Introducing
a New Service in the Dermatology Practice

R ecently, there was a great deal of excitement and controversy over the NCAA College Football Bowl Championship Series. Because of a complicated, convoluted and, some would say, Rube Goldberg-esque method of selection for the National Championship Rose Bowl, it turns out that perhaps the top two teams won’t actually be playing each other this time around. Again. In response, the NCAA authorities have turned to a time tested and proven method of deflecting criticism and increasing public support—education. The group used education as a tool to explain why such an awkward system really is the best method of selection. In this regard, the NCAA demonstrated an essential step in the marketing of a new product. When any new product (or service) is first introduced into the marketplace, there exists a series of pre- and post-release actions that will help to assure the overall success of the product, including maximizing the return on investment (ROI). Briefly, these steps may include some or all of the following: • Product Research/Technological Development • Market Research • Sales/Service Training • Test Launch – General Launch • Marketing Campaign • Advertising/Education • Assessment/Tracking • Adjusted Marketing • Expanded/Secondary Target Market Focus • Market Maturity • Discontinue/Replacement or Sale/Transfer or Passive/Unsupported Marketing. Roadmap to Success in Your Office In the medical world, and in office-based dermatology in particular, the five most important steps will usually include the following: 1. Market Research/Decision Making 2. Education/Training 3. Product Purchase 4. Service Launch 5. Marketing/Advertising. These steps, when followed, will help develop a timeline for the service or product launch. The length of time necessary for the completion of the project depends on the priority and/or complexity of each step. Some may require only a few moments, such as decision making (“I think I will start doing liposuction”), while others may take months or even years (training for proficiency in liposuction) to accomplish. The success or failure then of any new product or service in your office will depend, to a greater or lessor extent, on paying careful attention to these important steps. With careful assessment and planning, a timeline unique to each office, procedure and physician/provider can be created, which will then serve as a roadmap to success. A wide variety of different services, procedures, and products, such as lasers, estheticians, liposuction, MOHS, PUVA, Collagen and Botox therapy may be introduced into your office practice. There are many others, but for our purposes we can divide them into two broad categories (physician labor versus provider labor), and two levels (basic and advanced). For the physician versus provider labor, there’s a fundamental difference that affects you. If you perform the service/product/procedure yourself, then training and delivery of service is by definition a displacement of existing work (assuming that your schedule is already full). This should provide (hopefully) an incremental increase in your production. When it’s a provider-performed (RN, PA-C, ARNP, etc.) service, there is little or no change in your production schedule, therefore, any revenue generated by the new service becomes passive to your work effort. These two fundamental differences may play a crucial role in the market research and decision making stage. Generally speaking, developing passive revenue streams is a desirable choice for most practices. Regarding the second issue — the levels of new services or procedures (basic and advanced) — common sense tells us that until the entire office staff develops an organizational level of competence, simple services are easier to introduce successfully than complex ones. This is especially true for cosmetic services, as the consumer demands placed upon the office by this patient population can be extreme. Introducing Botox: A Case Study An excellent example of a new service/procedure is the aesthetic use of Botox therapy for wrinkles. Botox therapy has a number of unique qualities that make it an ideal “case study” for this article. First, Botox therapy is growing rapidly in popularity and is now the most common cosmetic procedure performed in the United States. FDA approval for wrinkle reduction appears imminent, which means that there will be increased media attention, publicity, and subsequent stimulated consumer demand. Experience tells us that Botox therapy appears safe and effective, with high patient satisfaction. The price of Botox therapy for wrinkles (average treatment costs range from $200 - $600+) is affordable for a large cross section of the U.S. population. The minimal “down time” necessary for Botox fits well with the quickening pace of life for many consumers. Botox therapy introduction requires very little in terms of training time, capital equipment or external advertising costs. Finally, Botox therapy is an ideal “gateway” cosmetic procedure, which allows patients to try a low-risk, low-cost, high-satisfaction service that can lead to a more confident and secure attitude for additional elective services and procedures. Developing Passive Revenue Second, Botox therapy has advantages for the development of passive revenue, as well as an incremental increase in production. Botox therapy can provide you with high revenue blocks in the schedule when compared to general dermatology and even compares favorably to many of the most “expensive” cosmetic procedures (liposuction, CO2 laser, chemical peels, etc.) on a time/value analysis. For the development of passive revenue streams, Botox therapy again compares favorably to virtually all other services. Provider-delivered (RN, PA-C, ARNP) Botox treatments can generate substantial production and help fund further training, expansion and growth of services. Also, Botox therapy delivered by clinic providers can substantially increase the “throughput” or clinic volume of elective desire-dermatology patients. These are the same patients who can help build the population base and reputation necessary for development of a cosmetic-office practice. In addition, this same patient population ultimately is destined to become practice advocates or “deputies.” The Role of Office Staff Office staff support is critical while developing satisfied patient advocates. This support is absolutely necessary for the successful introduction of any new service or procedure, whether we’re talking about desire or disease dermatology. This organizational support requires training to achieve and maintain. Education and experience is necessary to complete the training cycle. Botox therapy is an ideal vehicle for this process. Botox therapy for wrinkles also provides an excellent transition tool for office training. It’s essential to develop organizational proficiency in supporting the introduction of new services and procedures for practice success. When this process begins with low-cost, low-risk, high-satisfaction procedures, the transition phase is much easier to manage than when high-cost, high-risk, low-satisfaction services are initially used. Over time, office staff and culture competence develop, which allows for the progressive introduction of services that are more complex, expensive and problematic. Using the introduction example of Botox therapy for wrinkles , let’s examine each step as it could potentially be related to the general dermatology practice existing at level 1 or 2 on the Cosmetic Office Practice (COP) continuum. Market Research/Decision Making: In the case of aesthetic use of Botox, much of the demographic component .of market research has already been accomplished. Botox therapy for wrinkles has become the most popular cosmetic procedure for one simple reason—it works. Purchasers of Botox are generally very satisfied and share this satisfaction with their family and friends, who subsequently become satisfied patients themselves. Market research for the dermatology practice will be primarily local. It’s essential for you to assess local Botox availability and cost, schedule waiting time, hours available and convenience factors. Education/Training: Botox therapy competence has a relatively short learning curve. Abundant opportunities exist for training at local, regional and national conferences. There are many published articles in dermatologic literature concerning the basic science, pharmacology, dilution, storage and clinical uses of Botox. We recommend you review the anatomy of the facial muscles of expression—essential in optimizing aesthetic use of the product. You can probably achieve general clinical competence for basic indications in a short course or two. We also recommend training office staff as both recipients and proponents of Botox. A short “lunch and learn” with the office is a very effective method of accomplishing both of these objectives. Try treating your office staff for free—it’s an especially good method of increasing your Botox volume. By reviewing patient education materials and consent forms, your staff will be prepared to competently answer questions from inquiring patients. Review scheduling guidelines to minimize disruptions from inappropriate patient placement, such as when no Botox is in stock, or when only one or two patients are requesting treatment. Also, educate your staff on how to deal with the occasional frustrated, angry or disappointed patient. Product Purchase: Botox purchase timelines are of minimal consequence. It’s courier shipped and you order over the telephone. Shipments arrive frozen and should be stored as such until ready to be diluted for use. You just need to set up a billing account with the manufacturer. Remember to keep an ample supply of the product on hand for your expected needs, as Botox is generally not available on short notice from your local pharmacy. Some hospitals keep Botox in stock for use in the operating room, and on occasion may be persuaded to “loan” or sell a vial to your clinic. Otherwise, if you run short of Botox for your scheduled patients, you will need to borrow from a colleague or re-schedule. Service Launch: Botox lends itself well to a rather short two-step service launch. Because Botox results can be accurately assessed in about 2 weeks, your initial treatment group of family, friends, staff, and select patients can be available for “inspection” by photograph or personal evaluation in this same period. These testimonials are a primary reason to treat the office staff free. After the trial run, you can successfully introduce Botox into your practice with various levels of promotion. The next phase, marketing and advertising, is the fun one. Marketing/Advertising: The market plan for any service or procedure ideally should begin when the decision is made to commit. The marketing plan should be a fluid document, one that is constantly revisited with an intention to update, change, replace or even discard. It may or may not include features of advertising, internal or external. What it does do, we hope, is serve as a master plan for promoting and monitoring success. With regard to various types of service promotions. Examples follow. You can do a “stealth introduction” so that it’s available only if a patient directly asks about the procedure. You can also try an internal office promotion by placing brochures, posters or placards in the waiting areas and exam rooms. You also have the option of internal advertising programs with direct mailing to either a selected demographic treatment subgroup or the entire patient population. Also, an external advertising campaign, consisting of various media venues (TV, radio, newspaper, magazines, etc.), can be undertaken. One important point to remember is that for advertising to be successful and cost effective, you must do follow-up tracking. ALL methods of advertising need a tracking code that allows for analysis of impact and ROI. A Plan for Success The degree of success for any new service, product or procedure introduced into the dermatology office depends upon the time and attention spent on planning. While multiple steps can be found in any marketing plan, each unique plan will have its own essential ones. With careful pre-launch analysis, we can determine which of these key steps are required to maximize success. In this example, Botox therapy was used because it has several attributes that when considered for a dermatology practice new to product launches, help to assure success. Every new product or service will have strengths and weaknesses, and through careful evaluation and planning we can anticipate and prepare for multiple outcomes. Good luck.