Published in the April 2015 issue of Today’s Hospitalist
AS A HOSPITALIST, chances are you work for a corporately owned hospital or health care organization. If your community is large enough, your hospital is probably competing with one or more others, each with its own hospitalist program. Or you may have competing groups within your hospital.
Each competing facility or program wants to capture the greatest market share, and each marketing effort relies on brand recognition. Often, those brands show up on all forms of advertising including hats, uniforms and jerseys, with employees encouraged to “show the colors.”
I refer to such corporate competition as the “jersey wars.” Since retiring from private practice in 2008, I’ve worked as a locum hospitalist at more than a dozen hospitals around the country. That’s given me ample opportunity to see how hospitals and hospitalist programs duke it out for market share.
Some groups flourish while others wither. Why do groups fail? Because hospitalists rely on physician referrals for most of their business, much like subspecialists, and all referral practices need what I call the “3 As” to be effective: ability, availability and affability. If group members appear to have worse outcomes, do not return phone calls quickly, or act in a curt, surly or condescending manner, they will fail in a competitive environment.
“Carpetbaggers” and the hometown advantage
One large hospital I worked at contracted with a national hospitalist management company to bring in a new group (let’s call it the blue team) to compete with the red team, which was a local independent group of 10 hospitalists. The hospital expected the new group to help drive down length of stay and to better control admissions and referrals. Emergency physicians were encouraged to send admissions to the blue team, while blue-team ads appeared in the local newspaper and on local radio.
At first, that campaign succeeded. But after only a few months, the red team regained the lead. Eventually, the hospital cancelled its contract with the management company.
What happened? For one, the local medical community came to perceive the blue team as inferior. Although both groups had the same length of stay, the blue team had more readmissions. And when primary care doctors tried to reach blue-team members, they were kept on hold or informed that the hospitalist was busy and would call back. When callbacks came, conversations were hurried and less informative “a problem that never cropped up with red-team doctors.
Given how poorly the blue team was performing, it was no wonder that they began to be perceived as “carpetbaggers,” and the loyalty of the local physicians swung back to the competition. Outpatient physicians told the ED to admit their private patients only to the red team, leaving the blue team dealing with the majority of uninsured patients.
The hospital’s slick advertising campaign could not beat word of mouth. But here’s another example. A hospital with its own in-house group (let’s call it David General Hospital, or DGH) chose a large national organization to run its program.
In this case, the hospital didn’t have another hospitalist program. But a much larger, competing hospital (Megoliath Regional Medical Center, or MRMC) was several miles away. DGH was new, but MRMC had been around for decades. Community physicians and patients were familiar with MRMC and its hospitalist group.
Moreover, DGH was running at only 50% capacity, it had no special niche such as heart surgery or renal transplantation, and it couldn’t begin to copy MRMC’s entire service line. Instead, DGH needed an effective way to attract patients.
Knowing that most admissions come in through the ED, DGH first erected a large electronic sign beside the interstate that ran close by the hospital. The sign, which was constantly updated, indicated the ED wait time, which was usually less than 15 minutes.
DGH’s new hospitalist program benefited from this smart advertising. And to counteract the MRMC hospitalists’ hometown advantage, the DGH group carefully vetted candidates and ensured the quality of workups and reports. Group members made sure their lengths of stay and readmission rates were below average, which surgeons and subspecialists at both hospitals soon noticed.
DGH hospitalists were also readily available, responding promptly to physician calls and pages. In fact, the ED contacted the hospitalists through the hospital operator so that response times could be easily tracked.
Plus, DGH physicians always presented a cordial, caring public demeanor. Rudeness is never rewarded but always remembered. We all know that patients, visitors and friends ask nurses who the best physicians are, and, in my experience, nurses tend to name the friendliest doctors. The DGH hospitalists gained a significant market share over MRMC and are now actively recruiting.
What makes a difference
Other suggestions: Take time to communicate with patients after discharge, which I refer to as “service after the sale.” Hospitalist groups should find time to e-mail or, preferably, call the patient or family to be sure all is going well, or in the case of a death, to offer condolences. Such post-discharge contacts may need to be done on a day off. And programs should compensate such contacts for two reasons: Follow-up calls help prevent readmissions by reinforcing treatment compliance, and a caring approach breeds brand loyalty.
Also, reach out to referring physicians. Have a group physician visit community primary care physicians in much the same way as pharmaceutical reps. Such visits sell the program through effective communication and put a face on the team.
At the same time, don’t badmouth the competition. And because hospital walls have ears, do not air internal differences in public.
Finally, avoid the temptation to recruit the opposition. Although it may be OK to hire a hospitalist from a referring team, noncompetes typically discourage doctors who locally switch sides. Just as the physician community frowns on case stealing, taking physicians from the opposing team can escalate collegial competition to all out warfare and unprofessional name-calling “and the entire medical community will suffer.
Stephen L. Green, MD, is a locum hospitalist who maintains a telemedicine infectious disease consulting practice. He previously practiced for more than 30 years as a primary care internist and infectious disease specialist. He can be reached at SGreen5528@aol.com.