Marketing and Contracts

1. Marketing and Contracts Presented by Collins Uzuegbu RN, BSN Erin Steele RN, BSN Chris Fries RN, BSN School of Nursing and Health Wright State University August 17, 2011

2. Purpose • To explore marketing and contracting strategies for Advanced Practice Nurses (APNs) in light of traditional and contemporal marketing and contracting concepts

3. Presentation Outline/Objectives • Marketing Concepts • Marketing contract, models and theories • Marketing research: critiques • **Application of marketing concepts, models and/or theories to APN practice discussed throughout presentation • Criteria for evaluating effectiveness of marketing concepts, model, or theory

4. Marketing Concepts Five basic marketing concepts: • Product • Price • Place • Promotion • Partnership (Hamric, Spross, & Hanson, 2009)

5. Product • What the APN is offering to the market • What are those products? • Make the products “visible” to the consumer • Consumers should relate to the products • RNs as good marketers of the product (Hamric, Spross, & Hanson, 2009)

6. Price • What is paid for the product • What drives prices either way? • Familiarity with local, regional and national trend is important • Capitalize on delivering excellent products without emptying the wallet • Do not be afraid to publish the numbers – to compete! (Hamric, Spross, & Hanson, 2009)

7. Place • The “where” of marketing • Safety and accessibility of locale are important! • Know the area: Location! Location!! Location!!! • The “place” of the information age • APN in the consumers’ homes : e-commerce that meets the consumers’ service needs (Hamric, Spross, & Hanson, 2009)

8. Promotion • Emphasis on the value of the product to the public • Awareness is key • Visibility of APNs in practice settings • Assessment of client’s knowledge of APNs and clarification of roles upon first visit/encounter • Business card is a good asset • Promote word-of-mouth dissemination • Get involved at the locale level • Patronize another APN • Advertise (Jear, 2009; Hamric, Spross, & Hanson, 2009)

9. Partnership • Collaboration with other stakeholders in the business • Consumer centered approach • Use of care transition coach • Peer consultation (Hamric, Spross, & Hanson, 2009)

10. Marketing and Contract Theories/Models • Pay-for-Professional Reimbursement (P4P) Model • Top 10% will receive 2% bonus • Poor performance –penalties • $8.5 million awarded first year • APNs must fit into this context of improved quality care. • APNs not represented at the government level (Hamric, Spross, & Hanson, 2009)

11. Theories/Models • Brown & Olshansky (1988) - Research based model identifies “Limbo to Legitimacy” transition • Transition stages that new NP experience during the first year in primary care practice. • Stage 1 raises important marketing considerations. • Stage characterized by period of recovery from school • Finding employment • Negotiating bureaucracies • Worrying about meeting role expectations.

12. Theories/Models (cont’d) • Bolles (2002) – suggested teaching new grads five approaches to sustaining a positive outlook during transition • Keep physically fit • Deal with emotions as they happen • Monitor mental stamina • Utilize spirituality for support • Keep active by using time and talents in community. (Hamric, Spross, & Hanson, 2009)

13. Theories/Models (cont’d) • Customer Relationship Management (CRM) • Entire market with goal of optimizing revenues with needs and preferences • Patient Relationship Management (PRM) • Directed toward consumers. • Both are data driven approaches tostrategic planning and consumer relationship building and strengthening (Hamric, Spross, & Hanson, 2009)

14. Marketing Strategies • Kalisch and Kalisch’s (1981) work on nurses and the media • Recommend that nursing specialties work with media • Media continues to speak negatively of APNs • Center for nursing advocacy developed in 2001 • Addresses the negative portrayal of nursing by the media • Purpose to increase public awareness • APNs must be proactive in marketing the profession in a positive way when inaccurate perceptions present (Hamric, Spross, & Hanson, 2009)

15. Marketing Strategies • Terminology • Lack of consistent terminology across the states contributes to confusion by the public • Title of nurse practitioner in the 50 states include: certified registered nurse practitioner (CRNP), advanced practice registered nurse (APRN), advanced practice nurse (APN), and certified nurse practitioner (CNP). • How can the public be expected to know what to call APNs? • Physician dominance in the health care market who discredit APN practice can be obstacles to APN marketing

16. Marketing Strategies (cont’d) • Crucial that APNs support medical colleagues who do value and understand the role of APNs. • It is hoped that positive policy and legislative changes that promote APN practice will increase with the advent of more DNP-prepared APNs assuming leadership positions in health care systems. • Strategy to improve public image of nursing - disseminate positive and cost-effective outcomes of care provided by APNs in consumer publications as well as to professional journals.

17. Marketing Strategies (cont’d) • Gandhol & Hirsch (2006) – seven deadly sins of private practice marketing: • Spaghetti Marketing • Analysis Paralysis • Marketing Decision by Committee • Inadequate Training • Treating Marketing as a Cost Center • Insufficient Delegation • Inconsistency

18. Marketing Strategies (cont’d) • Bupport (2007) – Summarized general principles of marketing a practice that APNs need to consider. • Repeat the marketing message over & over in order to be heard. • Create in client’s a sense of affiliation with the practice. • Create an image of the practice & a marketing message. • Strive to exceed the expectations of clients • Remember that a new patient is worth the price of the visit, whereas a patient who values & stays with the practice is likely to generate more revenue

19. Brown, 2007 • Brown, D.J., 2007. Consumer perspectives on nurse practitioners and independent practice. • Purpose: To report the results of a survey conducted to determine the feasibility of NP-managed health care centers in a Washington county and to evaluate the acceptability of such care. • Methodology: • Descriptive study • Electronic survey • Convenience sample of 206 employees of a large non-profit organization in Washington (Brown, 2007)

20. Brown, 2007 cont’d • Findings: • Women and younger respondents were significantly more likely to say they would choose or change their care to an NP center (p=.03, .06). • Important factors in choosing health care: • Wait times #1 • Explanations of diagnosis and treatment • Respect by providers • Personal needs considered in treatment plan (Brown, 2007)

21. Brown, 2007 cont’d • Conclusion: • NPs must clearly articulate and market the niche in which they excel: patient-centered care, reduced wait times, patient education, and respect, particularly for women and younger persons. • Critique: Several limitations: • 21% survey response rate • No internal reliability data, only content validity addressed with a pre-test • Not generalizable, although sample taken from a diverse population of genders, occupations, income, and education levels. (Brown, 2007)

22. Contract Negotiation Literature • Kleinpell & Perez, 2006. Negotiation strategies for acute care nurse practitioner practice. • ACNPs employed with collaborate practices more commonly than in years past • Position involves diverse responsibilities, so negotiation skills are important to ensure adequate compensation, benefits, and position components in contracts. (Kleinpell & Perez, 2006)

23. Klienpell & Perez, 2006 cont’d • Negotiation Considerations: • Base salary, scheduled raises • Healthcare benefits • Role-associated costs • Continuing education or conference attendance compensation (Kleinpell & Perez, 2006)

24. Klienpell & Perez, 2006 cont’d • Contract Considerations: • Restrictive Covenants (“Non-compete Clauses”) • ACNP cannot practice within determined number of miles from employer’s business if ACNP is terminated. • Termination Clauses • Specify under what conditions the ACNP can be terminated • Should also specify under what conditions the ACNP may terminate the contract with the employer • Review with an attorney (Kleinpell & Perez, 2006)

25. Klienpell & Perez, 2006 cont’d • Communication of the value of ACNP care is important in negotiation: • Be ready with publications describing services offered and substantiating impact and outcomes of ACNP care. • Critique: • Informative • Expert opinion, not research or EBP (Kleinpell & Perez, 2006)

26. Marketing Literature • Dirubbo, 2005. Marketing 101: Setting your practice apart. • So many practices, so many providers… • Establish your professional image: • Define your role and how you with to be viewed. • Name your practice carefully • Make measurable goals and decide on budget: • Evaluate progress monthly, revise plan as needed. (Dirubbo, 2005)

27. Dirubbo, 2005 cont’d • Tips: • Join local Chamber of Commerce • Offer to be a guest speaker at events • Table at a health fair • “Tell-a-Friend” cards for new referrals from existing patients • Critique: • Good ideas • Anecdotal, expert opinion, not research. (Dirubbo, 2005)

28. Effectiveness of Theories/Concepts • APNs are getting jobs! • Example of Dirrubo (2005) article: concepts in action • Example of Brown (2007) article: APNs are more known and acceptable now than in studies out of the 1980’s

29. Conclusion • Effective marketing of the image and role of APNs, and also the services one provides is critical to the survival of each APN and the future of the profession! (Hamric, Spross, & Hanson, 2009)

30. Discussion Questions • What marketing tools/strategies have you seen used by APNs? • What marketing ideas do you have for your future practice? • Do you feel pay for performance plans will enhance the quality of care?

31. Recommended Reading • Kleinpell, R.M. & Perez, D.F. (2006). Negotiation strategies for acute care nurse practitioner practice. The Nurse Practitioner, 31(5), 6-11. • The Hamric text chapter 20. • Jear, J. (2011). Make your marketing simple, customer-friendly. Denver Business Journal, 2048. Retrieved from http://www.bizjournals.com.ezproxy.libraries.wright.edu:2048/denver/print-edition/2011/05/20/make-your-marketing-simple.html

32. References • Brown, D.J. (2007). Consumer perspectives on nurse practitioners and independent practice. Journal of the Academy of Nurse Practitioners, 19, 523-529. • Dirubbo, N. (2005). Marketing 101: Setting your practice apart. The Nurse Practitioner, 30 (9), 18. doi: 10.1097/01.NPR.0000393429.20113.37 • Hamric, A.B., Spross, J.A., & Hanson, C.M. (2009).Advanced practice nursing: an integrative approach. St. Louis, MO: W B Saunders Co. • Jear, J. (2011). Make your marketing simple, customer-friendly. Denver Business Journal, 2048. Retrieved from http://www.bizjournals.com.ezproxy.libraries.wright.edu:2048/denver/print-edition/2011/05/20/make-your-marketing-simple.html

33. References… • Kleinpell, R.M. & Perez, D.F. (2006). Negotiation strategies for acute care nurse practitioner practice. The Nurse Practitioner, 31(5), 6-11. • Leeflang, P. (2011). Paving the way for “distinguished marketing”. International Journal of Research in Marketing, 28(2), 76-88. doi:10.1016/j.ijresmar.2011.02.004 • Manikas, T. (2011). QUICK TIPS. Chief Marketer, 3(3), 40. • Peckham, S. and Wallace, A.  (2010).  Pay for performance schemes in primary care:  what have we learnt?  Quality in Primary Care, 18, 111-116. • Schumacher, S.  (2001). Identity management - at the heart of CRM.  Health Management Technology, 26-28.