community resource, and then you get an opportunity, maybe talking about some type of ophthalmology procedure, to talk about your major retinal program.

Talking about something like GI endoscopy may lead you into a discussion of what general surgery you offer that is abdominal-related.

It’s a door opener. It’s remarkable how little this is done, when you really look at it carefully, and how differentiated and special you look if you take this as your strategy,” Steinman says. “I think if you did a survey, you would be surprised. The centers that do it are good at it and successful as a result, and they put a lot of marketing emphasis and budget into this approach, and I truly think the personal approach has great merit.”

The business staff can also be approached one-on-one. “We always ask them what we’re doing right and not doing right, and a lot of times, when I’m doing that kind of marketing, I take my scheduler with me, because nothing is better than having a scheduler to schedule a face to face meeting, so they know who each other are and they can start building a relationship,” Kirchner says. “That’s one of the biggest tools.

You’d be surprised how many physicians tell the staff to schedule the patient for surgery and leave it up to the staff as to where they schedule them. Especially if you’re opening a new center, one of the things you have to do is educate that staff on who you are, what you’re doing, and what advantages there are for patients as well as physicians.”

Of course, physicians are not always receptive to the presentation of the marketing manager, and may declare they have no interest in utilizing your ASC. That requires immediate attention.

“If they blow you off, figure out why that is, because I often find there’s a fairly obvious reason for it,” says Steinman. “Either they are a leader at a local hospital, or they have a vested interest somewhere else, or some other process going on. Perhaps they have an anti-ASC philosophy. There are physicians who haven’t bought into the ambulatory surgery center concept.

“I think that we have to be aware and be intelligence gatherers. Did he have a bad experience? Did he come from another community where he was not involved with surgery centers and kept that as his way of looking at his practice [when he relocated]? Does he think there is a quality issue? Is there some way for you to address that directly and openly with him or her? Or is it simply that what constitutes the largest portion of ambulatory surgery practice is in fact not being addressed by your center? Show him what you now offer or what you could offer to be an active user, so that this becomes the place where the physician can feel comfortable bringing patients on a more regular basis,” she concludes.

If the physician is not interested in utilizing the center, “You walk away with a smile and send a handwritten thank you note, thanking them for their time, and go back six months later,” Kirchner adds. “A handwritten note opens more doors than anything else. It’s personal. It says to them that you’re willing to take your personal time and create a message just for them, instead of a form letter. When you have doctors who work in your facility, if you take time to go to their office and sit on their turf, they’re going to give you more information [than if you met with them at the center instead]. That’s going to buy you more mileage, because you’ve given up your personal time, and you have honored their territory.”

If the physician is not interested in using your center, there may well be legitimate reasons. “They may feel like their customer base is not around the surgery center that we represent, so you offer the solution: ‘May I research or get with your business office manager to pull some information about where your patients are coming from? You might be surprised.’ Or you can pull out demographics — ‘Did you know our surgery center is located in one of the fastest-growing demographics in the area? Are you aware we can offer you more convenient surgery times to better serve your patients?’ For most physicians that we partner with, and that we perform surgeries for, their concern is delivering quality care to their patients,” says Edwards. “When interviewing or talking with a physician, if you can get to the root cause of their lack of willingness to look at the project, remember that they want to better serve their patients — and if they realize your facility is better located, that you have more convenient scheduling times, your nurses have a better ratio, or you have a specialized service that you focus on, that will trigger something with the physician to at least open the door and take a tour of the ASC.”

Touting your center’s advanced technology is an important face to any marketing campaign, points out Kristen Franz, marketing manager at Titan Health Corporation. “It’s important to utilize the newest and most advanced technologies and provide unsurpassed patient care while maintaining cost-effective operations. Competition generally leads to lower reimbursement which further emphasizes the need to maximize operational efficiencies.,” she says.

Utilizing the local media is also an important segment of your campaign. “When getting ready to open a new center, working with the local papers and business journals is an important way to increase awareness and educate the community. Local publications welcome the opportunity to write a story on changes taking place in the community that have a positive effect on residents and the local business environment. Mailing out announcements to physicians and other healthcare providers also helps educate referral sources and increase their awareness of the services your surgery center has to offer,” adds Franz.

It’s a good idea, if possible, to have a full-time staff member dedicated to marketing. However, Franz says, “Due to time and budget constraints, a full-time surgery center marketing position isn’t usually feasible for most ASCs. Working with a surgery center management partner can help establish some economy of scale to reduce the cost of meeting the marketing needs of the center without detracting from the center’s day-to-day operations and patient care.”

Focusing on quality patient care is the most important marketing tool for Edwards. The main thing when marketing is to promote that it is a center dedicated to the best quality outcomes. We focus on our nurse-to-patient ratios, focus on some of our other physician partners that perform in our surgery centers. We focus on the convenience we provide for our physicians in the local area, because ultimately, our physician partners want to provide the same thing — the best patient outcomes, a convenient location for themselves as well as their patients, a facility that has a strong nurse-to-patient ratio, and a facility dedicated to one-on-one patient care,” she says.

1. Physician Compensation Report: Surgery Center Marketing Targets Patient Flow to Practices. Physician Compensation Report, August 2001.