Nancy Nikolovski, administrator of Physicians Endoscopy Center in Houston, offers 10 best practices on how to market colonoscopies at GI/endoscopy centers.
1. Develop a broad marketing strategy. "Marketing has been part of our strategy at Physicians Endoscopy Center for a long time," Ms. Nikolovski says. Colonoscopy is different from most other medical procedures because patients do not have any physical complaint. Rather, they come because they understand and appreciate the importance of early detection. This requires educating them through and their physicians through robust marketing, Ms. Nikolovski says. She tries to spend about one day a week on marketing efforts.
2. Use some traditional advertising. Physicians Endoscopy Center takes out advertisements in weekly newspapers and the Houston Chronicle to attract some self-referring patients and generally stir up interest in colonoscopies.
3. Consider direct mail. Direct mail can be more effective but is more costly than newspaper advertising. In January, when Medicare started waiving the patient payment for screening colonoscopies that result in polyp removal, Physicians Endoscopy Center initiated a direct mail campaign to broadcast the change. The center obtained a mailing list of residents over ages 45-50 and sent out 5,000-10,000 postcards to them. The center has seen a somewhat higher volume of colonoscopy cases this year as a result of the change and perhaps also due to the mailing, but Ms. Nikolovski says colonoscopy volume has not reached the levels of mammographies, which have similar coverage recommendations.
4. Work with insurers. Although private payors are now required to fully cover screening colonoscopies, Physicians Endoscopy Center has been asking them to follow Medicare's example and fully cover polyp removal. "The payors tend to follow Medicare's lead," Ms. Nikolovski says. Some payors, such as a few plans within Blue Cross Blue Shield of Texas, have made the switch. "It has started to get better," she says, "but there is still a way to go."
5. Meet with employers. "Insurance coverage for colonoscopies often depends on what the employer wants," Ms. Nikolovski says. "Therefore, it helps to reach out to employers." She has been asking to talk to human resources officials at local companies to discuss the need for coverage. She presents hard statistics, such as the added medical expenses and the work time lost if an employee gets colon cancer. "We talk to the local HR office where we can, but it's hard to reach the big employers," she says. "Policy is often made at a central office somewhere else in the country." However, even when employers aren't willing to extend coverage, they will often agree to help encourage employees to get colonoscopies.
6. Reach out to employees. With employers' permission, Physicians Endoscopy Center frequently provides "lunch and learn" events for employees, with the food catered by the center. "We always bring one of our doctors," Ms. Nikolovski says. The physician will bring along an endoscope, explain the procedure to them and answers questions. Gaining a familiarity with the procedure makes it more likely that people will agree to a colonoscopy, she says.
7. Visit primary care offices. Ms. Nikolovski understands the importance of close cooperation with primary care physicians' offices. She personally makes the initial visit, meeting with physicians for 5-10 minutes but spending most of her time with staff. Over a catered lunch, paid by the center, she educates the primary care office's staff about the importance of colon cancer screening and gives them literature to distribute to patients, such as postcards, brochures and pamphlets. She even gives them scripts for phone calls to patients. "Reaching out to the staff is important," she says. "Although the physician decides whether a patient should have a colonoscopy, it is often up to the staff to follow up with the patient on the details of the visit." Another member of her staff follows up, visiting the office within 12 months to glean feedback and answer questions.
8. Focus on open-access scheduling. Ms. Nikolovski encourages primary care offices to opt for open-access scheduling, under which the patient goes directly to the endoscopy center rather than visiting the gastroenterologist first. "This is both more convenient and more economical for the patient," she says.
To make this approach as easy as possible for the primary care office, staff are given pre-printed information slips to fill out on the patient and fax to the endoscopy center. The slips require just a few pieces of basic information, including the patient's name and phone number. The center uses it to contact the patient and schedule the colonoscopy. "If the primary care office simply directs the patient to contact us, it might not happen," Ms. Nikolovski says. "For the patient, it can be a matter of 'out of sight, out of mind.'"
9. Track primary care referrals. Even when patients come to the center on their own, they are asked which physician referred them, and this information is used to track each physician's level of referrals. If referrals from a particular physician's office decline, the center contacts the office and asks if there is a problem. "This is a good way to keep on top of issues with the referring physician, before they get out of hand," Ms. Nikolovski says.
10. Urge patients to fight denials. Prior to the colonoscopy, patients are advised that their insurer may not pay the bill if a polyp is found and removed. However, "we urge patients to challenge this decision," Ms. Nikolovski says. "We let them know that payors do have the option of following Medicare's example and covering the polyp removal, as well as the screening."
Center staff members educate patients on how to appeal a denial with the insurer. "Payors are more likely to respond to patient complaints," Ms. Nikolovski says. "When they are unhappy, the complaint gets escalated to a higher level within the company." While only a small minority of cases are overturned, these victories contribute to a wider effort encouraging fuller coverage by payors.
Learn more about Physicians Endoscopy Center.
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