From mini putting greens to magic tricks, there were many gimmicks to catch the attention of healthcare executives' attention this week at the Healthcare Financial Management Association's HFMA 2011 ANI conference in Orlando.

But, diversions aside, what drew healthcare leaders to fill the seats was the opportunity to interact with peers and to share practical strategies for contending with the serious issues we're all facing: reimbursement cuts, changing models of care delivery, and the need for technology integration.

In his keynote address, Monday, HFMA Board Chair Gregory Adams emphasized that the "days of the suits versus the white coats are over." This was one of the major overlying messages at the conference. And it's message healthcare marketers should take to heart: There is a great need to put egos aside and work together to solve common issues such as what to do about accountable care, how to improve patient safety, and how to recruit and retain physicians.

So how does this new language and teamwork system begin? As marketers we need to better understand how the leadership systems within our organizations work, in order to communicate better with both providers and patients.

At the IL-based Carle Physician Group, a large multi-specialty practice, the goal was to improve care efficiency and reduce costs by becoming a physician-led integrated delivery system. To save $40M in margin losses as a result of Stark laws, and to benefit from shared services, Carle Clinic Associates, Health Alliance Medical Plans, and the Carle Foundation formed one legal entity in 2009. Consequently, a new leadership structure was defined.

"We wanted true integration, not just in name only," said Dorrie Guest of Deloitte Consulting. "It was time to take your silo hats off and figure out how you are going to work together."

The first step was getting physicians on board and having them brainstorm ways to cut costs. The progressive steps that took Carle Physician Group, Health Alliance Medical Plans, and the Carle Foundation from separate entities to a single group look like this:

1. Competition
2. Cooperation
3. Collaboration
4. Co-management
5. Co-ownership

"Our biggest problem was the 'Tower of Babel' of diagnosis," said Bruce Wellman, MD, CEO of Carle Physician Group. "Physicians all had to agree on the same terms. We needed to get them to use a common language."

Wellman explained how the group hired five or six nurse navigators to help streamline the process of care and identify a common language. As a result, the 30-day readmission rate dropped to under 10%.

It's known that a physician-led model performs significantly better than non-physician led models in cost-efficiency, Guest explained. However, she said, "most organizations have not put enough money into physician leadership training in order for them to become sustainable leaders."

In the current financial climate, as many groups may consider becoming an integrated delivery system (IDS), they have to understand the level of effort involved.

Integration does not happen just with a name change, but with a change of leadership, communication, and collaboration. From a marketer's perspective, it's important to keep tabs on the leadership structure to market opportunities for physician leaders to step up and help run an organization.

Are healthcare workers really practicing what they preach in terms of wellness? The doctor's office has come a long way from the days when physicians used to puff cigarettes while diagnosing patients. Now smokers are shooed outside hospital walls for their nicotine fixes and more hospitals are putting hiring bans on those who smoke.

Next month, SSM Health Care hospitals are launching a tobacco-free hiring policy in order to set a better example for patients. If an applicant admits to using tobacco on the job application, they are eliminated from the hiring pool.

The reason is clear: Each smoker costs a company an additional $3,400 annually in health care costs and lost productivity, according to the Federal Centers for Disease Control and Prevention.

"As an organization that provides healthcare, we want to encourage our employees to take better care of themselves and set good examples for our patients," said Chris Sutton, SSM spokesman.

The SSM hospitals are eliminating what many think as hypocritical – doctors who can't or refuse to follow their own advice. From the marketing perspective, hospitals and their employees should be united on wellness promotion. But banning smokers opens a can of worms…what's next, a ban on hiring obese docs?

I chatted with a former morbidly obese doctor last week about whether physicians have a responsibility to be healthy role models for their patients. Nick Yphantides, MD, Chief Medical Officer for San Diego County, used to straddle two scales to weigh his 467 lb body. He was a candidate for seven different chronic disease medications, had high cholesterol, high blood pressure, and high risk for many other conditions as a result of his weight.

After embarking on a "big fat Greek diet" and a journey to all 50 states, Yphantides lost a total of 270 lbs.

"As a guy who spent a majority of my life as a board-certified hypocrite, it pains me to see those preaching one message and living another," he says. "People doubt what I say but have to believe what I do."

Yphantides lives by the mantra of St. Francis: "Preach the gospel at all times, and when necessary, use words." He considers it his duty to his patients to promote a healthy image. Other health systems are following in his footsteps in the journey to promote their staff's personal wellness journeys.

BayCare Health System, which operates 10 hospitals in the area including Clearwater's Morton Plant, Mease Countryside and St. Joseph's in Tampa, has launched an employee weight-loss competition called the Ultimate Loser. The winning man and woman each will receive $3,000 as a reward.

Tampa General Hospital's wellness program focuses not only on weight loss but also on healthy behaviors, like as eating breakfast. Participants who stick with the plan and keep a daily journal will be entered in a drawing for cash prizes. The hospital has hired two full-time wellness educators, who say that for every $1 spent on employee wellness, companies can expect to save $3 in health care costs after three years.

The issue of weight can be an uncomfortable one to discuss with patients and Tampa General is working to tip the scales in a healthy direction. Physicians must educate patients on healthy behavior, but should follow the same healthy principles they preach.

A recent case where image calls credibility into question involves Regina M. Benjamin. Many critics fault the new U.S. surgeon general for being overweight as she addresses the nation's obesity problem.

But the fact remains: Subconsciously we all judge those giving us advice. Would you go to a hairstylist who is always having a bad hair day or a dentist with rotting teeth? Yes, these people can still do their jobs, but the image they are promoting (intentionally or not) does not quite align with the profession. We all have our vices; who's to say that thinner people are any healthier? Nurses and physicians have hectic schedules, often with little sleep or downtime, which can adversely affect weight. Why not cut them a break?

If you want to promote wellness within your healthcare organization, offer a weight-loss program like the one at Tampa General, or create other incentive programs that encourage good employee health habits.  

Hospitals have a right to set an example for their patients, but physicians still have the right to make healthy choices on their own accord especially on their own personal time. Staying healthy should remain an unspoken rule in the healthcare community—no one likes a hypocrite.

Readers – do physicians have the responsibility to be healthy role models for their patients? Should hospitals have a role in their workers' wellness? Discuss.

Newsflash: the physician shortage is growing and so is its effect on marketers. The Association of American Colleges predicts that Americans will need an estimated 45,000 primary care physicians and 46,000 surgeons and medical specialists by 2020. As a result, marketers will need to shift priorities to focus on physician recruitment and retention.

Last week, HealthLeaders covered 6 Physician Retention Strategies, so this week I will discuss some recruitment strategies marketers can keep in their back pockets, using Springfield, MA-based Baystate Health, a 783-bed integrated health system, as an example.

When Emerson Moses, projects & operations manager, first began work at the Office of Physician & Advanced Practitioner Recruitment at Baystate Health six years ago, there were only two internal staff, including herself. Today, the staff has expanded to six internal employees and three recruiters, the largest it has been in 15 years, Moses estimates.

The expansion mirrors Baystate Health's increasing attention on physician recruitment. Upon expansion, cost per hire decreased by 22% (from FY2006 to FY2010) as internal recruitment staff continued to increase.

"We were able to grow because we were able to demonstrate that it was easier and more cost efficient to have a full in-house staff rather than rely on outside agencies," Moses says. "It was a lot of heavy documenting and educating physician leadership on the value we provide to physicians on how we have the knowledge of our organization and its needs compared to an outside agency."

• Increased the number of visitors by 201% in 2011 compared with 2010
• 520 visitors per month on average since Feb. 2010
• An average of 65% new visitors per month on average

• Interviews conducted dropped from 222 in 2009 to 188 in 2010, another possible correlation to the web portal helping candidates self-select
•  Number of hires increasing by 17% from FY09 to FY10
• 30% of hires sourced through online advertising, the largest source of candidates next to Referrals and BMC/Tufts Residency Programs

"By providing as much information and resources up front to physicians via our website, we also expect a bit of 'self de-selection' of those candidates who are not going to be the best fit for the organization," Moses explains.

"By controlling the information that is provided to candidates on our website, it filters out someone who may not ultimately choose our organization and, in turn, increase our acceptance rate because we are (ideally) only interviewing candidates who truly want to work at Baystate Health."

As the physician shortage goes from bad to worse, Moses recommends that in order to survive, even the larger healthcare organizations will need to start focusing on alternative resources for physician recruitment instead of just relying on word of mouth.

Smaller organizations, she says, will need to focus on building brand awareness and creative (and free) innovations. Within the next six months, she expects Baystate Health to add a live chat feature to its physician portal where potential hires can ask questions live to a recruiter.

"The live chat option is especially important for younger generations who are using smartphones for research to go online and chat with recruiters," Moses says. "Hopefully this feature will give us a step up from other recruitment websites."

One of the biggest mistakes marketers make when recruiting physicians on their website is focusing too much on promoting lifestyle, says Shawn Kessler, senior strategist at Aloysius Butler and Clark, a national consumer marketing communications agency.

"Marketers rely so much on promoting quality of life that they forget about quality of care," he says. "Physicians aren't going to think that your mountain bike trails or fishing streams are any better than their mountain bike trails or fishing streams."

Also marketers are too focused on building patient volume, when the larger issue will be accommodating staff to meet that volume, Kessler says. His top strategic tips for marketers looking to improve their physician recruitment efforts include the following:

1. Website – Physicians research. It's what they do. Make sure your website is accurate before they investigate.

2. Branding initiatives – If you are going to direct marketing tactics, you need to understand and build your organization's reputation.

3. Unity – Make sure that your website and organization are united with the same message.

4. ROI – Here's one of the most important points. A physician portal allows marketers to track and measure response rates and can manipulate their efforts as a result.

"In the past, marketing practices have asked how do you get more patients to more programs, but pretty soon you are going to see more strategies to get more physicians," Kessler says.

"You are going to see smaller health systems struggle – big players will come in and crowd the field – you have to build your brand so it won't be a significant challenge," he adds. "It's going to be a significant investment and there's no quick solution, [marketers] should start looking into it now."

I agree with Kessler. It's time for marketers to start building their recruitment strategies before they are attracting too many patients without anyone to treat them.

See Also:
Buzz Survey: Physician Growth Strategy

Marketing campaigns are routinely challenged to promote a hospital's services and capabilities without overstating the benefits or understating the risks. When the manufacturer's materials are being used to market a product or service, patient education is at risk.

We've all chuckled over the litany of negative health consequences speedily read at the end of drug ads on TV, over a backdrop of incongruously positive visuals. Are marketers telling patients what they want to hear while effectively communicating the possible negative consequences?

A study from Johns Hopkins Journal for Healthcare Quality reports that hospital websites promoting robotic surgery largely ignore the risks associated with the procedures.

About four in 10 hospital websites in the U.S. promote the use of robotic surgery "touting its clinical superiority despite a lack of scientific evidence that robotic surgery is any better than conventional operations," the study states.

Here's the kicker: 73% of the reviewed websites used manufacturer-provided materials to promote robotic surgery. Many hospital websites even link directly to the manufacturer's website.

"This is a really scary trend," said Marty Makary, MD, associate professor of surgery at Johns Hopkins University School of Medicine, in a statement. "We're allowing the industry to speak on behalf of hospitals and make unsubstantiated claims."

We often hear about the positive effects of robotic surgery, which Johns Hopkins researchers call into question:

• Better cancer outcomes
• Shorter recovery
• Less pain
• Superiority --- Superior to what? The answer is undefined, Makary says. The marketing does not specify if robotic surgery is being compared to the standard of care, which is laparoscopic surgery, or to open surgery.

Laura Harner, Marketing Manager for Lehigh Valley Health Network says that using terminology such as "best" or "superior" is insufficient and should to be supported by evidence. Lehigh Valley Health Network uses marketing phrases such as the words "best" and "first" around specific claims, then backs them up:

• "Best Heart Attack Survival Rate" -- substantiated by CMS data that points to Lehigh Valley Health Network's lowest mortality rate in the state

• "Pennsylvania's first and the region's largest trauma center" --- supported by statewide trauma volumes reported to the independent state agency, the Pennsylvania Health Care Cost Containment Council.

"When we make a claim, we also give the consumer a "proof" point to support it. Before we make any claim, we make sure it is a fact that can verified by an outside source and something we can provide documentation on," said Harner.

Two years ago, Lehigh Valley Health Network rebranded with a new tagline: A Passion for Better Medicine. The word "better" was chosen because it shows a journey to improved care. Consumers were shown to appreciate the word "better" because it was more believable, aspirational, and approachable.

Lehigh Valley Health Network does not use manufacturer-provided materials on their website, and instead aligns marketing information based on individual needs of the facility.

"As it becomes more and more difficult to differentiate services in highly competitive markets, it becomes even more important to make sure marketers hold their organizations accountable for what they say in their marketing messages and the level of care actually provided by supporting claims with facts and data generated by a reputable, outside sources," Harner added.

Using outside sources to validate material is another method to ensure accurate and balanced information. If clinicians or providers do not have time to review marketing materials, marketers can use third-party accredited sources to validate information, advises Elizabeth L. Scott, Principal Stategist for Raven New Media. The third-party option also helps marketers keep their materials fresh as the industry changes and new medical information becomes available.

"This information usually comes bundled in a health information encyclopedia, health risk assessments or service line information. If fed into your website dynamically, the information should be current and refreshed as needed by the source," Scott explained.

Marketers do not need reminders to point out the positives of a particular service. Keeping accurate information in check is also important, even if it means telling the potential patient the risks. In terms of the robotic surgery marketing information that is on many hospital websites, perhaps there should be an added disclaimer such as the one listed at the bottom of the Phoebe Putney Memorial Hospital website:

As with any surgical procedure, individual results may vary. Benefits of minimally invasive surgery cannot be guaranteed as surgery is both patient and procedure specific.