Although declining reimbursement led to a fall in sales of 64-slice CT scanners in 2007, practices with sufficient volume can still make their technology investment pay off, thus bringing marketing to the fore in the battle to maintain or increase market share. Despite the decline in sales, 64-slice scanners are still selling, and with recent innovations in the field — such as Toshiba’s Aquilion ONE, a dynamic volume CT with 320 detector rows with 0.5mm elements — the challenge for both new and established practices is keeping the cardiac CT scanner busy enough to at least break even.

Early adopters had the advantage of touting a new technology. Now that the bloom is off the rose and more practices and hospitals have the technology, you’ve got to find another way to differentiate yourself from the competition.

Marketing is the key—but how, when and who to market to are questions you’ve got to answer before you can get started. This isn’t a problem you can just throw money at and expect to succeed. In fact, some approaches don’t require much money at all, just some creativity on the part of the physicians and marketing staff—if any—in your practice.

State of the Heart Cardiology in State of the Heart, Texas, not only succeeded in getting far out in front of the competition in terms of early adoption of cardiac CT angiography (CTA) technology, but also has focused its marketing efforts to capitalize on cardiac CT’s strength: to noninvasively image the heart like no other technology. “We have spread the word to our referring, primary-care physicians and providers by bringing them in our office and showing them the scans and how the technology works,” says John Osborne, MD, PhD, a solo practitioner. State of the Heart purchased a Philips Brilliance 64-slice CT scanner in December 2005 and does approximately 1,800 CTA scans annually.

Osborne doesn’t just show referring physicians sample high-quality images—rater, he actually invites them in to get a free CTA of their own hearts. The result? “Phenomenal,” says Osborne. “Once they experience the technology themselves and see their own results, they totally get it.” This guerrilla marketing approach is quite effective for Osborne, who estimates that more than 90 percent of all primary-care physicians who get a scan end up referring patients to his practice. Other practices have found success in this and alternative approaches.

Cardiology Associates in Mobile, Ala., also was an early adopter of cardiac CTA, says CEO and Administrator Vance Chunn, installing a GE Healthcare LightSpeed Volume CT scanner in 2005. It succeeded in building momentum by holding educational presentations for primary-care physicians, informing patients about the technology through its in-house newsletter and getting coverage of its physicians and the technology in local media, among other approaches.

Other cardiology practices have succeeded with techniques that include placing physicians on radio talk shows to answer questions about the technology; getting feature stories in local newspapers and TV segments produced; sending staff to visit primary care physicians in their offices; meeting with corporate executives to inform them about the technology; featuring staff versedin the technology at community events, including service club meetings and health fairs; and offering seminars with continuing education credit and the opportunity for question and answer sessions for primary-care physicians and other primary-care providers.


The options

When marketing your practice, you can try a number of approaches, including marketing to patients, the general public, private-practice leaders and/or primary-care physicians; a public relations campaign to get attention in your local newspapers, magazines, radio and television outlets; and so-called “guerilla” marketing tactics. Guerilla marketing involves unconventional and low-cost marketing tactics and strategies (see Guerilla Marketing).

While public relations and guerilla marketing tactics don’t require the publication and advertising budgets that a more traditional marketing campaign entails, they aren’t without cost. You either need a non-physician staff member to coordinate marketing and public relations activities or you need to devote physician time in concert with administrative staff efforts, or both.

Regardless of which approach you take, a number of successful cardiac CT practices have found that focusing on the following basics before implementing a particular approach will.

• Defining your market: Will you market to referring physicians, private-practice or specialist leaders, patients, civic organizations or the community as a whole? Or all of the above?
• Focusing on internal or external communications: Will you market to your existing patient base or to new patients? How about to your existing network of primary-care physicians or to all of the primary-care providers in your area?
• Choosing your medium: Will you advertise in radio, print and TV (the expense of which increases in this order), send educational materials such as newsletters or letters to referring physicians, sponsor dinners or work on public relations placements in local media? Or some combination of these methods?
• Persuading your audience: How will you persuade your target audience that your practice is the place to go for cardiac CTA? Publicize your unique strengths in terms of physicians and staff, geographic advantages, easy scheduling and quick access to convenient appointment times.
• Refining your message: What do you want to communicate about your cardiac CTA program—the technology you’re utilizing, the expertise of your physicians, your history with the technology or the specific uses you’re making of the technology?

Traditional marketing

As long as you are focused, a traditional marketing program is as good a method as any to tout your cardiac CTA program. Many larger practices have hired a marketing director to take charge of these efforts full-time, such as New Mexico Heart Institute in Albuquerque, N.M., which has a Toshiba America Medical Systems Aquilion 64-slice scanner and 38 cardiologists in the practice. The practice currently does approximately eight to 10 cardiac CT scans per day.
 

Practices can advertise CTA’s ability to image any part of the vasculature. Occluded superior mesenteric artery just beyond the stent and stented renal artery with restored blood flow. (Provided by Cardiology Associates)

A marketing director can assume a number of tasks, including coordinating all marketing and public relations, overseeing the production of newsletters, letters, brochures and other printed and web-based educational materials as well as setting up events and seeking out publicity opportunities in the local media. An internal marketing director or coordinator can work with outside advertising agencies to handle the design of any ads or marketing materials you want to place—or perhaps the person brings skills to create materials. Cardiology Associates in Mobile has a full-time marketing director on staff and a part-time employee and also uses an outside agency. In general, hiring an outside agency involves hourly costs for various creative services—such as writing and designing brochures and ad campaigns—plus a percentage of commissions on printing, media, photography and other services you purchase through the agency. Hourly rates vary and range from $150 to $225 an hour for a contractor or small to mid-size agency to produce an integrated marketing and public relations. Cardiology Associates spends approximately $20,000 a year marketing their cardiac CT practice.

There are four potential audiences to focus on when designing a marketing program, but unless you have a large budget, you probably can’t successfully market to them all. Here are some techniques that various cardiac CTA practices have used to raise awareness and gain market share:

Newsletters. If the target market is your current patient base, an existing newsletter can continually reinforce your message about the diagnostic utility of cardiac CTA as well as the professional expertise of your staff. While rising postage and printing costs can mean a substantial outlay of costs in publishing a newsletter, especially on an ongoing basis, gathering patients’ email information and getting permission to send a newsletter electronically can cut these costs substantially. Cardiology Associates also publishes its newsletter online on its website and keeps past issues in the archives as a reference for patients, Chunn says.

Letters. An announcement on letterhead from physicians in your practice or medical director sent to local primary-care physicians is another tried-and-true method that can be quite successful, especially if you follow-up on the letter with phone calls, personal visits and/or invitations to seminars or to make an appointment to have a CTA. In lieu of a more expensive newsletter, you also can send letters to patients as well as corporate and community leaders, who are interested in innovative healthcare technology that can ultimately save them money down the road.

Advertising. Mass advertising to the general public is one way to raise awareness of the benefits of cardiac CTA technology and your facility, but it is a potentially expensive and difficult to measure endeavor. “We’ve done some advertising to raise general public awareness,” says Chunn of Cardiac Associates. “But it’s very difficult to measure the results. However, marketing efforts with physicians are usually very effective, because once a primary-care group attaches itself to us, we continue to get referrals.” New Mexico Heart Institute decided not to advertise on TV due to the expense involved in contrast to the benefits of marketing directly to primary-care physicians, where you get more bang for your buck, says Brendan Cavanaugh, MD.

Events. Holding seminars, lunches and dinners for local primary-care physicians is one of the most effective tools for communicating with what is probably your most important market for cardiac CTA. Primary-care physicians and other practitioners, including physician’s assistants and nurses, hold the keys to the referrals you need to keep your cardiac CT procedure volume increasing. William Muhr, MD, a radiologist with South Jersey Radiology Associates in Voorhees, N.J., believes that educational seminars have been an important part of this 41-physician group’s success in promoting its cardiac CT practice.

“We do the educational seminars and also have a marketing person on staff who targets some of the larger primary-care practices in our area to get information and visits,” he says. South Jersey Radiology Associates has a Siemens Medical Solutions Definition Dual Source 64-slice scanner, and is the only facility in the area with this advanced technology, which gives the practice a considerable edge over other groups with more traditional 64-slice scanners, Muhr believes. “You can see the beating heart with better resolution, so you get a much higher quality scan,” he says, noting that the practice touts their superior technology in seminars and interactions with primary-care physicians.

Cavanaugh of New Mexico Heart Institute has given seminars at lunches and dinners designed to not only inform primary-care physicians about the overall benefits of cardiac CT, but also about other uses of the technology, such as peripheral vascular disease. Cardiology Associates of Mobile emphasizes their physicians’ experience and education in their seminars as well as the benefits of CTA and calcium scoring. Continued marketing to local primary-care physicians has lead to growth in the group’s cardiac CTA practice, with volume growing 53 percent in the third year, Chunn says.


Guerilla marketing

For cardiac CTA, guerilla marketing tactics include not only encouraging primary-care physicians and providers to schedule their own CTA scan, but also focusing on the strengths of the technology with patients.

Physician and provider scans. Like State of the Heart Cardiology, South Jersey Radiology Associates also brings in local physicians to get their own CTA scans as a way to demonstrate the power of the technology first-hand. When primary-care doctors express curiosity about the technology, Muhr and his colleagues invite the doctors to schedule a scan of themselves at a time convenient for them. “It’s been a relief for some of these doctors who weren’t sure if they had problems to find out that they have a normal scan and don’t have to worry,” Muhr says.
 

While many insurance companies do not cover calcium screening, practices can still include the service in their marketing campaigns. This patient has severe coronary artery disease and a calcium score of 802. (Provided by Cardiology Associates)

The power of the technology then sells itself once the primary-care doctors have seen the clarity of the images and how it helps patients with disease that is otherwise difficult to diagnose, says Osborne of State of the Heart Cardiology. “This is still a novel technology to many primary-care doctors, so it is very important to bring them into our office to show them exactly what its capabilities are,” he says.

Patient show-and-tells. Another important component of their guerilla marketing tactics for State of the Heart Cardiology is to maximize the opportunity to educate and inform patients about their heart health at the time of their scans. To that end, the practice has a conference room complete with a Philips 52-inch LCD screen to meet with patients following their scans. This meeting is the last step of a point-of-care cardiology practice delivery model that State of the Heart Cardiology uses. A typical patient is scheduled for a two-hour appointment, complete with all lab work, the cardiac CTA scan and a 45-minute meeting with a cardiologist.

“We turn the meeting into a show for the patient and any relatives or friends that he or she brings with them,” Osborne says. “We can do a virtual autopsy of their heart using the monitor and show them exactly where any problems or potential problems are, linking that with a treatment plan for the future if that is necessary. Before they leave, we give them a CD of their heart images as well as some pictures. It’s a great way to utilize physician time because we get all the labs and results we need at once and can fully inform the patient during our meeting and it is great for the patient, who goes home with their images and shares them with family and friends.”

The word of mouth referrals that have come into the practice as a result of this point-of-care cardiac CTA approach has enabled State of the Heart Cardiology to keep their scanner busy five days a week, completing 12 to 15 CTAs per day. In fact, the practice is so busy with CTAs that they don’t do calcium scoring tests, although Osborne says he may open the scanner on Saturdays and offer $50 calcium scoring tests for the general public at some time in the future. The practice grew its CTA practice by 30 percent the second full year the scanner was in use, he notes.


Public relations

Public relations involves communicating with the local media; community relations efforts targeted to corporate leaders and community groups also can be a component of an overall public relations plan.

Media. Communicating effectively with the print, radio and television reporters in your area is another way to build awareness of your practice. Focus on health reporters within the media venues, as well as business reporters. Approach both local and regional media in your area. It’s been an ongoing effort for Cardiology Associates in Mobile, which has been featured on local television health news segments as well as in the newspaper. “When we initially acquired the technology, we sent out a press release to the reporters in our area and invited them in to see the CT scanner,” says Chunn. “We were the first private practice in the area to install a CT scanner, so we made a big splash locally.”

Cavanaugh of New Mexico Heart Institute has appeared on talk radio shows several times and touts radio as a highly effective medium to get a message across. “Radio is a much better backdrop to getting your message across to the general public than television,” he says. “A radio call-in show is the best, where people can call in and ask questions. There are an amazing number of people who listen to those shows religiously.” He and several of his partners also have been interviewed for local newspaper and magazine articles, which have reaped good publicity for the practice.

Corporate leaders and community groups. South Jersey Radiology Associates widened the focus of their public relations efforts by approaching corporate leaders and community groups.

“With healthcare costs rising, corporations are interested in any technology that has the potential to prevent more expensive care down the road, so we’ve made a point of meeting with local corporate executives to explain and demonstrate the technology,” he says. Besides the corporate executive meetings, the practice has a nurse who not only goes out to meet with primary-care physicians in their offices, but who also speaks at meetings of local community groups, such as the Rotary Club, to inform club members about the technology and answer questions.


The Bottom Line

In an increasingly crowded marketplace and with the threat of new technology looming, it’s essential that you find a way to differentiate your cardiac CT practice from the others in your community. Your efforts don’t have to come with a high price tag – with some imagination and effort you can either come up with your own guerilla marketing tactics or adopt those of others. It’s worth the effort to put your practice out there and to make more potential patients and referring physicians aware of the value of cardiac CT as a diagnostic tool.