In an intensive ‘Special Session’ taking place at CIRSE meeting 2008, four prominent interventional radiologists discussed their views on how to promote interventional radiology (IR) to patients and referring physicians according to their respective therapy areas.
Chaired by Drs Marc Sapoval, France, and Peter Haage, Germany, the session began with Dr Siegfried Thurnher, Hospital Brothers of St John of God, Vienna, Austria, discussing the importance of IR marketing, the basic tools to drive and deliver information to the public, the importance of teaching diagnostic radiologists, and how to start a marketing programme.
Challenges of IR
In his opening remarks, Thurnher explained that increased competition among healthcare providers, the advert of specialties and sub-specialties, and a growing number of health-conscious consumers mean medical professionals of all persuasions can benefit from a well-executed marketing strategy.
“In general, few medical services speak for themselves,” he said. “Their providers must heavily rely on marketing communications to give prospects something firm to evaluate.”
A central issue for IRs is that knowledge about their treatment options is scarce among the general public, patients and referring physicians. “IRs will find it not only important but mandatory as they establish clinical practices and work to change existing perceptions in the healthcare system,” stated Thurnher. “A good marketing strategy is very important to make interventional radiologists’ service visible and keep the prospect comfortable.”
According to Thurnher, ‘Identity’ is one of the biggest challenges for IRs. He believes that currently, an inaccurate impression (brand identity) exists in the medical community. “It is important for all customers to know the difference between diagnostic specialists and IRs. Don’t let competitors [e.g. vascular surgeons] define IR. If IRs want to advance toward the perception of a clinical specialty, they need to change this misconception, particularly with primary care doctors,” he said.
Following this, Thurnher discussed the importance of a generic ‘name’ for IR. He said that because IR offers a broad range of treatment alternatives, therapies can not be promoted under one unique name. He suggests creating a name, such as ‘Centre of Excellence for Minimally Invasive Therapy’, or ‘Centre of Excellence for Spinal Interventions’ etc.
Another important challenge is to “take control of patients”. “IRs must gain control of patients to the same extent as other sub-specialties to compete on equal terms by setting up a practice,” said Thurnher. “They must gain the respect and confidence of primary care doctors from whom they wish to receive referrals.”
Additionally, he discussed the importance of defining target groups, developing a marketing plan for setting up a practice, and developing marketing tools. He concluded, by stating “In recent years, IRs have been faced with the fact that other specialties have taken on invasive procedures. Other specialists have marketed their power to control patients with the result being a threat of extinction of IR referral practice. To compete effectively, IRs must market themselves to prospective patients to achieve a public profile that will generate patient-initiated visits for care. Advanced marketing has become very important to make IRs service visible and to assure success in the future.”
How to attract patients for UFE
Dr Thomas Kroencke, University Clinic Charite, Berlin, Germany, discussed the role of the internet and media as a key factor to direct the patient to the IR suite. He also stressed the importance of educating GPs and gynaecologists about uterine fibroid embolization (UFE).
“The range of treatment options for symptomatic fibroids has increased considerably within the last two decades, however, information about non-surgical alternatives such as UFE is still not available to most women in Europe,” said Kroencke.
Traditionally, IRs have used in-house education of physicians to obtain referrals for their procedures. “Although excellent cooperation with the gynaecology department is an essential pre-requisite to offering UFE, it does not automatically lead to increased awareness among patients and office-based gynaecologists and therefore to higher numbers of referrals.”
Kroencke’s view is that gynaecologists should be targeted directly through information events that are organised by IRs, and that IRs need to position themselves as clinical partners with long-standing expertise in minimal-invasive image guided techniques. He also states that targeting GPs is worthwhile, as they are often trusted partners of women with symptomatic fibroids and have a deep understanding of quality of life issues.
According to Kroencke, using the media is also an effective communication tool to educate the public. It is a low cost method that may be challenging. However, information will be reached to a wider population and hence draw attention to procedures such as UFE. Another effective tool is to create patient information leaflets, develop a user-friendly website with clear and concise simple facts and diagrams, and attend patient groups and forums, or internet-based forums, to allow women to speak with other fibroid sufferers.
How to attract patients for vertebroplasty
Excellent knowledge of the procedure, education of colleagues and patients, and patient follow-up are some of the essential obligations for an IR wishing to promote vertebroplasty as an alternative treatment option, said Professor Afshin Gangi, Strasbourg, France. He also indicated that the role of modern diagnostic imaging is a key factor to select and direct the patient to the IR suite.
“It is important for IRs to know the indications, contraindications, technique, and precautions for this procedure, as well as having the best equipment and most importantly, taking care of the patient from the beginning until the end,” Gangi said. He also stressed the importance of working closely with diagnostic radiologists, explaining the importance of IR to them and making them aware that there are more options when it comes to treating vertebral fractures.
Furthermore, Gangi indicated that multidisciplinary communication is also vital when it comes to IR. Encouraging clinicians from the oncology, bone and spine, and pain management departments to take part in multidisciplinary meetings will help with education of these team members and hence further promote the use of vertebroplasty.
How to attract patients for PVD interventions
Peripheral artery disease (PVD) is a prevalent disease in older individuals with lower extremity PVD present in 5% of those over 50, 10% over 60, and 20% over 70, explained Dr Timothy Murphy, Rhode Island Hospital, Providence, RI.
“What is happening in the US with regard to delivery of interventional revascularisation services?” asked Murphy. He explained that using the CPT (Current Procedural Terminology) procedure code 37205, which is for stent placement in the first peripheral vessel, the overall volume increased 2.4 fold, from 45,073 to 108,450 procedures from 2000 to 2006. When comparing 2000 to 2006, there was a 680% increase by vascular surgeons, a 177% increase by cardiologists, and a 34% by radiologists.
Continuing, he said “Growth among surgeons has been at a compounded annual rate of 30.3% since 2000. Radiologists’ market share decreased from 49% to 28%, and vascular surgeons’ market share increased from 10% to 27%.”
Murphy asked, “How did this happen?” and explained that over ten years ago, vascular surgery and interventional cardiology leadership started initiatives to compete for peripheral artery disease (PAD) interventions. “Cardiologists generated procedures that wouldn’t have existed and vascular surgeons diverted referrals that traditionally went to IRs,” he said. Many radiologists could have strengthened their position if they didn’t provide services to referring doctors as technicians, but to patients as doctors; didn’t establish ‘joint ventures’ with surgeons that involved training them; and didn’t agree to allow vascular surgery fellows to train with them, he added.
In discussing referrals, Murphy said that PVD referrals can be accepted by radiologists only if they have clinical offices and accept referrals for disease management and not just for procedures. “Once this is in place, calling on potential referring doctors to recommend services is possible.” He also highlighted the importance of obtaining an office that is not part of a hospital nor in the radiology department.
“Differentiating yourself from competition by offering comprehensive vascular diagnosis, consults, and follow-up is an important step forward for IR. Also, never practice like a technician. Ideally you should refuse to accept consults or referrals unless you are the primary vascular specialist, that is, get the referring community educated to you serving in that role,” he concluded.