Five Steps for Survival: How to Prepare for Continued Independence

If you got lost in the woods, ran out of food or got confronted by a bear, do you know how you'd react?

These unexpected challenges of hiking and camping - and the reactions they produce - can be very similar to the obstacles critical access hospitals (CAH) and other small or rural health organizations are facing. But instead of getting lost in the woods, your organization may be struggling with how to balance quality, transparency and affordability. Instead of running out of food, you may be running out of budget dollars. And you probably aren't facing a bear, but one or more larger competitors.

To overcome all these difficulties, all you have to do is follow five steps that I like to call "Survival of the Smartest." These steps help you take a comprehensive deep-dive into both the business and marketing perspectives of independence and success.

Step 1: Size up the situation
Understand what you're up against by determining your strengths, weaknesses, opportunities and threats.

Step 2: Have a positive attitude
Don't let the challenges or misperceptions leave you hopeless. Actively decide that you are willing to take the steps necessary to survive and gather the support of employees and the community.

Step 3: Navigate negotiations
Sometimes being 100 percent independent isn't possible, but be sure to stand your ground when establishing beneficial partnerships for a modified independence.

Step 4: Chart your course
Create a business development and marketing plan that will guide you in increasing awareness, market share and patient volumes.

Step 5: Make yourself visible
Develop a strong brand and position, and then market your strengths in your target service areas.

Interested in learning more? If you are attending the National Rural Health Association (NRHA) CAH Conference on October 1-3 in Kansas City, you can attend the speaking session, "Survival of the Smartest: How to Retain Independence" on October 2 at 2 p.m. Lisa Schnedler, CEO of Upland Hills Health (UHH), and I will present a case study of how UHH used these five steps to create unique partnerships and gain market share to become a financially-independent and award-winning healthcare organization.

If you are not able to attend, send me an email to receive a copy of the presentation.

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CAHs: Telemedicine Promotion=Profit Part 2

My last post discussed some of the "clinical" aspects of telemedicine and the benefits rural hospitals can expect from a well-implemented program. But there is one caveat to those statements of success.

Most consumers won't fully understand the value of telemedicine unless you effectively deliver your message - and continue to reinforce it. Successful telemedicine programs do this well. On the other hand, hospitals that take an "If we build it, they will come" approach realize a minimal return on investment, at best. Others simply fail.

Just like the services your on-site providers offer, telemedicine is a marketable service line. Do it right, and your hospital will not only increase awareness and utilization of your telemedicine program, it will improve your reputation as a leader and provider of innovative, high-quality, comprehensive healthcare.

Here are some - and I emphasize "some" - major marketing to-dos that you'll want to check off your list as you implement your telemedicine program. I'll go into more detail during my upcoming webinar.

  • Conduct a market analysis to ensure your program has a sustainable service model. It will help you define your program and identify and describe your key customers, competitors and potential partners.
  • Create a climate for success. Even though telemedicine services have been available for some time, the concept will be new to many of your patients, clinicians, administrators and others. An effective marketing and promotional program can help ensure your telemedicine program is highly accepted by major stakeholders and the community.
  • Identify specific marketing objectives. Be sure to link them to your overall program goals.
  • Create a messaging platform. Determine how you'll differentiate yourself; create a unique selling proposition.
  • Develop your marketing strategy. Using identified customer groups, value to these groups, concerns and barriers, you can determine the best strategies and mediums to target each audience (e.g., patients/consumers, staff, clinicians).
  • Develop promotional materials. Once you have clearly defined your program, customers and external environment, you can begin to develop the materials and activities to promote, communicate and educate your target audiences.
  • Monitor results. No marketing strategy should be set in stone. Monitor results and be prepared to adjust your efforts.

As I mentioned, I'll be taking a deeper dive into the marketing aspect of a successful telemedicine program during our upcoming webinar, "Building and Marketing a Telemedicine Program," on Tuesday, September 9 from 12 - 1 p.m. (CDT). Donna Jennings, vice president of Valis - a telemedicine consulting and solutions firm - will join me and lead a discussion on the clinical and financial side of telemedicine.

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How Your CAH Can Turn "Telemed" Into "Teleprofit" Part 1

Did you see the recent Wall Street Journal article, " Rural Hospitals Feel Pinch --- Strapped Facilities Squeezed Further by Medicare Changes, Dwindling Subsidies"? If you didn't read it, the headline says it all.

What the article doesn't tell you is how to "pinch back." In other words, "How can your hospital succeed in spite of Medicare changes and decreased subsidies?" One solution is telemedicine.

Now hear me out … I know "telemedicine" has become a healthcare buzzword these days. But there's more to it than video conferencing with a specialist hundreds of miles away. I also know that a lot of rural hospitals are turning "telemed" into "teleprofit." That's not rhetoric. It's a fact.

I've worked closely with Donna Jennings, an expert in the field of telemedicine consulting, and we've learned quite a bit from each other. As vice president of Valis, Donna not only knows her stuff, she's been elbow-deep in setting up successful telemedicine programs across the country.

Based on our discussions, I can tell you unequivocally, that rural hospitals can benefit both clinically and financially from an effective telemedicine program. While I've seen evidence of this with my own clients and business partners, Donna shed some light on a few lesser-known facts that it's important for your hospital to know about.

For example, according to Donna, "Many hospitals don't know that they can bill - and get paid - for telemedicine services if the program is set up appropriately and is very tightly organized."

She also stressed that, "It's important for hospitals to realize that return on investment goes beyond the telemedicine consultation itself. It's also related to things like reduced readmissions and mortality rates and value-based care metrics, which hospitals now get paid on."

Telemedicine can provide a multitude of benefits to your hospital and patients. To help get your arms around them, I've broken the advantages into four distinct categories:

  1. Improved access to inpatient and outpatient care: Telemedicine allows your hospital to offer your patients high-quality and consistent specialty care that's close to home. And that care can be provided without the large investment of hiring full-time, on-site providers.
  2. Improved patient outcomes: Telemedicine gives your patients immediate access to the specialists they need so they receive the right care, right away. This has been shown to improve outcomes for inpatients. You know what that means for your hospital when you're paid on performance. Earlier specialist treatment can also result in lower costs. And telemedicine allows similar benefits to outpatients, improving care without the cost and inconvenience of travel.
  3. Improved hospital performance: Telemedicine can decrease lengths of stay, mortality rates and patient transfers to tertiary facilities as well as encourage appropriate admissions and discharge decisions.  But that's not all. When patients have local access to the specialists they need, readmission rates and outmigration can be minimized, which can be a major coup for your hospital.
  4. Improved patient satisfaction: Telemedicine helps reduce travel time, wait time and related stress and uncertainty for patients needing specialty care. Inpatients also benefit from continued care by their own doctor who knows them best, with assistance from a well-trained telemedicine specialist.  And a well-organized and clinically sound telemedicine program can produce excellent patient and family satisfaction scores.

I also learned about different grants that are available to hospitals.  According to Donna, "Many grants are available to hospitals, especially in the area of rural healthcare. These grants can help hospitals invest in a telemedicine program and, with appropriate monitoring and outcomes support, hospitals can retain the grants so they can continue, and expand, their telemedicine program."

This is just the tip of the telemed iceberg when it comes to leveraging the benefits and opportunities available to your CAH.

You can find out more during our upcoming webinar, "Building and Marketing a Telemedicine Program," on Tuesday, September 9 from 12 - 1 p.m. (CDT). Donna will take a deep dive into the clinical and financial side of telemedicine, and I'll share a marketing perspective both in the webinar and in my upcoming blog.

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How Your CAH Can Build Surgical Volume

Rural hospitals across the country are looking for ways to increase surgery volume. But in their search for an elusive cure-all, many overlook opportunities right in their own backyard. Consider the following example:

Most rural hospitals serve an older demographic. With an aging population come age-related healthcare needs, like knee replacements. And the total number of knee replacement surgeries has soared 161.5% among Medicare participants over the past 20 years.

Let me put that into context for your CAH:

  • Today, about 4 million people - or 1 in 20 consumers over the age of 50 - have had knee replacement surgery.
  • That number is expected to grow to an estimated yearly demand of 3.48 million procedures by 2030.

Your CAH can leverage this opportunity, or opportunities like this, to immediately increase surgical volume by:

  • Developing a targeted marketing campaign for consumers 50+.
  • Implementing a strong PCP program to build relationships with physicians to help your CAH build surgical volume for the long term.
  • Managing the surgical process effectively, as described in this white paper.
  • Developing relationships with neighboring hospitals to share surgical teams and services. This recent article in The Rural Monitor highlights how robotic technology is expanding surgical capabilities of CAHs in Michigan, Minnesota and Washington.

What if your CAH doesn't have an orthopedic surgeon?

The principles are the same. There are many opportunities to develop relationships with specialists, whether they're independent or part of a system.

If you have questions about how your CAH can keep your surgery suites busy, give me a call at 920-544-8102 or send me an email at mikem@golegato.com. I have some ideas and case studies I'd be happy to share with you.

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How to Build a Women’s Health Program

In my last blog, I shared why it's important for your CAH to build a women's health program. The facts spoke for themselves. So let's move on to the how.

  • Analyze before you strategize: Conduct a demographic and needs analysis to identify gaps, overlaps, challenges and opportunities.
  • Drill down. Your CAH can stand out in women's minds by personalizing services - and marketing messages. For example, is your primary audience women age 55+ who enjoy gardening and knitting or is it physically active, service-minded middle-aged women? That leads me to my next point …
  • Know what women want. Studies show that women want to be treated like women - not just "consumers." This female-centric focus encompasses everything from providing a feminine décor and tranquil environment to communicating with women on a personal level and making it convenient for them to engage with your hospital and staff.
  • Build a core area of excellence. Develop at least one core service to build as a competitive advantage, (e.g. breast health). As you establish your CAH as an expert in this area, it can help build the perception that your hospital is a leader in other areas of women's health.
  • Mine your mix. "Women's health" goes beyond OB-GYN. It's evolving into a multi-discipline mix of service lines. Increase revenue by taking a cross-departmental approach to carve out niches from orthopedics, cardiovascular and other high-margin services your target audience needs.
  • Don't underestimate provider relationships. According to a 2011 Kaiser Women's Health Survey, most women (83%) report that they have a provider they see on a regular basis. These women maintain a consistent relationship with the healthcare system, which fosters the use of preventive and other women's health services.
  • Think virtually. This goes beyond using telehealth services. Many CAHs are building virtual women's health programs with the help of their marketing department or an external marketing firm.
  • Partner for progress and profit. Work with the community and local organizations to provide women's services beyond the scope of your hospital. This is an effective way to build loyalty among healthcare's number one decision-makers who can drive business to other areas of your organization.

I've worked with many CAH clients to help them build profitable women's health programs. If you'd like to learn more about these specific strategies and see case studies, don't forget to register for my June 4 webinar, "How to Build a Women's Health Program in Rural Healthcare." If you have questions prior to that, shoot me an email or give me a call.

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Why Build a Women's Health Program?

We all know that women make the majority of healthcare decisions.  But the reasons for building a strong women's health program extend far beyond this well-known fact. For starters, The Advisory Board Company (a global research and consulting firm) found that:

  • Women account for about 60% of hospital volumes.
  • Women have significant unmet needs for health services.
  • Nationally, women in the 45+ age group has grown 25% over the past 10 years and is expected to grow another 14% over the next decade.1

And then there's the Affordable Care Act:

  • Under the ACA, women's preventive healthcare, like mammograms, screenings for cervical cancer, prenatal care and other services, generally must be covered by health insurance plans - with no cost sharing.
  • The law also recognizes the unique health needs of women throughout their lifespan.

I hope these facts have caught your attention …

Because they can point to profit for your CAH. The time is ripe for your rural hospital to build a women's health program that address the changing needs of women throughout their lives.

While OB-GYN will remain a core focus, it's time to think beyond the "baby stage."  An aging population - especially in rural communities - translates into additional needs for  breast and heart health services, urogynecology, screenings for osteoporosis, hormone therapy, management of chronic conditions and more.

Building a comprehensive women's health program can increase revenue for your CAH while building a loyal following of female patients, engaging them throughout every stage of their lives. And don't forget: these women have a big influence on the healthcare decisions made by other family members.

Now that we've established "why" your CAH needs to build a strong women's health program, my next post will focus on "how" to do it - regardless of the size of your hospital and its staff.  In the meantime, I'd be happy to field any questions you have about this timely topic.

You can also register to attend our upcoming webinar, "Building a Women's Health Program," to learn the best strategies for program development.

Wednesday, June 4
12 - 1 p.m. CDT
Presented by the National Rural Health Association Partnership Services

REGISTER NOW!

1The Advisory Board, Future of Women's Services: State of Women's Services, September 2008.

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Quality Care can Come in Small Packages

In the worlds of rural and critical access hospitals, size is typically an obstacle. But in our eyes, it's never about how big you are; it's about how you position and market yourself. With this idea in mind, along with commitments to quality and strategic marketing plans, our clients have received national recognition for patient and employee satisfaction and quality of care - despite the fact that they are "small."

Recently, we've seen personal evidence of the truth of our motto by receiving eight national awards through the 31st Annual Healthcare Advertising Awards and the 2014 Aster Awards.

The Healthcare Advertising Awards are sponsored by Healthcare Marketing Report and honor healthcare marketing professionals for exceptional quality, creativity and message effectiveness in advertising. This year's competition was one of the largest with over 3,700 entries submitted by some of the nation's largest healthcare systems and marketing/advertising agencies. From this impressive pool, we were incredibly proud to receive:

  • A Silver award for the Telespecialists, LLC logo design
  • A Bronze award for the Black River Memorial Hospital "Up Again" urology campaign
  • A Merit award for the Bone & Joint pain management primary care provider piece
  • Two Merit awards for the Holy Family Memorial "life.Empowered" TV spots
    • Cardiology - "I beat the widowmaker"
    • Orthopedics - "I made it out of the rough"

The Aster Awards are also an annual competition hosted by Creative Images, Inc. It recognizes the nation's healthcare marketing professionals who've demonstrated excellence in advertising. This year we won:

  • A Gold award for the Bone & Joint Walk-In Care campaign
  • A Gold award for the new Legato website
  • A Silver award for the Black River Memorial Hospital "Hoopla" orthopedics campaign

It just goes to show that being smaller doesn't mean you can't be better.

Visit our portfolio to check out the winning pieces.

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Are you speaking your patients’ language?

Addressing Health Literacy: An Always Event

Nearly half of all American adults - 90 million people - have difficulty understanding and using health information, according to the Institute of Medicine. 1

Low health literacy affects people from all walks of life. Even many college graduates don't have the health literacy skills needed to navigate the health system and actively participate in their care. Holding an MBA does not necessarily mean a person understands the medical jargon physicians - or nurses - often use. In fact, well-educated people may be at an even greater disadvantage because embarrassment about not understanding instructions they think they should understand may prevent them from asking questions.

The impact of low health literacy on rural hospitals and health systems:

Low health literacy can contribute to outmigration as confused and helpless patients feel their needs aren't being respected or met. They'll drive a little further, when possible, if the nearest urban teaching hospital's communication style resonates with them. Not addressing low health literacy can also lower your HCAHPS scores and thus, reimbursements.  And here's the kicker: higher rates of hospitalization and avoidable use of emergency services associated with low health literacy wastes billions of dollars. 2

Does your hospital have room for improvement?

Do your patients routinely answer these HCAHPS questions with "Always"? 3

  • During this hospital stay, how often did doctors treat you with courtesy and respect?
  • During this hospital stay, how often did doctors listen carefully to you?
  • During this hospital stay, how often did doctors explain things in a way you could understand?

Make effective communication an "Always" event:

  • Teach providers to lose the medical jargon - Communicating in plain language won't undermine their authority; in fact, clear communication enhances the perception of value of the encounter and helps create trust.
  • Create an environment free of shame and blame - It works both ways: caregivers and patients should feel there are no dumb questions.
  • Use the teach-back method - Educate physicians and staff in this tried-and-true method of testing whether they have communicated in a way patients understand.

Getting started is easier than it sounds!

There are an overwhelming number of resources out there, including solid information curated by the NIH. If you're brave enough and have time to do some heavy reading, look here.

Or, for a quick start, check out these reliable, user-friendly resources:

  • The AHRQ Health Literacy Universal Precautions Toolkit has everything you need to know to assess your current performance on health literacy issues and begin to make significant changes. Download it for free.
  • The "Always use Teach-Back!" training tool kit is a free interactive online learning module for providers developed by the University of Iowa, The Picker Institute, Des Moines University and Health Literacy Iowa. Access it here.

If you are not already aggressively addressing low health literacy in your community, getting started is not as difficult as you may think. And it's the right thing to do for hospitals and patients.

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Turn Wellness Trends Into Profit for Your CAH

Wherever you stand on the Affordable Care Act (ACA), I think we can all agree that preventive care is in the air.  The ACA and many of its programs, parts and parcels focus on care coordination, prevention and wellness. That has both employers and health insurance providers placing greater emphasis on wellness. And consumers are following suit.

SymphonyIRI (a market research company) found that:

  • ¾ of all consumers are trying to eat healthier today to save money on health care later.
  • 30% of all adults (on average) are concerned about weight loss.
  • 29% are worried about stress management.
  • As people grow older, their health concerns become more focused on problems associated with aging instead of weight and stress. The top two health concerns of seniors, aged 68 and older, are:
    • Cholesterol.
    • Heart-related issues.

OK, so I think we're clear on why your rural hospital needs to take note of these facts and stats. But that leads to an even more important question: How can your CAH leverage these trends?  I'll give you some examples:

  • Develop a campaign around preventative care, such as mammograms or colonoscopies.
    • Don't waste consumers' time by telling them what it takes to be healthy and all the reasons it's important. They already know what and why, and will just tune you out.
    • Focus on making it easy and "nonthreatening" for them to take action, like holding a "Mani and Mammogram" event.
    • Offer a farmer's market on your hospital's grounds to increase physical activity and promote healthy eating.
    • Leverage the ACA by partnering with local businesses offering employee wellness programs.
      • Employers know that wellness programs help reduce absenteeism, employee turnover and insurance premium costs.
      • The ACA supports workplace wellness programs, such as those that provide incentives for attending a weight loss, nutrition or smoking cessation program.
      • Building strong business partnerships can ultimately result in stronger consumer/patient relationships for your CAH.
      • Get involved in the community to promote preventive care. WEPAC Hoops for Hope Weekend is a great example. Ashland Health Center and Comanche County Hospital put on an annual event with 90% of the proceeds going to pay for mammograms, pap smears and colonoscopies for women in those five small towns.

These health and wellness initiatives can lead to more revenue, increased volume and stronger patient relationships for your CAH. That's a fact. I'd be happy to share some proof points with you. Give me a call or shoot me an email if you'd like a professional perspective on what your CAH is doing - or could do - to leverage health and wellness trends in 2014.

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Patient Engagement: Improving Health and Decreasing Costs

Patients want to take a more active role in their healthcare, sometimes they just don't know how.  Improved engagement not only benefits the patient, but also can lead to increased satisfaction scores, greater quality and safety and a higher likelihood of patient compliance. Here are a few ways you can begin to improve patient engagement:

  • Create an environment for shared decision making. Involving patients in the decision making process, or making sure their voices are heard will make them feel as though they are an integral part of the hospital (which they are).
  • Develop a powerful patient portal. The world is going digital, and patients want access to their information wherever they are, 24/7. A patient portal can give them this access and improve their overall engagement in their health needs.
  • Create a strong web presence. A website can create the first impression your patients have of your facility and staff. Having useful and relevant information will frame you as a resource.
  • Generate a strong patient feedback program. Most hospitals have places for patients to give feedback. The key is what you do with that information.
  • Traditional advertising. Though some traditional advertising, like newspaper or direct mail, may seem outdated, they actually still have a strong effect on patient engagement. People want to be affiliated with a respected organization; traditional advertising can help show patients that your organization is just that.

Want to learn more? Join the Rural Healthcare Marketer on April 2 to delve deeper into this topic and see how rural hospitals across the country are leveraging their marketing efforts to engage patients and help them be an active partner in their care.

Wednesday, April 2
12 - 1 p.m. (central time)
Presented by the National Rural Health Association Partnership Services

Register now!

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