I want to talk about marketing and consumerism and what you can do. Marketing, why? Because I want you to increase your patient appointments. You're hearing already that your reimbursement is going down. I want you to understand the terminology that all your administrators are talking about. It's not, it's just like we have terminology. You just need to hear it so you can feel comfortable in having a conversation when you do it. And that's, you've already heard a little about social media. So it's all about quality. And I will tell you, you may not like it, but it is about quality. And we're not all the same. But the basic principle is, if the doctor, that is you, and the patient win every time, if you consider safety and quality. And there are three pillars of this quality. It's being achieved and sustained with an outcome, so you have to record it. It's evidence-based innovation. And for once, I want to say it, you must be the captain of the ship. You have to demand it. It is our obligation. And somewhere along the way, we lost it, and I don't want you to lose it. It doesn't mean you have to be impolite, but you have to say no, politely, because a lot of people are telling us in every day what to do. So if you maintain function, you minimize morbidity, you don't have hopefully death, you're going to win. Unfortunately, people have told us again what quality is. This is from Michael Porter. I will say previously, that is still considered the gold standard, and it's not. Value is not, I will show you, outcome over cost, although we're told it is every day. Why do I say that? Dr. Porter says that value is defined as outcomes perceived per dollar. But whose value is it? Like this schmuck coming down the mountain. Is it the payer's value? Is it the taxpayer's value? Is it society's value? Is it the patient's group? Is it us? And what's really going to be achieved? Is it a short-term gain? Is it a long-term gain? Whose economic input it is, it's not going to be this young man's right now coming down because he had his friend to help him, and he decided. There it is. He's out. So how are you going to achieve this value? We have to focus on improving patients' outcomes. You read about infections. You read about other things. You have to allow the patient to stop spending more but not getting less. And I'm telling you, the plot's unwinding. Please don't watch at the sidelines. Get involved. Recently, total knees and total hips, 15% decrease in reimbursement. What's next? We have to say something. We have to. Because medicine is really a noble profession. It's the only profession that we share things to seek our own demise. That's what we do. We have room to help each other. But in business world, that's not what you do to get ahead. And I'm not asking you to change. I want you to share. But I show you how we can lift ourselves up. We work against our own economic interests. When I took my MPH and MBA, the head of Aetna came. I was at Columbia. And he said, doctors are idiots. And we are always going to win. We have more money. We can outsmart them. They're not smarter than us. We just take a back seat. And it's time that we move forward. So the world's broken. Healthcare's a little upside down. You hear it from patients. You hear it from you. So let's do something about it. We can be really upbeat about it. So the answer is, and I have to forward it, you have to click on the video. It's a little fun. Where's the money? It's in the insurance company. It's not in your pocket. And I'm happy if you're doing well and everything. Need you to click on that video. You should be able to. My mouse is, there it is. So, you know, and there's, you know, they're happy, show me the money. It's all there. We just have to go out and figure out how to get it. Whether you quote code it, whether you do it social media, show me the money. What am I going to show you? In COVID-19, when everyone from exhibitors to insurance company were complaining, when we were on the front line, I want you to see that United Health Group, because there was a sharp decline, I live in New York City, in elective procedures. They went from 3.4 billion to 6.7 billion. They got the money. They're just holding on to it. They invested in it. Anthem, 1.1 to 2.3. I want to make you upset. Because we can do something to help each other. So we're told in a business market, as you learn, a normal market. Think about the supermarkets. Competition drives relentless improvements in quality of cost. You get innovative, you lead to rapid new technologies, excellent competitors prosper and grow, but if you're weaker, you go out of business. We don't like that. But you need to know it. That's why you have to stay in your game. That's why we're here and learning. Quality addresses prices. Prices fall. Value improves. Prices expand. More needs for the consumer. They're happy. Is that what medicine's about? That's what every other business is about in the world. It's not our world. And we've accepted it. And it's time to say no. It's not okay. Look at healthcare. Look at the plastic surgeons, what they did. They fought. They're cash. They said, I'm not going to take insurance. I'm going to change the world. And they found some level. I'm not talking about reconstructive surgeons. I'm not talking about giving health and care for those who are indigent that can't afford it. We need to do that. Even lawyers that are married to one, 10% is required in most states of free care. That's a noble thing. Not all lawyers are noble. But nonetheless, we should do that, too, and then get paid some. The kind of competition we have is too broad at the health plans. It's too narrow. We fight each other. And so we're at this inflection point. Is it fee-for-service going up? Is it value-based reimbursement? And it's time to take the bull by the horn. So I wanted to find marketing for you. It's about planning. It's about making. It's about pricing it. It's about promoting it. It's about distributing it. And it's very purposeful. I'll give you an example of bad marketing that we all live in. Press one for billing. Press two for outpatient surgery. Press three for pharmacy. Press four. I don't want to hear any goddamn menu. I want to know that I paid a human being to answer the phone and say, welcome. How can I make your day better? They're coming to you. So we got rid of our phone system, and it increased immediately the patient, oh, I could get to someone right away. And it increased it and paid it in dollars. You can build your practice however you want, but you need to decide it. Don't let others decide for you. It's about you. It's about your image. And marketing does all these things you learn in business school. It's building your reputation. It's maintaining your image. It's developing more patients. It's generating new income, and it's protecting you against a crisis. So you need to know three words in the marketing world. It's called needs, wants, and demands. Needs, it requires a push in the marketing. The customer wants something that's differentiated. We are all orthopedic surgeons. We're all sports medicine doctors in this room. But the point is, how are you going to differentiate yourself without hurting the person to say, this is what I do. This is what I like to do. It's tough when the same brand and the same offering there, just another orthopedic surgeon, do they even know your name? Do they call you Doc? My name's not Doc. I want you to memorize my name. Who did my surgery 10 years ago? I don't know, some Doc at that hospital down the street. Make them learn your name. It's important. The product, you need to constantly push it till the customer knows. So the basic difference between wants and desire, when an individual wants something like that Aston Martin, which is a premium, then their wants are converted suddenly to demands. How can you accept $10 copay? Did they invest anything in you? Where do you get that? You didn't give anything emotionally to you. And so we have to figure it out a better way. And then the step of wants with the demands, do I really know what the public needs here? There's no skin in the game. And sometimes, and now, things are starting to change to put skin in the game for the patient. There's a psychological aspect of needs, wants, and desires. And I want you to understand it's all about trust. And that's what we do well. If you can get your patient and show them that you're there for them, you're trusting, you have that ethics, especially in this day and age, most customers will come back. That's how you're going to get more patients. He really was nice. She was really nice. And they really cared about you. People don't want spam, as it says. Always build that level of trust. It's a quality of your service. And that's difficult, I understand, when you're measured by metrics in a hospital. So how do you market all this? Well, you have to choose between public relations, social media, as you heard, and branding yourself. What's good? Well, provide useful information. Believe it or not, every day at 9 o'clock in my household, the phone rings. I still have a landline. My kids make fun of me. But the cell phones don't work where I am. The point is, CVS calls. Remember to pick up your script. Remember to pick up your script. It sounds annoying, but it's that constant bombardment. And it actually works. And CVS made more money last year figuring that out. Don't send information that's not provided that's good. Bad information. I want to distinguish advertising between public relations. Advertising, you decide what you want. You control it. It's paid for by you. It's kind of non-personal. But public relations and finding someone to help you is a third party says something about you and why it's good. It's increasing stakeholders. Stakeholders are patience, awareness. It deals with, unfortunately, when you do have crisis management, when someone says something wrong about you, and the message is predetermined. And people are really good about that in firms. But you have to choose the right medium. Is it TV that costs a lot? Is it radio? Is it newspapers? Is it magazines? Or is it internet, as you just heard from Al? It's difficult to measure, though, the viewer's retention. You know, what's called the click rate. Did they really look at it? Did they really investigate it? But it's getting out there. Get your name out there, because you're all terrific. We all are. That's difficult to do if you're in a hospital. But I want you to know when you go and you're employed by a physician, if you're not in private practice or another situation, it's difficult for hospitals, they say, to make a profit. So they have all these entities and nonprofit entities, and they siphon off the money. But if you look, hospitals have increased the hospital systems, their budgets. So you say, and they spend on the average $1.4 to $5.8 million. And you say, wow. But in a hospital budget, that's just not a lot of money. So they're really not making or taking a lot of money to advertise you or the hospital. And so you're going to have to do it individually, with your own website, with your own way. Here's something interesting that happened in New York State. Blue Cross Blue Shield said, effective January 1, 2021, and it's in a lawsuit right now in the courts. If you don't belong to a private, self-standing surgical center, meaning if you're in a hospital and you have an ambulatory surgery center, we're not allowing you to do the total knee because you've got to do it outpatient, and you have to do it in a self-standing one. You're not allowed, because the reimbursement for the hospital in New York City, $36,000. It's $8,000 for a private surgical center. That's a problem unto itself, saying we're not letting you take it there. And every hospital then banged back to sue them. But those people that own private surgical centers started increasing their volume. You might think about outpatient surgery and working with your hospital to figure out how to invest in a private surgical center. The insurance companies are going to push back. That's the newest thing that happened in New York. But it's easier to do than you think. You have to tell a story. You have to care. You have to watch HIPAA. You want to protect patient security, and you have to get patient's written consent. And patients can opt out, but maybe you need to tell a story about a patient. We have great stories every day. Tell your story to others. It will help you market. Here it is. Story. That's what businesses do. Think about the elevator next time when you walk in. They made us do this in class. The elevator doors are closing, and as they're closing, you're seeing someone on the outside. What are you going to say in that 15 seconds? You got 15 seconds to say something about yourself. What is it that captures that patient? Try it sometimes. It's not so easy. You have to tell a story of what's called the P's. It's the product. It's high quality. It's to the public, the people, your patients, what your price is, the cost. You need to know. Don't tell me, I don't know how much it costs when I do an injection in the shoulder. You need to know. Ask. Reimbursed, care, you want it, you want it increased. Where it's gonna happen, the place, the production, the promotion, and the packaging. Believe it or not, colors matter. If you didn't know that, when you go to a pediatrician's office, you ever think about why they have fish tanks and the back is blue, it's calming. It's known, they've done the studies. These are all subtle ways. It's like in the old days, I'm old enough in the 50s, they flash, buy popcorn, it's illegal to do and you didn't see it because it was so fast, but it got into the human brain and people would get up from the movie theater and buy the popcorn. Be careful with red. Think about it, the Academy, it brings anger. Okay, they've shown the studies. Color matters in your office. Think about what your waiting room, which doesn't exist. I think the waiting room's going away after COVID, but the point is, think about colors in your own life. The elements of successful marketing. The hospital will help you. It's the product, the price. What are customers willing to pay in biologics? The place, is it convenient? You come to New York City, people won't get a cup of coffee if it's not within one block of themselves. I go, I lived in Indiana, they'll travel 20 miles to go somewhere. It's all perception in your neighborhood. It's promotion and I'll tell you, it's a craziness. I live in New York City. Did you know that if you're in insurance, you're thought to be an okay doctor. You're not really a good doctor. If you're out of insurance and you don't take it, you must be better. How did we convince the New York City public to understand that? It's crazy, it's upside down. It was promotion, it was marketing by a lot of people. You can change it. We think we can't, we can. But the doctor way and we're taught that in med school and our training is comfortable, it's the non-marketing driven planning process. We meet in committees, we meet in meetings. We have it going on here. We discuss our missions, our goals. We debate it, we're smart. We respect each other, we talk about it. We vote, decide, we implement. Then it implodes, we blame someone else. We don't know what to do. We reconsider it and we get nowhere. Then we just cycle it around. So the first step I want you to do in your own practice is to figure out what's your goal? Be that leader, try to change it politely, make a difference. The only way to do that is you have to do research on your outcomes. Examine your competition. Why is she better than me? Why is he better than me? Look around and be willing to say maybe I'm not as good as I thought. Test it out. It's called the strategic thinking. It's the P's. You don't have to attack your consumer, but ask. How come you're successful? What have you done? The best news my father-in-law told me, if you build a furniture store on the corner, you build a second furniture store on the corner because more people come. It's not about them being the only one. We have to be the only one there. We can together be more important. I like the expression to tell my patients, without your health, you have no wealth. They only learn it when they come in, but we need to transmit that story of our importance as physicians. I will say, never say no to a patient. Say perhaps if the front office says, the doctor unfortunately can't see you today, but we could squeeze you in tomorrow, would that be okay? Your front office is probably your most important person, more than yourself. Once they get to us, everything usually works out fantastic. It's getting to us. So sit in your waiting room or sit in the front office. Listen to the conversation that comes in. Do you like it? Do you not like it? Have you ever done that? Bring some food one day and sit there. You'll be appalled at what's said sometimes when you don't know it. And if you say you have no control because they're hiring it for me, sit there and then go to the person that does the hiring. So do you know this is the conversation? I would love the conversation to change to X, Y, and Z. Understand your patients. They're called stakeholders. Make a value proposition. Stakeholders are your best. Invest in them. How do you determine to do that? Well, it's important to understand why they're coming to you. Why, as Al said, and Hussein said, define what you wanna be. But you gotta do the research. You have to do data collection to understand why they're coming to you, if they're coming to you. Why do you lose clients? 14% complaints are never handled. They never tell you. Very low, it's the competition. Maybe it's relocation. 68%, they've done the study, leave for no special reason. They don't feel engaged. They don't emotionally feel attached. You may have a lot of physician assistants and APPs and nurse practitioners. Even if you can't get into the room because you're there and you're running through the mill, stick your head in. Say hello. If they've done a study, if you sit for 15 seconds in a room, the patient thinks you were there for over 15 minutes. Just sit down for a second. Just for a second. Remember where we started. We said it's needs, wants, and desires. So think about this for a second. When someone buys perfume, are they buying it because of the aroma? Nope, they've done the studies. They're buying it for romance. It's all psychological. So you have to understand that subtlety. Why is the patient coming to you? The new exercise machine doesn't sell because of the latest feature. It's sold because the patient thinks they're gonna get thinner and healthier. The end result, as it says, of a product or service does what it does for the buyer. How to make them feel, how to love it, how to act on it. Therefore, you need to get broad motivational reasons, as it says, to market. Convince people that your service makes them live longer and happier. And that's the answer. It's not about the ACL. You're gonna live longer. You're gonna do all the things that you haven't done in the last 10 years. Don't wait, oh, I'll see you in 10 years if you're a total knee when you're really bad. No, are you not doing the things that you wanna do now? Why not? Change it. We have the techniques. Learn from hotel management, good hotel management. Touch a consumer in a way they don't expect. Did you ever notice if you go to Nordstrom's, they were the first, now everyone does it, they walk around the counter to hand you your bag. Other places hand you your bag over the counter. That little move changed Nordstrom's income. Just walk around the counter. Walk the patient out down the hall as they're going to billing. Get involved emotionally. It will change your life. Those are called innovative disruptions. Whether it's education from knowing things from registry, whether it's better decisions on consumerism aligned with what they want, whether it's moving to an ASC, the modern physician has to take control. The more we do, the more effective we are. It's really important. It's time to realize that medicine, believe it or not, is emotional, it's financial. As Dr. Warren taught me, you know, when they say it's not about the money, it's always about the money, and it is political. It's about being good to people, and that's the part we do so simply, more than others. And COVID-19 may have taught all of us, at least in New York City, to the tipping point, the only good out of this, that there was so much bad, it only can get better for us. So this is my daughter, everyone knows, I leave it, she's now married and she's 27. Who knew what was in her head when she went up to this other child she didn't know on the beach and hugged her? Okay, we need to do that better. I think the younger ones, rather than my age group, do it better. We need to take each other in, help each other, because together we're going to win, and I encourage us to do that as we're here at our meeting, because it's the best time, two societies coming together, and so it's really exciting. Always better, this real bridge in the Midwest, it took these morons this long to figure out that the two sides are never going to meet. I think we do a better job all the time, and I hope we can help impart some of that information to you. Thanks.

marketing

healthcare industry

patient appointments

quality

trust

differentiation