Episode 42: Patient Engagement As Restrictions Lift

Michael, Scott, and Jared dive deep into the ways patients are starting to engage online as states begin to lift restrictions on elective procedures. They discuss digital marketing trends they’re seeing from practices as they ramp campaigns back up, projections about surgical volumes, and what telemedicine needs to do to continue to provide a meaningful patient experience.

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Full Transcript

Announcer: It’s time to think differently about healthcare, but how do we keep up? The days of yesterday’s medicine are long gone, and we’re left trying to figure out where to go from here. With all the talk about politics and technology, it can be easy to forget that healthcare is still all about humans, and many of those humans have unbelievable stories to tell. Here, we leave the policy debates to the other guys and focus instead on the people and ideas that are changing the way we address our health. It’s time to navigate the new landscape of healthcare together and hear some amazing stories along the way. Ready for a breath of fresh air? It’s time for your “Paradigm Shift.”

Michael: Welcome to “The Paradigm Shift of Healthcare” and thank you for listening. I’m Michael Roberts with my co-hosts, Jared Johnson and Scott Zeitzer. On today’s episode, we’ll take a look at how patients are starting to engage online as states lift restrictions on various elective procedures around the country. 

Scott: Hey, Michael, Jared, just wanted to bring up an interesting article that I read in “JBJS,” “Becker’s Spine” pointed out in analysis last month, I think it was, that focused on how long it would be before elective orthopedic surgery would return to, say, 90% of the expected pre-pandemic. And it was quite a range of outlooks, anywhere from seven months, I think, to 16 months. It’s interesting about that, I read that and then I’ve been talking to a lot of our orthopods and spine guys that we talked to on a regular basis and we’ve got quite a few. And it really is a wide spread, part of it is dependent upon geography. Obviously, the people that are in, say, in New York City, are gonna be very different than somebody in a very rural area. And where the pandemic hits and how the pandemic hits are all gonna be a big part of that. 

I am happy to hear that orthopods are starting to see patients again. That’s a good thing. A lot of people are in pain, they are in need of help. And I do think that it’s incumbent upon everyone to try to best take care of all these people. I think a big thing is, how do we get that information out there, you know what I mean, to the prospective patients? I think a lot of them are a little nervous about coming back, even though they are in pain. 

Jared: Yes, Scott, I feel like, even just being aware of the fact that there’s no exact answer. No one knows. Even those figures in “JBJS,” there were the conservative estimate like, the ambivalent estimate, and the optimistic, so 7 months, 12 months, 16 months, right? That’s a pretty wide range. 

Scott: It really is. I mean, every surgeon that I talked to, they love to do surgery, they love to take care of their patients. I mean, it’s quite a change. And not only are they dying to go take care of their patients, they got to go figure out stuff they never had to think about before. There is the business side about cash flow. How do you bring people back on while you’re not able to see all the patients that you need to see? This is not unlike, you know, here in New Orleans where we have the restaurant industry is trying to figure out how to reopen safely and economically viable way. Same thing with any other small business like, a practice. 

I’ll say it over and over if you know what you’re doing in terms of how to best take care of your patients, whether that’s masks, social distancing, new rules for the waiting room, or lack thereof of waiting room, you’ve got to get the word out. You know, you’ve got to tell your patients the specifics of what you’re doing and how you’re taking care of them. I can’t belabor the point any more. Michael, I know that you and I have been talking to a lot of our offices out there about how important that is. 

Michael: Yeah, it’s interesting to see how practices are approaching that level of communication because…and we’ve talked about this quite a bit on the on the podcast itself. But some of the practices are doing a really great job of like, fully spelling out everything and really getting that out on the website, but maybe not everybody’s ready to go see that content on the website yet. And we’ll kind of get into this more a little bit later on. But during all of this quarantine time and trying to find times to meet with the physicians and whether it was telehealth or in office, patients were very, very focused on everything else going on, like the rest of us, right. Like, the economy’s doing all kinds of, crazy things and we’re all kind of worried about our health. 

And you know, one of the ways that we’ve seen practices succeed in the midst of all that was getting out there with very active messaging on Facebook and on channels where you’re not waiting on the patient to show intent. They don’t have to search for something, they don’t have to go look for something but you’re trying to get out there in front of everybody. And this really goes back to old school advertising. You know, this is the billboard. This is the ad in the newspaper. This is…that kind of thinking, but to make sure that you’re communicating in a way that gets in front of the patient. And it’s been very effective. We’ve seen practices be able to get in front of people. We see the numbers of how many people they’re actually reaching. And then we see all the level of interaction with that. That’s drawing conversation and has worked all the way through all this stuff. 

Scott: Yeah, Michael, I couldn’t agree more, you know, that this…some people really embrace conceptually the idea of a “new normal” and some people are trying to fight it. It is a lot about habits, I mean, at its core. A lot of us just want to simply, you know, get back to work the way we were. And I think a lot of things are changing, you know, whether telehealth is gonna stay. I think telehealth is going to stay I don’t think it’s whether it’s gonna stay. It’s just how it’s gonna be added and what the changes in workflow are gonna be. A lot of different things are happening here and as the practices are turning on, Jared, I know you’re talking to a lot of hospitals, how are they turning the valves back on?

Jared: It varies just as much as those projections that you were just talking about in terms of when we’re gonna hit that 90% figure, again. It varies widely across the country. Some are really trying to, oh, probably all, really all of them are really trying to do it a little bit more conservatively than they want. But it’s also because it doesn’t actually, at the end of the day, provide them a whole lot of benefit because this is going to be a long, long engagement to convince people that it’s safe to come back and really what that means. So even just based on folks like, Dr. Scott Gottlieb, who he was the Commissioner of the FDA from 2017, to like, midway through 2019, and on Twitter lately, over the last few weeks, he’s shared some very interesting projections. And one of those was what I feel like was probably one of the more realistic ones about how hospital volumes when they’ll even get to like an 80% figure. 

So kind of, similar to the figure you’re looking at. This is overall hospital patient volumes, and I believe it was inpatient and outpatient combined. But the anticipation there from what he’s seen, he says it’s gonna be maxed out at 80% of pre-COVID levels for up to 18 months from now. And that depends on the availability. 

Scott: Yeah, I think that.

Jared: Yeah, like, that depends on the availability and, you know, the effectiveness of medical treatments and vaccines. I think he was trying to walk a, you know, fairly middle line in terms of not being too cautiously optimistic and not too pessimistic in terms of what that means. Like, what, you know, how quickly a vaccine will be available, how quickly other treatments will be available to treat COVID symptoms and patients. That is really profound in terms of how do we plan for that?

Scott: I agree, Jared, it’s something that everybody’s got to be thinking about. You know, you talk about the small practice where it’s, in some ways so much easier, like, “Hey, we’re just not gonna let anyone in the waiting room. Just stay in your car.” Well, you’re not gonna be able to have that conversation in a hospital. Let’s face it, it’s a lot more of a complex conversation. And how you engage with those patients on a practice level, Michael, I know you’ve been really kind of, digging into that, we’ve been working with a lot of our customers. How’s that coming along? 

Michael: It’s really interesting to see. I mean, some of the data is kind of, like, “Oh, well, of course, that makes sense,” right. So one of the things that we’re looking at, and we’ve been really starting to kind of, pull together for our clients is how their website traffic is doing. You know, it’s sort of an ongoing discussion, of course, but taking it a step further and looking in systems like, Google Search Console, for those that aren’t as nerdy in the SEO space, and then search engine optimization space, you know, there’s a tool that Google provides that says, “This is how often your website is showing up in search results. And then this is how often, you know, people are actually clicking through that result and actually finding your website and going to your site.” 

And not only is that overall, you know, amount of traffic, that’s actually getting to the practice is going up. But it’s also that interest online is going up pretty substantially. I mean, we saw practices jump 30 to 60% in their overall traffic in just a month, you know, because that month of April, everybody’s staying home, everybody’s doing what they’re supposed to, and they know they can’t get in the door, and now, we’re really opened back up and in some areas, right, so. 

But as that’s happening, I feel like that’s kind of like an early indicator for what practices, what hospitals, what different medical organizations should start expecting is there in so many ways, you know, the way that you’re measuring the effectiveness of your business is how many people completed the main action that I wanted them to complete? If you’re an orthopedic surgeon, how many surgeries did I get to complete? How many patients was I able to see…that was I able to see in the practice this day?

And you’ve got that set of indicating factors but you also have this level of engagement of what’s going on in your website. And like I was saying, you know, during the time of quarantine, everybody stopped looking, I mean, the search volume. And this was not just like, in an organic search, like, the search that you earn, right, for having the practice as well optimized and all that sort of stuff with your website. But also like all of the advertising, you know, advertising competition dropped substantially, because, you know, people may still be clicking, but they can’t actually get an appointment right now. So they’re not converting, you know, from the marketing language, they’re not going through that process. So now there’s much less incentive to keep going there.

So all of these factors just drop substantially, and now it’s all starting to wake back up. And this is a time when, if you paused your advertising, or if you switched paths, or you know, you took a different route during the middle of all this, now is the time to jump back on it. You know, you may even be a little late on it, because everybody’s waking back up. Now, whether that means that you can do surgery in your state or all of those kinds of, things, people are thinking of what’s next now. And that’s a real opportunity for practices and for patients as well. 

It’s interesting because it leads to one of the things that I saw just recently online, Dr. Dasa, who was recently on the podcast, had put a post on LinkedIn where he was comparing his patient schedule during the quarantine time and showing here’s all the different, you know, telehealth visits and they’re just all lined up. And then here’s what’s happening now. And, Scott, I don’t think there was even like one listing of telehealth on that when it was just everybody coming back to being in person again.

Scott: We are very social animals, human beings, and there’s a lot of stuff. When you talk to an orthopedic surgeon, every specialty is going to be different about where telehealth can help and where telehealth is not gonna be as helpful. So, in a post-operative if somebody just had a total hip procedure and they’re doing pretty well, you know, I know I’ve spoken to a lot of patients and doctors’ offices I have some friends as well. And they were always like, you know, kind of, moaning like, “I’m fine I don’t know I need to go in.” And that’s great, you know, I’m glad that, you know, you’re in no pain post-surgery and a few months out and, “I don’t know why I need to go in.” And there’s a great place you know, for telehealth. I can think of a lot of dermatology questions that might be able to be answered instead of having to come in. 

But in orthopedics, you know, touch is important. Understanding the pain, a simple drawer test, the orthopods, of course, know what we’re talking about for ACL, anterior cruciate ligament. The simple drawer test is not something you’re gonna be able to do telehealth wise, but is something that you would learn very quickly to be able to do easily and efficiently if they walked into the practice. So, how these technologies are merged in dependent upon the specialty is going to be an ever-adapting thing. 

And then, guys, let’s face it, Jared, you brought this up, the treatments that hopefully will start to improve, the vaccine that one day will come. Until that happens, the wave of spikes of CORONA, throughout the country are gonna wax and wane. And I go back to like, using that website to update efficiently, whether you’re the hospital or whether you’re the practice, it’s gonna be a critical win. And you know, Michael, you and I both have seen Facebook has become…it’s an intent conversation, but Facebook is certainly an important avenue to get some of that word out as well.

Michael: Yeah, certainly. And, you know, we’re having conversations with different types of practices around which one is creating more volume for them, which one creates more opportunities for them. And it’s another tool in the toolkit, right? Like, be aware that you need to have different tools for all of these different experiences that you’re trying to convey. When things are changing rapidly you can’t wait. You can’t wait until the patient thinks about you. You can’t wait until somebody needs to come in the door again. You got to get out there and be ahead of that kind of information through Facebook, through other avenues like that, that will let you get out there in front of everything.

Scott: Yeah, it’s absolutely critical. And you know, I know, Jared, you and I were talking about this earlier. But one thing practices who take insured patients don’t need to worry about is that there’s a lot of people who, you know, don’t have insurance like, they’re without a job. And that’s something the hospitals have to deal with as well, right now.

Jared: Yeah, I think it’s just it’s really throwing the entire business model out the window for so many practices, because they did rely on commercially insured patients. And of course, I mean, financially, that’s always made sense. Like, that’s what’s allowed you to treat for others with either no, you know, cash pay or other insurance options. It’s what’s allowed you to treat them. And yet now, that’s all been thrown on its head, right. 

And I think some of the things we’re getting at in terms of what we’re kind of, recommending here is to spend the time to start making some of these projections yourself. In my opinion, start thinking about how can I find the opportunity in what’s going on? Because the opportunities are those who are going to take the time now to figure out what their best options are. Okay, hey, say that, in this example that you were just referring to, Scott, use that as an example. Hey, you know, let’s put our heads together as a practice and say, “Hey, what if we do have like, a 30% drop in commercially insured patients the rest of the year?” We might consider ourselves lucky like, it might be more like 60 or 70. What do we do with that? You know, do we need to divert resources do we just need to be aware like, do we need to…”

I feel like their digital support, everyone who…all the partners and agencies who are helping there at all with marketing and communications really have an opportunity to step up and be that partner even more and help them make those recommendations. “Okay, hey, if we have less to play with, like, let’s focus even more of this content or this web page, you know, or this social media campaign, let’s focus more of that on this population.” 

Scott: Absolutely. 

Jared: It’s basically I feel like, it’s just better, it’s the opportunity. Finally, you don’t really have a choice anymore. Let’s use the tools that you have and let’s work with the partners that are already there to help you, that have been helping you. Let’s put all that together and really just get that to be a well-oiled machine because I don’t know if there’s as much of a choice to do that anymore.

Scott: It’s interesting. In orthopedics, relative to, say, something like pediatrics has always been a more profitable practice. I always say that pediatricians probably have, like, they get to go to the front of the line, you know, in terms of like, a pat on the back, etc., because they’re usually making less money than everybody else. And they’re much more used to the pediatrician or the family practice looking at the bottom line. You know, I have a lot of friends of mine, orthopods, who have just said like, “Ah, you know, I, would just wake up in the morning, I do my surgery, see my patients, I’d make my money. I didn’t have to worry that much.” Yes, everybody who runs a small business, including an orthopedic surgeon, of course, worries about money, but we’re in a capitalist society, of course, we do. That being said, it was a lot easier and you don’t have to worry about it as much. Now, you do. 

And Jared, I think you’re right, you know, don’t hide from it. Go dig in. I know I’m saying this to some surgeons right now who are listening who are wincing when I say this, but, you know, man, embrace it, go take a look at it, what’s working, what’s not working. Be transparent with yourself and the rest of your group about how you’re gonna move forward and what you’re gonna do. And I think you’ll get through the next six months to a year a lot easier if you’re not hiding from these things.

Michael: Speaking of the new things that we’re trying and the ways that patients are engaging in this time, like, what’s working and what’s not working, right? 

Scott: Yeah.

Michael: This is definitely a big moment for telehealth. Everybody’s very excited about the platform really getting the chance to step up and really kind of take center stage there for a while. But it’s not been completely smooth. It’s not worked out without any hitches at all. So, Jared, I know you had mentioned this on another podcast that we were on. I’m gonna name drop for a minute here, Scott. 

Scott: Absolutely.

Michael: Jared and I are on another podcast. And so we had the opportunity to bring this conversation up. And it was really fascinating and something I wanted to kind of weave into what we’re talking about here, Jared, that conversation you’re talking about around the experiences of patients on that platform. 

Jared: Yeah, I refer to some research during that interview which, you’re right, it was Michael and myself. I’ll just point that out, you know. Gotta get that dig in while we can. On that I refer to some research by Cast & Hue which is an experienced design agency, among other things. And they had recently, this was just middle of May, that they released this consumer research about how COVID-19 has affected patient and consumer perceptions of healthcare. And one of them was about just, in general, like, by now, I don’t think it’s that much of a surprise. But one of the points, the data points, was that more than half of consumers are worried that COVID-19 will affect their personal health. But then that translated into telehealth visits itself, right? Because when they looked at that, specifically, when you took them into account, what they found is that more than 40% of consumers have already delayed care due to COVID-19. So you know, that does speak to how people are feeling, in general. 

Then when they dug into telehealth, they did qualitative and quantitative research. And I thought it was interesting. The more I dug in with the research, there’s some pieces that stood out. One was that it wasn’t surprising the exponential increase in how many consumers overall have had a virtual visit or a telehealth visit of some kind. And their research has said that the number of consumers that have had one had doubled in the last three months. But challenges still remain for continued adoption. And it came to light in some of their individual interviews where they said because…and I think this is the part that I don’t hear a whole lot in other headline news in the industry. All we hear is that, “Yep, telehealth is having its moment the toothpaste is out of the tube.” You know, the toothpaste is out of the tube, we’re never going back.

And even TeleDoc itself, which was, you know, one of the one of the larger telehealth providers. TeleDoc, of course, when they release their quarterly earnings in the middle of Q2, no surprise how high the number of visits have jumped. I found interesting that their projections for Q3 and Q4 this year, we’re basically coming back to Earth somewhat. It wasn’t gonna go back to pre-COVID levels, like we said, like, we’re not going back all the way. But we’re not staying up there in terms of volume of telehealth visits either. 

And that kind of, came to light too in this research from Cast & Hue because, the more they talk to people, they basically said, like, you know, “Tell us about your visit, tell us about the experience.” And it wasn’t just like everyone across the board saying, “Yeah that was great. I can’t wait to do that again.” It was pretty much a “meh” reaction when they were asked, “Well, was that good enough? You know, would you do that again, you know, if you have the choice to do a virtual visit or in person?” They’re like, “Well, it worked this time, but I felt like, I didn’t have…I really didn’t have a choice. I definitely didn’t feel like I had a choice. And if I had the choice to go back to my doctor next time, yeah, probably will.” You know, there wasn’t anything, too crazy bad, but definitely not anything good enough for them to say, “Oh yeah, I’m gonna do virtual visits from now on.”

So I think there’s some opportunities there even just based on that research. It makes sense when we think about it, I just don’t want us to miss the thought of…I don’t want the headline to only be, “Yeah, telehealth has had its moment.” I want us to recognize the opportunity to improve the experience or add that as an option to your existing patient experience. There’s a lot of opportunities there. And that’s really where the hard work is gonna come. It’s hard to say that but I feel like that’s true. The real work is gonna come from this point on now that you have to realize, okay, virtual visits have to be part of this experience, they have to be an option. Now, we really have to create an experience that makes it a little easier and reduce some friction in there. That’s gonna take some work. 

Scott: Yeah, really well, it goes back to that habit conversation, right. So you’re used to seeing your doctor, you’re used to walking in, you’re used to having a conversation in person. This is just like, you know, as we as a web and application development company, an online marketing company, we’re very used to having remote conversations, you know, where we’re not in the same room and talking amongst ourselves, you know, at P3. 

So it wasn’t that major of a transition, really. I felt a little lonely that I couldn’t have lunch with other people. But honestly, we’re getting our work done fairly well. But it’s a big change for a lot of other people. Forget about the telehealth part, like they just wanna go in and it takes more work to have to interact when you’re not in the same room, right. And so now you’re talking about something very serious where it’s about healthcare. And that’s why I said, you know, a lot of it is gonna be on the edges where there were a lot of visits that had to take place to make sure that everybody’s okay. But really, it was more about a couple of quick questions that could have been asked. And I do think that’s where telehealth can easily step in. 

And then as you were saying, Jared, there’s a lot of places where, hey, we can do better than that. Here’s where telehealth can really help out a lot, you know, that kind of, thing. I still think you’re going to have to take your infant in to take a look at that eardrum when they’re crying and crying and crying. Like, that’s not gonna be solved with telehealth. There’s a lot of other things, you know, that could be handled, the telehealth conversation, so we’ll just have to figure that out.

Jared: Yeah, you know, like, a quick story to kind of dovetail on that and then kind of wrap us up here. So my daughter has a chronic condition, has Crohn’s, and we’re constantly dealing with hospital visits and all that sort of stuff. I mean, in the past couple of months, I’ve been in the hospital with her at some point, you know, two or three times now. 

We had a visit just recently that was through our telehealth system with the hospital. And it was such a positive experience, like, so as we’re kind of, like, you know, saying like, “Hey, it’s not…this one platform isn’t gonna solve everything.” The positive side of that was that we were able to meet with like, a team of doctors and we had a child psychologist on there, and we had a nutritionist on the on the line with us. And my wife and my daughter were able to go through sort of their entire case history. And everybody was very, very well prepared. I think the medical team that day was sort of going through like, a list of patients where it’s like, hey, let’s do a check-in and really kind of, reset some expectations, reset some treatment ideas. 

And it was such a useful way to go through that appointment. And I can’t imagine getting that group of people all in the same room with my daughter and my wife at the same time. That’s so rare for us to be able to have that kind of, experience in the hospital. So I think there are some very, very positive things that can go beyond just the, “Hey, I’m just gonna call you. Can you just help me answer this one question?” But it does, to everybody’s point here, take a different way of interacting. It takes a different way of thinking on that. 

That’s really where we’re going with this. Patients are wanting to engage. They’re using different channels maybe, but they are showing intent. Again, they are starting to get back engaged. But they’re gonna need that level of reassurance through all the different channels that you can offer it. So please take that level of hope away from this conversation, but also that level of advisement of, you’re gonna have to think differently, you’re gonna have to bring some strategy to this, and we wish you all the best with that.

Guys, thanks so much for our call today. It was good to get everybody back together again. And thank you for listening.

Announcer: Thanks again for tuning in to “The Paradigm Shift of Healthcare.” This program is brought to you by P3 Inbound, marketing for ortho, spine, and neuro practices. Subscribe on iTunes, Google Play, or anywhere you listen to podcasts.