To market, to market! A marketing plan for the next 6 months.



As promised, I would set up a goal for the year, and plan to achieve it.  I had earlier noted that business for my company, ExtraMD was down for the first time in five years.  My company supplies physicians to clinics/hospitals/urgent care in the city where I live.  I am the physician owner, and feel responsible to the other 5 physicians in our group.  So, I developed a marketing plan for the next six months to bolster our shifts.  The general marketing theme was a birthday celebration, as ExtraMD is turning five.   

The goal: have 5o shifts per month for our physicians.   (This is what we usually have, but has suddenly decreased.)

Unless noted, all responsibilities for marketing are mine.

The plan (by month):

January: send an email to our clients, announcing our birthday celebration, and giving a discount of 10% off the first shift.  (Already done by our trusty office manager.)  Send out a press release announcing the birthday celebration.  (My responsibility.)

February: deliver birthday cupcakes to potential clinics with cards/brochures. 

March: build a referral tree via email.  E.g.: if a client refers someone to us that uses us to fill shifts, the referring client will get a discount off their next shift with ExtraMD.

April:  send out postcards reminding clients/potential clients of our services, focusing on how we benefit the practice when one of our doctors fills in.

May: send out email reminder for practices to book now for summer vacations.

June:  send out a newsletter with tips on practice management to our email subscribers.

Most of the marketing will be low cost.  This marketing plan was developed with help from Philippa Kennealy, a physician entrepreneur.  I also consulted Duct Tape Marketing, by John Jantsch.   I’ll keep you informed as to our progress.


And the winner is… Dr. Bobb!

In the contest to describe a goal and a plan to meet that goal for a medical practice, Dr. Bobb is the winner (and the ONLY contestant!)!  Now, I don’t know exactly how well his plan will work, but I’m loving the idea of the vacuum.   He notes that they will take turns cleaning the bathroom.  Hmmm, we’ll see how that works out!  Visit his blog for more fun!

Here is his plan for his practice:

The Goal:
Cut nearly $5000 a year from the practice’s operating expenses.

The Method:
Terminate the practice’s contract with its janitorial service.

The Timeline:
As soon as current janitorial service contract is up, sooner if it is an “at will” contract.

The Plan:
Purchase an iRobot Roomba to vacuum the office building’s carpeted surfaces and a Scooba to clean the tiled floor areas. Cost: about $370.
Office staff will take turns cleaning the office’s bathrooms.

The Personnel:
Office Manager will purchase the cleaning robots. All office staff (including the doctor) will take part in keeping the office clean.

Dr. Bobb is the recipient of  a $15.00 Amazon gift card from PookieMD.  Don’t spend it all at once, and keep us posted, Dr. Bobb!

Staying Afloat in Tough Economic Waters Part 2

So, continuing on with my tale of my little business…I left off describing how ExtraMD ( my local locums company) was going to weather these stormy economic times.  I have noticed a drastic drop in shift requests.  Over the past two years, we have typically had 10 shifts per month unfilled, almost enough for a full time physician.  However, over the last 3 months, I have seen a distinct drop, such that by December we only had 2 shifts that went unfilled.


Next, an urgent care cancelled a shift, saying they were so far behind in their receivables, they couldn’t afford any more debt.  We haven’t yet received the money owed for work we did there.


In addition, a large clinic system cancelled over 16 shifts for one month, leaving 4 doctors with out work for February.  They emailed me, saying, “Good news for our clinic…we’ve hired a full time physician, so won’t need coverage.”  Bad news for us.  We do have a 30 day cancellation policy, but the clinic squeaked in at 31 days, so didn’t have to pay the full cancellation fee.


So, what will we do?   How will I find work for my  docs, keep my company afloat and sleep at night?

Here’s my plan:

  1. Calm down.
  2. Send out a post card mailing, advertising a birthday discount.  (ExtraMD is turning 5.)  Something cute and eye catching will be on the postcard,  like a birthday cake.
  3. Email our clients, letting them know we have a birthday  celebration discount going on.
  4. Consider taking  birthday cupcakes to our best customers.
  5. Put an ad in the local medical journals.
  6. Talk to the other physicians in our group about leaving business cards and chatting up the business at practices where they are working.  As the physician owner, I have done all the marketing myself, but hey, it’s worth a try.
  7. Create a press release targeting the local market about ExtraMD’s birthday celebration and discount.  Let practices know that we are a  good interim solution during tough times–it’s cheaper to use us than hire another physician, especially if  a practice isn’t certain it can support another full time physician.

I’ll keep you posted as to the results.  How is YOUR practice doing in these tough times?

Crash Test Dummy: 5 Signs Your Practice is Failing

Buckle up, partner, it’s time for another PookieMD biz refresher course!  This time, it’s on unmistakable signs that your practice business is about to crash and burn!

Knuckle gripping sign number 1:  You have cash flow problems.  You can’t meet payroll because you don’t have enough cash on hand.  YOU MUST BUDGET FOR CASH FLOW!  (Which leads to my even more basic rule for doing business: you must BUDGET!)

Knuckle gripping sign number 2: Expenses are greater than revenues.  Whether it’s decreased productivity, or that @%*# insurance company that pays so late, the basic rules is that revenues must be greater than expenses.  You must figure out what is happening, and how to reverse the trend.

Knuckle gripping sign number 3: You’re borrowing more than Citibank.  If you are borrowing to meet expenses, you are in deep doo.  No, the feds aren’t going to bail physicians out.  Tighten the belt, sniff the smelling salts and make a plan .

Knuckle gripping sign number 4: You hide from the postman.  The overdue notices keep on coming.  You need to structure your own bail out!  Call in the experts, and swallow the medicine.  You wouldn’t encourage a patient to ignore a breast mass, so why are you ignoring your business?

Knuckle gripping sign number 5: No one looks at financial statements.  This is a variation on the ignore the breast mass and it will go away scheme.  To get an adequate idea of how your practice is doing, you need to look at budgets, budget variances, cash flow and accounts receivable monthly, at the minimum.  In tight times, you may need to budget WEEKLY for cash flow.

So, what to do?  Just like you would tell an alcoholic, first you must recognize that you have a problem.  Next you must review your financial statements to find out the depth of the problem.  Then you must develop a plan to get back in the black.  You must budget, analyze your cash flow issues, and tighten the belt.  Lastly, get help.  Would an internist do a cardiac cath in the office?  Of course not!  Why would you try to go the financial world alone?  Get referrals from friends on good accountants and bookkeepers, read all you can, consider educating yourself through seminars, and take it one day at a time.  If you actively follow your plan, your practice can become viable again!

Group Visits: Treadmill Medicine or Meaningful Encounter?

I have been encouraging physicians to explore group visits for a while.  Group visits are especially suited for stable patients with chronic disease–think hypertension, diabetes, COPD. Patients with chronic diseases make up the majority of the primary care office visits, especially for internists.  Group visits can increase patient and physician satisfaction, and encourage healthier patients and lifestyles.

Following is a short primer on what must go into a group visit:

  • Privacy issues must be addressed.  The patient must sign a confidentiality form, allowing their case do be discussed in a group, and also agreeing NOT to discuss other patients’ medical issues outside of the group appointment.
  • The chronic disease addressed must NOT require the patient to disrobe.  (Duh.)
  • A physical exam must be done.  In order to bill appropriately, a nurse should document vital signs for each patient, and the physician should document an appropriate exam for the problem.
  • Patients should be encouraged to have questions formulated for the physician ahead of time.  These questions may be posted on white board and reviewed through out the meeting.
  • Physicians should be prepared to answer questions as they examine each patient.  This is where the efficiency exists–many of the patients will have the same questions, and will be relieved that they are not the only one with questions/problems.
  • Time should be available after the group appointment for individual questions ON THAT SPECIFIC DISEASE PROCESS.
  • Schedule enough time and enough patients.  Eight or nine patients in one hour is a good number.  You may need to have the initial group visits be 2 hours and discuss how the group visit will run.  Realize that Seniors tend to have more flexibility as to scheduling an hour long visit, while working folks may require early morning, lunchtime or late afternoon appointments.
  • Have enough support staff to take vital signs, sign privacy statements and get patients situated.
  • Be prepared for emergencies–if Mr. Pickwick shows up for the group visit with a pulse ox of 70%, be prepared for how you will handle the emergency AND  the group meeting.

As to billing issues: each patient is billed as if seen individually, hence the emphasis above on vital signs, appropriate physical exam, lab tests, level of decision making etc.  Utilize E/M codes 99212-99215 as appropriate.  Documentation is key here.  Consider a check list form, or a template for your EMR, that patients fill in regarding symptoms and questions, and then a check off form for the physical examination.

So what do patients think of group visits?  About 75% of patients that have participated would do so again, and 5% would not. 

I personally have done group visits with diabetics, and enjoyed it tremendously.   We served lunch at the first meeting, and had a nutritionist and pharmacist there as well.  The patients enjoyed it, and learned a lot.  I think group visits will go a long way towards easing the treadmill approach we employ in primary care medicine, and encourage physicians to try it.  Some practices delegate this to the “mid-level” providers, but I think patients get more out of the group visit when it is physician run.  I also believe that most physicians enjoy the interaction and ‘teaching moments.’

Let me know if you do this, and what works or doesn’t work.

For an overview of how Harvard Vanguard Medical Associates is doing group visits, see:

For more information, forms, and another in-the-trenches view point, see:

TightMD Gazette II: 11 More Tips to Tighten the Belt

All right, Dr. Practice Owner, here are more tips to keep you practice’s head above water in these turbulent times:

  • Share staff.  If you have an excess of staff, could they be shared with another office rather than laid off?  You  get to retain a valued staff member, the staff member keeps their job, and everyone wins.
  • Enlist your staff for help.  Everyone is anxious about keeping their jobs.  Set up a brain storming session for ways to save money, and ask your staff for input.  Once they realize they can directly impact how the practice runs, they will be diligent in finding ways to keep the doors open!
  • Pay bills on line.  You can pay bills closer to the due date, and keep the money in your account longer.  (See “sweep account” in previous post.)
  • Get a free energy audit.  Your local power company will do this for free, and can give you information on where the energy is going, and how to improve the leaks.
  • Turn off your computer at night and on weekends.  Ditto the lights.  (Duh, but did I turn off my computer last night?!)
  • Evaluate your payroll company.  Payroll companies must guarantee accuracy in withholding and tax filing.   (Penalties are huge for mess ups!)  However, make sure you are not paying for services you are not using–if there is just three of you, do you really need the Human Relations functions?  Also, examine direct deposit.  See if you can get your payroll service to do it for free.  Direct deposit saves the payroll company money–which should you be paying for it?
  • Make sure you take all the tax deductions you are entitled to.  Keep receipts as if they were gold.  If you haven’t done this during 2008, make it a top priority for 2009.
  • Tax tips continued: (     

–If you started a qualified retirement plan, you can claim a credit of $500 per year for the first three years to offset the administrative start up costs (e.g., educating your employees about their participation in the plan).
–If you conducted scientific research, you may qualify for a 20% tax credit for these research activities.
–If you hired someone from certain targeted groups, such as a disabled veteran or long-time family assistance recipient, you can claim a credit for a portion of their wages.

  • Choose the best business entity.  Partnerships, LLCs, and Corporations all have various tax benefits.  Talk to your accountant and then business attorney about what is right for your practice.  General rule: “Any business with the potential for claims against it, which includes most businesses with employees as well as those with customers who visit the business premises, should probably opt for an entity type that protects owners’ personal assets.”  (Barbara Weltman, contributing writer for Inc. magazine.)
  • Cross train your employees.  Rather than laying off, see if they can do other functions.  Beware of the training costs, but it may just save you money.
  • Don’t be Scrooge McDuck.  Get creative with perks.  Consider dress down Fridays, if appropriate, or Pizza Fridays.  Ask you staff if they want that Holiday Gala, or if they would prefer some decent lunches, or maybe just a bonus check.

My company, ExtraMD, does the following: we use a virtual assistant, we pay bills on line, we keep payroll in  house, and are looking at giving bonuses this year.  I look at our profit/loss and budget variances monthly.  We have an ace controller, and an amazing tax attorney.  Our accountant is appropriately pessimisic  (that’s what I am paying him for!)  And, yes, I print on both sides of the paper.  I promise to turn off my computer at night.

Good luck!   Keep the doors open, the employees EMPLOYED and your practice business in the black.  Remember, if you aren’t open, you can’t see patients!

The TightMD Gazette: More Ways to Save Money in Your Medical Practice

So now that we are in the spend, spend, spend season, I thought I would round up some more ways to SAVE money in medical practices.  The following tips are from the mundane to the grandiose.

  1. Get your printer cartridges refilled, rather than buying new ones.  And, hey it’s “green”!
  2. Get free forms.  Visit  They have forms for collections, credit cards etc.  Better than making ’em yourself, or paying for them!
  3. Use independent contractors.  ExtraMD (my company) is made up of independent contractor physicians.  We fill in locally around town, and cost less than the big locums  companies.  Practices save because we are independent contractors, and pay our own taxes/malpractice etc.  There may be similar groups in your location.  In addition, consider independent contractors for prn nursing, front desk help etc.  CAVEAT: check with your attorney/accountant to make sure the people you are using fit the stringent IRS definitions of independent contractors.
  4. Shop around for over night mail couriers.  Boy was I shocked at the differences!  It cost about FIVE dollars less to use USPS over night versus another big company!
  5. Make sure you plan for taxes appropriately so you don’t get soaked with penalties.  My bookkeeper calls this “tax anticipation.” 
  6. Get the best credit card rates.  If you run balances, for pity’s sake get the lowest interest rates!
  7. Look at a “sweep” account. If you run large balances for 2-3 weeks at a time, a sweep account allows you to move your money in and out of an interest bearing account easily, and earn interest, rather than having your money sit in a non-interest bearing account.
  8. Ask suppliers if they will give discounts for early payments.  Hey, it doesn’t hurt to ask.
  9. Make sure your billing company is a bull dog.  Don’t let them write off claims too easily.  I will post more on this later.
  10. Get at least three bids on every purchase  (especially the big ones!)  When you DO finally purchase something, see if you can bargain, or quote a competitors price!
  11. Reassess your phone plan and the number of lines you have.
  12. Eliminate paper waste.  Copy on both sides of the page.  Why  add more to the land fill any way?
  13. Use coupons.  Don’t laugh!  Get your medical assistants to find them.  Check out for lots of coupons on just about any purchase.
  14. Sell equipment you aren’t using on Craigs List.  ( )
  15. Make sure you are getting the best rates on business/medical/malpractice insurance.

Just try doing one or two, and see where it gets you. I will search out more ideas in the next post.  As a reminder, try to have your staff look at this list and implement a few money saving practices.  Your time should not be spent clipping coupons!  I would love to hear YOUR tips!  Also would love to hear gripes/tips/info on coding in your practice.

For more info check out these on-line articles: