How To Run A Facebook Contest For Your Medical Spa

Facebook marketing is becoming a necessary marketing arm for successful medical spas and laser centers.

By Cary M. Silverman MD

There are several reasons a medical practice should consider setting up a Facebook fan page:

• It's free.
• It gives you another way to communicate with potential patients through updates that will appear on their news feeds.
• You can promote events and services in your office.
• You can boost your SEO.
• You can promote brand awareness for your practice.
• Facebook can act as a funnel to your main practice web site.
• You can build a community for your patients.

Once you decide to set up a fan page for your practice, the next task is to build a fan base. A Facebook contest is an excellent way to achieve this goal. These contests offer several benefits:

• A highly cost effective way to build a database.
• 50% of online users enter a contest once a month.
• Contests can be highly targeted.
• Creates positive brand awareness for your practice.
• Patients can further spread word about the contest to all their friends.

Make Your Idea Social “Well my contest is on Facebook – so it’s social, right?” Wrong. Your Facebook fans are more excited to participate in a contest where they can help determine the outcome, than one where you pick the winner. Furthermore, when you require voting or involvement of some sort, that means your fans must find friends to join in their quest to win (hence “social word of mouth marketing”).

Keep it Simple

Do you fill out every field of surveys you get trapped into taking? Didn’t think so. Contests are the perfect way to gather important information about your fans (remember to tell them how you intend to use it), but only ask for the essentials so that you don’t miss out on any entrants. Remember that users will give you more information if you make it enjoyable, functional, and easy.

Originality

This one should be a given, but you’d be surprised how many times organizations run extremely similar campaigns back-to-back. Fans don’t want to enter the same contest or participate in the same campaign over and over again on Facebook, and if you don’t catch their attention, they sure won’t tell their friends about it. The greatest Facebook contests are the most creative and memorable ones (just don’t over-do it and forget to keep it simple).

Know the Rules

If Facebook catches you doing something illegal they will delete your page and ban your practice from using the platform. So remember first and foremost that you must run your contest on a third-party application. We use Shortstack, which is fully customizable and affordable. Others include: Offerpop, Wildfire, and many more. You cannot require Facebook users to submit any content or take any action on Facebook itself (i.e. posting a photo to your page’s wall, liking, commenting, or re-posting content, etc.). You cannot announce a winner on Facebook which is actually a good way to drive people to your blog or website. Here are the current Facebook Promotions Rules and Guidelines so that you can remain compliant (they are always changing, so be watching).

It Starts In-Office

What better access do you have to potential Facebook fans and contest entrants than your own office? In a past contest we ran on EyeCare 20/20's Facebook page called “The Eyeball Challenge”, we started by attracting the patients in the clinic. We filled a large glass jar with candy eyeballs, posted a photograph of it on our Facebook contest tab, and directed fans to guess how many eyes were in it in a commenting section on the tab. The winning guess would receive a pair of sunglasses. This way people who knew us both offline and online could participate.

We had in-store signage at the front desk with a call to action and QR code taking patients right to the Facebook page to enter. We trained the entire staff to know what the contest involved, rules, and prizes so that they could urge patients to submit their guesses. We also designed takeaway collateral pieces so that those without smartphones could be reminded to enter when they got home.

This was an exciting way for us to inform our patients that we were on Facebook, and for some was their very first introduction to the social network. [As a side note: remember to speak in laymen’s terms, and be prepared to assist novice Facebook users.]

Come With All Guns A’ Blazing

Just as it helps us to have all parts of our bodies to perform at our highest level, our social media presence and success depends on the coordination of many factors. Plan your contest launch with a timeline marked with a dedicated email blast to your current database (don’t hide this in a regular email, give it its own special delivery date, if you are able to, without inundating your recipients). Be sure to include Twitter updates (reaching out to influencers in your niche, or local organization/people), digital and social media press releases, maybe an image or interchangeable banner linked to the tab, and utilization of any other platforms or people that you have at your disposal.

The Buddy System

Join forces with another party (maybe a prize sponsor). Bring traffic from their website, stores, brand name, etc. to increase traffic to your contest tab. Maybe a few months later you can offer to sponsor a contest for them. You can even offer your contest as an on-site giveaway at a major community event where people must enter on Facebook, and you announce the winner at the end of the event. Get creative. Just remember that the buddy system expands your network exponentially. It’s Okay to Spend a Little $

Facebook ads are a very effective way to gain not only entrants, but fans in general. When we initiated an advertising campaign for EyeCare 20/20, we increased our fans by more than 60%. And our contest entries quadrupled! Ads can be tricky, so play around with titles, ad copy, images, landing pages, and your bids until you get the right combination. These ads are great for local practices and organizations, so set a little money (and time to monitor) aside to find out what will work best for you! Converting New Fans to Patients

Some people become so consumed with getting new fans in running their contests that they forget to focus on bringing in potential leads. Focus on spreading the word with your current patients, local places where your target market can be found, and use ads that involve ad copy that will catch the eyes of prospective patients. Although numbers are important for establishing credibility and providing an audience for your later initiatives, remember to make each fan count.

Effects of a Campaign

Although your campaign may not make the Top Ten Promotions of All Time list… remember to take with you what you learned. Yes, you are going to get those few fans who are “Contest-Hoppers”, liking you, winning or losing, and then unsubscribing. Prepare to lose a few fans, but not to worry, the majority will remain with you. Remember to thank all of your participants, maybe even post a few examples from your entries (if you have permission in your rules), and continue to speak in your fun voice, building anticipation for your next campaign as soon as your current one ends to keep fans engaged.

Bonus Point: When overwhelmed, Get some Help

Sounds like a lot of work? Trust me – it’s worth it! For years, we did all our social marketing at EyeCare 20/20 in house. When we saw how much time and energy we were expending we decided to seek the aid of a professional online marketing team. We still spend a lot of time with our social marketing, but having this professional support has helped you to attain social media perfection. There are many excellent ones out there.

About: Cary M Silverman, MD, MBA is Medical Director of EyeCare 20/20 in East Hanover, NJ. He specializes in LASIK and refractive cataract surgery. You can read his blog or connect with him on LinkedIn.

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Cyber Discrimination: A New Frontier of Liability for Healthcare Providers

By Dr. Jeffrey Segal, MD, JD of Medical Justice

Pause for a second, stop reading this article and close your eyes. Imagine living life as one of the 1.3 million blind people in the United States. Think about how you would access information exchanged over the Internet. For 60-year old New York resident Mindy Jacobsen, this is her reality. She has been blind since birth.

Thanks to the American for Disabilities Act (“ADA”) it is easier for Mindy to navigate around New York City. She can walk sidewalk to sidewalk, hop on a train and live a fully functional life, except when it comes to navigating through the internet.

“You go to a hospital’s website and want to get the pre-op information there, but it isn’t available and if it is, it is in a format we can’t read. Then we have to ask people to read it to us and it becomes such a big deal,” Jacobsen said.

Mindy uses a screen reader to read web pages to herself. It is a helpful tool that allows her to navigate the World Wide Web.

"We have computers that take advantage of the speech kit that is built into all computers. Instead of using that speech kit to show a movie, which it certainly can do, we have a program that uses that speech kit to read the screen. So every time the screen refreshes, the software sends the information to the speech kit and it is read aloud to us,“ Jacobsen said.

Section 508, added to the Rehabilitation Act in 1986 and amended in 1992 and 1998, requires Federal agencies to make their websites accessible to people with disabilities. Outside of Federal agency websites, the United States government policy is to encourage self-regulation of the Internet wherever possible. Only if self-regulation is insufficient does government involvement become necessary.

Self-regulation hasn’t fared well for a handful of public companies nationwide. The most famous and commonly cited case was litigated several years ago, when the National Federation of the Blind filed a suit against the retail giant, Target.  The plaintiffs alleged Target's website was not compliant within the outlines of the ADA.   National Federation of the Blind v. Target Corp., 452 F. Supp. 2d 946 (N.D. Cal. 2006) asserted the requirements that Title III of the ADA imposes on places of public accommodation also applies to e-commerce websites.  The plaintiffs were blind individuals who claimed the Target website discriminated against them since the website did not work well with screen reading software.  The case was the first lawsuit applying the ADA to a website that survived a motion to dismiss.  The Target case was recently settled out of court for reportedly six million dollars. Quite a sum. 

Target is not the only organization whose website triggered a claim under the ADA. Southwest Airlines has been named as a defendant, as well as Twentieth Century Fox and Schering-Plough. It seems reasonable to anticipate a wave of litigation against healthcare providers that, in whole or in part, provide services to disabled individuals.

Title III of the ADA provides, “No individual shall be discriminated against on the basis of disability in the full and equal enjoyment of the goods, services, facilities, privileges, advantages, or accommodations of any place of public accommodation….” 42 U.S.C. § 12182(a).  Is a website a public place?  There seems to be so strong arguments that a judge could say, "Yes." 

"I hope that legislation will come about requiring anyone on the internet to make his or her site accessible.  I am dreaming but it is a hope,” Jacobsen said.

Mindy’s hopes are not far off. In July of 2010 the Department of Justice (DOJ) published documents saying they are considering updating the ADA regulations so that it would explicitly state that both state and local government and places of public accommodations must make websites usable to people with disabilities. Public comments were accepted by the DOJ for an advanced notice through January, 2011. Many take this as a clear sign that rules applying ADA regulations to commercial websites are coming in the near future.

To help physicians get a jump start before legislation may take effect, there are a handful of easy changes to their websites to make them more accessible. First, physicians who already have a website should get it tested for accessibility.

Accessibility Partners is a company that helps organizations implement electronic and information technology accessibility solutions for people with disabilities. Their company hires people with and without disabilities to scan websites to make sure there are no kinks during operation.

“If somebody doesn’t have use of their hands and arms and they have some type of mobile disability, they might use some type of speech recognition to navigate the web. If they are trying to research a medical practice in their city and they Google it and doctors office comes up and they get to the website and the website is not accessible for them; it might be like getting to the door and having the door locked and having the doorbell be out of reach. So it kind of cuts off, unintentionally a whole population of potential clients,” Dana Marlowe with Accessibility Partners said.

A screen reader can read almost anything - eliminating barriers for the blind like Mindy; until it comes across a graphic with no behind the scenes description attached to it for the screen reader to read.

“When my screen reader encounters graphics, it can’t read them. So it just quiets down and doesn’t do anything,” Jacobsen said.

This encounter has been described more graphically by Premium Websites web designer Dotty Scott.

“It is like somebody reading off a Uniform Resource Locator(URL) that has a bunch of question marks and numbers, stuff that is not relevant to what they are looking for. Unfortunately, most websites are built that way, so the person is actually forced to sit and listen to all of that before they actually get to the information they are looking to find,” Scott said.

Scott encourages all web designers to experience a screen reader. Then it becomes obvious what they need to do.

“It was shocking and eye opening. It is amazing to me, the patience blind people have to find anything on the internet. It really is an eye opener,” Scott said.

Here are a few changes physicians can make to their website to make them more user friendly immediately.

• Provide text alternatives ("alt") for images and other non-text content.
• Make it easier for users to read text by using high contrast colors between the text and        background, and making text resizable.
• Provide captions and other alternatives for multimedia.
• Use headings to group information and mark up the heading in the code.
• Make all functionality available from a keyboard, since some people cannot use a mouse.

W3C is the international organization that defines the standards for the web. Within the W3C is the Web Accessibility Initiative (WAI). The WAI's core mission is to make sure the web is accessible to those with disabilities.

 WAI has developed web accessibility standards that organizations can follow, although WAI itself is not an enforcement body. The DOJ is considering using those standards in revising regulations for the Americans with Disabilities Act. Shawn Henry has been working to help organizations understand WAI's standards with the hope that many will make the changes on their own.

"Organizations would be wise to think about accessibility when they are updating their website, instead of waiting until they get a complaint," Henry said.

About: Dr. Jeffrey Segal, MD, JD, is Chief Executive Officer and Founder of Medical Justice and is also a board-certified neurosurgeon.

Michael J. Sacopulos is a Partner with Sacopulos, Johnson & Sacopulos, in Terre Haute, Indiana. His core expertise is in medical malpractice defense and third party payment disputes. Sacopulos may be reached at mike_sacopulos@sacopulos.com

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Understanding The HITECH Act: HIPAA On Steroids

By Jeffrey Segal MD JD and Michael J. Sacopulos JD

Understanding the law before you send your patients any e-mail.

Snail mail is becoming less popular as the calendar pages turn. E-mail and social media networks have changed how we communicate. Before clicking the send button in an e-mail template, healthcare professionals should better understand that HIPAA violations have also entered a new era. More cases are prosecuted with assessment of both statutory civil fines and criminal penalties.

A little background: Even though HIPAA passed in 1996, little prosecution followed when patient privacy was violated. Since the law took effect in 2003, nearly 45,000 complaints were filed with the Health and Human Services (HHS) Office for Civil Rights. Of these complaints, only 775 cases were referred to the Department of Justice or the Centers for Medicare and Medicaid Services for investigation. None resulted in direct civil monetary penalties.

Then, in 2009 the HITECH Act (“HIPAA on steroids”) was enacted. This act intended to increase HIPAA confidentiality protections of Electronic Protected Heath Information(ePHI), instill tough civil and criminal penalties for violations, mandate notification of breaches of HIPAA protected heath information, and extend the definition of covered entities to include business associates. A tall order indeed.

For example under the tougher HITECH Act, in April 2010 a former employee of a hospital was sentenced to four months in prison for accessing the medical records of his coworkers and various celebrities. He had no “valid” reason for accessing these records.

According to the Health and Human Services (HHS), penalties have increased. Prior to the HITECH Act, the HHS Secretary could not impose a penalty of more than $100 for each violation or $25,000 for all identical violations of the same provision. Section 13410(d) of the HITECH Act strengthened the civil money penalty scheme by establishing tiered ranges of increasing penalty amounts, with a maximum penalty of $1.5 million for all violations of an identical provision.

Just how "high tech" are physicians when it comes to communicating with patients?

A survey by the health information firm Manhattan Research in 2009 found that 42 percent of physicians had some online communication with patients.

The American Academy of Family Physicians reported in a 2009 survey that just 6 percent of responding members had performed a Web-based consultation - that number was more than double the 2.6 percent who had done so in 2008.

But is all of this electronic communication legal?

The HITECH Act requires that all communications involving ePHI be encrypted.  HHS recently adopted National Institute of Standards and Technology guidelines for encryption.  This means that if a physician wants to consult, refer, or prescribe for a patient by e-mail, the e-mail had better be encrypted.  Of course most patients do not have software to decrypt.  So what alternatives do healthcare providers have? And, more importantly, how can this be made easy and pragmatic. Email was designed to simplify, not complicate.

Healthcare providers may seek their patient's consent to communicating via unencrypted e-mail.  While HHS does not provide a standard form for securing patient consent, basic "informed consent" strategies should apply.  First, get the patient's consent in writing.  The patient should not be given just a binary choice – but a menu of choices.  For example, a patient may wish to electronically receive information on appointment dates but not test results.  The consent document – as is standard with most routine HIPAA forms -should also note that the patient may withdraw his or her consent at a later time. This can be part of an expanded HIPAA form the patient signs when first seeing you in the office.

Here are some more recommendations when communicating with patients electronically:

1) A physician may be held responsible for a delay when responding to a patient's e-mail. Solution: A physician that wishes to accept e-mail from patients should use an auto response feature that informs the patient that a) the physician typically responds to e-mail within XXX number of hours/days; b) if the patient requires immediate attention, the patient should telephone the physician's office or contact an emergency healthcare provider.  

2) If a patient initiates an e-mail with a physician, Rachel Seeger of HHS Office for Civil Rights says that it is assumed that the patient consents to unencrypted communication.  "If this situation occurs, the healthcare provider can assume (unless the patient has explicitly stated otherwise) that e-mail communications are acceptable to the individual”.

3) If a physician does end up sending a patient an e-mail, double check the recipients’ e-mail address before clicking the send button. This is to prevent the e-mail from being sent to the wrong person, therefore sharing private information to an unintended party. Good advice also in the non-healthcare world.

4) Add any e-mail a patient sends (and any response) to the patient's chart.

5) In the HITECH Act code 170.210 section B states that the date, time, patient identification and user identification must be recorded when electronic health information is created, modified, deleted, or printed; and an indication of which actions occurred must also be recorded. This means if you send an email to a patient with protected health information – and delete it – you will need a record of what was deleted and when. This is not dissimilar to crossing out a line in a paper medical record- updating the record – with a date of the update.

6) Since communicating with patients via e-mail is becoming stricter, more physician offices and hospitals are using portals as a means of communication. This allows the patient to sign in with a secure username and password to view their records and communicate with their physicians. The security rule allows for Electronic Protected Heath Information (e-PHI) to be sent over an electronics open network, as long as it is adequately protected.  Of course, this is more complicated than using Outlook or gmail.

The HITECH Act has ushered in a new era of technology requirements and standards that must be met by physicians.  Given HHS's recent enforcement efforts, physicians should use caution when electronically communicating with patients.  By working within the boundaries of the six points above, physicians should comply with the HITECH Act. 

Jeffrey Segal MD JD and Michael J. Sacopulos JD are with Medical Justice, a Medical Spa MD Select Partner that protects physicians from frivilous lawsuits.

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Treating Non-English Speaking Medical Spa Patients

By Jeffrey Segal MD JD and Mike Sacopulos, JD

According to the 2000 U.S. Census 18% of people living in the U.S. spoke a language other than English in their home.

Jump ahead 11 years and that number continues to grow. We are asked to press one for English and have the option of reading everything from a manual to a menu in Spanish. 

Of the more than 18% who don’t speak English as their first language, most, if not all, will see a physician here in the U.S. at some point. The physician they choose may not speak their native tongue.

 Title VI of the Civil Rights Act prohibits discrimination based on race, color, or national origin. The Act goes even further in protecting against discrimination of those with limited English proficiency -also known as “LEP”.

 Health care providers receiving Federal financial funds are mandated by law to take adequate steps ensuring those who can’t speak English are provided with the necessary tools to clearly communicate with their physician. Physicians who are unsure whether they receive financial assistance from the government should think twice. Physicians who receive reimbursement from Medicaid or Medicare are recipients of Federal financial assistance, and, thus must comply with Title VI requirements for language assistance.

The challenge goes beyond compliance with government rules.  Failure to comply can also result in civil liability claims.  The type of language assistance that must be provided to LEP patients depends on a variety of factors including:

•        The size of the medical practice
•        The size of the LEP population
•        The nature of the service
•        The total resources available to the medical practice
•        The frequency with which particular languages are encountered 

If the Office Civil Rights (“OCR”) gets a complaint about a noncompliant physician’s office, they will inform the practice in writing of its findings and identify the steps that must be taken to become compliant. If the practice chooses to ignore the OCR’s helpful hints,  the OCR is empowered to terminate any Federal funding (after an administrative hearing).

A practice’s responsibility

• Contact the Department of Justice (“DOJ”) to get the information they provide to health care providers on compliance with the American with Disabilities Act

• Decide what foreign language assistance is most needed in the area

• Find out what LEP services are already available in your area examples: hospital, community center, schools and the library.

• Develop a written policy for your practice to ensure effective communication with the LEP population. The policy must be in compliance with federal laws and regulations. The plan should also include a list of qualified individuals who have the medical terminology to satisfy your requirements. A physician’s position in a lawsuit will be enhanced if they have relied on the interpretation of a qualified individual.

• Educate the staff on LEP requirements and practice policies.

• Schedule extra time with an LEP patient to ensure translation was as complete and accurate as possible

How should physician offices handle telephone calls to and from LEP patients? 

•  Determine how your staff is handling calls from LEP patients and develop procedures to help them respond to patient communication needs.
•  If possible, telephone calls from LEP patients should be answered by bilingual office staff or onsite interpreters. 
•  If possible alternatives include enabling staff members to activate three-way calling with a telephonic interpreter or to transfer calls to someone at the office who speaks the relevant language. 
• Answering machine messages should be provided in more than one language (with prompts) if there are a significant number of LEP patients in the practice who speak one or more non-English languages.
•  In the case of a high volume of diverse LEP patients, telephones can be programmed to rollover directly to a phone line with telephonic interpretation services. 
•  If using an answering service, consider contracting with one whose language capacity mirrors that of your practice.

While coming into compliance may seem like a daunting task, it pales in comparison to what will happen if your case is tried in a court of law.  Language does not seem to be a barrier when non-English speaking individuals hires an attorney – to go after you.  A thoughtful compliance plan can save much grief for both physician and patient.

About: Jeffrey Segal, MD, JD, is founder and CEO of Medical Justice Services, A Medical Spa MD Select Partner.  Mike Sacopulos, JD, is general counsel for the organization.

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As A Physician, You Need to Understand Your Online Reputation

By Jeffrey Segal, MD, JD & Michael J. Sacopulos, JD

The observation that social media is experiencing explosive growth is hardly novel. Moreover, social media is significantly influencing the medical profession. 

Free Webinar: "How To Control & OWN Your Professional Reputation Online!"

CNN Money.com reported that Facebook passed the milestone of half a billion signed on users half a year into 2010.  The professional and legal ramifications from the rapid growth of social media touch almost every aspect of physicians practicing today.  One of the most challenging of these ramifications is a physician’s online reputation.

Pew Internet and American Life Project recently released numbers that document just how important the source of information regarding medicine and physicians the internet has become.  Sixty-one percent (61%) of American adults look on-line for health information. Forty-nine percent (49%) of Internet users report researching a specific disease or medical problem on the Internet.  Forty-seven percent (47%) report seeking information about their physician or other healthcare professionals from on-line sources. 

Finally, five percent (5%) of “E-Patients” have posted a review online of a doctor. It is these very reviews from a small subset which form the basis of a physician’s reputation on-line.

Most physicians equate a tainted online reputation with a direct loss of business.  The analysis is simple; the worse the online reputation, the fewer the patients.  There are certainly many examples to support this reasoning. 

Dr. Linda Morrison, a physician practicing in Indiana, experienced first hand the harm that arises from an online reputational attack.  In July of 2000, Dr. Morrison noticed that an anonymous individual was posting defamatory statements about her via the internet.  Dr. Morrison received e-mails from this individual under a pseudonym “Surfycity45” that, among other things, made threats against her medical license.  The attacks continued into the fall of 2000.  Dr. Morrison ultimately learned that “Surfycity45” had been circulating defamatory comments about her while simultaneously encouraging others to do the same.  “Surfycity45” worked hard to organize a cyber mob with Dr. Morrison as its target.  

Dr. Morrison, via counsel, attempted to enjoin Defendant American Online, Inc. from the continued posting of the defamatory statements about her by the anonymous subscriber.  For a variety of legal reasons, the United States Northern District Court of Indiana ruled against the injunction.  Although Dr. Morrison alleged that “Surfycity45” statements were false, defamatory, and had resulted in damage to her professional reputation as a physician, she was unable to have these remarks removed from the Internet in a timely fashion.The damage was done.  

The implications of a physician's online reputation now extends beyond patients.  At least twenty seven (27) states have a recognized cause of action for negligently credentialing a physician.  Given this liability, credentialing committees will likely perform detailed background checks using all available search tools, including social network sites.

It is not just patients and credentialing committees which are scrutinizing physicians’ online reputations.  In any  medical malpractice action, physicians should assume that the plaintiff’s attorney will checking the doctor’s online reputation.  Geoffrey Vance, a thirty eight (38) year old partner at McDermott, Will and Emry, makes use of social networking sites to gather facts about the opposing side for trials.  “I make it a practice to use as many sources as I can to come up with and to find information about the other side” Vance said.  “We used to run Lexus Nexus; we still do that.  We always look at cases, and now we use the internet – Google, and social networking sites.”

Mr. Vance is not alone.  Paul Kiesel, a lawyer in Los Angeles County, admits to using social media not only to investigate the opposing side, but also to help select jurors.  “Last month I had fifty (50) jurors, and as the Court Clerk read out the names, I had two (2) people in the courtroom and the third person back at the office, with all three (3) of them doing research.”

Lawyers are not the only actors in a courtroom who are using social media at trial.  Courts across the country are grappling with the serious problem of “Internet-tainted” jurors.  In case after case, judges and lawyers have discovered that jurors are doing independent research via cell phone during trials.  Last year in Arkansas, a state court judge allowed a 12.6 million dollar verdict to stand even though a juror sent eight (8) messages via Twitter from his cell phone.

Physicians’ online reputations are being examined with increasing frequency at crucial moments in their professional career.  It is no longer  prudent for a physician to fail to monitor his or her online reputation.  “Physicians should carefully monitor their online reputation.  I have seen examples of ex-spouses, past employees, and competitors all posing as disgruntled patients in an online effort to damage a physician’s reputation.  This is a real threat that is not going away,” says Rivera.

Whether physicians work through organizations such as Medical Justice or Search Engine Optimization companies or go it alone, they need to guard their online reputations.  In the words of Benjamin Franklin “It takes many good deeds to build a good reputation, and only one bad one to lose it.”

About: Jeffrey Segal, MD, JD, a neurosurgeon, is the founder and CEO of Medical Justice Services. 

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Opportunity In Surgitels & Medical Travel?

By Arlen D. Meyers MD

Building a chain of Surgitels

Jackie G, a 23 y/o investment banker and avid tennis player, has arrived at the Meyers Palo Alto Surgitel following her arthroscopic shoulder surgery in a facility across the street from the hotel. Jackie lives in Denver, but came to Palo Alto because of the reputation of her surgeon, Dr. Meyers, who charged a lot less than her Denver based orthopedist. MedVoy has recommended she spend the first postoperative night at  the Meyers Surgitel Suite because of its reputation for catering to patients needing accommodations following discharge from a medical facility or needing a place to stay while getting outpatient treatment. Jackie is accompanied by her girl-friend, Sara, who will be watching over her.

Fortunately, everything went smoothly with Jackie’s operation and she was discharged from the Palo Alto Surgicenter at about 3Pm that afternoon. A hotel van takes Jackie and Sara from the Surgicenter to the Meyers Surgitel. They arrive via a private entrance with a wheelchair ramp and are met by a hotel greeter who wheels Jackie in her wheelchair to her room. Jackie and Sara have been preregistered. The room is on the ground floor with spectacular, soothing views , just right for a patient who needs rest and relaxation. The room looks like no room she has stayed in before…part hospital, part hotel. All the surfaces are antibacterial and the bedroom and bathroom have guard rails, walk-in tub and antibacterial soap to clean her wounds. The sink in the bathroom has fixtures that allow her to turn on the water with her elbows, an advantage for someone who arm is in a sling. Her friend, Sara, is staying next door and can enter through a common door. There is a small kitchen so Sara can make Jackie a bowl of oatmeal for breakfast.  The room service menu accommodates her special post op needs as does part of the menu in the hotel restaurant. An inconspicuous storage locker has medical supplies and wound dressings for medical professionals who might come to the room to visit her before she leaves for home. Her postoperative pain medicine has been delivered to her room, thanks to an arrangement made with a local pharmacy chain. She attaches her cooling shoulder apparatus.  A computer monitor allows her to communicate with her doctor and the doctor’s staff as well as her children back home. It also asks her to review a video of postop instructions before she leaves and confirms that she has done so.

During the night, Jackie is awakened with pain in her shoulder. She calls the medical concierge who has the contact information for the orthopedist taking call for Dr. Meyers. Within minutes, she gets a call and is reassured that this is a normal event following her surgery. Soothed by the presence of her Shetland sheepdog, Charlotte, sleeping next to her, she has an uneventful night.

After breakfast on the deck of her room, Jackie and Sara check out online, the bellhop takes their bags and they leave through a private exit to a waiting vehicle that will take both Sara and Jackie to her surgeon for a postop check (if she can’t come to her room) and then to a relaxing three day recuperation at a local spa arranged by MedVoy as part of her medical travel experience. They even allow pets. Much to her surprise, a few months after returning home, Jackie receives a check from her health insurance company as a reward for helping them keep down medical costs. Jackie bought a new tennis racket.

About: Arlen D. Meyers is a founder of Medvoy and blogs regularly at Freelance MD

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When Clients Demand a Refund: Free Webinar

Our friends over at Healthy Aging Magazine are hosting a free medical webinar that should be of great interest to our members.

What happens when a patient is not happy with service or the result and demands a refund? ADVANCE for Healthy Aging, a trade magazine for cosmetic medicine professionals, will be offering a medical webinar, called “Doctor, I want my money back.”

• This free webinar takes place Wednesday, Jan. 19, 2011, 8:00-9:00 p.m. EST, with presenters Jeffrey Segal, MD, board certified neurosurgeon and CEO of Medical Justice; and Michael J. Sacopulos, partner with Sacopulos, Johnson & Sacupulos of Terre Haute, Ind. The Webinar will address how doctors can level the playing field; and when refunding makes sense and doesn’t. In addition, these presented will also discuss what to do with negative online reviews—that often come as a result of disgruntled patients.

Use the link below to register:

https://www1.gotomeeting.com/register/590756176

2011 Tax Changes That Impact Physicians

Guest post by Setu Mazumdar MD

The tax laws are changing in 2011. Here's how that will apply to you as a physician.

Recently I sent the following information to my clients regarding the 2011 tax law changes which are almost a done deal. Hope this helps you

You may have heard that a deal for 2011 tax laws is almost a done deal. I'd like to point out several things which will apply to you.

1. Federal income tax rates

Will remain the same as they are now for 2011 and 2012. However, we don't know what the cutoffs for the tax brackets are yet. It's unclear whether phaseouts for deductions on Schedule A of your income tax return will remain as is or will get worse next year. It looks like they will remain the same as now for the next 2 years. Obviously this is good news for high income taxpayers such as all of you.

2. Dividend and capital gains tax rates

Before this deal dividends in taxable accounts were going to be taxed at your highest rate, which was going to be 39.6% as of next month. However even the current dividend tax rate of 15% will stay on for 2 more year. This is also true for capital gains taxes, which were supposed to go up to 20% and instead will remain at 15% for 2 more years. If you have a taxable investment account, this will make it easier for me to rebalance portfolios since the cap gains rate will remain low.

3. Roth IRA conversions

I've already discussed and converted several of your traditional IRAs to Roth IRAs already this year. If you have not converted your traditional IRA to a Roth yet but are considering it, you may be OK doing it next year in order to defer paying taxes on the conversion. However, realize that by converting this year there is an option to spread out the income over 2011 and 2012 and that option is good ONLY for converting in 2010.

The other issue is that for those of you whom we've converted in 2010 already, it is probably more advantageous for you to spread out the income over 2011 and 2012 since tax rates will remain the same. Please discuss this option with your CPA when tax time comes. In other words instead of reporting the income on the conversion for 2010 only (this would be more advantageous if tax rates are going up next year) you may be better off reporting it in 2011 and 2012 in order to defer taxes to those years.

That brings up another issue—estimated tax payments. If your CPA plans on reporting this all in 2010, then adjust your 2010 Q4 estimated tax payment. However, if the plan is to split the income from the conversion in 2011 and 2012, then there may not be a need to adjust your Q4 estimated tax. Instead, you will have to adjust estimated taxes for 2011 and 2012.

And finally if you have nondeductible IRA contributions, remember that portion is not taxed on the conversion.

4. Estate tax

It looks like the estate tax exemption will be $5 million for 2011 and 2012. This changes things like whether to set up life insurance trusts. However, realize that this is once again a temporary rule and eventually this will change again in 2 years. So it may still be better to proactively address these issues rather than to address them later. But at least this might buy some more time.

5. Medicare investment tax is coming

For taxable investment accounts starting in 2013 there will be an additional Medicare investment tax on investments sold for a gain in addition to capital gains tax. This tax will be 3.8% on "high income" earners and will apply to both capital gains and dividends. This was part of the health care law passed earlier this year. Of course the details on this still have to be worked out.

Hope that helps put some of this in perspective. If you have any questions about this, please ask them as a comment and I'll do my best to answer them.

Setu Muzamdar MD blogs on physician investing and wealth management at Freelance MD

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Using LinkedIn As A Physician

One of the first key points of advice I have for physicians interested in non-clinical career expansion is get on LinkedIn.

Why?  Well, for one, it is a major player in the world of networking 2.0.  It has taken the place of the rolodex and become the place to present your professional presence online.  For physicians that have not begun networking, it is a great way to start expanding your circle of contacts from outside of your direct friends and colleagues, to those who are “friends of friends”, 2^nd degree connections, and professionals interested in the same things you are.

For docs that are considering expanding into industry, I recently read that more than 60% of Fortune 100 companies use LinkedIn to save time and recruit/hire best candidates.  This means that recruiters from these organizations – some of the largest and most recognized in the world – are on LinkedIn every day to find and vet job candidates.  Hence another reason why you should be on it, and making the most of it.

Here are some ways to make your LinkedIn account work for you:

1. Make sure that you have a comprehensive, detailed profile set up.  This is the first place people will look to get a sense of who you are.  You want it to be a solid overview of your professional direction, your accomplishments, and a snapshot view of what you “bring to the table”.  Make sure it includes a picture – professional picture only, so that viewers can get a visual of you.  And skip the personal details on your profile – there is no need to include your birthday, your home address, or your personal interests.  This isn’t Facebook!  Your professional  email and (optionally) your work phone number will suffice.  Make sure to check the box that you are open to career opportunities if that’s what you want to reflect.  And make sure you use keywords in your profile set up, so if someone (a recruiter perhaps) is searching for a “CMO”, you will show up in search results. 
   
   
2. Make your profile (or most of it) public so that people who are not within the LinkedIn network can still view it without having to set up an account (although I don’t know why they wouldn’t!).
   
   
3. Join Discussion Groups in your areas of interest.  Do a search under “groups” for keywords that you’re particularly passionate/knowledgeable about.  For example, if you search for “Healthcare IT” over 5,000 groups are listed!  Be particular, and sign up to join the ones you think would be best (i.e., have a large network, are reputable).  Joining a number of groups will keep you actively engaged with a strong network of people with similar interests, and it will also drive traffic to your profile.  
   
   
4. Participate!  Once you’ve signed up for groups, go on them regularly to either post questions / discussion points, or to participate in dialogues going on over particular topics.  You’ll be amazed at what you can learn from other like-minded professionals.  You can also quickly build a reputation as a subject matter expert in your area of interest.  The key to success?  Contribute thoughtfully and intelligently – your answers become your online professional personae, and you don’t want to come across negatively.  If you post questions, make sure they are of a relevant, interesting topic that you think might be of use to the others in the group.  And if people answer, make sure to thank them.
   
   
5. Don’t try to “sell”.  Add value instead.  One of the things I’ve seen be the kiss of death for peoples’ LinkedIn reputation is the “over-selling” of their products or services to their LinkedIn contacts or within their Discussion Groups.  The purpose of these forums is to network, and if networking is truly about building relationships and looking for strategic alliances, then the better approach is to simply add value.  You won’t need to puff up yourself or your products/services if you simply provide something – be it an opinion, a resource – that gives back to the people in your network.  If they find it useful they will come to you, usually by checking out your profile and seeing who you are and what you do. That is why having a “meaty” profile matters.
   
   
6. Make connections.  Your network is a good reflection of your professional reach.  If you only show 5-10 connections, people don’t know what to think … that you’re a late adopter?  That you’re a technophobe?  That you don’t have any friends or colleagues?  At least 30-60 connections gives a much better impression for people viewing your profile, so the effort it takes to connect with others is worth it.
   
   
7. Protect your network.  My rule of thumb is to connect with people that are either 1)  people I’ve worked directly with and are my “trusted colleagues” that I can vouch for, 2) people that I’ve met through networking events, conferences, etc., who I know fairly well, 3)  people that are work “acquaintances”, but who I am confident will be value-added members of my network, 4) people that are connections of my trusted colleagues, who basically have credibility by affiliation, or 5) people that are members of my trusted LinkedIn groups, based on the same reason as #4.  There are people who will connect with anyone and everyone simply to build their network and rack up numbers.  I am not that way.  Since I view my LinkedIn network as a trusted source of friends, colleagues and professional contacts – as well as a group that overall reflects upon my professional presence online – I make sure that I choose my connections wisely.

For a great series of articles on how to make LinkedIn work for you, see here:  http://linkedintelligence.com/smart-ways-to-use-linkedin/. 

And for those of you that are really new to LinkedIn (the majority of physicians that I talk to!), here is a real “how-to” for getting started :  http://www.dummies.com/how-to/internet/Blogging-Social-Networking/LinkedIn.html

 See you on LinkedIn!

Ashley Wendel is a physician coach and change management expert who blogs at Freelance MD.

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Are Doctors Terrible At Business?

You've heard it over and over again..."Doctors are terrible business people". I disagree.

Firstly, what do people mean when they say "businesspeople"? My definition is someone who runs a business and can sustain it profitably. Most docs I know who run their own practices (admittedly fewer and fewer as more gravitate to employed positions) do an admirable job keeping all the balls in the air, with minimal training, and seem to take home a paycheck every month.

Second, in addition to how successful physicians are as self-employed owners, the term "business person" also applies to physicians as entrepreneurs, leaders, and investors. Again, while lots of us suffered from the recent economic downturn with a hit to our pensions plans and investments, I haven't seen any evidence that docs did any worse than anyone else.

Finallly, there is considerable overlap between business skills and clinical skills-data acquisition and analysis, risk assessment, problem solving, interpersonal skills, accumulating "clinical judgement" i.e. learning from your mistakes, and lots of others. Docs inherently have business heads that overlap with their clinical heads.

People think doctors are lousy business people because practitioners place patient interests above the bottom line. The result is delivering services that don't generate a profit or inefficiencies in practice management. As more and more doctors pursue non-clinical interests, some for a profit, the unintended consequence and the good news will be a recognition of how good physicians actually are at business when that's the first priority. Unfortunately, it's also the bad news if you are looking for someone to manage your diabetes.

Arlen D. Meyers MD MBA is a professor and physician entrepreneur who blogs at Freelance MD.

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Healthy Aging's Annual "Top of Class" Survey

Our friends over at Healthy Aging are gathering their annual "Top of Class" votes for our industry.  Cast your votes and we will publish their results in January.

Physicians must stay on the cutting-edge of technology. Your knowledge of leading industry reps, manufacturers and distributors can assist your colleagues during crucial equipment selection and purchasing decisions. Share your experience with colleagues in our annual "Top of the Class" survey, which allows dermatologists, estheticians and plastic surgeons to identify companies they feel are "among the elite."

Review the categories listed below, then cast your vote for your favorite vendors* by Dec. 30, 2010. We’ll tabulate the results and share the "Top of the Class" vendors online in January 2011. 

Click here for the survey.

Physicians' Need to Understand & Influence Their Online Reputation

Here's some very good advice from one of our Select Partners, Medical Justice.  

The observation that social media is experiencing explosive growth is hardly novel. Moreover, social media is significantly influencing the medical profession.  CNN Money.com reported that Facebook passed the milestone of half a billion signed on users half a year into 2010.  The professional and legal ramifications from the rapid growth of social media touch almost every aspect of physicians practicing today.  One of the most challenging of these ramifications is a physician’s online reputation.

Pew Internet and American Life Project recently released numbers that document just how important of the source of information regarding medicine and physicians the internet has become.  Sixty-one percent (61%) of American adults look on-line for health information. Forty-nine percent (49%) of Internet users report researching a specific disease or medical problem on the Internet.  Forty-seven percent (47%) report seeking information about their physician or other healthcare professionals from on-line sources.

Finally, five percent (5%) of “E-Patients” have posted a review online of a doctor. It is these very reviews from a small subset which form the basis of a physician’s reputation on-line.

Reputations are forged when people make judgments upon the mosaic of information available about us.”  Viewed in this light, ratings, blog postings, and web pages are the pieces of the reputation mosaic.  Unfortunately, all it takes is one or two bad pieces for the mosaic to be marred.  The implications of a damaged online reputation are extensive."

Most physicians equate a tainted online reputation with a direct loss of business.  The analysis is simple; the worse the online reputation, the fewer the patients.  There are certainly many examples to support this reasoning. 

Dr. Linda Morrison, a physician practicing in Indiana, experienced first hand the harm that arises from an online reputational attack.  In July of 2000, Dr. Morrison noticed that an anonymous individual was posting defamatory statements about her via the internet.  Dr. Morrison received e-mails from this individual under a pseudonym “Surfycity45” that, among other things, made threats against her medical license.  The attacks continued into the fall of 2000.  Dr. Morrison ultimately learned that “Surfycity45” had been circulating defamatory comments about her while simultaneously encouraging others to do the same.  “Surfycity45” worked hard to organize a cyber mob with Dr. Morrison as its target.  

Dr. Morrison, via counsel, attempted to enjoin Defendant American Online, Inc. from the continued posting of the defamatory statements about her by the anonymous subscriber.  For a variety of legal reasons, the United States Northern District Court of Indiana ruled against the injunction.  Although Dr. Morrison alleged that “Surfycity45” statements were false, defamatory, and had resulted in damage to her professional reputation as a physician, she was unable to have these remarks removed from the Internet in a timely fashion.  The damage was done.

The implications of a physician's online reputation now extends beyond patients.  At least twenty seven (27) states have a recognized cause of action for negligently credentialing a physician.  Given this liability, credentialing committees will likely perform detailed background checks using all available search tools, including social network sites.

Health institutions making credentialing or hiring decisions currently face a dilemma when it comes to information about physicians contained in social network profiles.  Although there may be some risks in searching against them (as discussed in the next section), the potential liability for making a panel decision in the absence of such information likely tips the balance."

It is not just patients and credentialing committees which are scrutinizing physicians’ online reputations.  In any  medical malpractice action, physicians should assume that the plaintiff’s attorney will checking the doctor’s online reputation.  Geoffrey Vance, a thirty eight (38) year old partner at McDermott, Will and Emry, makes use of social networking sites to gather facts about the opposing side for trials.  “I make it a practice to use as many sources as I can to come up with and to find information about the other side” Vance said.  “We used to run Lexus Nexus; we still do that.  We always look at cases, and now we use the internet – Google, and social networking sites.”

Mr. Vance is not alone.  Paul Kiesel, a lawyer in Los Angeles County, admits to using social media not only to investigate the opposing side, but also to help select jurors.  “Last month I had fifty (50) jurors, and as the Court Clerk read out the names, I had two (2) people in the courtroom and the third person back at the office, with all three (3) of them doing research.”

Lawyers are not the only actors in a courtroom who are using social media at trial.  Courts across the country are grappling with the serious problem of “Internet-tainted” jurors.  In case after case, judges and lawyers have discovered that jurors are doing independent research via cell phone during trials.  Last year in Arkansas, a state court judge allowed a 12.6 million dollar verdict to stand even though a juror sent eight (8) messages via Twitter from his cell phone.

 In another case, a juror decided to seek the wisdom of the masses by holding a Facebook online poll. “I don’t know which way to go, so I’m holding a poll, wrote the democratic juror.”  Upon learning of this misadventure, the juror was dismissed and the case proceeded.

Physicians’ online reputations are being examined with increasing frequency at crucial moments in their professional career.  It is no longerprudent for a physician to fail to monitor his or her online reputation.  “Physicians should carefully monitor their online reputation.  I have seen examples of ex-spouses, past employees, and competitors all posing as disgruntled patients in an online effort to damage a physician’s reputation.  This is a real threat that is not going away,” says Rivera.

In the words of Benjamin Franklin “It takes many good deeds to build a good reputation, and only one bad one to lose it.”

Resource: Physicians + Facebook Marketing - How to do it correctly!

Guest post by Joy Tu of Medical Justice.

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Cosmetic Surgery For NY Teachers: No wonder our school taxes are so high!

Now I know why there seems to be a reprieve in the economic status of the medical aesthetic market. I just couldn't believe this article on FoxNews.com so I am posting it in it's entirety for your viewing pleasure:

Buffalo, N.Y. Teachers Spend $9M in Taxpayer Cash in '09 on Cosmetic Surgery 

Buffalo teachers rang up nearly $9 million worth of taxpayer-covered cosmetic surgery in 2009, according to the state-appointed authority overseeing public school finances.

The Buffalo Fiscal Stability Authority found that last year's costs for elective procedures such as chemical peels and other skin treatments were up $8 million over 2004's $1 million tab for cosmetic surgery.

The procedures, provided under the teachers' union contract, accounted for 9 percent of the district's total spending on health benefits for employees and retirees, The Buffalo News reported Thursday.

About 10,000 school employees are eligible for the benefit. District officials said teachers or their dependents accounted for 90 percent of the approximately 500 people who received cosmetic surgery last year.

The president of the Buffalo Teachers Federation said the union has agreed to give up the benefit in the next contract and said teachers may be simply rushing to use the benefit while they can.

Board of Education member Christopher Jacobs said the cost increase "smacks of abuse" and is asking the district and the city comptroller to investigate.

 - I'm thankful for the boost to our industry, but not this way! Unbelievable!

This guest post is written by Paula D. Young RN, author of Advanced IPL & Laser Training For Non-Physicians and co-owner of Young Medical Spa in Center Valley PA.

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