social media for fertility centers

Set Up to Fail: Fertility Clinics Not Structured for 2018

By Griffin Jones

Part 1 of a four part series on the main business challenges facing fertility centers because of the shift from "small clinic" to "entrepreneurial endeavor"

“Young doctors aren’t willing to work long hours,”

“Fellows today don’t have entrepreneurial chops,”

“New REIs don’t want to pay their dues.”

Millennial fertility doctors may sometimes be perceived this way

Millennial fertility doctors may sometimes be perceived this way

Have you ever made any of these comments or heard them said about your peers? It’s common to razz new subspecialists coming out of their Reproductive Endocrinology and Infertility (REI) fellowship. I often hear from recruiting physicians, that new REIs are not entrepreneurial. That they have no desire to take over a retiring doctor’s fertility center and run their own practice. It is said that fellows and new specialists want to work for someone else, clock their hours, and go home.

There may be valid points in this general perspective, but I see a much more comprehensive picture. Would you like to see what I observe from my semi-outsider’s vantage point? The radical statement to follow is the thesis behind the core business challenges with which so many fertility centers battle today.

The Tectonic Shift from "SMALL CLINIC" to "ENTREPRENEURIAL ENDEAVOR"

I don’t believe that many practice owners wanted to be entrepreneurs either. I suppose many physicians wanted to run their own fertility center and practice medicine the way they prefer. Is that unfair? Twenty to twenty five years ago, that may have been a tenable position. At that time, fertility specialists opened and operated small medical practices. Today, whether they like it or not, independent practices are entrepreneurial enterprises. We have sailed away from our calm cottage lakes, and onto the ocean of commercial venture. Here, our competitive threats come not only from other fertility centers, but from Wall Street, Silicon Valley, and a dynamically changing society. Canadian and European friends, this includes you too.

In this series, we’ll identify the main threats and challenges that fertility doctors, now accidental entrepreneurs, face in this new, unforgiving landscape.

  • Practice Business Structure
  • Vision and Strategy
  • Fierce Competition
  • Rapidly Changing Technology and Society

And we will force ourselves to answer the question we can no longer afford to avoid:

What is the plan?

Part 1: PRACTICE BUSINESS STRUCTURE

Independent fertility centers’ competitive challenges begin long before we even begin to think about marketing. Typically, they are inherent to the structure of the practice. If you own an IVF center run by fourteen employees, it may be tempting to ignore corporate structure. On the contrary, it is lack of structure that frequently keeps small practices from competing with large firms. Here we see the first differences between an REI practice, and a commercial endeavor.

A fertility clinic is run by a

  • Medical Director
  • Practice Director
  • Lab Director
  • Practice Administrator

Who runs the large corporations that are buying and operating fertility clinics across North America? Did you know that your new competitors are led by a C-Suite? They have a

  • Chief Executive Officer (CEO)
  • Chief Operating Officer (COO)
  • Chief Marketing Officer (CMO)
  • Chief Technology Officer (CTO)
  • Chief Financial Officer (CFO)
  • Chief Information Officer (CIO)
  • Chief Human Resources Officer (CHRO)
Entrepreneurial Operating System (EOS) Accountability Chart applied to fertility clinics

Entrepreneurial Operating System (EOS) Accountability Chart applied to fertility clinics

This isn’t to suggest that a four physician, twenty five employee IVF clinic needs to have the same corporate structure as their large competitors. They don’t. They need to run their company on a business operating system (BOS) if they want to articulate a vision, agree upon a strategy, and enable their entire team to achieve their collective goals. Fertility Bridge is run on an operating system called the Entrepreneurial Operating System (EOS). To clarify, I am not an EOS consultant, nor do I sell their services at this time. You can find another BOS or you can build your own, though I have no idea why anyone would want to start from scratch.

One of the strongest arguments of EOS is that there are three core functions in any business. In our field, we might split Operations into Medical and Lab, or even Compliance, but the three core functions are

  • Operations
  • Finance
  • Sales and Marketing

In most independent IVF centers, instead of planning for the three core business functions for which someone must execute, they are often bundled into “other” and dropped in the lap of the practice administrator. Is she or he expected to run the operations of the practice, account for the finances, recruit and manage team members and write and execute a complete marketing plan? Is she or he an expert on digital media, law, technology, workforce development, and corporate strategy? Is that fair? Is that realistic?

How many seats are you in?

Rather than hire someone for each of these roles right away, which most fertility centers cannot do, EOS helps with the concept of “one person, one seat”. One person can hold more than one seat, but one seat cannot be occupied by more than one person. This helps small practices flush out capacity related issues and step out of roles as they grow.

Take a look at an example accountability chart below. How many seats are you in? How many seats are unclear as to who is accountable for them?

Example Accountability Chart for fertility clinics.png

As an REI physician, in just one very busy seat, you probably have to perform

  • 150+ egg retrievals,
  • Several dozen intrauterine inseminations (IUI),
  • All other surgeries

Oh, and you still have to spend time with and respond to your patients.

While infertility doctors at corporate-run clinics can devote all of their working time to their "REI seat", you’re the Medical Director or Practice Director of your IVF center and you have many other roles. As the head of an entrepreneurial venture, you now have additional responsibilities to properly delegate or do yourself.

  • Implement the vision of your company
  • Hire and interview every employee
  • Execute the marketing strategy
  • Account for the finances
  • Run the operations of the office
  • Manage every member of every team

Simply delegating each of these responsibilities can be a full time job, let alone sitting in each individual seat. Again, independent practices don’t necessarily need dozens of employees to run the business side. If they want to maintain or grow their practice, they need to eliminate, automate, and delegate. [A wink to those practice principals that are still signing paper checks].

Is "control" hindering your practice's growth?

Something stops fertility centers’ teams from taking ownership of each of these responsibilities and taking them off of the practice owner’s lap. As one writer says, “Want to drive your employees absolutely crazy? Give them responsibility without authority”.

If we hire a Human Resources Manager, but she doesn’t have the authority to choose the payroll company, negotiate salaries, or make the final decision on hires, then the responsibility of Human Resources continues to consume our time and energy.

If we hire a finance officer, but this person isn’t able to choose the bookkeeping software, set pay dates, and decide the terms of Accounts Payable and Accounts Receivable, then we haven’t delegated finance.

If a practice hires a marketing director, but the marketing director doesn’t have creative control and isn’t given a budget and goals for which they are responsible, then the load of marketing remains in our lap.

How does it impact the growth of your practice if you and your partners deal in every facet of the business without clearly defined roles in an operating system? How does it affect the way you practice medicine? How does it weigh on your relationships with your patients, your team members, and your loved ones?

SHIFTING from "practice owner" to "visionary"

If this describes you or your partners, is it because you're reluctant to pass on control? When practice owners feel that that they need to manage every movement in the practice, it may be because there is not a cohesive culture behind a clear vision. By acknowledging the tectonic shift that has happened in the field of reproductive health, that independent fertility practices are in fact commercial enterprises, practice principals can step into the role of visionary. In the next part of our series on the difference between fertility practices and entrepreneurial ventures, we’ll see when a company follows an operating system, practice principals are able to chart a vision and plan that allows them to pass responsibility to their team and adapt their practices to our changing world.

Why did these 9 patients just leave word-of-mouth referrals for their fertility doctors on Instagram?

By Griffin Jones

**Fertility Bridge does not endorse any of the programs or doctors mentioned. They come from responses from our Instagram community**

"The only thing that matters is the lab"

That's what a board-certified reproductive endocrinologist (RE) told me over lunch at the 2016 American Society for Reproductive Medicine (ASRM) annual scientific congress. "The patient experience doesn't matter. The only thing that matters is if they get a baby or not." My efforts to show him all of the evidence to the contrary were fruitless. That was the end of the conversation. Why try to convince the inconvincible?

In some perverse way, it excites me when people are so neglectful of what our patient population demands. Meritocracy might be a lofty ideal, but I love working with fertility clinics who take IVF cycles from people who think like that. A slop-eating grin came over my face as I stared at his plate and thought of the perfect metaphor:

I'm going to eat your lunch.  

Who are they and what did people say?

Who are they and what did people say?

Satisfied don't mean delighted

A 2014 study by Software Advice states that 61% of patients evaluate their new doctor before their first appointment. Over 40% of new patients of Fertility Bridge clients confirm having read online reviews before scheduling their first visit. Nearly 30% say they were referred by a friend.

Bain's Net Promoter System suggests that patients can be divided into three categories across a satisfaction scale from 0 to 10. The single question is, "how likely are you to recommend our practice to a friend or family member?" Those who answer between 0 and 6 are called detractors. They actively discourage others from coming to your practice. Those who respond with a 7 or 8, are labeled passive, because their referral rates are less than 50% of those who respond with a 9 or 10. Finally, those who respond with 9 or 10 are promoters, people who sing the practice's praises to anyone who will listen. You can read more about using your practice culture to turn patients into promoters in Chapter 2 of the free e-book, The Ultimate Guide to Fertility Marketing.

I know many of these promoters very well. They brought me into the field of reproductive health in the first place. After all, people don't get so fired up after they buy a power washer from the Home Depot. So, among thousands of people in the trying-to-conceive (#ttc) community on Instagram, who are actively undergoing or pursuing fertility treatment I asked them the question. Would you recommend your fertility clinic, and why?

1). By Name in New England

Absolutely and I actually have. The first place we went to was terrible and I've shared that with people who have asked for recommendations. I wish I had done some thorough research beforehand but I wasn't aware how common infertility is and how many clinics were out there. The second place was beyond anything I could have hoped for! We saw Dr. Gargiulo at the Center For Reproductive Care (CRC) in Stratham, NH. We are less than an hour away from Boston which is home to some of the top hospitals in the country so we fortunately have a large number of places to choose from. The entire staff at CRC was absolutely fantastic.

I was greeted by name every single time I walked into the office and the nurses were amazing when it came to making the entire process less stressful and knowing when to crack a joke to lighten the mood. The thing that really set CRC apart was the welcome packet. In addition to the typical insurance forms they included an illustrated book that talked about how to talk to all of the different people in your life from co workers to your spouse. Also, they make sure to include that due to the sensitivity of this journey, no one under the age of 18 is allowed into the office for any reason. Reading that one policy was the moment I knew we had finally found the place that truly focuses on their patients and not their numbers.

2). Memorable in Montana

I totally would! I should mention, my RE and her partner are the only ones in the state. Even if she wasn't, I would still recommend her. Her name is Dr. Stacy Shomento with Billings Clinic. Dr. Shomento is in Bozeman, and that is the staff I know and love! She has a pile of patients, but always gives you lots of time and takes a personal interest in you. She also has a stellar, amazing, outgoing staff. Infertility is very personal and invasive. Having a comfortable relationship with the medical staff is a must for me.

She took the time to make personal connections and remembered us, not just our chart. Really, because RE's are so busy, you end up dealing a lot with your nurse, so they really need to be awesome.

3). Compassion in California

I totally would!!!! Coastal Fertility in Irvine, CA is the best! So compassionate. Dr. Werlin rocks!!! He's amazing!!!

4). Knowledge in New Jersey

I would. More specifically, I would recommend my doctor, even though all the doctors are great. Dr. Marcus Jurema from Reproductive Medicine Associates of New Jersey (RMANJ) is what every reproductive endocrinologist should be. I'm thankful I have him in my corner. My doctor is part of RMANJ and was originally with IVFNJ before the merge. I've had several issues with several staff members with both practices.

There's very little communication within the company within different departments (billing, nurses, etc). I'm sure that's because the company is just so big. With that being said, RMA has the best labs in the state, maybe the East Coast. Because of that, I can't leave. Plus, my doctor is amazing.

He teaches as he goes. He knows I need technical info, good or bad. I can't have anything sugar coated. I'm a medical assistant so I research everything. He knows that and will give it to me straight, while also holding my hand through the bad stuff. He's been with me from day one, with every cycle and every loss.

5). Benign in Boston

We switched doctors for our last round of IVF, but we stayed at the same clinic, IVF New England. The nurses are magnificent and since that's who you're interacting with the most, it's invaluable. I never felt like a number there, even though they're a bigger clinic. I always knew I was in good hands, even after 4 failures with my first doctor. It took me a long time to decide to switch. It broke my heart to try someone new, because I trusted him implicitly.

My new RE, Dr. Pauli is amazing. I don't regret not going to him sooner but I'm so glad I did. We were successful on our first round with him and I'm currently 11 weeks pregnant. I love that both doctors called with results of the bigger tests (pgd, era etc) and called to check in on us. Dr. P. called me once with results while he was on vacation.

I have nothing but good things to say about IVFNE. They're not perfect, and some of their methods aren't for everyone. But they are perfect for us. Even if we never got pregnant, I wouldn't feel any differently.

6). Education in the OC

Yep!!!! HRC Fertility in Newport Beach!! I think the best thing about HRC is the coordinator is amazing financing and they can do preimplantation genetic screening (PGS) with a fresh transfer. My doctor was very, very busy all the time, but he did give me pregnant the first time. He never did an ultrasound which I thought was odd but I love the girl who did my ultrasounds.

My doctor was always kind, and answered all my questions but the relationship was definitely not personal. I don't care about that; I want results, and he provides results.

My tech was wonderful because she would walk me through exactly what she was doing. During stims, she would explain what she was counting, what she was looking for, and what she saw. Same after I became pregnant. They followed me for 11 weeks.

7). Making changes in Maryland

Our first one, absolutely not. We were a paycheck at [a very large fertility practice group] and never felt like patients. Our RE told me that our son "must have been a lucky egg and I wanted to go cry in the car, go ahead". It was the worst year of my life. My new doctor, Dr. Mary Ann Sorra with Natural Fertility, actually held my hand when I was put under for a laparoscopy. It feels so nice to finally be cared about.

8). Looked After in Louisiana

Definitely. Arklatex Fertility and Reproductive Health with Dr. Vandermolen. I just felt like they're all so patient. Any time I had questions, I could call the nurse and she would call me right back. They knew me by name. The success rate for the doctor is pretty high, which is always a plus. When I first went to him, he told me what was going on. I felt like I had options instead of having him tell me what I was going to do.

9). Genial in Jersey

Absolutely! RMANJ, because of their lab. I was told I was going to be treated as a number, but on the contrary, I got to talk with my RE personally. He even called me right before my egg retrieval to know how I was doing. The nurse was always on top of things and answered me right away.

The transfer was very detailed oriented. They addressed yeast infections and progesterone levels while my previous clinic always dismissed my concerns.

"A great lab is necessary, but not sufficient"--Jake Anderson-Bialis

While I chose not to include the names of these volunteer promoters, they are perfectly willing to share their experiences with thousands of other people in the infertility community on Instagram. We often believe that people only recommend their IVF center online if they become pregnant or have a baby. We're told that they'll leave negative comments if they have a failed cycle, but research from Fertility Bridge and Fertility IQ show that that's not exactly true.

True for almost every fertility clinic review we read.

True for almost every fertility clinic review we read.

"No question, if a patient has a good result, they're more likely to recommend their fertility doctor/clinic," says Fertility IQ co-founder, Jake Anderson. "With that said, when we look at patients who had failed cycles, it's very clear who is likely to recommend the doctor, and who definitely won't."

It seems that the contrapositive is also valid; when we look at patients who've had successful cycles, it's clear who will be the source of future patients in the form of word-of-mouth referrals. Many people have success at their fertility centers and are "satisfied", but we see in these recommendations that it's compassion and personal connection that turn former IVF patients into zealous promoters of their practices. So the next time a competing fertility doctor tries to convince you that the patient experience is meaningless, and clinical outcomes are all that matter, don't feel disappointed when you can't change his mind. Eat his f'ing lunch.

_________________

For strategy on improving the patient experience, read chapter 2 of my free e-book, The Ultimate Guide to Fertility Marketing, by clicking the button below.

 

 

 

Flipping People's Peanuts at MRSi 2017: Everything is changing, and it's just the beginning

By Griffin Jones
 

This is my third annual recap of the Midwest Reproductive Symposium international (MRSi) , so I'm going to have a little fun with this one. I don't feel like writing another list and I think there's a more valuable point I can convey to you. As of right now, MRSi holds the title for my favorite meeting in the field of reproductive health and I want to use it nudge other meetings to follow suit. I should be a fair judge, I go to almost all of them.

It certainly doesn't hurt that it's on Lake Michigan in Chicago in the summer time, and Dr. Angeline Beltsos knows how to incorporate an interesting theme. Those are pluses, but not enough to make a meeting my favorite. It's big enough to have a diverse range of programming and small enough to be very collaborative and social. People get to know each other and build meaningful relationships. I truly understand how important that is for the field. Louise Brown, the first baby ever born from IVF was a guest at the conference. As Louise put it,

"My parents were willing to advance science and try something that had never been done before because they felt their doctors were truly there for them."

These reasons not withstanding, do you know what I really think MRSi holds over our other meetings in the field? It's the most forward-looking.

Other meetings sometimes do a great job of exploring the latest science and the future prospects for assisted reproductive technologies, but they often stop there. I believe that's a mistake. Compared to some of the technologies that are being developed both inside and outside of our field right now, PGS looks about as complicated as tying a shoe.

A Change Gonna Come. Oh wait. It already did.

Several presentations detailed the incredible growth of technology across multiple facets of society, not just ART. My own talk was titled The Biggest Change Ever in Human Communication: the Tech Revolution and Our Patients. The title isn't hyperbole. I made the case that we are living through a bigger shift than that of the printing press, perhaps even greater than the written word itself. If you would like the slides from my presentation, I will be happy to e-mail them to you. Here's the punchline: the supercomputer in every one's hand, that we call a smartphone, has changed dating, parenting, conversation, and commerce, for us and our patients. We have hardly begun to adapt our operations accordingly. And this is only the beginning.

Bob Huff, Chief Information Officer of RMA of Texas, shared with us technology that is changing the way generalists refer patients, and even the way patients are diagnosed. Scientists have just created functioning mouse embryos through 3D printing

My co-speaker, Hannah Johnson, Operations Director of Vios Fertility, and I, had the pleasure to speak to the mental health professionals group as well as the practice administrators' Business Minds group. We desperately need more of this inter-disciplinary kind of discussion because entire industries are being radically and forcibly changed. You'll forgive me for not using the popular buzzword, "disrupted". I prefer to put it more bluntly. Large institutions and established companies are losing double digit market share or going out of business in periods of 12-36 months. How does that sound?

"We could be looking at widespread clinic closures within the next 5-10 years."--Hannah johnson

I don't want that for this field. I started my career in radio advertising. I watched wealthy and powerful stakeholders go bankrupt because they were comfortable or because they weren't willing to invest time, money, and energy to adapt. As Dr. Francisco Arredondo from RMA of Texas says, "we produce one new fertility specialist per 10 million people per year". A need of such titanic portions is one that is begging for more technological disruption.

how can we learn if every effort is required to produce a particular result?

Broad social and technological change isn't a frame of mind that we usually allow ourselves to explore at most of our regional meetings throughout the year, or even at ASRM. It's a bit more welcome at MRS to question the status quo, and test new platforms and processes, without the scrutiny of the exact result that any particular effort might produce at the given moment. Elizabeth Carr, the first baby born from IVF in the United States, is now a marketing data consultant who also spoke at the conference. "I wouldn't be standing before you today if my parents and their doctors weren't willing to try something that had never been done before."

Virtually every area of medicine and practice management is ready to be disrupted by technology. We can wait for pain, or we can put in the effort and patience required to adapt to these changes. MRSi is the first meeting in our field where we're starting to think and talk in these terms. I hope it serves as an example for the others.

 

The 7 Steps of the Fertility Bridge Proven Process for Tracking IVF Marketing Results

How we measure and improve our KPIs (key performance indicators) in the fertility field.

How we measure and improve our KPIs (key performance indicators) in the fertility field.

how do we measure the return on investment (ROI) of an ivf marketing program?

Jackie Sharpe is Regional Marketing Director for HRC Fertility in Southern California. Once, at an Association for Reproductive Managers (ARM) marketing meeting, I asked Jackie, "Is it easier, or harder, to track the effectiveness of marketing today than it was several years ago?"

I could tell she had thought about it before. "It's harder," she replied.

Harder? We have every tool under the sun, from Google Analytics to every kind of Customer Relationship Management (CRM) software and marketing dashboard. We can track every click, page view, Instagram like, Yelp review...everything down to how many minutes the average visitor spends on our website. How is it not easier than ever to track our ROI? Yet, you know what? She's absolutely right.

It's harder to singularly track patient sourcing, not only in spite of these infinite tools, but partly because of them. The  avenues from which today's patient becomes aware of our services are virtually limitless. So too, are the factors that can influence her decision. We need a system, as opposed to a single figure.

indispensable indicators need to be analyzed together

In my last blog post, I wrote about the Six Indispensable Indicators that IVF Marketing is Doomed Without. There are six, because individually, none of them offer us a wholly accurate synopsis of our marketing results. Whether we use the hottest CRM, or an Excel workbook, tools do not replace our overall system for tracking and measuring results. Two examples explain why we report on multiple sources of data.

  1. Human Omission: About 1/3 of patients of Fertility Bridge clients do not fully complete their referral-source questionnaires.  Furthermore, the number of questionnaires entered by the practice is typically only 75% of the total number of new patient visits.  
     
  2. Limits to Digital Tracking: We track internet goals (i.e. appointment requests), but sources are frequently only attributed to the most direct channel. In simpler terms, an IVF clinic on the west coast hosts informational fertility sessions at their offices. When we run ads on social media, registrations increase. On the submission form, registrants overwhelmingly check Facebook or Instagram as the sources of how they came to hear about the event. Still, when we look at our goals in Google Analytics or Hubspot, a much smaller percentage are credited for coming directly from any one channel. 

Instead of relying on numbers that provide incomplete information, we use a proven system that includes our Indispensable Indicators. Functioning as a whole, the system allows us to measure and understand the effectiveness of our efforts, and subsequently, the money we're spending. These are the seven steps of the Fertility Bridge Proven Process for Tracking Marketing Results that we implement with each new client.

1). Put the right person in the right seat

Someone inside the clinic must own your Indispensable Indicators. If these data are not readily available and accounted for, then the marketing strategy operates aimlessly. This person is often the practice administrator. He or she may be the clinic liaison, marketing director, or billing manager. Ideally, this is someone who is fascinated with being a student of your practice's key performance indicators. If the person has neither the authority nor the capacity to implement all of the steps involved in the Proven Process for Tracking Results, the point is moot. Whoever is chosen, he or she is responsible for reporting on the Indispensable Indicators every single month.

2). Collect existing data

Because of clinical reporting, you likely know your clinic's IVF volume, year-to-year, but that doesn't tell us anything about our monthly progress. We still don't know what impact individual marketing efforts have had on profit and patient volume.  In this phase of the Proven Process for Tracking Results, we gather all of the information we have for our Six Indispensable Indicators and enter them into one file. It's likely that you don't have complete figures for all six indicators, but partial information is a start. If you use a practice software like eIVF, you may be able to readily pull some of these fields.

3). create uniformity

Even when clinics do record some of their necessary KPIs, we at Fertility Bridge often find that we're not comparing apples to apples. The way you define your Indispensable Indicators can be customized to your practice, but they must be defined to ensure continuity. 

Monthly recorded table of Indispensable Indicators

Monthly recorded table of Indispensable Indicators

1). Lead

Is a phone inquiry, a website appointment request, and an RSVP to a fertility seminar all worth the same?

2). New Patient Visit

Does this include patients who had a successful IVF cycle with your practice but come back for babies two and three? Only someone who comes to the practice for the first time? Phone consults? Couples (including same-sex couples)? Individual female patients? Male and female patients separately?

Define new patient visits so that there are no duplicate or missing appointment numbers.

3). New Patient Sources

One clinic on the east coast had "the internet" listed as one of four questionnaire options for more than six years. So of course, from 2010 to 2016 the number of people that came from the internet increased by nearly 70%. But the internet has changed a lot in six years. What does "the internet" mean? Online reviews? Referrals from friends through social media? Searching for reproductive health services?

Offer different referral sourcing options to which respondents check "yes" or "no" to reduce ambiguity.

4). IVF cycles: For business purposes, how do we define an IVF cycle? Starts? Frozen transfers? Once the cycle bills? Does our number include restarts? Cancellations?

Again, the objective is to avoid duplication. An IVF cycle, as it is billed, should be unique to a particular month.

5). IVF Conversion Rates

If New Patient Visits and IVF Cycles aren't uniform, this number will start to look really funky.

6). Gross Revenue

4). Set benchmarks

Once we have our figures, month-to-month, we have clear benchmarks from which to measure our progress. The more months of data, the more reliable the benchmarks. It typically takes Fertility Bridge clients at least three months to collect this data; it's not readily available.

5). Set Internet Goals

Marketing dashboard customized for fertility clinics

Marketing dashboard customized for fertility clinics

Many IVF clinics have appointment request forms on their websites, but most do not have goals set for these forms in Google Analytics. Using a thank-you page for these forms, we track how many appointment requests and contact forms we receive on a weekly and monthly basis. Depending on your practice's size, you may have anywhere from fifty to several hundred of these forms completed in a given month. The person in charge of your Indispensable Indicators  checks how many inquiries went on to schedule new patient visits. Once we know how many new patient visits lead to an IVF cycle, we can even assign dollar values to these goals. 

6). Link the appropriate online properties

All vessels must row in the same direction. When we run a pay-per-click campaign on Google, Bing, or Yahoo, for example, we sync with your website's Google Analytics account so that we can measure the effectiveness of your campaigns in one place. When we run Facebook and Instagram ads, we install a pixel on your practice's website to show us how our ads convert. It's another way of seeing how many people fill out a form submission when coming from these channels.

Tracking how many request appointment forms came from a Facebook campaign

Tracking how many request appointment forms came from a Facebook campaign

7). Collect Weekly. Report Monthly

Tracking these numbers at the end of each month would be a bear. It's much easier to record them as they come in. Weekly recording also provides greater accountability; we don't wait until the end of the month to realize that we are missing our Indispensable Indicators

the whole is greater than the sum of its parts

We have a year of data on IVF cycles, patient volume, and referral sourcing. At month 12, we feel comfortable making a shift in our marketing strategy. We decide to take half of the budget that we had spent on print advertising, and spend it on paid social media advertising. How do we track the return on investment of our new advertising campaign?

If we've only recorded one number, we likely won't be able to.  If between months 12 and 15, however, we have the necessary data to see

  • A 30% increase in new patient appointments.
  • An 18% increase in new appointment requests submitted from visitors coming from social media, and
  • A 50% increase in the number of patients who report coming to our practice after having seen us on social media

then we can reasonably conclude that that marketing campaign was successful.

In a vacuum, none of these figures give us enough information to gauge the effectiveness of our marketing efforts. Because there are so many factors for which to account, we implement one system to measure and understand them. Individually, they are incomplete, and can therefore be misleading. When we organize and rely on our Six Indispensable Indicators, however, our IVF marketing's return on investment becomes greater than ever.

For more tools and tactics on measuring your fertility marketing efforts, read chapter 2 of my free e-book, The Ultimate Guide to Fertility Marketing.

 

 

All In This Together: 4 Ways Practices and Patients Are Uniting Around Infertility Awareness Week

By Griffin Jones

If I asked you to name what comes between September and November, you might answer Breast Cancer Awareness Month (BCAM) before you say October. Is there any oncology center in America that doesn't participate in breast cancer awareness month? Is there anyone who doesn't recognize those pink ribbons? Over 1.5 million people participate in the Susan G. Komen races alone. With major partners like the NFL and Proctor and Gamble, the month is almost too popular; to the point where criticism is made that brands exploit the cause for their own profitability. Meanwhile, all the infertility community wants is recognition of their disease and the resources to treat it.  Yet of course BCAM is so much more widely known than National Infertility Awareness Week (NIAW). After all, statistics show that 12% of all U.S. women will develop breast cancer in their lifetime. That's dramatically higher than the 11.9% of women who receive infertility services within their lifetime. 

Oh.

Infertility lacks a giant brand champion, like the National Football League

Infertility lacks a giant brand champion, like the National Football League

Breast cancer is a serious disease that causes horrible hardship on millions of families. It deserves every bit of attention that it receives. I hope 2016 is the year when the infertility community acts in solidarity for the same.

NIAW 2016 is quickly approaching, April 24-30 (May 12-20 in Canada), and clinics and patients have a vested interest in spreading awareness about infertility. The lack of infertility awareness is one big problem that compounds many others. Practices have time and priority constraints that sometimes keep them from being fully active in their promotion of the cause. Those struggling with infertility have priorities of their own, and for some, infertility may be too personal of an issue to discuss with others. I understand; no one can tell you that you should talk about infertility in an open setting. It's a personal decision and one only you can make. It's worth examining, however, how obscuring infertility from the public eye compounds the other issues that come with it.

1). Social PRESSURE

"When are you going to have a baby?"
"Don't you want kids?"
"You can have my kids."
"You can always adopt."
"Just relax and it will happen."

People ask these questions because they know very little about the infertility journey. Comments like these are what spurred Tyra Banks and Chrissy Teigen to inspire the #stopasking hashtag in the fall of 2015. I know how much this bothers you because I see the companionship that forms around the #ttc (trying to conceive) community every time this pain point comes up. Some of the most popular themes that I post to social media are the articles that talk about what not to say to someone with infertility.

One of the most popular infertility e-cards on Pinterest

One of the most popular infertility e-cards on Pinterest

Discussing your plans for children makes for easy conversation...for someone else. Most of your friends and acquaintances have no idea how common infertility is or how painful such otherwise ordinary questions can be. I would have had no idea if I didn't work in the infertility space. I'm sure I would have made many of the same stupid comments, all with the best of intentions. If these conversations bring you great pain, it may be less painful to participate in the conversations that help educate people.

Social pressure may also be projected onto fertility clinics and their staff. When someone spends thousands of dollars on IVF, they are essentially paying you to solve their problem of infertility...problem...singular. Of course infertility actually becomes an amalgam of many problems. Because you are the one being paid to "solve the problem", by default, you can be assigned responsibility for all of them. By participating in the greater cause to address the social pressure that your patients face, you may be able to allay some of the pressure that you feel as well.

2). Financial BURDEN

At issue: far too many people think of infertility treatment as elective. Only 15 states mandate that insurances cover any kind of infertility treatment and of those, RESOLVE grades only five with an A.  Legislators and employers don't feel hurried to extend coverage because they don't perceive it as a great enough priority to their constituents or employees. If infertility was more widely talked about, and greater societal emphasis was given to its treatment, less cost would fall on you as a patient. It's a big deal when an insurance company tries to avoid paying for treatment of other diseases. If everyone you knew understood the severity of infertility, far more companies and states would mandate coverage for IVF and other services. Having to pay for IVF out of pocket is owed in no small part to a lack of knowledge about the disease.

States ranked by RESOLVE

States ranked by RESOLVE

Clinics, too, face financial limits when public understanding of infertility is poor. There are three reasons.

  1. Your "word-of-mouth" referral network is dramatically smaller than its full potential if your patients don't feel comfortable speaking about infertility. A patient cannot recommend you to someone who would really benefit from hearing about her experience if the conversation isn't welcome to take place. 
  2. People are sometimes terrified to see an infertility specialist, because they have insufficient information and a lack of assurance from confidants. Fear reduces the total number of people who should be coming to your office.
  3. Cost is the single greatest factor that prevents patients from proceeding with treatment for infertility. Dr. Tarun Jain of Chicago IVF finds that "in states where IVF coverage is mandated, about thee times as many people use IVF than in non-mandated states. It's about the same multiple seen in European countries which cover IVF." If infertility was enough of a public concern, your center could be doing three times the number of cycles that you  do now, and many of your patients wouldn't be overwhelmed with the stress of the cost.

3). Emotional STRESS

Many people going through infertility say they feel much better when they are able talk to others who can validate their feelings and experiences. "I am so happy to have found all of you" is a very common sentiment among the #ttccommunity on Instagram. Many more would love to connect with people who share their experience: they just don't know they exist. Not all support groups are equal and some types of support may be better fit for you than others. You may feel more comfortable face to face, or you might like an online setting with anonymity. Some may prefer not to connect with anyone at all, and that's perfectly fine, but everyone should be informed of their options. Most people struggling with infertility say that they found their support resources on their own. Neither peer support nor mental health professionals (MHP) can eliminate the burden of stress that accompanies infertility, but a lack of general attention to infertility lays an unnecessary barrier to emotional relief.

Photo from Good Housekeeping

Photo from Good Housekeeping

Emotional stress has even broader implications for practitioners than only their patients' mental health . According to a study by Courtney Lynch, PhD, MHP, of The Ohio State University School of Medicine, women with high stress levels had decreased odds of pregnancy of 29% compared to women with low levels. While there's no data to prove that greater emotional support will increase the likelihood of pregnancy, research from the University of Michigan Health System concludes that peer support helps reduce stress, isolation, and depression.

Equally, my research shows that only 2% of negative fertility center reviews mention a successful pregnancy or the birth of a baby. The contrapositive is true for positive fertility center reviews. What's interesting is that several dozen fertility doctors in the United States and Canada have very few negative reviews. We know that their success rates are not above 80%. For reasons not yet defined, patients feel they have other venues for venting their stress. Neither the clinic, nor the doctor, nor the nursing staff should be the focus of an individual's emotional stress, so it is in the practice's interest to empower patients to access other avenues of support if they so choose.

4). Medical Impact

A very common concern shared by reproductive endocrinology and infertility (REI) specialists is when a woman waits too long to be seen by a fertility doctor. Time can be a crucial factor in the process of fertility treatment and if a woman is reluctant to schedule an initial consultation, she may be equipped with less options later on. Melissa Campbell of the infertility awareness blog, Triumphs and Trials, shares that women dealing with infertility are often hesitant to see an REI because they are nervous that the doctor will pressure them into IVF.

"To me, it felt like a death wish," Campbell says. "I'm going to go [to a fertility clinic] and they're going to push me into IVF. I feel like I have to do everything possible before I even go see an RE"  

"We need to remove the perception that REI equals IVF," says Dr. Matt Retzloff of Fertility Center of San Antonio. "One of the trade-offs is, the longer we wait, the less tools we have in the tool chest to help out. We want to see you sooner. It gives us more options."

Is it a reach to say that clinics' success rates would improve if couples and individuals coping with infertility scheduled their first appointments earlier in life? Very generally, patients would have increased probabilities of having a baby if they were able to take advantage of more options and benefit from earlier detection. As a society, we can both receive and deliver better medical services if the public is more alert to the challenges of infertility.

Take action: #Startasking

It's time to team up. Practices, advocates, couples and individuals dealing with infertility, and their collective communities can act together to turn the tide to bolster understanding of infertility. This year, RESOLVE has laid the groundwork for a very powerful social media campaign. Instead of a theme that demands that people stop asking, the #startasking initiative addresses social stigma head-on, by encouraging people to learn more about infertility, its implications, and options for treatment. Working together, and taking advantage of the tremendous power of digital media, here are four ways to make National Infertility Awareness Week 2016 the most successful yet.

1). Snap those selfies
 People love to see their fertility doctors and nurses through social media. People love seeing IVF babies. People still struggling with infertility love to see their supporters from the #ttccommunity. Download the official NIAW selfie sign which includes a #startasking bubble to write in your #startasking topic. Here's the easiest way to approach the topics you'll pick for your #startasking questions. 

  • For clinics: What are the five most common misconceptions that your new patients have about infertility and treatment? These usually tie into patients' greatest fears. For example, if you find that your patients are reluctant to schedule an initial consultation because they are afraid that they will be pressured into using IVF, your post might be, "#startasking us about options other than IVF".
  • For people with infertility: This is your chance. You get to control the conversation for once. Instead of holding back tears because someone else took your conversation in the direction of when you will have kids, this is your opportunity to decide what you want people to know about your journey. 

2). Ask with video
Instagram video allows for fifteen seconds and there's no such limit on Facebook. For no cost, use your smartphone to record your video questions and post them on your own channels and those of others. Practices can both pose and answer general questions to and from their communities. People dealing with infertility can record their questions and answers and share them with both the #infertilitycommunity and their clinics.

3). Share each other's content
I normally don't recommend that clinics spend too much time on Twitter, but if you have a Twitter account, this is the time when it makes sense to post and share other groups' content using the #startasking and #niaw hasthtags. Share RESOLVE's posts on Facebook and Twitter. The #ttccommunity is very good at sharing content, even on Instagram where there is no native reposting function. Sharing one another's posts about #NIAW is a tremendous way to increase the visibility of the community.

4). Tag each other
I know I needn't say more, #ttccommunity. You are the best at tagging one another and bringing each other into the conversation. I hope that #startasking and #niaw make for a very meaningful dialogue for all of you. While fertility centers can't tag patients without the proper authorization, we can tag @resolveorg and other support resources, and even tag other clinics. Yes, competing fertility centers can collaborate on content distribution. Competitors joining forces for a specific cause is often very well-received, like when the three major news networks came together for the fight against cancer.  Patients find it reassuring and media outlets pay greater attention.

Push for The Turning Point

Nearly every problem we face in the infertility space is compounded when awareness about infertility is low. You face unfair social pressure and financial stress because not enough people are conscious about the devastation caused by infertility. Medical treatment is denied to hundreds of thousands of people every year. Other medical conditions have found tremendous recognition through their awareness efforts and the infertility world has an opportunity to unite in a way that benefits everyone and gains the acknowledgment it deserves. RESOLVE President and CEO, Barbara Collura, encourages "the entire infertility community to call attention to this disease. By asking the tough questions about infertility, we not only have an opportunity to raise awareness about this disease, but also to motivate all who are touched by infertility to commit to the cause.”

At the very least, National Infertility Awareness Week 2016 is an opportunity to gain more exposure for your practice and more understanding for your fight as a patient. As a specific time-frame with a specific goal, it is easy for the media and public to understand and support. More ambitiously, it could be a turning point in this long, exhausting struggle of an issue that people know so little about, or worse, doubt its seriousness. You don't have to hope that a major network reporter will pick up your press release and decide to cover infertility awareness week. We have the power to call attention to the cause with the content that we create. Our own social media efforts give us the distribution to reach beyond our immediate communities. Our creativity will determine how far it will go. Patients, practices, and advocates are coming together to benefit the entire field. 

 

3 Common Things Fertility Practices Do On the Internet that Make HIPAA Lawyers Cringe

By Griffin Jones

"We must all obey the great law of change. It is the most powerful law of nature."--Edmund Burke

In the summer of 2015, I asked my e-mail list of fertility doctors if if they had any questions about the Health Insurance Portability and Accountability Act (HIPAA) as it relates to internet marketing. Except I didn't write HIPAA. I wrote HIPPA. Thankfully, someone who read the e-mail, corrected me. I was a little embarrassed. I knew what the acronym stood for, but I still wrote it incorrectly. Why would I spell it that way? 

What happens when patients want to engage with you?

What happens when patients want to engage with you?

It wasn't until several weeks later that I realized why I would misspell such a commonly known acronym. It's because nearly everyone spells it that way. You may have made this mistake, I see it from physicians frequently, even on their websites (sometimes even from lawyers). Heck, even the Substance Abuse and Mental Health Services Administration misspells HIPAA. My observation isn't that we're all phonetic spellers, it's that we don't have a great deal of familiarity with such a broad legal statute.

Technology, culture, and the law

I don't envy your position of having to handle protected health information (PHI). So why, as a marketer, am I so interested in learning more about privacy regulations? Because technology moves faster than the law can possibly hope to keep pace with. I'll take this one step further; the way human beings annex technology into their daily lives moves faster than they can properly regulate it. We see legislation failing to keep up with assisted reproductive technology (ART) across the field. We see antiquated laws or delays in new regulations for driverless cars, music sharing, and even new currencies like Bitcoin. Why wouldn't we expect a similar legal lag in privacy and communication?

Unlike many disciplines in medicine, and contrary to what some people in our own space still seem to believe, fertility is an extremely social category. The #infertility hasthtag has been posted on Instagram 142,335 times--up 30% from when I reported on the rise of Instagram among the infertility community, three months ago. Patients post medical records with their practice and doctor's name. Sometimes they just say hello. When do we engage? When do we not?

The phrase "social media" does not appear anywhere in HIPAA, so we are left to turn to lawyers to interpret the law. That's why I interviewed seven of them. Their insight spans beyond my scope of internet marketing, and I suggest you educate your team on HIPAA because all of the attorneys agreed that training is the best way to prevent a breach. I recommend you consult your own attorney often and that is not me. I'm just someone who knows how infertility patients communicate and what they use to connect, which leads me to observe some scenarios in which fertility centers may be at risk of privacy law violations.

Be human, be careful

We have to imagine that future laws and statutes will have to be more explicit with rules of engagement between patients and providers in digital media and communication technology. I hope that legislators involve physicians, patient advocacy groups, and tech developers in their consideration of new regulations, because I worry that a lack of understanding in how communication technology is actually used could lead to limits on patients' free speech, and ultimately hinder the standard of care. Reservedly, I'm optimistic because millennials are only beginning to change healthcare and we are a demographic that demands online engagement. In the meantime, I am paying very close attention to how policies and technologies develop, so that we can continually adjust and evolve when called for. I'll say it one last time--I'm not an attorney. Talk to an attorney. Maybe I'm too conservative, but this is how I see the intersection of law, culture, and technology at this moment. From what I observe as someone who monitors the fertility marketing landscape, these are common mistakes:

1). Posting pictures of baby collages

In 2014, the New York Times published an article about fertility centers having to take down baby photos in their office because it is a violation of HIPAA to display any of the 18 identifiers of PHI without explicit authorization. 

18 identifiers of Protected Health Information; from  UCSF

18 identifiers of Protected Health Information; from UCSF

It seems that most of the fertility centers took down the baby photos, though they didn't necessarily have to. It is possible for you to post baby photos to your website or social media accounts and keep them in the office for public view. If you have a signed HIPAA authorization on record for every image in the collage or baby wall, for the purposes of external marketing and social media, you are allowed to post those pictures. If I were a betting man, however, my hunch would be that you have not done that.

2). Sharing pictures from the fertility center baby reunion. 

Trust me, I know how this hurts. The picture of everyone--team members, physicians, former patients, spouses, and adorable children--makes for the best fertility center cover photo of all time. Many of you have this very picture on your websites, place pages, and social media accounts. Again, unless you have a signed authorization from every single patient in the picture, this isn't legal. Would it be likely that the Office of Civil Rights (OCR) would take action against you? I doubt it, but I always play it cautious in this space. Just last month, a physical therapy provider agreed to pay $25,000 in fines for posting pictures of patients to their website without the proper authorization. This doesn't mean you can't post the incredible pictures of your wonderful baby reunion, it means you should have HIPAA authorization forms on-hand at the event. 

HIPAA Authorizations have six core elements:

  1.  A specific and meaningful description of the information to be used or disclosed.
  2. The name or other specific identification of the person(s), or class of persons, authorized to make the requested use or disclosure.
  3. The name or other specific identification of the persons(s), or class of persons, to whom the fertility practice may make the requested use or disclosure (i.e., the intended recipients).
  4. Description of each purpose of the requested use or disclosure. 
  5. Must contain an expiration date or an expiration event.
  6. The signature of the individual and the date.

And they must include these three statements:

  1. Individual’s right to revoke the Authorization.
  2. Clarification that the covered entity is not permitted to condition the provision of treatment on the execution of a valid Authorization. 
  3. Explanation that there is a potential that the information may be re-disclosed by the recipient of the information and that the recipient may not be required to comply with the Privacy Rule.

You can borrow an example of a simple authorization form from Tulane University Medical Group. Most of the people at your baby reunions really want you to use their picture. A socially appropriate way of asking their permission might be

  • "Hi everyone, we would hate to leave you out of our event photos, but we can only share them publicly if we have your authorization. Please come over to our table to sign the form if you'd like to be in the pictures." If you have a photographer on site, you may even consider having a team member accompany them with a clipboard of the appropriate forms. Don't worry, in an environment like your baby reunion, most people would be disappointed if you didn't ask.

3). Publicly responding with too much information

Often when I see this, it is in response to a negative review. Physicians sometimes refute complaints by using details to support their argument. This makes for poor marketing, atrocious customer service, and worse yet, it may be illegal. If any of the 18 patient identifiers can be traced to that person's review account (a full face photo in Yelp, a name on Facebook, and e-mail address on a Google account, etc.), that would be a breach of PHI. Please, please, please, resist the temptation to respond to a reviewer with any of their information.

This is an example of a potentially illegal, and otherwise awful way of responding to a fertility patient review

This is an example of a potentially illegal, and otherwise awful way of responding to a fertility patient review

To be fair, it is isn't only the negative reviews in which I see doctors and nurses respond with too much information. Sometimes, with the very best of intentions, doctors and nurses comment on a patient photo to the effect of "I'm so glad we could help you through this. That was such a hard time for you." We suppose this is of much lower risk than responding with too much information to a negative review; after all, do you think a person who was very upset with you wouldn't take the first chance they could get to file a complaint? But once more, I would rather play it safe. If you look at the way I respond to patients, I really don't even acknowledge that they were a patient at the practice. We want to be human, authentic, and emotionally sensitive in our engagements, but we also want to make sure we don't add any patient information. We can tell them their photo is lovely, thank them for their kind words, and wish them a great week. If it is a complaint, we can tell them we are sorry to hear that and we would like to hear more from them offline. That's it. Keep it very simple.

Pay attention and adjust accordingly

There is a lot of fear mongering on the web about privacy and patient engagement, and I'm concerned that practices will be afraid to engage their patients online, which is a critical part of patient relations in our connected world. Equally, extreme caution is necessary to protect the trust and privacy of our communities. Because we want to engage our patients effectively, authentically, and respect privacy laws, we have to be smart. You should consult with your attorney often because this is just one of the many areas of our field and our world that is changing faster than laws can keep pace with. I am guardedly optimistic that as new generations impact healthcare, more widely-adopted practices for patient engagement will establish themselves. In the meantime, we can pay attention to legal, technological, and social developments and continually evolve our policies and habits. 

What Are We Doing? An Interview on Forming Social Media Policy with Paul Anderson

By Griffin Jones

This is the eighth interview in a series that explores the implications of patient privacy and the effective use of digital media. This piece centers on the importance of forming a social media policy. Paul Anderson is director of risk management publications at ECRI Institute.

Paul A. Anderson

Paul A. Anderson

Jones: You don’t tell practices that they have to be on social media, but what do they need to consider?

Anderson: Your patients, colleagues, and even your competitors are using social media. You want to know what patients are saying. If it’s positive, you want to thank them and share that. If it’s negative, you want to be aware of what they’ve said. If you’re not participating in social media, you’re missing part of your constituency. If you’re not using it, they’re going to sail right past you. You’re not in the space where people are talking.

There is often worry from physicians about participating in that space where people are talking. What about the risk? What about privacy?

Providers have a lot of misconceptions and fears about HIPAA. And of course, there is cause for concern. You don’t want to identify a patient in any way without their authorization. It is much better to get patients to tell their own stories, because patients can tell their own story to whomever they want. Practices should consult someone who is experienced with HIPAA compliance. I also recommend thoroughly educating someone in the practice on compliance issues, and having that person in charge of advising the social media policy. That person can be the word of caution and help the practice be smart about what they are doing. The first thing an agency will look for when investigating a privacy complaint is to see if there was a policy in place. The second thing they’ll look for is, “did we teach anyone about it?”

Many fertility centers participate in social media, but have yet to put a policy in place. Where do they start?

They first have to identify their goals. “Are we just going to monitor or are we going to engage people? Who’s going to approve content? Who’s going to post? What is our voice? Is it formal and academic? Or informal and casual?” Depending on the size of the practice, an individual or a committee should be placed in charge of initiating and enforcing the policy. Someone needs to be in charge of posting, because if a practice has a social media account, but never posts anything, that doesn’t look very good. I’m in favor of being active by posting and promoting content. You only do that when you have a well-defined reason for doing that and goals to employ.

How should practices respond to negative reviews?

One first has to be aware of the risks. If the review is too hostile to address productively, it’s perfectly reasonable to just leave it alone. If it’s negative commentary, take that conversation offline. There’s a lot of high emotions. You don’t want to inflame the situation.  Your response may be as simple as, “We hear your concern. We value your feedback. We’d like to talk to you. Here’s our phone number.” You can get a sense pretty quickly if the situation is resolvable. If it’s not, you have to disengage and try to balance that with positive reviews.

How about responding to positive reviews?

It’s never bad to say thank you, or when someone’s said “thank you” to say “you’re welcome.” Keep it simple. You don’t want to say too much but you’ve got to engage. Social media is a marketing tool that isn’t one-way.

Who is a healthcare provider with an exemplary social media policy?

The folks at the Mayo Clinic really have one of the best social media presences in all of healthcare. They have a center for social media and educational boot camps and social media trainings for employees. They’re very active on social, you can follow them almost everywhere. Their policy and their practices in place are really great resources.

But how does a small fertility practice implement a good social media policy?

Whoever’s going to spearhead this initiative better know how to use social media. Familiarity with the platforms and their nuances is necessary in order to be able to use them to effectively communicate. Define why you are going to use social media, first. If you can articulate that clearly, that will drive the rest of your conversation.

Paul Anderson is the director of risk management publications at ECRI Institute, an independent, non-profit, research institute that works with all sizes of healthcare providers from single practitioners to large research hospitals. They help practices with risk, quality, and patient safety management. You can learn more about ECRI Institute and their services here


Avoid Common HIPAA Violations: An Interview with George Indest

By Griffin Jones

This is the seventh interview in a series that explores the crossroads of the Health Insurance Portability and Accountability Act (HIPAA) and digital media.

George Indest

George Indest

George Indest practices healthcare law in Florida and across the country. Mr. Indest’s comments don’t provide legal advice, but they do offer us some insight on how the Health Insurance Portability and Accountability Act (HIPAA) impacts digital media for fertility centers. I asked Mr. Indest about some of the more common mistakes that practices have made to lead to a HIPAA breach.

Indest: Very often, breaches are inadvertent disclosures of protected health information (PHI) to people who didn’t have authorization to view it. Unauthorized disclosures may even include the patient’s immediate family members. Unless the patient has signed a HIPAA authorization for their family members to be able to view their information, the provider cannot release those records. There are several inadvertent mistakes that lead to HIPAA breaches, often including unintended recipients of patient information. This can include sending or forwarding an e-mail to the wrong person, replying to all instead of to an individual, or sending a fax to a recipient whose number is only one digit different from the intended recipient.

What happens when a patient releases their own information on a blog, place page, or social media channel operated by the practice?

The patient is free to release whatever information they want. That in no way effects the practice or the covered entity. I know of no legal obligation to take down patient posts. If the channels are open to the public, it’s the patient’s right and decision to disclose that information. That’s not covered by HIPAA. But, if the channels are open to the public, the covered entity needs to make warnings available that the practice does not have control over who can see that information.

What are the implications when the practice responds to the patient? Does a general response disclose a patient-physician relationship?

I don’t think there’s any sort of violation at all in a response that doesn’t contain PHI. Social interactions take place between patients and physicians all the time. There’s no breach of anyone’s confidentiality unless medical information is discussed. With that said, I have read of breaches wherein a practice responded to a patient’s Better Business Bureau (BBB) complaint and disclosed some of their records to refute the complaint. This is an unauthorized disclosure of PHI and a clear HIPAA violation. The patient is free to release whatever information they want, but that doesn’t authorize the practice to do the same. Even if it is a positive review, where the practice wants to share or retweet information that the patient has already made public, it would be on the safe side to get HIPAA authorization.

What should healthcare providers be doing right now to ensure HIPAA compliance?

The Office of Civil Rights (OCR) and the Department of Health and Human Services (HHS) have indicated more HIPAA audits and investigations. There are more law suits and more complaints of breaches than ever before. Personnel need constant training. They need constant reminders of HIPAA risks. Go overboard in your risk assessment and risk management. There are plenty of plaintiff attorneys looking for suits and there are plenty of things that shouldn’t be occurring. Personnel not directly involved in a patient’s care should not be viewing that patient’s records, and it’s a risk that happens far too often. Education and training need to be provided on an ongoing basis.

George Indest is the principal of the Health Law Firm in Altamonte Springs, Florida. The Health Law Firm, concentrates in representing health care providers, exclusively. Their attorneys include those Board Certified in Health Law. If you would like to learn more from George’s legal expertise, you can contact him here.

Start With The Law: An Interview on HIPAA and Social Media with Paul Hales

Paul Hales

Paul Hales

This is the fourth interview in a series exploring the implications of the Health Insurance Portability and Accountability Act (HIPAA) as it relates to digital media.

Paul Hales is an attorney from St. Louis, who specializes entirely in HIPAA law. Mr. Hales’ comments do not contain legal advice, but they do educate us about some of the risks that face fertility centers with respect to HIPAA and social media. Mr. Hales gives us some background on the Act.

Hales: We have to start with the law. My focus is on enabling practitioners to make use of social media and comply with the law. HIPAA was passed in 1996 with two objectives;

  1. To be able to keep insurance when switching from one provider to another.
  2. To have a uniform code for information and payment

It has had further additions since.

  • The privacy regulations were added in 2003. 
  • The HIPAA security rule was added in 2005 
  • HITECH was passed in 2009. 
  • In 2013, the Omnibus rule was added to HIPAA to extend liability to “business associates”.

What is a business associate?

A “business associate” is a person or entity that performs certain functions or activities that involve the use or disclosure of protected health information on behalf of, or provides services to, a covered entity.

What are common areas in which covered entities and businesses associates fail to meet HIPAA compliance?

  • Protected Health Information (PHI) is made up of 18 identifiers, including but not limited to name, e-mail address, full face photos, and date of birth. 
  • Under HIPAA, every health care practice or organization must designate a privacy officer. The privacy officer must perform a risk-analysis.
  • Health plans and covered health care providers are required to develop and distribute a notice that provides a clear explanation of privacy rights and practices with respect to patients’ personal health information.

What about when a patient posts their own information on a blog, social media channel, or place page operated by the practice?

It’s important to look at how HIPAA defines a website, which is any site that provides information about a covered entity’s services or benefits. Therefore, if a patient posts their own information to a site that’s owned by the practice, that is unauthorized PHI on the practice’s site. The practice has to obtain HIPAA authorization before allowing any patient content to be published to its sites.

What is necessary in a HIPAA authorization?

HIPAA Authorizations have six core elements:

  1.  A specific and meaningful description of the information to be used or disclosed.
  2. The name or other specific identification of the person(s), or class of persons, authorized to make the requested use or disclosure.
  3. The name or other specific identification of the persons(s), or class of persons, to whom the covered entity may make the requested use or disclosure (i.e., the intended recipients).
  4. Description of each purpose of the requested use or disclosure. 
  5. Must contain an expiration date or an expiration event.
  6. The signature of the individual and the date.

 

A HIPAA authorization must also include three statements.

  1. Individual’s right to revoke the Authorization.
  2. Clarification that the covered entity is not permitted to condition the provision of treatment on the execution of a valid Authorization. 
  3. Explanation that there is a potential that the information may be re-disclosed by the recipient of the information and that the recipient may not be required to comply with the Privacy Rule.

What should fertility practices be conscious of right now to minimize risk of HIPAA violations?

Recently, there has been more enforcement, and soon there will be audits. On February 16, 2016 the Office of Civil Rights (OCR) settled an enforcement action against Complete P.T., Pool & Land Physical Therapy, Inc. for impermissibly disclosing patient information in the form of testimonials on their website. HIPAA is a very extensive law. There is a lot of information on the internet that is simply wrong. HIPAA regulations are very demanding and products cannot ensure compliance. No product can be HIPAA compliant. It’s how a covered entity uses a product that makes it compliant or not.

Paul Hales is an attorney who provides legal services and consultation regarding HIPAA compliance. His software, the HIPAA e-tool helps covered entities and business associates with a complete HIPAA compliance solution. If you’re interested in an educational webinar with Mr. Hales, you can register here.

1 Big Unexpected HIPAA Risk Facing Fertility Centers Online: An Interview with Rachel Yaffe

By Griffin Jones

This is actually the second interview in a series exploring the Health Insurance Portability and Accountability Act (HIPAA) that I recorded in August of 2015 and published in September. The Fertility Bridge blog was not active in its current form, then. I wanted to make sure this interview was in the blog archives because (speaking for myself) HIPAA is not always as common sense as we would like it to be. Rachel Yaffe practices healthcare law in Chicago. Ms. Yaffe's comments are not legal advice, they simply offer us some insight into how HIPAA might impact a fertility center's digital media strategy. In this interview we discuss

  • What are the implications when a patient posts their own information on a fertility center's website, place page, or social media channel?
  • Should practices follow patients on platforms like Twitter and Instagram?
  • Should practices have personal Facebook pages for their business?

Rachel Yaffe represents physicians, medical practices, laboratories, pharmacies, and other healthcare clients in corporate, transactional and regulatory matters. She practices with the firm, McDonald Hopkins in Chicago. If you would like to learn more about HIPAA compliance from Rachel, you can contact her here.