Bariatric Times

AUG 2016

A peer-reviewed, evidence-based journal that promotes clinical development and metabolic insights in total bariatric patient care for the healthcare professional

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10 Commentary Bariatric Times • August 2016 Tools and Keys for Success in New and Established Bariatric Practices by RACHEL L. MOORE, MD, FACS, FASMBS Bariatric Times. 2016;13(8):10–12. T rauma call at Charity Hospital was an exceptional training e nvironment that I am glad is in my past, and bariatric surgery bears little resemblance to it. It is a mixed blessing that we do elective cases, because the patient has the opportunity to see a competitor, or forego treatment entirely. To reach maximum success, healthcare in a bariatric practice must be viewed as both a business and a service. The American Society of Metabolic and Bariatric Surgery (ASMBS) is comprised of surgeon and integrated health members who practice in the field of metabolic and bariatric surgery. Surgeon members of the ASMBS work in various settings, including "hospital," "academic," "university," " military," and "independent/private practice." The private practice group, of which I am a member, has a significant representation among the the ASMBS surgeon membership. In fact, the ASMBS Community/Independent Practice committee was recently created to better serve this subset. During a session on private practice for Obesity Weekend (June 23–26, 2016, Las Vegas, Nevada) I spoke about increasing patient volume. Here, I aim to share and expand on that discussion, providing ideas for building your referral base and Internet and social media presences. While these tips are mainly directed toward individuals in private practice, those with other practice patterns may also find them useful. BUILDING YOUR REFERRAL BASE Previous patients. It is appropriate to first think about where patient contacts originate. My group has been tracking this for years and has discovered that 51 percent of our patients are referred by previous patients. These satisfied customers entrust their friends and family to us, and we consider their referral to be the u ltimate compliment. Your practice can contribute to a patient's satisfaction by emphasizing pleasant interactions with your office, from consultation through surgery and postoperative follow up appointments. Strive for consistent messaging, starting with the person who is likely to be a patient's first point of contact—the receptionist or office manager. Be sure that all staff members are educated and trained on the following: practice information (location, directions, hours, surgeons, and surgeries performed), and knowledge of patient processes like consultation, support group offerings, and meeting with a patient advocate. The American Society for Healthcare Engineering lists "a culture of caring, policies and procedures that support patients and staff, and physical environment" as the three most important factors for improving patient experience. 1 Additionally, a survey in the Annals of Family Medicine ranked "appointment timeliness" second in importance after medical skill. 2 Other physicians. The second most common source of new patients for our group is referrals from other physicians, which account for 21 percent of our business. Physicians in other specialties play an important role by recommending surgical treatment, helping with health optimization prior to surgery, and postoperative care, too. We can help strengthen this resource by working to spread knowledge. My strategy for increased referrals from other physicians is to say, "Yes" whenever I am asked to speak. This year alone I have spoken at gastroenterology grand rounds, a surgical assistant convention, and a CME event for primary care physicians (PCPs). I also talk to other physicians one- on-one wherever I see them, including the hospital, kid birthday parties, the ball field, and elevator. In my experience, people gather around and are eager to hear more about bariatric surgery. As Dr. Christopher Still said in a previous Bariatric Times article, "It can be easy to forget to share the basics with PCPs because we, as bariatric professionals, know the basics so well." 3 This knowledge gap was recently demonstrated by Funk et al 4 in an article that identified the following five factors that made primary care physicians hesitate to refer patients for bariatric surgery: 1) wanting to "do no harm," 2) questioning the long-term effectiveness of bariatric surgery, 3) limited knowledge about bariatric surgery, 4) not wanting to recommend bariatric surgery too early, and 5) not knowing if insurance would cover bariatric surgery. The bariatric community as a whole has been working hard to address all of these factors, especially in regard to knowledge and awareness. One such event that is focused on educating other specialties about bariatric surgery is the National Obesity Summit on the Provision of Care for the Obese Patient, hosted by the ASMBS and led by Dr. John Morton, Chief, Bariatric and Minimally Invasive Surgery, Stanford School of Medicine, Stanford, California. The 3 rd Annual Obesity Summit is scheduled to take place in September 2016 and include representatives from more than 30 major health and medical organizations, including the following: American Diabetes Association (ADA), American Medical Association (AMA), American Society of Clinical Oncology (ASCO), American Heart Association (AHA) and American Academy of Orthopedic Surgeons. Collaboration with specialties can also be seen in the literature as we discover the ways in which bariatric surgery works on obesity-related comorbidities. When speaking to another doctor, target your audience with the weight-related comorbidity that affects them most. For example, you could discuss type 2 diabetes mellitus (T2DM) with an endocrinologist, citing literature on the benefits of bariatric surgery in improving this condition. If talking with a specialist in obstetrics and gynecology, you might discuss the connection of obesity to infertility and polycystic ovary syndrome (PCOS). When conversing with an orthopedic surgeon, it is helpful to mention how obesity contributes to joint pain. Aim to educate physicians about the safety of bariatric surgery too, so that they can help patients make informed decisions. Share information about insurance coverage and the resources that exist for those who don't have coverage for obesity treatment. In addition to data, your It is appropriate to first think about where patient contacts originate. My group has been tracking this for years and has discovered that 51 percent of our patients are referred by previous patients. These satisfied customers entrust their friends and family to us, and we consider their referral to be the ultimate compliment.

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