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Chronic Care At Walgreens? Really? 

5/1/2013

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Walgreens, the country’s largest drugstore chain, announced on April 4th that its 330+ Take Care Clinics will be the first retail store clinics to both diagnose and manage chronic conditions like asthma, diabetes, high blood pressure, and high cholesterol. The Nurse Practitioners (NPs) and Physician Assistants (PAs) who staff these clinics will provide an entry point into treatment for some of these conditions, setting Walgreens apart from competitors like Target and CVS whose staff help manage already-established chronic illnesses or are limited to testing for and treating minor, short-lived ailments like strep throat.

A one-stop shop for toothpaste, prescription drugs, and a diabetes diagnosis? The retail clinic phenomenon has its appeal: it allows patients convenience and better access to care through longer hours and more locations than our health care system now provides. Walgreens leaders bill their latest offering as a complementary service to traditional medical care. They envision close collaboration with physicians and even inclusion in Accountable Care Organizations, according to reporting by Forbes’ Bruce Japsen (though it’s not clear how the retailer would share the financial risk or savings in such a model).

But the Walgreens announcement was met with skepticism by physician groups like the American Association of Family Physicians (which has responded defensively in the past to non-physicians’ growing roles as primary care providers). And there are certainly causes for concern, at least based on what we know so far: Such expanded clinics exacerbate the fragmentation in our already piecemeal system. Providers at retail store clinics don’t have access to patients’ medical records, so they might repeat prior efforts or miss key details in caring for these patients. Per standards set by the American Medical Association, retail clinic providers must establish continuity of care with a patient’s primary care doctor if he has one – this usually takes the form of a faxed note, which can’t compare to real-time communication within an integrated network. Providers at retail clinics are obliged to adhere to rigid protocols for evaluating and treating medical issues, but good chronic care management is customized to a patient’s particular lifestyle and needs. In short, chronic care, more so than one-off medical treatment, is best delivered with consistency by a coordinated team of providers (including NPs and PAs but also primary care doctors and specialists) who have gotten to know the patient over time and have built a relationship of trust.

The idea just might work if established health care systems with specialty providers forge meaningful partnerships with retail clinics – for example, with shared access to electronic health records and staff members who move between settings. If, in other words, the retail clinics are true extensions of the primary care home. It’s hard to say if a retail clinic could or would want to meet these criteria.

While those of us working in more traditional health care settings may have legitimate reservations about how Walgreens-brand chronic care will be delivered, we have to acknowledge that it addresses a need that we are not fulfilling. Walgreens made a savvy business move by targeting a growing population of aging Americans with diabetes and cardiovascular disease and offering services that are truly important and underused. We can and should learn from how their experiment plays out: Who will opt for this care? Will Americans use it as a stopgap between visits with their primary care doctor or only when they don’t have one to begin with (according to the Salt Lake Tribune, nearly half of current Take Care users don’t have access to one)? Will they come back a second time? What will they like about it? Which locations and hours will be most popular? Will the appeal of cheaper care (compared to paying out of pocket) fade as more Americans are folded into insurance plans? If we can better understand how these nontraditional clinics address gaps in the system, we can work with retail clinic providers more effectively and fill those gaps with truly coordinated chronic care.
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Minute Clinics Threaten Doctors: Who Wins?

10/17/2011

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All of us have been to fast food establishments. We go there because we are in a hurry and it’s cheap. We love the convenience. We expect that the quality of the cuisine will be several rungs lower than fine dining.

We now have a fast medicine option available to us. Across the country, there are over 1000 ‘minute-clinics’ that are being set up in pharmacies, supermarkets and other retail store chains. These clinics are staffed by nurse practitioners who have prescribing authority, under the loose oversight of a physician who is likely off sight. These nurses will see patients with simple medical issues and will adhere to strict guidelines so they will not treat beyond their medical knowledge. For example, if a man comes in clutching his chest and gasping, the nurse will know not to just give him some Rolaids and wish him well. At least, that’s the plan.

Primary care physicians are concerned over the metastases of ‘minute-clinics’ nationwide. Of course, they argue from a patient safety standpoint, but there are powerful parochial issues worrying physicians. They are losing business. They have a point that patients should be rightly concerned about medical errors and missed diagnoses at these medical care drive-ins. These nurses, even with their advanced training, are not doctors. It is also true serious or even life threatening conditions can masquerade as innocent medical complaints and might not be recognized by a nurse who treats colds and ankle sprains.

The Annals of Internal Medicine, a prestigious medical journal, reported on the quality of these retail clinics and concluded that the quality of care for ear infections, sore throats and urinary tract infections in fast-medicine outlets was similar to that in physicians’ offices, but at lower cost. While this is ammo for fast-med aficionados, it doesn’t address a more important point. I’ll concede that if I take my kid with an ear infection to a Wal-Mart clinic or the pediatrician, then the outcome will be similar. (Many experienced Moms would also know what to do.) The tricky part is when the symptom is murky and the range of medical possibilities is broad. If my kid were having stomach pain, for example, I want a physician to decide if this is simple constipation, intestinal gas or acute appendicitis that needs urgent surgery.

These clinics are proliferating because the market demands them. The fundamental cause is the inadequate number of primary care physicians in this country. This shortage will become more acute when Obamacare extends coverage to tens of millions of uninsured. Massachusetts discovered this a few years ago when they provided coverage to the uninsured, but didn’t have enough primary care physicians to care for them. These clinics are also providing a service that physicians have been unable or unwilling to match. They offer evening and weekend hours at low prices. Patients come at their convenience and are seen without waiting.

Pharmacies and big box stores benefit from minute clinics. They bring shoppers into the store who are likely to purchase other items after their scraped knee is bandaged. And if a prescription is needed, guess where it gets filled? From a patient’s point of view, this experience sure beats an emergency room adventure.

Are these clinics a good idea? It doesn’t matter because they’re coming and they can’t be stopped. They fill a legitimate need that the medical profession cannot address and the public demands. Market forces created the opportunity and will monitor its success.

Will they survive? Remind me, how long have McDonalds, Burger King and all the rest been around?
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First Use Of Crisalix e-Stetix, The First 3-D Simulator

3/5/2011

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In order to better serve his plastic surgery patients receiving breast implants, Dr. Suresh Koneru is the first physician in Texas to use a new software program from Crisalix - the e-Stetix 3-D simulator. Developed by engineers in Switzerland, e-Stetix is the first Web-based 3-D physical simulator for breast implant procedures. Dr. Koneru, who also has an electrical engineering background, will offer e-Stetix as part of the initial patient consultation for breast augmentation at his practice - Advanced Concepts in Plastic Surgery of San Antonio, Texas.

e-Stetix is the first simulator for breast enlargement surgeries using the body’s actual physical properties. Using just a few digital pictures from a regular digital camera and the patient’s body measurements, e-Stetix is able to generate a 3-D simulation of the patient’s body and then simulate the results of a breast augmentation procedure by selecting implants from a standard database. All the simulations are calculated instantaneously, giving the patient results in less than 10 seconds.

“This innovative simulation technique takes traditional ‘before and after’ photos to a new level,” said Dr. Koneru. “Now my patients have the capability to actually see what their body will look like with different types and sizes of implants and make better decisions based on realistic 3-D images of their own body before and after surgery.”

Traditionally, 3-D imaging systems have required large elaborate camera systems and required patients to remain uncomfortably still. With the e-Stetix simulator, Dr. Koneru is able to take 3 simple photographs in his San Antonio plastic surgery office and upload the photos securely to Switzerland. There the 3-D reconstruction is accomplished and then the surgical simulation can begin from Dr. Koneru’s office in San Antonio.

Dr. Suresh Koneru treats patients in San Antonio, Austin, Houston and other cities in Central and South Texas. He offers consultation and surgical procedures for breast implants, breast augmentation, breast lifts, breast reduction and breast reconstruction.. Advanced Concepts in Plastic Surgery also offers services for body contouring and other cosmetic surgeries.

About Dr. Koneru

Dr. Suresh Koneru is a Board Certified Plastic Surgeon who has been in private practice in San Antonio since 1996. He is fully trained in all aspects of modern plastic and reconstructive surgery, including cosmetic surgery of the face and body, breast surgery (including breast reconstruction, breast augmentation, breast lift, and breast reduction), suction-assisted lipectomy (liposuction), non-invasive fat reduction and lifting procedures, body contouring (tummy tuck, belt lipectomy, post massive weight loss surgery), and laser procedures.

Licensed in Texas, Dr. Koneru is Board Certified in Plastic Surgery and is the immediate Past President of the San Antonio International Society of Plastic Surgeons. He has been named one of Texas Monthly’s SuperDoctors, Scene in S.A. Monthly’s Top Doctors, and one of America’s Top Plastic Surgeon by Consumers’ Research Council of America.
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Marketing Online Without Professional Assistance

12/2/2010

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There’s a lot to be said for people who are go-getters and who aren’t afraid to try something new. Skydiving, for instance, is just one of those things that anyone with some guts and “chutzpa” can do. Unfortunately, the same can’t be said for marketing your medical practice online. It takes a skilled professional to know what to do, where to do it, and how to get the best results. Here are several disadvantages you’ll experience if you try to “go it alone” with your SEO and Internet marketing. 

Any Skill Takes Time - and Lots of It

First off, you won’t know what questions to ask, so you won’t be able to find the answers. Talk about confusing, right? When any Internet marketer starts to learn about SEO, search engine marketing, and Internet marketing, they are overwhelmed. Every single one of them! And that goes for someone who has the time to spend learning it full time. Now try to run a medical practice and learn online marketing in your spare time. It’s laughable, isn’t it? 

The point here is that you don’t have the time to put in to find out what you should be researching in the first place. This can put your learning at a major disadvantage because you will be scattered, unfocused, and frustrated. The best way to handle learning about Internet marketing is to find a professional marketing firm and ask them to explain things to you. It’s generally accepted that you’re best at what you do and we’re best at what we do. As a result, we’re more than happy to answer any questions you may have about how the process works and what particular action items are going to be put into motion. 

Slow and Steady Wins the Race

The next reason not to try to market your practice by yourself is because it requires maintenance. There aren’t five or ten “magic steps” involved in Internet marketing that will yield results and allow you to put the project down. Rather, marketing online first involves a strategic plan for implementation of the initial steps to achieving results. Then, a maintenance plan must be executed to keep the results your site has achieved (or to continue clawing your way to the top of Google). Once you’re in maintenance mode, you can worry less about the small details and concentrate more on pushing your competitors out of the race! 

Keep Up With the Times

The last reason why you should always hire a professional for your marketing online is because they will stay on top of changes in the industry. Google has algorithms in place for ranking sites and, unfortunately, these can change. Any adjustment to the way they weight a site for its value need to be discovered right away. 

Professional SEO experts and Internet marketers make a living by staying on top of the trends and changes to the online world. You can trust them to make the necessary changes to your site’s marketing strategy should something change. If you try to stay on top of it yourself, however, you may find that you’re spending too much time behind your computer and not enough time doing what you love – seeing patients. 

Find out more about our services that help improve your online marketing from day one. Please contact us for a free site analysis and get on the phone with us for a free consultation. We’re happy to speak with you because we genuinely want to help every client succeed.
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Avoid These Five Common Marketing Writing Mistakes

11/1/2010

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Even if you have partnered with BAC Medical Marketing, there may be times when you have to write a letter or a promotional piece without professional assistance. To help you get through that process, here are five things you can do to make your own communication more effective and more likely to be accepted by your target audience:

1. “YOU” is always better than “ME” – Instead of placing too much emphasis on your practice or yourself (ME, ME, ME), focus your message on your patient or referrer (YOU, YOU, YOU). Instead of starting your message with a phrase such as, “Here at XYZ Family Healthcare, we…,” focus on the recipient of your message with a phrase such as, “When you need faster pain relief, you’ll find it at….” Readers need to know that you care more about them than yourself.

2. What’s in it for the reader? – The American consumer only cares about “What’s in it for me?” Your words, therefore, should include all the benefits to the reader. Benefits such as fewer appointments, less waiting, faster pain relief, friendlier service, greater convenience and more compassion are more important than features.

3. Clinical language vs. plain language – Clinicians tend to write most healthcare materials (including instructions to patients!) at a 12th grade level. Unfortunately, most American consumers read at a 5th or 6th-grade level. Avoid medical terminology and clinical language in favor of plain English to ensure that your message is received and understood. Medical terminology, jargon and statistics may be perfectly suitable – and desirable – when communicating with other health professionals. But, when communicating with patients, plain conversational language always works best.

4. Write for your target audience (Hint: That’s not you!) – Think about the patients you want in your practice. How old are they? Are they primarily white-collar professionals or blue-collar laborers? What do they want and need from your practice? Are they well-educated or not so much? It might help to jot down a list of their characteristics before crafting your marketing message. (Also, see #3 above.)

5. Always include a call to action – Perhaps the most common mistake in marketing writing, this is one area where you can be prescriptive. Tell your potential new patient what to do next. Visit your web site. Call for a complimentary consultation. Ask about your free offer.

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Are You Spending Enough (or Too Much) On Marketing?

8/10/2010

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Most medical practices are not strategic about their marketing budget. Their approach to determining how much to spend on marketing is often random – picking a number that feels right or that they can feel comfortable spending. Does your practice fall into this trap? Your marketing budget should be a number that you can back up with results, not just because you think it’s the right amount.

In my experience, there are two methods to determining a marketing budget that gets the best results.

Percentage of Revenue Method

The first method is a percentage of revenue. The exact percentage is determined by the type of medical practice. The range for marketing a medical practice varies from three to fifteen percent (3 to 15%) of annual forecasted revenue. A medical sub-specialty that markets directly to the patient for services not covered by insurance, such as plastic surgery, cosmetic dentistry, or Lasik eye surgery, can expect to be near the top of this range. An audiologist who dispenses hearing aids should find their marketing budget to be in the ten to twelve percent (10 to 12%) range. The high markup on hearing instruments plays an important role in the equation. On the lower end of the range there are medical professionals who acquire their patients mainly through professional referrals. These sub-specialties include urologists, oncologists, and physical therapists. Their marketing budget typically ranges from three to five percent (3 to 5%) of revenues.

Return-on-Investment Method

The second method of determining your marketing budget is the Return-on-Investment (ROI) Method. You have all heard the old adage: You need to spend money to make money. The basic idea of the ROI Method is that for every dollar spent, you will make more than that dollar in return (optimally much more). You can usually forecast your investment from between a ratio of three to one to eight to one (3:1 to 8:1) by analyzing two factors about your practice. The first is the size of your practice. How many locations do you have? Also, the maturity or age of your practice is important. How established are you in your area? A large, well-established practice should expect a much higher return-on-investment than a small practice that is just starting out. Where does your practice fall on this spectrum?

Of course, there are many ways to market your practice for little or no money spent. However, certain methods do require an investment if they’re necessary in order to compete in your market. Having trouble determining the appropriate marketing budget for your practice?

Contact BAC Medical Marketing today for an expert analysis of your practice. 
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