The Relationship Business

By Denise Napoli

Don Dixon, CPO, president of the Center for Orthotic and Prosthetic Care (COPC), knows that, for better or worse, a profitable O&P practice relies on more than the skill of its practitioners. "It’s a relationship business," he says. And the very first relationship a successful practice can hope to cultivate is with a referral source.

COPC is a thriving practice by anyone’s standards: Dixon and his partners run the O&P patient care and management services for Duke University Medical Center, Norton Healthcare and Shriners Children’s Hospital of Lexington, Ky.

Dixon says that four or five years ago, in order to support his philosophy about the importance of good relationships both to referral sources and the patients themselves, he instituted a patient care coordinator program. The company has since experienced rapid growth. Could your practice be the next to benefit from such a program?
   
The investment
The program is this: Dixon employs three coordinators—two nurses and one person with a medical background in diabetic programs and geriatrics. The coordinators work to improve relationships with everyone involved with an amputation, including the doctors performing the surgery, the patients’ physical therapists and the patients themselves. The hope is that the strength of these relationships will result in positive feelings from both physicians and patients, which will in turn generate referrals and repeat business, respectively.

To that end, the coordinators do things like sponsor physician lunches, respond to patient satisfaction surveys and offer their ear for even the smallest complaint from a doctor, therapist or patient about the quality of COPC’s service.

"For example, maybe a doctor or a physical therapist isn’t happy with the way the receptionist answers the phone or the response time. All kinds of little details affect your relationship. Whatever affects our relationship to the referring source, we need to address that," says Dixon. "Even if it’s something as minor as the receptionist’s tone of voice… [doctors] don’t bother to say all these little things to clinicians but they will say them to a patient care coordinator." The coordinators relay this information to COPC, which then takes steps to remedy the complaint and improve relations.

When it comes to initiating relationships with patients, the coordinators often meet with patients pre-amputation. "They make sure no one drops the ball in taking care of patients’ needs," says Dixon. For instance, patient coordinators will put the patient in touch with support groups like the Amputee Coalition of America (ACA). The coordinators will also conduct follow-up conferences to determine patient satisfaction with COPC’s service and care. Coordinators’ ears are open to patient complaints and concerns, too, especially when the patient is shy around a doctor or other clinician.

"This is to ensure the service we’re providing our patients is of the best quality," says Dixon. "[The coordinators] are going to challenge a clinician if they think the clinician isn’t doing something quite as good as they could be." Dixon hopes that if the patients are happy, they’ll keep coming back, and tell their friends.

The naysayers
The program isn’t immune to criticism. One reason is that Dixon freely admits he has no way to measure whether what he pays the coordinators is offset by the referrals and customer satisfaction that the coordinators generate.

"We're not absolutely positive this results in more referrals, but we are positive it results in better communication with our referring sources, which has to result in keeping referrals, if nothing else," says Dixon. "This is a very positive program and it’s worth the money. We've grown tremendously and that speaks for itself."

Another downside to the program is that a facility has got to be financially sound in order to institute the program at all.

"You have to have enough presence in a market to make it worth doing," agrees Dixon.

Aside from the profitability concerns of such a program, some groups, like the ACA and the Michigan Society to Advance Rehabilitation (MSTAR), worry that hospital patients counseled in facility-sponsored programs like Dixon's will receive biased information about the best treatment that is available to them. The ACA and MSTAR both maintain peer support programs for amputees. Those programs seek to provide unbiased support, emotional or otherwise, to amputees or patients awaiting amputation surgery.

Dixon counters that any pre- or post-surgery consultation with a prospective patient doesn't purport to be peer counseling. "We connect patients with a peer support person whenever possible but that's not what our guys do, they're not peer support," he says. Rather, his coordinators are working with a different goal in mind: "They're there to start the rehabilitation process. We are only visiting patients that are referred to us or we are asked to visit," says Dixon.

The payoff
Bill Gombeski, director of strategic marketing for UK HealthCare and editor of the magazine Marketing Health Services, agrees that a program like Dixon’s isn’t cheap, but extols its possible benefits for a practice.

"To me it’s a no-brainer—great marketing, good service, better quality," says Gombeski. "Anything that helps the patient by giving them more information, better service, more service, or improving their overall satisfaction with the health care experience is great.

"Is it financially viable? I don’t know. A company may be losing money but feel that the added value is worth it because it supports their care philosophy. Or they may make money because it results in higher quality care, so down the road it may lead to more business," says Gombeski.

The bandwagon
So, could your practice benefit from a similar program? That may be a moot point. Gombeski predicts that if this trend takes hold in more facilities, your practice may be forced to hire coordinators like Dixon’s in order to stay competitive. "It raises the bar and it forces others who aren’t providing this level of service to start doing it," says Gombeski.

"From a marketing perspective, I think it’s brilliant. I suspect that you’ll see more and more of this," he says.

But Dixon is humble.

"We’re growing," he says. "We only have so many resources. We have to figure it out the best we can."

Denise Napoli is a staff writer for the O&P Almanac.