Today, Griffin Jones spoke to Dr. David Sable, who directs healthcare and life science investing for the Special Situations Fund in addition to acting as the portfolio manager for the Special Situations Life Sciences Fund and the Life Sciences Innovation Venture Fund. Dr. Sable’s deep background in reproductive medicine and his interest in entrepreneurship led to a fascinating discussion about the future of reproductive endocrinology and IVF, with a focus on the fear of a private equity takeover and the realities of the large population of underserved people experiencing infertility in America today.
15 - Are Millennials Ruining the Field of Fertility? An Interview with Hannah Johnson
In this episode, Griffin speaks to Hannah Johnson, Director of Operations for Vios Fertility Institute, which has branches in Chicago, Milwaukee, and St. Louis. With a deep background in practice management, Hannah’s the ideal candidate to discuss the joys and challenges that come with working with millennials, as employees and as patients. Hannah appreciates their passionate approach to their work and recognizes that whether we like it or not, practices have to adapt their processes to suit millennials.
9 - Setting Expectations between Practice Owners and New Doctors: An Interview with Holly Hutchison
In this episode, Griffin talks to Holly Hutchison. Holly and her brother, Dr. Scott Hutchison, operate Reproductive Health Center in Tucson, Arizona. Holly and Griffin discuss the importance of establishing key performance indicators to ensure that partnerships begin successfully and go the distance. Additionally, Holly and Griffin tackle the importance quality of life plays in their practice and the need to establish boundaries related to that early in a partnership.
8 - How Can We Set Our REI Nurses Up for Success? An Interview with Monica Moore
In this episode, Griffin spoke with Monica Moore, a former nurse practitioner who currently consults with fertility practices around the globe from her home base in Florida. They discussed the topic of nursing staff retention, how to prevent burnout, and the importance of emphasizing employee engagement.
7 - Does Selling Your REI Practice Help Patients or Limit Care with Dr. John Storment
In this episode, Griffin talks to Dr. John Storment, a successful REI practicing in Louisiana. Dr. Storment talks about the potential pitfalls of accepting an offer from a private equity group, and how that can impact the way that you practice, as well as the importance of understanding the business side of your medical practice.
5 - The Use of Social Media Amongst REs: An Interview with Dr. Natalie Crawford
In this episode, Griffin talks to Dr. Natalie Crawford, an accomplished REI practicing in Austin, TX. Dr. Crawford has successfully utilized Instagram as a tool for education as well as marketing; today, she has tens of thousands of followers who turn to her for information and connection. Griffin and Dr. Crawford speak about the role social media plays in medicine, and the ways that physicians can use social media to create a connection with patients and prospects alike.
3 - Is Reproductive Health a Field or an Industry? An Interview with Rebecca Flick
In this episode, Griffin talks to Rebecca Flick, Vice Presidents of Communications and Programs for Resolve, the national infertility association. They discuss how the treatment of IVF and infertility as an industry has hurt patient advocacy and the ability to give access to people who may not have the insurance or out of pocket ability to go through infertility treatments. Rebecca explains how they are trying to change the internal viewing of fertility treatments by lawmakers and employers as a optional medical practice to one that anyone should be able to have access to. Griffin and Rebecca then continue to speak about how being a part of Resolve not only allows businesses to further influence the fertility community, but to give back to it as well.
2 - Who’s Responsible for Lowering the Cost of IVF? An Interview with Dr. Kiltz
In this episode, Griffin talks with Dr. Robert Kiltz, the founder and director of the first successful IVF center in Central New York, CNY Fertility Center. Griffin and Dr. Kiltz discuss the topic of who is really responsible for lowering the cost of fertility treatments. They discuss whether the responsibility falls on the insurance companies, pharmaceutical companies, medical device, hardware and software companies, or the providers themselves. They then discuss Dr. Kiltz’s methods of becoming a successful fertility specialist that offers a lower cost treatment plan, creating a new market with new levels of accessibility and affordability.
Four Reasons the Tech Revolution Has Disrupted Fertility, and Why Practice Owners are Frustrated
CHANGING TECHNOLOGY
For some IVF centers, the change has already done them in. For others, it is the level playing field needed to thrive against massively funded competitors. No phenomenon presents a greater threat, nor a greater opportunity to today’s fertility centers than the technological revolution through which our society is living.
So far, we've deeply explored the four major implications of the following axiom: today's fertility practice is no longer a small, independent healthcare clinic, but an entrepreneurial venture. We talked about business structure, strategy and vision, and accelerated competition. These three tenets pale in comparison to our society’s rapidly changing technological and social behavior.
The Natural Route
My husband, Colby, and I received our infertility diagnosis 6 years ago, in April of 2012. As most couples who have been diagnosed with infertility would understand and agree, we were completely caught off guard. You get married and you have kids, right? Well for 1 in 8 couples this is not the case and we happen to fall into that statistic. This diagnosis came quickly and although we were so thankful to find out what we were up against sooner, rather than later, it was still devastating. What we thought was just routine tests before we started our family, turned out to be much different as we were diagnosed with both female and male fertility.
The Battle for the IVF Market: 5 Wall Street backed companies vs. private practice
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?
A New Vision and Different Strategy for IVF Centers to Thrive Beyond 2018
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.
Set Up to Fail: Fertility Clinics Not Structured for 2018
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?
Should I fire my fertility center's marketing manager?
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.
What 22 Infertility Bloggers Hated About Choosing Their Fertility Clinic
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.
MRS 2016 Meeting Recap: How To Use the Patient Experience as a Business Strategy
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
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
“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
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
12 Nuggets of Wisdom You Missed at the New England Fertility Society 2016 Annual Meeting
It was a weekend of fools at the New England Fertility Society's (NEFS) 14th annual meeting, which took place on April Fools'weekend, April 1 and 2. The meeting was set amidst the gorgeous landscape of Vermont's Green Mountains in the resort town of Stowe. Yes, we had dessert catered by Ben and Jerry's Ice Cream. NEFS President, Jill Attaman, MD, thanked the roughly 170 people in attendance, and introduced the April Fool's theme, with practical jokes played throughout the weekend. Yes, there were woopie cushions. If you weren't fortunate enough to have joined us for this year's meeting, here is a brief synopsis of what you missed.
1). 2014 SART reports expected to be released this week. Brad Van Voorhis, MD, the President of the Society for Advanced Reproductive Technology (SART) discussed Big Data for Personalized Medicine and the role that SART has played over the last thirty years as the nation's first national patient health registry. Dr. Van Voorhis reports that just under 400 treatment centers report directly to SART, with only roughly 30% of that number reporting directly to the Center for Disease Control (CDC).
2). Selwyn Oskowitz has left the building. Well, sort of. Selwyn Oskowitz, MD, the founding president of NEFS (then the Boston Fertility Society), retired from his storied career at Boston IVF the day before the meeting began. His colleagues paid him an emotional homage, and he received a standing ovation from everyone in attendance. "Is this real?" Dr. Oskowitz joked, referencing the April Fool's theme. Dr. Oskowitz will be traveling to Rwanda intermittently over the next year to provide pro bono medical services to those with infertility.
Dr. Oskowitz's colleagues remember his career fondly
3). 60% of human embryos result in pre-clinical losses. Steven Young, MD, PhD, of the University of North Carolina School of Medicine lectured on Endometrial Receptivity. Implantation abnormalities are common causes of infertility, pregnancy loss, and pregnancy complications. Dr. Young believes that the next major breakthrough for infertility therapy will come from optimizing successful embryo implantation, which may have important downstream advantages in reducing pregnancy complications.
4). Focus on fertility preservation. Clarisa Gracia, MD of Penn Fertility Care discussed Ovarian Tissue Cryopreservation. With respect to reproductive function, high-risk cancer survivors in their mid twenties have measures similar to naturally aging women in their early forties. She adds that maturing immature eggs from tissue in vitro eliminates the risk of transplanting cancer cells.
5). Cryopreservation now routinely applied to oocytes and embryos. Terry Schlenker, of the Colorado Center for Reproductive Medicine presented on the Vitrification of Oocytes and Biopsied Embryos. Ice formation is avoided by loading the cells with high concentrations of solutes to convert the water into a non-crystalline solid. Vitrification is now considered indispensable to ART.
6). May the force be with you. Judith Daar, JD, of the Whittier Law School reports that in February 2016, U.S. Secretary of Defense, Ashton Carter, announced a $150 million pilot program to fund egg and sperm freezing for all active duty military. Due to Congress's current ban on IVF, however, the frozen eggs might never be accessed once the soldier is discharged from service.
7). Stress on the rise. 44% of Americans report that their stress levels have increased over the last five years, according to a 2012 American Psychological Association study cited by Courtney Lynch, PhD, MHP, of The Ohio State University Wexner Medical Center. Though not yet conclusive, evidence is suggestive of an association between infertility and stress.
8). You're not crazy. Rachel K. Ashby, MD, of Brigham and Women's Hospital talked about the importance of validation of feelings with respect to Patient Centered Care in an Infertility Practice. "Patients are worried, 'I'm crazy, I'm not handling this well, everyone else's relationship is stronger than mine'". Dr. Ashby emphasizes the importance of validating these patient experiences as common and that distress is an appropriate reaction.
9). Triplets don't come cheap. Barbara Luke, ScD, of Michigan State University cited a 2013 American Journal of OBGYN study in her lecture on Designing Research to Assess Health Outcomes After Assisted Reproduction. The per infant cost of triplets counts at $135,733, compared with $8,327 for singletons. Media outlets often sensationalize high profile cases of multiple births but omit information regarding the highly common medical risks.
10). Politics is messy business. 132 Congressmen and Congresswomen have co-sponsored the leading federal embryo-personhood bill. Lee Rubin Collins, JD, spoke on behalf of RESOLVE on Infertility, Ideology, Patients and Politics. RESOLVE has fought legislation threatening IVF in 24 states and counting.
11). We're not the only ones. "Why would they invite a Canadian to come speak on law regarding funding for reproductive health in New England?" joked Neal Mahutte, MD, of Montreal Fertility Centre. Dr. Mahutte shared the legislative challenges to ART in Canada and in Quebec. Like the United States and virtually every nation in the world, it is very difficult for lawmakers to write consistent laws pertaining to ART. In Canada for example, clinics can import sperm from paid donors in other countries, but donor compensation within Canada is prohibited.
12). People aren't having enough sex. That was the conclusion of pretty much everyone I spoke with. Well...you heard it here first.
The Top 10 Tweets from ASRM 2015
We've just wrapped up an excellent time at the 2015 meeting of the American Society for Reproductive Medicine (ASRM) in Baltimore. It was my very first ASRM meeting, and the only thing I like more than meeting new friends is getting to see old ones.
With so many tracks and sessions over the five day meeting, you couldn't be everywhere at once. But thanks to #ASRM2015's live tweeters, we had people keeping us abreast of what went on. Here are 10 of the most informative tweets from the meeting.
What Makes Online Reviews Different For Fertility Centers
I shot this video post back in June after the 2015 Midwest Reproductive Symposium. The way infertility patients use online reviews for their Reproductive Endocrinologists and their practices is vastly different from most other categories. Facebook is by far the most positive review source for fertility centers. Yelp is certainly the most negative. Other sites, such as RateMDs, ZocDoc, HealthGrades, and Fertility Authority tend to fall in between the two ends.