Episode 90: Expanding the Reach of the Practice

For practices to expand outside their local market, they must start with the basics. But while you can update your website content to focus on the fact that you treat out-of-town patients, you often can’t rely on organic search alone to reach out of town patients searching for a specialist. Join Michael and Scott as they discuss how to expand your geographic reach through Facebook and Google ad campaigns, location targeting, and  proper evaluation of results.

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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 here today with my co-host Scott Zeitzer. This show is focused on the many ways that healthcare is changing and how the consumerization of healthcare is affecting practices. We talk about this topic on a regular basis over at p3practicemarketing.com, and we’d invite you to be a part of that conversation. Today, let’s talk about expanding the reach of the practice.

Scott: Yeah. That’s something that is… I don’t know. It’s something I talk about every day, all day long to practices. You know, how practices get the majority of their patients is via word of mouth. I mean, if you ask a practice, “Hey, how do they find you?” It’s like, “Well, we try to do good work, and we get lots of friends and family, and there’s a lot of doctors who know that Dr. X is the best.” And that makes a lot of sense, but now the paradigm shift, right? So, that first bucket, shall we say, of friends and family, Michael, I’m thinking there’s very low leakage in that particular bucket, a funnel bucket, whatever marketing folks wanna call it. The second funnel is interesting, right? The second funnel where it’s a primary care provider says, “You should go see Dr. X.” Now, Michael, you and I have talked to a lot of primary care providers. Sometimes they’re not allowed to say just see one doctor. Correct?

Michael: Right. Right. It’s funny because I’m even thinking about, like, the friends and family recommendation.

Scott: Yeah.

Michael: I get recommendations and I go, “Okay. You know, sometimes like maybe I’m gonna see that person, maybe not.” It’s definitely a point in their favor, but…

Scott: Without a doubt.

Michael: …it’s not a decision in a vacuum for sure.

Scott: And I want everyone to listen in on this and lean in. It’s like, you don’t know when they don’t call you. There’s no magic measuring like, “Did you know 45 people didn’t call us?” No, you just didn’t get a call.

Michael: Right.

Scott: And so, just focusing on those first two things where you think you’re getting everybody, you’re not, and that’s okay. You know, you could still be very busy. Don’t get me wrong. Again, there’s busy, and there’s how busy you wanna be, and then there’s what, kinda, patients, so that you’re finding value, but last but not least, it’s what about if they don’t know you or hardly know you, or the primary care doctor says, “Here are the three people that I have to tell you to go see because I’m not allowed to tell you one anymore because I worked for the blah, blah, blah system.” Okay.

Michael: Yeah.

Scott: So, if you want to get control of your own destiny, this word of mouth, how you get the word out about you, you really got to, kinda, open up a little bit and come up with different ways to get the word out about you.

Michael: Yeah, for sure. Let’s say that you’ve got whatever level of the word being out there already. You know, people are gonna look to those online channels and we have talked about this quite a bit so we’ll, kinda, just hit them, kinda, quickly, but, you know, do you have a website that’s in place that does all the things? Does it check all the boxes, easy to navigate, it loads quickly, it’s mobile-friendly, has the content on there that helps you differentiate, again, this is stuff we’ve talked about, like, just on our last show, even, we already talked about reputation marketing and how tightly integrated that is with local SEO. So, all of those map listings that you have, are they up to date? Do they have the right information? Do they have positive reviews? They have the right views, kind of, thing, you know, like…

Because negative reviews aren’t necessarily a bad thing if you show that you’re responding to people and you’re actually giving them a fair chance to resolve issues online, that sort of thing. So, in a lot of ways, that’s table stakes. That’s what you have to do to get started if you really wanna hold your own is you’re gonna have these word of mouth channels, but then are you providing, like, a good spot for them to be able to come online and verify what they’ve heard or to give some, kind of, easy compare and contrast because, you know, the friends and family may not have only gotten one recommendation.

You know, Aunt Mildred might have recommended this doctor and somebody else recommends this doctor. Then you have a choice to make and it’s not just about whether you like Mildred or the other person better. You have to actually, kinda, take a look at these doctors and figure out who’s right. So, let’s say you’ve done that. You’ve covered the basics, you have good word of mouth, you have somewhere for your patients to go, and in your market, whatever you’re defining as your market, you’re doing okay, right? Like, you’ve got a decent presence there. So, now we start to, kind of, like, broaden that net. What does it look like to try and expand your reach? Are we talking about out-of-town patients? Are we talking about, depending on your metro area, just people that are on the other side of town, you know, like…

Scott: Of said river, bridge, etc. Yes, yes.

Michael: Exactly like, “Oh.” Like, “Do I…” It’s so funny because we’re in the New Orleans area and you’re on the West Bank, Scott and I’m out here in Metairie near Lake Kenner, according to whomever you talk to. And when I talk to my wife about going to the West Bank, it’s like, oh my gosh.

Scott: It’s like a safari, right?

Michael: It’s like, “Oh,” well, I mean, if you wanna be in the car all day and if that’s the way that you wanna handle it is you and get all the way over there… And the New Orleans metropolitan area isn’t that large. I mean, it’s like…

Scott: Yeah, it’s 20 minutes.

Michael: …in rush hour, it’s an hour to get to the West Bank at the most.

Scott: I grew up in New York City and it’s the same conversation about going borough to borough, you know, like, “Whoa, you wanna go over there.”

Michael: Whoa. No way. No way.

Scott: But, you know, it’s a critical point though because no matter what you have to overcome from a geographic perspective, whether it’s a localized area of going over a bridge or whether it’s really just hours of driving, you know, there are areas of our country where it’s quite rural, you better have a good reason to go. And you know, we talked about this in the past about if you do wanna expand your reach and you do want people to come and visit you, whether it’s a local visit or far away visit, put some information on your website about how to make that easier, right, in a medical tourism page, but what I’m always fascinated by is, like, somebody will take the time to build whatever that page is, but they really won’t put any information about how expert they really are. Like, I get it, man. I know where to stay at the hotel, but why am I coming?

Michael: Let’s definitely dig into that in a little…a little bit later on because I wanna, kinda, like, walk through this process a little bit, you know. So, like…

Scott: Right. Makes sense, makes sense.

Michael: Let’s say that you are expert at whatever procedure or whatever thing that you feel like patients should come across the city or even into another state or whatever it may be. The tactic that you use to get in front of that patient, the patient that’s not geographically tied to your area is gonna change. The things that we just talked about aren’t enough at this point because now we’re having to say, like, the way that Google is going to provide answers to people, you know, is gonna have a lot to do with proximity. So, this is actually a big thing that I used to deal with in another field entirely. We were dealing with, like, tourism kinds of things.

And so, people that were in a town maybe half an hour from here would say like, “I wanna rank for New Orleans.” I’m gonna go, “Yeah, cool, but you’re not in New Orleans.” Good for you that you’re trying to rank that and you’re trying to get that spot because yeah, that would be free traffic to your site and all that, but it’s just not the way that Google is gonna reward you unless some, sort of, extreme circumstance changes that. This is also something we run into with practices. I’m in the suburbs, but I wanna rank for Boston. I wanna rank for whatever and it’s like, “That’s cool.”

Scott: You got some work to do. Let me kinda step in for everybody. So, this happens a lot where somebody wants to rank for another place, so to speak, and Google thinks they’re helping you. You know, it’s like, “Yeah, but you’re in Portland, man.” So, Portland, Maine, there’s no reason why you would look for an orthopedic surgeon outside of Portland, Maine, or Portland, Oregon for those people I just irritated. And so, excuse the rankings for that. And I think that’s critical for everybody to know.

Michael: And it’s my definition of what’s skewed, what’s skewed, and what’s not, right?

Scott: Yeah, go ahead.

Michael: Like I said, Portland. I didn’t say the greater Portland area. I didn’t say the greater, you know, like the greater…or the tri-state area.

Scott: And nobody looks up stuff like that, I’m gonna have to find somewhere in the greater Portland area. That’s not how people do it.

Michael: Right. So, yeah. So, like, let’s talk about just search behavior just for a second. You know, we as people, as patients, as consumers, our behaviors have changed because of the tools that we use.

Scott: That’s right.

Michael: We go to Google and we type in things like “best surgeon near me.” And that’s never a question that you’re gonna just ask somebody, best surgeon near me? You know, like, but we adapt to the tools all the time. So, Google is using your geographic location specifically. But think about the difference in ranking and what search results you’re gonna get for “best surgeon near me.” I’m in Kenner, practically. I’m on the Metairie-Kenner line, but I’m in the suburbs of New Orleans and if I say “best surgeon near me,” as opposed to being downtown in New Orleans and saying “best surgeon near me,” obviously, you’re gonna have very different results. So, the types of experiences that people are getting, all that to say, Google is personalizing depending on exactly where you’re at and exactly what you’re searching.

So, if you’re gonna overcome this dynamic, all of this to say, if you’re gonna overcome all this, you’re gonna have to start running some advertisement, and you’re gonna have to start very deliberately targeting who you’re trying to get. If you’re trying to get somebody in the suburbs to come in to see you, or to go to whatever city, like let’s say our best surgeon is in Baton Rouge, well, that’s never gonna show up in my organic results, right, like, because I’m so close to New Orleans. It’s gonna try to put me towards the surgeon that’s in this area. So, what are the things that people can do to overcome? Running different kinds of ad campaigns. There’s lots of other methods that you can use, you know, offline as well, but, like, if we’re just looking at, like, an easy-to-approach digital tactic, this is a good one that can really target and really get the right kinda patient for you.

Scott: Let me, kinda, jump in for a second. So, if you’re a surgeon, there are a couple of different reasons you may wanna extend word of mouth practice reach. So, one could be like, “Hey, I think I’m the only guy doing a particular procedure.” We talked to a lot of people who specialize in a specific surgery, treatment, etc., and, you know, we often hear like, “I think I’m the only one trained to do X, whatever X happens to be.” And they know they’re not gonna pull enough patients into their area for this particular procedure or surgery just because there’s just not enough people. Not everybody lives in Manhattan where you do have millions of people, right? So, that could be one reason that you may wanna “expand” your geographic reach.

The other one could just be like, “Man, there’s just a lot of competition in this area and I just need to pull for more…I need more geographic area to hit, you know, for my overall, about what I’m trying to do,” and all these are good reasons for that. And please listen to the other shows about what the table stakes are, right, that Michael, kinda, went through very quickly, which I’m not gonna bore you with. Everybody’s heard it and if you haven’t, hey, man. Podcasts, we’ve got from this radio show and previous podcasts, more than enough information. Look it up, you’ll see it. But now we go into this whole thing, and Michael, this is one of those things that I’d love for you to walk me through. If I’m a surgeon, I go, “Okay. I think I’m the only one doing this procedure,” and we come back to you with like, “Well, ads would probably be your next best, right, your next best bet.” You got a good site and you get good content on the site, that’s great. Walk me through that. What’s the minimum spend? Do I go Facebook? Do I do Google? Both? How do you, kinda, walk through that?

Michael: Absolutely. Yeah.

Michael: Quick break here. If you’re just joining us, this is the “Paradigm Shift of Healthcare.” I’m Michael Roberts here with Scott Zeitzer. Today, we’re talking about expanding the reach of the practice and some of the natural barriers that you’re gonna hit just because of what Google will allow people to see because of what the algorithm says, the almighty algorithm says that people will want to see, also because of consumer behavior, what they are looking for. So, there is a limit. You do have to make sure that you’ve got your standards, you know, your basics of a good website, good content, good information online. So, that’s, kind of, the table stakes to get going. And then, hey, we’re talking about, like, Google is gonna limit it at a certain point. So, advertising is a great next step. It’s really interesting to see how advertising shifted during the height of the pandemic was what I’ll call it versus what, you know, not the height of the pandemic as people are, kinda, starting to get back out.

You know, during the height of the pandemic, Facebook ads I feel like really became a major, major way of reaching people, and one of the more effective ways of reaching people at the time because people didn’t necessarily know what to search for at the time. Like, we were all, kind of, in this new space, we didn’t know like what was happening with health and what was safe and what wasn’t, right? So, we’d used Facebook a lot because of its ability to gain exposure. It’s not necessarily a behavior-based thing as much as it is, like, a demographic-based thing, an interest. So, if I know that I need to reach patients that are between the ages of 55 and 65, and, you know, maybe our weekend warriors are there, whatever, like, I can start getting into targeting the demographics, I can start targeting some behaviors that people talk about on their profiles, you know, all those different things that you do in your Facebook profile, where you say, “I’m interested in movies,” or, “I’m interested in sports.”

Scott: That’s right.

Michael: Facebook uses that as fodder for its advertising system. And as a medical practice, like, you can use some of that information to help you find the right patients. So, in terms of being able to find the right fit from just, “I’m trying to find this type of person for my practice,” Facebook’s a great platform for that. I mean, we usually will try and do some sort of combination of Google and Facebook to help provide both of these things that we’ll be talking about in just a second, but, you know, I’ve seen some really strong results from a Facebook advertising budget of like $500, you know, as, like, a part of your advertising spend that you’re doing per month. But I would partner that with at least an equal spend in Google because you do start to get behavioral targeting and that behavioral and, like, intention kind of target.

Scott: Let’s talk about that for a second. So, in general, for us, if you came to us and you wanna do advertising, we basically say, “Look, your minimum budget’s about $1,000 and we can spread it out between Facebook and Google, then there’s a management fee.” These are not crazy things. Every agency out there does it the same way. What their minimums are, etc., that’s all dependent upon the agency. For us, it’s an experiential one where, you know, we tried to get away with lower numbers and we just weren’t seeing the volume we needed and we felt strongly after doing it for quite some time that, hey, that $1000 minimum total, like you were mentioning, Michael, yeah, spend $500 here, spend $500 there, do more if you wanna be more aggressive, but the thing I love, love about online ads is that, man, you can really get a good idea from a return on investment perspective.

Both Google and Facebook give you lots of tools to take a look at who’s looking at the ads and what they’re doing after they’ve looked at the ad. And it really does empower an agency to make some good decisions about how to tweak that, you know. And I wanted before we, like, “Okay, so, now I got about $1,000, you know, maybe more depending on how aggressive I am.”

The other thing that I tell a lot of people, Michael, is that, “Hey, it takes a little while to get it right.” It’s not like there’s a magical formula, right, like, “Oh, you just do this and then, you know, you’re automatically gonna get a high conversion rate.” It’s like, “No.” Every practice is a little bit different. So, how does that work at most practices? You know, in that first month or two, there’s a lot of fine-tuning happening, correct?

Michael: Yeah, for sure. I mean, those are, like, way simplified things for a second and just say like, there’s two components, right?

Scott: Let’s do that. We’ve only got so much time on this particular one.

Michael: There’s two big components that you’re looking at here. How many times did somebody click on my ad and then what did they do when I got to my site because Google, Facebook, any advertising platform you wanna use, they’ll happily accept your money, right? Like, they will… You know, every click that you do, or whether you’re doing impressions by, or whatever you’re doing for how you’re setting up your spend, they’re gonna get theirs. And when used correctly, these tools are dramatically helpful, so I’m not trying to disparage the platforms too much, a little bit, but not too much, not too much.

Scott: A little bit.

Michael: But so, you get that initial click and then they get to your site, they get to your experience, is that patient, is that consumer the right fit for the ad that they just clicked on?

Scott: That’s right.

Michael: So, I’m interested in getting this procedure done, I get to your site, and I go, “Whoa, nope, not here, right?” Like, we’ve all been to that website where we land and we go, “Oh, no.”

Scott: No.

Michael: I’m backing up as quickly as I can and I’m going back to look at the competitors at that point. So, let’s speak specifically about you expanding your reach target, right, like, that idea. You know, we, kinda, mentioned this idea very quickly about medical tourism and making sure that we’re providing enough expertise as to how and why you would travel that far, right? So, like, if I’m targeting somebody that’s two or three hours away to come to my practice, I better have a darn good reason why they’re going to make that drive.

Scott: Right. There’s gotta be some good content on that site. You know, I always go back to people because we get this a lot, Michael. I’ll get a phone call from a practice, I’ll be looking at their website, we’ll both agree that the website is very thin on content, maybe a little bit old in the tooth, but they wanna start their advertising campaign immediately. And I can’t tell you how much business I’ve, you know, honestly just walked away from saying, “I’m not gonna help you, like, because you’re gonna pay Google and/or Facebook a lot of money to come to a site where there’s no explanation as to why they should pick up the phone.”

Michael: Right.

Scott: You know, so, I do wanna reiterate, like, if you’re spending money with Google and/or Facebook, Michael is correct. Google and Facebook will take your money with ease, but give the potential customer, in this case, a patient, a reason. Like, they clicked on you for a particular reason like, “Hey, I’m interested.” Now, you’ve got to actually close the deal, right? There has to be information on there to make them want to, and this is a big part too, fill out a form, pick up the phone. If you don’t have an appointment request form, or a contact us form, or some way to interact with the patient online, and I don’t mean just a phone call, that’s a problem. Not everybody wants to pick up the phone yet. It’s 2:00 in the morning and my shoulder hurts. [crosstalk 00:20:48]

Michael: Right. And again, these are table stakes. Like, this is the minimum. You have to have this as a minimum.

Scott: Yeah. But I like bringing that up, right, because…

Michael: Totally. Not everybody is ready for the table stakes. We have to bring that back up.

Scott: You know, so, you got to get that foundation right, and now we’ve got, like, the spend of about $1,000 a month or more depending on what city, you know, the competition…

Michael: Lots of [inaudible 00:21:07]

Scott: …what your geography is like, like, there’s a big difference in what you’re gonna spend in terms of attracting potential patients between say Midtown Manhattan and Montana, just to stick with lots of M’s. From that perspective, that’s part of that fine-tuning in the first month. Are we doing the ads right? Are we writing them correctly? Are we getting enough people to click on it and then do what we want them to do? That doesn’t happen in a week or two. It happens in a month or two. That’s part one, right, but once we get it well oiled, you’re able to go take a look at what’s going on? There’s HIPAA-compliant ways to handle this, everybody. So, if you’re a patient listening, don’t worry.

Michael: For sure.

Scott: The only people seeing this are the people who are managing the practice or have signed what’s called a BAA, a business associate agreement, so that all that information is protected, but that’s one of the things I love about ads, when it works well, you could really have some great conversations about I spent X and I’m making 2X, 3X, whatever the number is. But, you know, I, kinda, wanted to talk to you, Michael, and we’re gonna have to talk more about ads, we’ve got a limited time, but what’s an ad like on Facebook and how is that worded differently than an ad on Google, if you can, kind of, walk people through that?

Michael: Yeah. So, you know, think about like when you’re scrolling through Facebook, like, what are the kinds of things that are gonna stop you and actually get you to pay attention?

Scott: How does Paul Rudd stay this young?

Michael: That is a fascinating question.

Scott: It is a fascinating question. I don’t know but keep going.

Michael: But, you know, what are the things that are gonna work? So, we’ve run and tested a lot of different options on this kind of stuff. One of the things that, you know, I was certain would work, which automatically means it’s not gonna work, but one of the things I was certain was gonna work was, you know, “Hey, let’s run some fun stock photos, you know, the patient that’s doing well, right?” Like, that’s, kind of, like a traditional mindset of like, “Show me the stock photo of the person that’s already supposedly recovered from the procedure and is back to their active lifestyle.” And this is a lot of what you see in pharmaceutical advertising, that kind of stuff.

Scott: Absolutely.

Michael: The ad for that particular campaign that did really well, and this was this particular campaign and this particular market at this particular time, and that’s the great thing about advertising, it really does differ depending on where you’re at, but the pictures of the doctors did the best. That caused people to stop, and slow down, and see what we were talking about. And in this particular case, you know, you could do something as high level as, “This particular orthopedic practice offers great service. Here are all the different things that we provide. This particular practice does great hip replacements.” That could be the kind of subject line, but all of this you’re gonna be seeing as almost like an interruption, right? Like, it’s gonna be judged as an interruption if it’s irrelevant. How can I, kind of, like, insert this into a conversation and give something that’s helpful, that’s not too pushy, that’s useful, as opposed to a Google search where it says, “I’m looking for a hip replacement now.” This surgeon can help you.

Scott: It’s a much more direct kind of conversation on Google whereas in Facebook, it is really like a lifestyle [inaudible 00:24:10]… And you’re right about that. You know, there was a particular surgeon we worked with where the medical device company really wanted the robot, but thankfully, they were very, very open to, you know, measuring, etc., and they’re like, “Yeah, robot is not doing well, but the doctor’s doing very well. Can we combine the two?” And it’s like, “We can.” And that was the win.

Michael: That word there, just the measuring of it.

Scott: Yes.

Michael: Advertising is experimentation and that is, like, the mindset that has to be there if you’re gonna run a successful campaign.

Scott: No doubt.

Michael: You’re talking about, like, I talked about, like, I was certain that blah would happen and it definitely didn’t, but understanding that there will be trial and error, especially in those first couple of months. After the first couple of months, then you’re looking for, how do I keep improving upon my results? How do I keep beating out what came before? So, I can’t emphasize enough.

Scott: You know, for setting an expectation thing. When I talk to surgeons, I’m always like, “Look, man. Hey, bro. If somebody breaks their arm or has a total knee replacement, you know, you set expectations about when they’re gonna feel better.” And the same thing goes with ads. It’s like, if you’re working with an agency, I always try to tell them like, “Look guys, it’s gonna be a month or two before we get this right.” We’re gonna get some wins. In a particular case, you’re talking about where it wasn’t working that well, we immediately fixed it and tweaked it, and we were able to see measurable increases and everybody was happy. And I think it’s important that if you’re listening in and you are a practice, it’s like, you know, plan for that month or two. Be open about it. Work with your agency. See what’s working and what’s not working. Know how you’re doing pre-work and post-work because, you know, this is something Michael and I talk about all the time, like, “How do we specifically define that we got the win here?”

And it’s like, “You never got the win alone.” You know, all we did was like do a good ad and pointed to the practice where there was good information, but ultimately, when the doctor walks in the room and says, “Tell me a little bit about what your problem is,” you know, everybody’s involved, everybody.

The scheduler, the PA, the surgeon, it’s a team effort. But, you know, if you’re a practice and you’re going like, “Hey, man. I’m only doing like,” I’m just making something up, “two or three jumping jacks a month,” I always use jumping jacks, “and now that I’m working with this agency and we got this ad campaign working, I don’t know. On average, I’m seeing four or five. Is it the agency? Is it the practice?” Well, it’s both. It’s great. Everybody’s working with each other, but you increased. And so, when you look at like, “Wow, I’m spending,” just to make it up, “$1,000, $1,500,” whatever it is, “but I picked up this much money in net revenue,” well, everybody’s good, right? I think that’s critical.

Michael: Yeah. Just to be clear for everybody, like, the budgets that were throwing around here, we’re talking about smaller practices running these ad campaigns, so.

Scott: Absolutely. It could be larger practices where those numbers are much higher. Absolutely. Yeah.

Michael: For sure. For sure. Everybody, there’s so much more we can get into. If you have questions, feel free to send them our way. We’re at p3practicemarketing.com. I’d love to have a conversation about this if you just wanted to even throw out just a question around how your campaign is set up and if you wanted a second opinion on something, but we also set up a short quiz to help practices think through their approach to word of mouth because today it looks different than it used to. So, this is another tool that you can use to, kinda, help evaluate how your practice is doing. You can find that quiz on our homepage. Until next time, thank you so much for joining us. Have a great week.

Announcer: Thanks again for tuning in to the “Paradigm Shift of Healthcare.” This program is brought to you by Health Connective, custom marketing solutions for med tech and pharma. Subscribe on Apple Podcasts, Google Play, or anywhere you listen to podcasts.