Strategy

The Battle for the IVF Market: 5 Wall Street backed companies vs. private practice

By Griffin Jones

In Venture Capital fertilization

Part 3 of a four part series on the main business challenges facing fertility centers because of the shift from "small clinic" to "entrepreneurial endeavor"

Multi-million dollar private equity firms offer fertility practices an ultimatum: sell part of their practice, or have their market-share siphoned away.

Major firms spend hundreds of millions of dollars nationwide because they are in a race to consolidate as much of the fragmented IVF market as they can. This is only to speak of companies who own and operate networks of fertility clinics. In parallel, in 2017, PitchBook tallied more than $178 million invested into startups developing fertility products. In our series about fertility practices’ tectonic shift from small clinic to entrepreneurial venture, we’ve detailed the challenges that independent fertility practices face that their big new competitors don’t. So who are these new titans, and what are they up to?

 Merger and acquisition pattern of fertility centers

Merger and acquisition pattern of fertility centers

Important disclaimer: Neither I, nor Fertility Bridge have a direct commercial relationship with these companies at time of writing, though we certainly may in the future. We work or have worked with clinics in some of their networks. This profile is not a revelation of insider knowledge. Rather, it is a curated synopsis of public information. My observations and opinions are exactly those, based on information that has been publicly released by these companies or covered in the press.

compete with or join them. just don't pretend they don't exist

deciding to sell fertility practice

I have good friends that work for these companies or have affiliated their practices with them. Some might be very happy with their corporate partners and some might not be. It could be an excellent decision for your practice to sell equity to one of these firms or engage in a different level of strategic partnership with them. For some practice owners, a relationship with one of these firms is the answer to a lot of headaches. The stress of operations is shared with someone else, so providers can focus on practicing medicine.

Other practice principals feel they would lose control over the way they treat patients. They have their own vision for their culture and operations. If you’ve been struggling with this decision, I suggest reading part 2 of our series on vision and strategy, to see where you stand. This might be a long conversation, or several, with your business partner, spouse, clergyman, or bartender. You have to make the decision that’s right for you, your family, and your practice. There’s no right or wrong answer in a vacuum. Whether you decide to fight ‘em or join ‘em, however, we just can’t pretend these major new players don’t exist.

Second important disclaimer: It can be very fashionable to say these companies are more interested in their quarterly profits than the best interest of the patient. There may be cases when business pressures affect personal care. But I would be just as quick to point out that these companies might better serve patients in certain areas because they are better suited to face the challenges that we talked about throughtout this series. Their bankrolls may come from Wall Street, but the people that I know that work for these fertility networks are just as passionate about serving patients as those in private practice. Nevertheless, neither you, nor I, nor they get to pass final judgement on the quality of their output. The patient market decides.

The (Relatively) New Kids on the block

If we covered all newer companies in non-direct competition with fertility practices, this blog post would be longer than Don Quixote. In this article, we profile those networks who directly compete with other fertility centers. We also learn about the private equity firms behind them. Once again we ask ourselves, what is the plan?

Now let’s meet the people who want to buy you out or blow you over.

1). PRELUDE FERTILITY

 Fertility acquisition strategy

Fertility acquisition strategy

Prelude Fertility splashed into reproductive headlines in the fall of 2016 when Forbes magazine reported on The 200 Million Dollar Startup That Wants to Stop the Biological Clock. Where does a startup get $200 million and how have they acquired market-share so quickly? Meet the war chest and strategic acquisitions behind Prelude’s rapid market entry.

  • Lee Equity Partners. If Prelude’s coffers total $200 million, and Lee Equity’s buy-in was in line with their disclosed portfolio, then one might speculate that 25 to 50% of Prelude’s initial funding came from Lee Equity Partners. Massive capital from Lee Equity Partners has allowed Prelude to accelerate their acquisition of existing companies, and have they ever.
     
  • RBA. In October 2016, Prelude reported that it had acquired Reproductive Biology Associates (RBA) of Atlanta. RBA is the largest IVF practice group in the state of Georgia. Perhaps more importantly, RBA came with their sister company, My Egg Bank.
     
  • MyEggBank was created by RBA in 2010. According to their corporate timeline, their affiliate network grew from 22 clinics in 2012 to 109 in 2017. They report that over 4,400 babies have been born from MyEggBank donor eggs.
     
  • Vivere Health. Why buy one IVF lab at a time when you could acquire several at once? In a parallel running story, Prelude reported acquiring Vivere Health in October 2017. Vivere Health, LLC was founded in 2010 in partnership with Houston Fertility Institute. After an impressive acquisition journey of its own, Vivere Health had owned and operated IVF clinics and labs in
    • Austin
    • Dallas
    • Houston
    • New Orleans
    • Florida
    • Arizona
    • Kentucky

In April 2016, Vivere was listed in Fortune Magazine as one of the fastest growing female-owned companies in the United States.

Prelude says that their strategic goal is national scale. With a few more acquisitions of this pattern and magnitude, they will have achieved that end.

2). IVI RMA Global

If you’re less familiar with European originated IVI , Reproductive Medicine Associates (RMA) might ring a bell.

  • IVI was founded in Valencia, Spain in 1990. They own subsidiaries in genetic testing, IVF lab consulting, research and development, and stem sell banking, to name a few. In 2016, IVI owned and operated 60 clinic locations in 11 countries and treated over 60,000 patients.
     
  • Nova IVI. Major fertility networks aren’t relegated to the United States. They come from all over the globe and their expansion is international. In April 2012, IVI acquired Nova Pulse IVF and now owns and operates one of the largest fertility networks in India. Nova IVI reports over 19,000 IVF pregnancies in India alone.
     
  • RMA. According to their own PR announcement, RMA of New Jersey grew 70% in new patient volume from 2012 to 2017. I am unclear on RMA of New Jersey’s exact relationship with other RMA network clinics in the United States. Clinics under the RMA name operate in
    • New Jersey
    • New York
    • Pennsylvania
    • Florida
    • Connecticut
    • Michigan
    • Texas
    • Florida

In February 2017, IVI announced that their merger with RMA of New Jersey would make them the largest fertility network in the world. In a horridly translated press release, IVI reports that they own 70% of the new company while RMA of New Jersey owns 30%. They mention their combined 2,400 employees, including 200 physicians and 300 research scientists across 70 clinics in 13 countries.

3). INTEGRAMED

Integramed Fertility’s model is different from many fertility networks. Private equity is only one of three relationship models for Integramed. They also sell services for marketing and practice management that do not involve taking equity in the practice.

  • Integramed Fertility is a division of Integramed America and they report to be the largest fertility network in North America. With 2,200 employees and affiliate employees, the network is comprised of 39 centers at 153 locations across 32 states and the District of Columbia.
     
  • Attain Fertility. Integramed owns Attain Fertility, a patient-facing IVF finance program. They offer multi cycle programs, multi cycle programs with refunds, and bundling with additional services such as PGS and third party services. Subsequently, Attain functions as a lead generation company. Patients can search for Attain Fertility member clinics by doctor or by geographic area and Attain funnels those new patient leads to the clinic. Their business model is similar to that of ARC Fertility.
     
  • Sagard Holdings. Similar to how Prelude Fertility acquires practices through the funding of Lee Equity Partners, Integramed’s capital comes from Sagard Holdings. Integramed had been a publicly traded company, but Sagard reportedly took them off of the Stock Market in 2012 for just under $170 million.

4). OVATION FERTILITY

Ovation Fertility was founded in 2015 by physicians at Texas Fertility Center after a “major private equity investment to form a national network of assisted reproductive technology (ART) labratories”. At time of writing, Ovation Fertility owns and operates six IVF labs in five U.S. states.

  • California
  • Texas
  • Louisiana
  • Nevada
  • Tennessee

The private equity manager behind Ovation's capital is MTS Health Services.

 May meritocracy win all in the competition for best serving the patient population.

May meritocracy win all in the competition for best serving the patient population.

5). CCRM

The Colorado Center for Reproductive Medicine, CCRM as you fondly know them, enters new markets by acquisition like everyone else. Perhaps more than the other groups, however, CCRM enters new market areas through De Novo clinics. This means they help develop new labs and clinics in strong markets. In recent years, CCRM has opened or acquired IVF labs and practices in

  • Atlanta
  • Boston
  • Houston
  • Minneapolis
  • New York
  • Northern Virginia
  • Southern California
  • San Francisco Bay Area
  • Toronto

CCRM markets their lab advantages in every one of their markets. Since 2015, the private equity behind CCRM’s expansion comes at least partly from TA Associates in Boston. TA reports having raised over $18 billion in capital across their portfolio.

HONORABLE MENTION

In this article, we’ve only talked about your direct competitors. There are more companies from China and elsewhere that are buying fertility practices at high multiples that I don’t know very much about. There are large practice groups without private equity that acquire other clinics into their group. We didn’t even mention the new competitors that siphon market-share by offering new solutions or focusing on particular services. Here are just a few:

You don’t need to find Indiana and Arizona on a map to see that Boston IVF has interest in expanding beyond the northeast. Boston IVF is the “preferred provider of fertility services” for 15 different major health insurance plans. Boston IVF is the clinical affiliate of the Beth Israel Deaconess Medical Center and Harvard Medical School REI fellowship program. How would you like that advantage for recruiting new physicians? If there is a private equity firm associated with Boston IVF, I didn’t find it.

WHAT DOES IT all MEAN FOR YOU?

What’s a good ol' independently owned fertility practice group to do? Is there an opportunity for you to compete and thrive in this radically different world? You might look at regional banks or craft breweries. A century ago, every city in North America boasted their own local brewery, likely several. Beer became commoditized, and the corporations with the best distribution, market share, and financial leverage acquired or vanquished their competitors. By the 1990s, we were left with Anheuser-Busch, Miller, and Coors. South African Breweries  purchased Miller  and Molson-Coors (another merged mega conglomerate) in 2008 to become SABMiller-Coors, and finally merged with Anheuser-Busch/InBev (another merged mega conglomerate) in 2016 .

The past twenty years should have been a terrible period to start a brewery. Yet, quite to the contrary, independent breweries opened all over the country and took marketshare from the big players, now at 23% . Middle market companies like Sam Adams and Yuengling grew their own sales and grew by acquiring small breweries. The cycle continues. We see the same pattern among regional banks, and I believe we are seeing it in our field as well.

Small practices join together to become mid-size practices, and large companies acquire both small and mid-size groups. Then, physicians leave big practice groups and academic institutions to start the cycle anew. (I’ve got my eye on you, Vios Fertility). I don’t believe that all independent practices will be acquired or wiped out. The current and coming landscapes are just exceedingly difficult for unintentional REI entrepreneurs.

if you can't beat 'em, join 'em

when fertility centers join big practice groups

What will happen if you're unprepared for these competitors when the next economic recession starts? What will you do if 30-40% of the money in the marketplace goes away, seemingly over night? What would that do to your IVF volume? To your new patient visits?

Entrepreneurial competition isn't the only answer. It might make sense to sell equity in your practice or control of your lab. It could be the answer to a lot of your problems. One of the companies profiled in this article might be a great fit for your office. If we want to sell our practice, and want to go into the negotiation with “strong upside”, plenty of options, and not as a “distressed asset”, what is the plan?

if you can't join 'em, beat 'em

Nick Foles superbowl.jpg

On the other hand, the idea of giving up control and direction of your practice might eat you alive. Only you can make that decision. By taking market-share from big competitors now, as opposed to letting them take ours, we can prepare for an economic downturn in which we will not only survive, but thrive. If we are going to defend and grow market share against majorly funded competitors, what is the plan? 

We’ll conclude our series on IVF centers’ tectonic shift from small healthcare practice to entrepreneurial venture with perhaps their greatest challenge of all. Yet, it’s also their greatest opportunity and their chance to beat their giant new competitors where they lag.

In Part 4, we discuss the biggest change ever to occur in human communication and technology.

The one that dwarfs the revolution of the printing press.

The one we're living through right now.

What is the plan?

A New Vision and Different Strategy for IVF Centers to Thrive Beyond 2018

By Griffin Jones

Part 2 of a four part series on the main business challenges facing fertility centers because of the shift from "small clinic" to "entrepreneurial endeavor"

We might criticize REI fellows for not wanting to take over existing IVF practices, but they are making the same decision that current practice owners have made for decades. They are deciding to be doctors and not CEOs. At the time, starting an independent practice didn’t mean launching a commercial enterprise. The difference is that new doctors know they can’t get away with that today.

 Organizational leadership is an issue at many fertility practices

Organizational leadership is an issue at many fertility practices

In Part 1 of our series on the contemporary fertility practice’s shift from “small, independent healthcare practice”, to “entrepreneurial venture”, we discussed the traditional model’s outdated business structure. Now, in Part 2, let’s talk about how the leadership atop that structure dramatically affects a fertility center’s ability to do business today, leave alone tomorrow. We’ll discuss eight critical elements of vision and strategy, and we’ll deeply explore those with which IVF centers tend to have the most trouble.

A new vision and different strategy needed for fertility centers

We mentioned that the Practice Director is in charge of an IVF clinic, where the CEO is tasked with the overall responsibility of creating, planning, implementing and integrating the strategic direction of an organization. But what happens when infertility clinics don’t have a clear vision in place? Here are some real life examples:

  • One partner wants to sell his share of the practice to a private equity firm but his partner wants to remain independent.
  • The practice principal wants to increase fertility preservation, bur the rest of her team knows very little about this initiative.
  • Practices jump from one marketing venture to the next, wasting time and money because they aren’t making their advertising work toward their vision.
  • Business development projects are started and abandoned because practices have few benchmarks in place and consequently don’t accurately measure if they’re moving toward their goal.

“Hope is not a strategy,”—Rick Page

Do any of these problems resonate with your practice? We’ve accepted that the head of our company, Principal, Founder, CEO, President, or whatever we choose to call it, has responsibilities that extend far beyond the role of physician and even that of Medical Director and Practice Director. Now visionaries can lead their practices in ways that allow us to super-serve their patients and grow. The leader of a company identifies, articulates, and plans its

  • Core Values
  • Core Focus
  • 10-year target
  • High Level marketing strategy
  • 3-year picture
  • 1-year plan
  • Quarterly Priorities
  • Issues

All of these tenets are essential, with the priority starting at the top of the list. Some we will link to external sources for further reading, because we need to spend more time with the most common principals with which fertility clinics struggle.

1). Core Values

I’ll wager that your values are far more compelling than those of the average business. After all, you’ve devoted a career to helping loving parents create life. But how do you articulate your values to your team, to patients, and to the public? We work in a field that is both being changed by society, and changing society…rapidly. How do we stay true to who we are and what we believe while being able to adapt? When core values are true and defined, leaders make hiring decisions that allow them to unload responsibilities and feel comfortable that their practice is in good hands.

2). Core Focus

Your Why and Your What. Purpose, passion, and cause combined with your niche. The more closely aligned employees are with Core Focus and Core Values, the more prepared they are to make decisions in the best interest of the practice, and the less practice owners need to micromanage.

3). 10 Year Target

Where one wants to be in ten years is the destination from which the rest of the roadmap is drawn. This is where fertility centers frequently fall off track. Do you want to open more offices or labs? Do you want to attract patients from overseas? Do you want to pilot a technological solution? You may notice that we can’t move to the next core tenet of Vision and Planning, the High Level Marketing Strategy, until we have solid long term goals.

 Original fertility marketing consultant, Yogi Berra, on strategic growth

Original fertility marketing consultant, Yogi Berra, on strategic growth

In the same week, I received two calls from two different fertility doctors who had the same question, “how much money should I spend on marketing?”

A million dollars. A couple thousand dollars. My answers to each of them were starkly different.

The first doctor was in his early sixties. He works for a larger practice group and does a little bit of marketing for himself. He’d like to perform seven or eight more egg retrievals per month. He plans to retire in the next two years.

The second physician just completed his REI board certification in the United States. He’s in his early thirties. He wants to move back to Latin America to start a large IVF center that draws patients from the United States, Canada, and Europe.

These are two vastly different long-term targets that dramatically impact who they will hire, how they will build from patient feedback, and how they will market. The 10 Year Target could be the most measurable differentiator between visionary entrepreneurs and independent physicians. Fertility practice groups without a defined long-term target are finding themselves directed by the demands of the day instead of concentrating their resources on becoming who they want to be. Entrepreneurial Operating System (EOS) founder, Gino Wickman, says that the 10 Year Target is not the time to be conservative. Dream big for the best version of yourself and your practice.

4). High Level Marketing Strategy

Do we know who we want to serve and what we mean to them? Is our 10 Year Target defined? Great. Our High Level Marketing Strategy involves doing whatever it takes to get there, within our core values and core focus. It details our

  • Goals (obtained from 10 Year Target, 3 Year Picture, and 1 Year Plan)
  • Benchmarks
  • Unique Marketing Position (obtained from Core Values and Core Focus)
  • Practice Brand
  • Content Strategy
  • Distribution Strategy (advertising)

Benchmarks

Many practices want to jump right into marketing without having reliable benchmarks or key performance indicators (KPI) to plan their strategy. Without them, money and effort may be wasted.  If you’ve ever spent money on advertising and aren’t sure of the results, revisit your KPIs. Do you have access to all or any of these Indispensable Indicators?

  • New Patient to IVF Conversion
  • Phone Call to New Patient Conversion
  • Online Contact Forms to New Patient
  •  Cost Per New Patient
  •  Patient Life Time Value
  • Cost Per Lead

We are data-driven marketers. Results must be measured as accurately as they can be. If you need help calculating your Indispensable Indicators, read Chapter 2 of The Ultimate Guide to Fertility Marketing.

Brand

If you feel like you can’t trust your employees or marketing partners with your message, you may need to document your practice's brand. At the Midwest Reproductive Symposium international (MRSi) in June 2018, I will be giving a branding workshop for fertility centers with branding expert, Mara Lucato. Here’s a glimpse of my thesis.

Brand is being known to the people we serve: how and why we help them with their problems. Logos, color schemes, and slogans, are relevant, or not, in so far as they help us achieve that end.

In our case, we have a community of people that desperately needs our help. In many cases, they don’t know who we are or how we can help them. Our brand and our high level marketing strategy involve providing them with as much value as we can, and then making it as easy as possible for them to do business with us. It includes

  • Connecting them with peer and professional support
  • Educating them
  • Encouraging them
  • Standing up for them

We are charged with making sure that everyone in our region knows that infertility is a common medical issue. That people struggling with infertility are human and their problem is human.
They need to know that we are the ones who will help them. That is a fertility center’s brand.

Content and Advertising Strategy

A fertility practice’s High Level Marketing Strategy activates its brand by delivering its message across the platforms on which patients spend their time and attention. The platforms, and consequently the methods, change. 15 years ago, creating an infertility support blog was a game-changer. 10 years ago, having a Facebook page was a tremendous way to reach new people. Three years ago, Instagram stories and Facebook Live didn’t exist. Today, they are among the best ways to connect with prospective patients. Four years from now, there will be new tactics, and some of our current marketing efforts will be less relevant. A High Level Marketing Strategy allows us to adapt our marketing efforts to the tactics that are relevant to the attention of the people we serve.

5). 3 Year Picture

The 3 year picture and the 1 Year Plan zoom in on the 10 year target. Where are we going to be in three years? What is our revenue? How many IVF cycles are we doing? How many physicians are on staff? In the same way that practices often lack a 10 year target, the three year picture serves the same importance, just getting closer to bridging Vision and Traction.

6). 1 Year Plan

Long term planning for fertility centers

Often fertility centers have annual volume goals, but are they committed before the start of the year? Are they realistic?

7). Quarterly Priorities

Again, fertility practices frequently fall off track here. Do we have three to seven quarterly priorities that must be accomplished this quarter? Are we accomplishing priorities that move our business toward its one year plan, its three year picture, and its ten year target? Or are we drowning in the issues of the day-to-day?

8). Issues

 Just another REI practice manager

Just another REI practice manager

The image of Sisyphus pushing the rock up the hill for all of eternity resonates with many practice managers. Fertility centers’ staffs frequently burn out because they are working on the same issues with no resolution. Care teams spend so much time working on issues that are urgent, they may have precious little time to focus on important, big picture issues. Take a look at the Eisenhower Decision Matrix. 

 The Eisenhower Decision Matrix applied to fertility clinics

The Eisenhower Decision Matrix applied to fertility clinics

As a fertility specialist, or a practice manager, you never have to deal with matters in Quadrant 1, do you? Yeah right. Fertility centers live in Quadrant 1. Employers that make their employees and managers work in quadrant 4 ought to go to jail, (joking…or am I?). Work of little importance and urgency robs human beings of their energy and happiness. Most of the responsibilities in Quadrant 4, by definition, can be eliminated. Let software do the rest.

Now we’re left with Quadrants 2 and 3. As the owner or manager of your practice, with your very limited time remaining from Quadrant 1, which do you prioritize between “urgent and non-important” and “important and not urgent”? It’s Quadrant 3, isn’t it? We often worry about issues that are not important but they have to be attended to right away. This isn’t to say that issues in Quadrant 3 don’t need to be addressed, but that’s exactly what we do, address them. By prioritizing issues in Quadrant 2, we solve them. Visionaries that focus their companies in Quadrant 2 make Quadrant 3 less relevant, and Quadrant 1 less overwhelming.

Paint the picture, chart the course

With a clear vision and strategy, fertility centers know exactly what their goals are and how to achieve them. Without them, practices frustrate their team members, exhaust resources, and find themselves losing market share to competitive IVF centers. Whether one wants to be the largest fertility preservation company in the world, or happily perform 150 egg retrievals per year and super-serve their patients, there’s no right or wrong answer. Their Core Values, Core Focus, and 10 year target inform their High Level Marketing Strategy, 3 Year Picture, 1 Year Plan, Quarterly Priorities, and resolution of Issues. When practices follow a strategy to a committed vision, they are prepared for the powerful competitors and challenges that pursue them. And just in the nick of time, because there are plenty. We’ll talk more about them in Part 3 of our series on the tectonic shift from medical clinic to entrepreneurial enterprise.

If you would like help building your practice’s High level Marketing Strategy, learn more about the Fertility Marketing Blueprint below.

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.

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.

 

 

6 Indispensable Numbers Your IVF Marketing is Doomed Without

By Griffin Jones

so...What can you do for me?

When a fertility doctor (or any business owner for that matter) hires a marketer, they very often want to know, to the dollar, what the results will be.

Imagine if I bragged, "My company will increase your new patient visits by 40%!" Would they know, even remotely to the number, what a 40% increase looks like? Would they know to what they could attribute the increase? I've found that the answer is almost always no, because in the fertility field, we rarely have the data we need to gauge the effectiveness of our marketing. Even less often is that data readily accessible. I called this The Biggest Marketing Challenge Facing Fertility Centers, back in 2016. Unfortunately, not much has changed.

 We need to know certain Key Performance Indicators (KPI) to measure fertility practice growth

We need to know certain Key Performance Indicators (KPI) to measure fertility practice growth

Extreme Ownership

To be completely fair, incomplete or non-existent tracking of key performance indicators (KPI) is not  a phenomenon that is unique to fertility clinics, or even small healthcare practices. I've written about it at length in The Ultimate Guide to Fertility Marketing; many marketers complain that their clients don't track the volume and sourcing of their customers and revenue. How can one be held to a measure of success if we don't have enough (or any) measurements? Years ago, I decided to hone the focus of my marketing company to the field of fertility, because I needed to take extreme ownership of certain Indispensable Indicators. Collecting, reporting on, storing, and making decisions from these Indispensable Indicators are part of the Fertility Bridge Proven Process for Tracking Results.

6 Indispensable Indicators Every Fertility Center Needs To Know

  1. Leads
    1. The total number of phone inquiries, contact submissions, new appointment requests, new patient e-mails, webinar registrants, and seminar attendees who give their contact information to the IVF center.
  2. New Patient Visits
    1. The total number of appointments scheduled by new patients or returning patients starting new treatment.
  3. New Patient Sources
    1. All of the ways that new patients learned about the practice before scheduling their first appointment.
  4.  IVF cycles
    1. The total number of unique IVF cycles started or billed to a particular month.
  5. Conversion Rates
    1. The percentage of leads that become new patient visits and the percentage of new patient visits that go on to start IVF cycles.
  6. Gross Monthly Revenue

Indispensable Indicators in action

In the following example, watch how effective these figures make our decisions on patient recruitment. 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. Why?

Instead of gambling on a hunch, we operate with data from our Indispensable Indicators.  Between months 12 and 15, we see a

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

We had enough data to reasonably make this first marketing decision, and now we have even more data to make the next one.

is branding dead?

Instead of thinking in terms of practice development, we frequently view marketing as tit-for-tat; purchase x advertising, receive y result. There are plenty of lead-generation sites, agencies, and pay-per-click platforms from which we can buy leads. Sometimes it's prudent to buy appointments in these ways, it's just not business development.

One REI from a small U.S. market, who participated in a fertility marketing network asked me, "how do I know whether or not the patients they send would have come to me anyway?" 

We don't.

patient relations in fertility marketing

Until we have access to some kind of Orwellian brain-mapping technology, we'll never know all of the reasons that someone came to our practice. To think that we can account for every one of our team's achievements with six key performance indicators would be very short-sighted. In fact, it would be very limiting to the brand and long-term vision of the practice.

Rather than accomplish top-line marketing goals, our Indispensable Indicators measure the bottom-line of our marketing efforts. Without them, we spend time, money, and energy aimlessly. With them, we have real, specific, and measurable objectives to which we are accountable. At last, we can focus on the progress of our long-term strategy.

Not sure where to start with your Indispensable Indicators? In my next blog post, I outline the steps of the Fertility Bridge Proven Process for Tracking Results! In the meantime, click below to read Chapter 1 (Defining Marketing Strategy) of my absolutely free e-book, The Ultimate Guide to Fertility Marketing.

Should I fire my fertility center's marketing manager?

By Griffin Jones

Fertility doctors frequently ask me, “Is it better to have an in-house marketing person or contract an outside marketing firm?” You might expect me to favor the choice of hiring the firm. I don’t. The two are not mutually exclusive; each role is critically important to the other. In fact, across the board, your staff are paramount to your fertility practice's efforts to recruit new patients. There are assignments that your in-practice marketer should and should NOT be tasked with to maximize effectiveness and cost-efficiency. The same is true of your agency. Depending on the size of your practice, it may seem redundant to have both an internal marketing person and an agency on retainer. When used correctly, they will each pay for themselves and then some. 

marketing manager or clinic liaison?

If the practice has only one dedicated marketing person, his or her greatest productivity may very well come from the assignment of practice liaison. This is a function that is extremely difficult to outsource. As a marketer, my focus on digital media is owed only to its powerful results in attracting new patients. Digital’s proven ability to grow fertility practices doesn’t make physician referrals any less meaningful. Even in 2017, OB/GYN referrals still count for a tremendous share of new patients. Having someone who can regularly schedule physician-to-physician lunches, deliver semen analysis kits and information about infertility support, and educate OB/GYN staff in your area is tremendously valuable to the practice. Markets differ widely on the return on investment (ROI) of MD referrals, but in some cases, it may be a fertility center’s fastest path to growth.

physician referral case study

I asked an expert on the topic to share her experience on nurturing relationships with referring doctors. Shirley Sinclair is the practice manager of the Fertility Center of Chattanooga.

"For over 10 years, we’ve tried to find the magic source of how to bring in more patients and one of the top ways is still through referring physicians.  This process has taken us some time to fine-tune, but it has proven to be very successful.  We know our physicians are very busy, especially OB/GYN’s, so it is critical to remember that every minute of their day is valuable.  With that in mind, we developed a few different ways for doctors to easily consume our message.
•    Distribute referral packets in a beautiful folder filled with
o    information about our clinics
o     fact-sheets about infertility and testing
o    semen analysis kit.  
•    Provide a referral sheet for the referring physician, in which they can
o    add the patient name,
o    check off the type of appointment they are requesting (such as semen analysis, consult, etc.)
o     Fax back to our office

"We contact the patient to set up the appointment, thereby freeing up the referral’s time.  We take these packets to each office about every 6 weeks, along with some type of goodie for the staff.  This is not the time to ask to speak with anyone!  They will remember you more if you do not become a nuisance.  Also, do not leave too many packets; the idea is to show consistency and for you to become familiar with the staff.   

"Another great tip is to set up lunches with referring practices.  While this can be time consuming, this is a wonderful tool to use, especially when you have a new program or new protocol that you would like to share with the doctors.  Always take one of your physicians and, in addition, it is helpful to take someone from your staff that is familiar with the clinical side, as well as financial.  Physicians are always curious about what insurance will pay for as it is one of the first questions patients ask their doctor when they are encouraged to see a fertility specialist.  

"Use this time to assure the physicians that you would like to set up a partnership in providing the best care for their patient.  In other words, remind them that your goal is to help the patient become pregnant and send them right back!  Also, educate the physician that referring a patient sooner, rather than later, will save the patient precious time, money, and especially undue emotional stress.  Hanging on to a patient 6 months longer could be the deciding factor of what type of treatment the patient will end up having, therefore, adding additional hardship to the patient.  

"While these tips are vital, they are worthless unless you track them.  We use an EMR that is designed for fertility clinics, called eIVF, to track our referral sources.  Keep track of which physicians’ offices refer to you! In addition, make sure your physicians follow a protocol to send letters to the referring physician after the patient’s visit. Then send a follow up letter when you send the patient, hopefully pregnant, back to her OB/GYN.  Keeping your referring physician in the loop about their patients will solidify a long, successful relationship that will not only be beneficial to each of you, but, most importantly, to the patients for whom you both care!"

WAYS YOUR MARKETING MANAGER CAN HELP YOUR AGENCY

If you have more than one practice marketing person, or you live in a market where physician relations is not a full time job, your marketing manager is irreplaceable for a number of tasks that need to be accomplished within the practice. 

hiring a fertility marketing agency

Content sourcing. I don’t fly a member of my team to Honolulu every time we want to post a picture of the Fertility Institute of Hawaii’s staff to Instagram. Homemade and frequent content is vital to any practice’s content marketing strategy. In-practice marketers can serve as “brand journalists”, collecting the necessary images, stories, and videos to be sent to the agency for editing and distribution.

Operational changes.  You may find that your online reputation is not as great as it should be, simply because of one or two common patterns. Patients might love your staff, but report your response time to be abysmal. The practice manager super-serves the practice when he or she is able to implement systemic changes that are needed to improve the marketing imprint of the practice.

Tracking. Your marketing agency will be able to tell you how many people RSVPed to your practice’s IVF informational session. Your in-practice marketer will tell you how many actually showed up. If using a CRM or not, the in-practice marketer is critical in measuring and reporting the volume and sourcing of new patients.

WAYS YOUR AGENCY CAN SERVE YOUR MARKETING MANAGER

 Not the first time I've included a Jerry Maguire meme on my blog 

Not the first time I've included a Jerry Maguire meme on my blog 

One stop shopping. Your practice manager has enough to do without searching for a website developer, a photographer, a graphic designer, a writer, or a cinematographer every time your practice needs something. Your agency can provide that to you under one roof. 

Social Media and Online Community Management. It’s not a good use of your practice manager’s time to respond to every comment on social media or online review sources, or to have to scour for content to post every day. Your agency can handle online interaction and take the lead from your practice manager when specific questions arise. 

Content Development. Your agency can turn the raw text, photo, and video your practice sends into polished infographics, edited e-books, and maximize their distribution on social media and the web. The creative content and design that your agency helps you create doesn’t have to stay on your online properties, either. Digital materials like infographics and guides make for valuable resources that turn your clinic liaison’s visits into less of a sales call, and into more of a service to the referring doctor. 

Advertising. It’s possible to waste a lot of money on bad advertising. Does your team know how to target same-sex couples, who married within the last year, who recently visited your website and live within 25 miles of your practice? Mine does.

Tracking. Your business manager doesn’t have to be an expert in Google Analytics or using a customer relationship management (CRM) software. Your agency can be in charge of mastering your conversion system. 

THERE IS NO "I" IN aggregate TEAM MARKETING EFFORTS

A clinic liaison or marketing manager can be very effective for your practice. So can a hired agency. When they work in tandem, they return their investment exponentially. Studies find that marketing leads convert seven times more frequently when employees are fully involved in the process.  Patients often mention their favorite staff when they leave positive reviews about their fertility center, and the compassion of team members can be invaluable in the fertility journey. Some personnel may want to be the star of a video, and others may prefer a “behind the scenes” role. From contributing to blog posts, to planning events like the baby reunion to promoting support networks, there are plenty of ways to engage staff in the practice’s marketing strategy.

What 22 Infertility Bloggers Hated About Choosing Their Fertility Clinic

By Griffin Jones

"a prudent question is one half of wisdom"--francis bacon

Recently, someone who is very involved in the field of infertility reinforced what hundreds of patients have told me for two years; there's an astounding gap between the way many fertility practices deliver their services and what patients want and expect. That's exactly why our company has the word "Bridge" in its name. According to a study conducted in 2012 by Forrester, 80% of companies say they deliver superior service to their customers. Meanwhile, only 8% of those companies received a superior customer rating. If you're seeking treatment for infertility, the delivery of the services you receive should be nothing less than superior. No clinic is entitled to your selection. Even in states and countries where some rounds of IVF are covered, there are still many circumstances in which you could pay tens of thousands of dollars of your own money. If you live in a large enough area, or are able to travel, you have a choice. Your choice isn't an easy one to make, given how much is at stake. I don't own any fertility centers (...yet), but because we direct their marketing based on what you tell us, I'll speak about them in the first person voice.

Getting out of our own way

infertility blogger round up

As fertility practice groups, we sometimes spend a lot of money in an attempt to help you make that decision. Or at least we think we do. Sometimes we try to grow our practices without any strong understanding of what you need to feel comfortable (and eventually very satisfied) to move forward with treatment at our center or someone else's. We frequently forget that there is a simpler way of earning your choice. We could remove the unnecessary challenges, annoyances, uncertainties, and causes for anxiety that you face when you are searching for a fertility specialist. How do we build not just a proven marketing system, but an entire practice culture, around what goes through your mind when you debate coming to our clinic, another practice group, or seeking no treatment at all? This is a laborious and continuing process, but I had a crazy idea of where to start when I entered this field, and I decided to do it again.

I asked you.

In early 2015, I wrote a report from interviews with several infertility peer support group leaders. This time, I decided to ask over twenty prominent infertility bloggers to candidly answer the same short question. One question isn't enough to understand everything involved in how you decide which practice will play this instrumental role in your life, and what we need to do to make you feel very good about that decision. We need as much feedback as we can possibly get. We need to ask follow up questions, issue patient satisfaction surveys, read what you say anonymously about us online, take action on your collective input and repeat that process forever. Still, in their own right, the candid answers of several different people to the same question is very insightful. I chose bloggers because they have not only a wealth of personal experience, but also because they are each in contact with hundreds of other people who deal with infertility. They are on the pulse of the infertility community. As you'll read, there are several reasons why people choose clinics, and they're not mutually exclusive. 

 20 infertility bloggers all answered one question

20 infertility bloggers all answered one question

What was the most annoying part about choosing your fertility clinic?"

OVERWHELMING OPTIONS

In Due Time , @caroline_induetime 
"There are too many clinics to choose from. It's so hard to choose one".

No Bun in the Oven @nobunintheoven 
"Choosing a fertility clinic is an overwhelming experience because it's an expensive process! The most annoying part of finding my clinic was finding reliable experiences about the doctors. Where is the Rate My Fertility Doctor website? Where can a couple go to find real life experiences on these professionals who are getting paid tens of thousands of dollars for treatment? It was hard to find and we were ultimately left shopping at several clinics before finding the 'right one' for us".

Hoping for a Best@hopingforbabybest
"Wondering if you made the right choice".

Anonymous 

"Just scared of making the wrong choice".

UNCLEAR COSTS/BILLING

Smart Fertility Choices, @SmartFertilityChoices
"It was difficult to understand the entire cost involved in doing a cycle".

Rad Kitten@RadKitten
"Cost first and foremost. Second is beside manner. I'm not just a paycheck, I'm a person".

TTC a Taxson Baby@ttcataxsonbaby
"The most annoying part about choosing my fertility clinic was finding out that they don't take either of our insurances! Annoying and frustrating"!

Happiness Glass@happinessglass_
"That insurance dictates where you can or cannot go. Also I chose based on location/convenience to me rather than quality of service".

Amateur Nester, @amateurnester
"I found it frustrating that most clinics didn't have their costs listed on their websites. It would have made planning much easier if we'd had this information up front".

Its Positive Living, @its_positive
"Insurance (not having many options to chose from in my network/being tied to my network ... I have an HMO)".

THE RIGHT FIT WITH THE RIGHT PERSONNEL

The 2 Week Wait, @the2weekwait
"It was finding both a doctor and suggested protocol I truly felt enthusiastic about. To me, success rates can be manipulated, other patient opinions can vary and ultimately - nothing is more reliable than your own gut. If a doctor clicks with you, if the treatment suggested makes sense and you feel good about, that's all you need".

PCOS Diva, @PCOSDiva
It is disappointing when doctors do not have a solid understanding of how to treat PCOS using lifestyle modification as first line therapy.

Expecting Anything, @expectinganything
The most annoying part for me was the "marketing" behind this process by doctors/clinics. I mean, I get that it's a business for them, but some doctors forget that we are human, and this is real life shit for us! They all have different "sell tactics". They either beat you down and make you feel really bad or depressed about your situation, or they try to be overly sincere and emotional. We just want some facts and compassion people! Is it that hard!? I don't need to see all of the trophies "ie, baby pictures" plastered on the walls or some premeditated sob story. Show me your success rates and that you give a shit. It's that easy!

Our Misconception@ourmisconception
"The gatekeepers. You know the receptionists. These are the first faces you will see and the first you speak to when scheduling a consult or an appointment. They will be the ones that set the tone for the rest of the patient/user experience. Having navigated a cacophony of medical offices, this is an area/industry where empathy, education of the patient and social etiquette need to be greatly invested in as it lacks in most cases. My husband once had to spell out craniotomy to the appointment scheduler of his brain surgeons office. True story".

Triumphs and Trials@triumphsandtrials
"The most annoying part was going in to it blindly. Not knowing what the doctors were like and if they would be a good fit".

Anonymous 
"I needed an individualized approach on my treatment and a specialist who is willing to spare time to answer my questions and stay on top of all the details about my case. Not every clinic can do that due to patient volume. I was glad I was able to find the clinic I dreamed for after trying a big center in bay area, CA".

A LACK OF ALTERNATIVES

Infertile Soil, @infertilesoil
"In Canada you need to be referred to a fertility clinic (sometimes clinics will charge you if you don't have a referral) and many times doctors will refer you to just one particular clinic.

SIFTING THROUGH COMPLICATED INFORMATION

Trials Bring Joy@chels819
"Navigating outdated SART data".

AN EASY CHOICE FROM A TRUSTED SOURCE

Secret Infertility@FranMeadows
"I had a transition with ease since my OB/GYN referred me over to a fertility doctor that they personally used. This helped me feel more confident from the moment I walked through their doors. There was nothing annoying about me choosing a doctor".

 Life Abundant@lifeabundant_jw
"Nothing. My OB is able to do everything except IVF and is very knowledgeable in infertility treatment practice after doing her residency in a fertility clinic, so I have gotten lucky and have the best of both worlds. If we need IVF, I'll have to go elsewhere, and I will connect with her residency clinic and the doctor she trained under".

LET'S NOT MAKE THIS ANY HARDER THAN IT HAS TO BE

Hilariously Infertile, @hilariously_infertile
Uhhh. Being freakin' infertile is the most annoying part about choosing a fertility clinic.

Waiting In Hope, @waiting_in_hope
Honestly the most annoying part about choosing a fertility clinic is having to choose one AT ALL. Having to acknowledge the need for a fertility clinic/reproductive endocrinologist is heart breaking. It’s an acceptance that something is wrong. You have to grieve the loss of having a baby the “normal OB/GYN” route. And that it just might not be "easy".

Give the people what they want

As much as it's a service to you to equip you with clear information to make your decision, really, it's in our own best interest. The most effective way to grow our practices is through the detailed execution of a very simple premise: give you what you want. You can't decide on a clinic because you have no idea how SART success rates are being presented? Guess we need to make a video explaining SART data in plain English. You can't compare IVF costs between our competitors because no one will give you a straight answer? Sounds like we need to make an IVF cost checklist that you can download to compare potential additional costs. You felt isolated during your time at our practice because we never told you about support groups in our area? Apparently we need to make sure all of our patients go home knowing about the online, professional, and peer support resources that are available to them. In the age of ubiquitous communication, there is no shortage of ways to be able to collect and validate your input. Some clinics will ignore you and tell themselves they do a great job of getting you the information you want. Others will heed your suggestions and grow because of it. These are the clinics that deserve your choice, because you deserve nothing less.

Do you have something you want to say about your experience with your practice? Good, bad, or neutral? Please leave a comment or send me an e-mail! I would love to hear what you have to say.

MRS 2016 Meeting Recap: How To Use the Patient Experience as a Business Strategy

By Griffin Jones

You could put summer-time Chicago against just about any city in the world, so we're all glad that Dr. Angeline Beltsos, MD doesn't hold the Midwest Reproductive Symposium international (MRSi) in February. From June 15-18, without a cloud in the sky and an oceanic view of Lake Michigan, we met at MRSi 2016 at the historic Drake Hotel in Gold Coast. The event boasted a Business Minds Meeting, a Nurses' Practicum, and a Scientific Program. I went back to Chicago this year for my second MRSi because it's just the right size. It's a great place to connect with colleagues who share your practice role and also for physicians, nurses, and practice managers to share programming and meaningful conversation with one another. If you haven't been, add MRSi to the list for next year. You'll be able to talk to people and listen to topics that you won't always be able to get to at ASRM.

 Panel discussion at MRSi Business Minds Meeting

Panel discussion at MRSi Business Minds Meeting

While I did attend some of Friday's Scientific Program, I'll use this post to run down Thursday's Business Minds Meeting for some of the things that you really need to know about utilizing different aspects of your clinic operations to grow your practice.

The ART of Incorporating the PATIENT EXPERIENCE as the Center of the Business Strategy

Janet Fraser, Board President of Fertility Matters and the COO of Atlantic Assisted Reproductive Therapies (AART), co-chaired the meeting with Derek Larkin, CEO of Boston IVF. 

“Improving our patients’ experience makes our patients happier and it’s better for our business”, Fraser mentioned of the day's theme. The thought was reinforced by all of the speakers; fine-tuning our operations so that our patients are more satisfied is measurably beneficial to the top line of the practice. Larkin emphasized the importance of continually adjusting to patient needs. "Patient expectations are continually evolving, and so must the experience that we provide to them. It's an unending process."

Incorporating Emotional Support to Decrease Patient Burden During Infertility Treatment

Dr. Alice Domar, PhD of the Domar Center for Mind/Body Health at Boston IVF talked about the importance of focusing not only on patient recruitment, but also on patient retention. “It’s human nature to pay attention to the patients in front of you, and not the ones who you don’t see (those who have dropped out of care). Studies have shown that people who were depressed were far more likely to drop out of their IVF cycle." Domar points to a 2004 Boston IVF study: Of 112 respondents, 40% displayed psychiatric disorders while going through infertility treatment. A separate 2011 study shows that care was significantly higher of a priority for patients, as opposed to physicians, for whom the greatest priority was success rates. "67% of people declined to fill out a survey on self-reporting depression because they didn’t want their physician to know how depressed they were," Domar adds. To date, four different studies show that infertility patients have the same levels of anxiety as cancer patients. 

Boston IVF tested retention techniques in a 2015 study that was published in Fertility and Sterility. Drop out rates reduced 67% in the intervention group."If you have effective communication with your patients, they perceive that you spent more time with them". Domar brings to attention the dollar amounts that practices spend on marketing to new patients, and how little is spent on retaining them by responding to trends in drop outs. 
 

Getting Staff Buy-In On The Importance of The Patient Experience

 Hannah Johnson speaking on patient retention, courtesy of Vios Facebook page

Hannah Johnson speaking on patient retention, courtesy of Vios Facebook page

“Intrinsic motivation tends to be lost when we only focus on the extrinsic motivators, so we have to focus on activities where the reward is inherent in what we’re doing". Hannah Johnson, Director of Operations at Vios Global dives deep into how we motivate and empower our team members to take personal interest in each of their patient interactions. We need to allow our team to step back to appreciate the positive difference they make, including making sure they are aware when they are named in positive patient comments. We also need to empower them to correct errors. "It’s okay for your staff to make mistakes. Let’s talk about how we can make the patient feel really good about what happened.”

 

The Magic of Using the Patient Experience as a Focal Point of Your Employees' Day

“People don’t do what the mission of the organization states, they do what their managers pay attention to.” Lisa Duran is the CEO of Reconceived and has trained dozens of fertility centers in North America on how to build a patient-focused culture. Duran says that when many practices don't feel like they're fulfilling their mission statements, it's often because of a breakdown in the details of execution. We broke out into separate teams to identify challenges that different members of our team face in their day-to-day duties, and how we might be able to support them. Departments and staff need reinforcement and understanding from one another. “I want to know that my opinion matters,” Duran says of the most common desire that staff report before going into training.

In their own words

We had the privilege of hearing the first hand account of a couple who has gone through infertility treatment for many years. When asked what would have most benefited them to know when they first began their treatment, they each replied
"Don't be complacent if you're not getting the answers you need. Keep asking". 
"I wish that I wouldn't have waited so long. I wish I would have sought out treatment much earlier".
Hearing from patients in panel-form was a first for me at MRSi, and should be common practice at our conferences...imho.

Strategic Planning: Folding the Patient Experience into Your Business Plans

"Perception is reality. What patients feel is what they share." Rick Dietz, Chief Business Officer of Boston IVF, spoke in detail about the constant feedback loop of implementing and adjusting to patient input. Dietz says that practice strategy should be informed by a number of different metrics, and that self-reporting from patients is only one method at our disposal. "We can use patient surveys to give us clues and direction. But they don't tell the whole story."

Never Underestimate the Role of the Nurse in Patient Retention

"Nurses need proper training of how to talk with patients or you're going to get a lot more questions." Lori Whalen, RN, of HRC Fertility spoke about the importance of nurses as agents of patient retention. Whalen reminds us that nurses frequently have the most contact with patients and can be excellent sources of what patients want or what about our operations might be frustrating them. They can even find other solutions to patient problems, such as helping them find ways to save money. "Shared donors can cut costs in half for patients who wouldn't be able to afford it otherwise," Whalen says.

The Vital Role of Digital Media in Recruiting New Patients 

It was my first time speaking in the field and I was very pleased to have a great audience that asked meaningful questions. What can I say in this single post that isn't better summarized in greater detail throughout the blog? Suffice it to say that I reaffirmed what matters above all else in fertility marketing: the attention of people dealing with infertility. When we know what people with infertility are paying attention to, then we can measure how we will increase IVF cycles, increase patient-to-patient referrals, and improve our conversions of prospective patients to scheduled patients. You can view the first half of my talk here:

It takes a village

The strongest recurring theme of the Business Minds meeting was the critical involvement of everyone at the practice. I frequently see public feedback when patients are happy with their physicians, but not their staff, and vice-versa. Patients form their opinions about their experience based on every interaction they have with us; from the receptionist who greets them, to the medical team that cares for them, to exceptional customer service both online and offline. When we support all of the role players on our team, and learn about best practices from clinic groups across North America, we can dramatically improve both our delivery of care and patient satisfaction. Now that's an excellent foundation for growth. I recommend that at least once a year, you accompany a few of your team members to an inter-role meeting like MRSi to identify how you can improve your practice operations. You might be pleasantly surprised by what you learn from your own team, and what they learn from you.

See you next year at MRSi 2017!

6 Topics You Need to Know to Run a Successful Fertility Practice: 2016 ARM meeting recap

By Griffin Jones

Time to get down to business

Thursday, May 5th and Friday, May 6th marked the 2016 annual meeting of the Association of Reproductive Mangers (ARM). The professional group of the American Society for Reproductive Medicine (ASRM) convened on a pair of gorgeous near-summer days in downtown Chicago. Roughly 100 practice administrators attended, coming from single-physician fertility clinics to multi-state practice groups. At the welcome reception on Thursday, ARM Chair Brad Senstra invited the group to introduce themselves and enjoy dinner with someone they hadn't yet met. It was an in-person networking and educational opportunity that isn't especially common for practice admins. Here's some of what we learned

1). Salary Surveys, Benefits, and Calculation of Total Compensation

Sara Mooney, Human Resources Manager at Seattle Reproductive Medicine (SRM), opened the meeting on Friday by addressing many of the common issues that we face when reviewing and rewarding our team members. Sara recommends an online tool called Payscale, to review the pay averages of positions by geographic area and years of experience. Tools like Payscale generate reports that you can share with your employees, so that they understand when you are compensating them at a higher percentile relative to your competitors. Even when pay increases are not in the budget or may simply not be timely, there are other ways of rewarding your team, such as peer recognition from employee comment cards, added vacation time, and small gifts such as restaurant gift cards or sweets.

Carla Giambona, Director of Human Resources at IntegraMed Fertility, tackled the topic of benefits and calculating total compensation. It's important that employees know what your practice pays into their health and overall benefits package. Very often, employees view their salary as their total compensation. In reality, the practice may well be spending an additional 50% of that on health insurance coverage and other benefits. Premiums are among the biggest staff expenses to practices so engaging your team in wellness activities is a way to reduce your premium costs. Carla cautions however, that wellness engagement is a longer term strategy whose benefits will likely not be seen in the form of premium reductions within two or three years. 

2). Values Development and Implementation

Marianne Kreiner, Chief Human Resources Officer at Shady Grove Fertility, shared a meaningful (and very fun) exercise from one of the most successful practice cultures in the country. The total audience was divided into small groups of around eight people. Each subgroup was given a list of 150 words; desirable qualities for any team. Teams were welcome to add a word to the list if they preferred a quality that wasn't mentioned. Each person selected their twenty most preferred words and then group voting reduced the list to twelve and finally three words. The subgroups merged with one another and repeated the process with their combined word pools until finally the two halves of the entire audience came together as one to decide upon the chosen values that they felt represented their group culture. Want to know something about this ARM group? You must be hiring class acts. Independently, both halves of the audience chose "integrity" among their final three characteristics, a word that wasn't listed in the original 150. 

3). Leadership 

"Leadership does not carry a title," asserts Brad Senstra, Executive Director at SRM. Senstra explains four ways that leaders can encourage leadership, and therefore exhibit it in themselves. 

  1. Clarifying Values
  2. Inspiring a Shared Vision
  3. Enabling Others
  4. Encouraging the Heart

Above all, what sustains leaders, is that they love what they do. "Leaders build character by enabling others to act."

 Example of leadership from Brad's talk. If the  story of these two dogs  doesn't rock your soul, then you don't have one.

Example of leadership from Brad's talk. If the story of these two dogs doesn't rock your soul, then you don't have one.

4). National Public Health Action Plan for the Detection, Prevention, and Management of Infertility

Dmitry Kissin, MD of the Centers for Disease Control (CDC) delivered some reassuring news about the agency's efforts to address infertility as a public issue. The mission of the National Assisted Reproductive Technology Surveillance System (NASS) is to promote the health of women and men who receive infertility services, the health of pregnancies achieved through these services, and the health of infants conceived through these services, by conducting surveillance and research, creating and maintaining strategic partnerships, and moving science to practice. Among NASS's goals to address infertility as a public health concern, are to develop a standardized case definition of infertility and to eliminate disparities in access to affordable infertility services.

5). Patient Services

Lisa Duran, CEO of patient focused, Reconceived, facilitated an exercise that can be replicated with both your patients and your personnel. Duran uses the Myers-Briggs personality survey to identify how people with different personality profiles communicate in distinct ways. The 16 distinctive personality types are determined by a combination of preferences.

 Learn where you fall in this spectrum.

Learn where you fall in this spectrum.

  • Do you prefer to focus on the outer world or on your own inner world?
    • Extroversion (E) or Introversion (I)
  • Do you prefer to focus on the basic information you take in or do you prefer to interpret and add meaning?
    • Sensing (S) or Intuition (N)
  • When making decisions, do you prefer to first look at logic and consistency or first look at the people and special circumstances?
    • Thinking (T) or Feeling (F)
  • In dealing with the outside world, do you prefer to get things decided or do you prefer to stay open to new information and options?
    •  Judging (J) or Perceiving (P)

Duran says its helpful to know patients' preferences because people with different personality profiles frequently equate to "speaking a different language to one another". I learned that I'm an ENFJ (the teacher) and I found the summary to be pretty spot-on.

6). The Knights at the Round Table(s)

I could only attend one of the round tables, and it certainly won't surprise you that I chose marketing. Jacqueline Sharp of HRC Fertility moderated the table of very different practice groups. All four squares of the big market, small market, small practice, large practice quadrant were represented. I continue to be fascinated by how different practices use different models to affect patient volumes.  Some groups follow the recommended 3-5% of total revenue as a marketing budget. Many practices have no planned budget at all, but rather approve or reject marketing investments as they arise. Proving return on investment (ROI) is a challenge for all of us--and I'm excited to  continue to address that challenge.

Come one, come all

This was my first ARM meeting and I plan to be back next year, which means I would recommend it to you. The content of the meeting is beneficial not only to administrators and those involved in practice development, but also to nurses and physicians. The ARM group offers what is probably the most team-comprehensive programming within ASRM. The input of others in our professional society helps us to build teams that grow, super-serve patients, and are just downright pleasant to work with. If you'd like to get to know the group and their topics before you board a plane to Chicago next year, join us for some of the incredible round-tables and symposiums that they'll be hosting at the ASRM Scientific Congress in Salt Lake City. See you in October!