When asking an REI physician or practice which patients they would like to see more of, the most common three answers are:
Treatment ready patients
Qualified patients
IVF patients
And these three terms are given for three distinct reasons:
This cohort is among the most rewarding to serve, because they need to be helped by a subspecialist
IVF is the revenue generator of the practice group
The clinic is so slammed with new patients that it’s almost a function of triage
While the interest in “IVF-ready patients'' can come from any of these reasons, it’s usually a combination of all three. The mistake is thinking that there is a magic demographic of treatment-ready patients, and one marketing tactic will pluck and drop them through all Four Phases of the Fertility Patient Marketing Journey . While there are patient profiles who are more likely to move on to treatment, optimizing your Fertility Marketing System from end-to-end is what both qualifies and nurtures patients. It isn’t just the third phase of the journey, consult-to-treatment, that affects IVF volume; it’s all four.
CONSULT-TO-TREATMENT (IVF)
Not all fertility patients will or even should convert to IVF. This resource isn’t about recommending IVF to those whom it is not in their best interest. This article is about the systems and content required to reduce the confusion, fear, and uncertainty that prevents people from moving on to IVF when it is indeed the best option.
There is often a wrong assumption about why patients don’t proceed to treatment post consult. The most common assumption is that they can’t afford it, and while this can certainly be true for a fraction of patients - it’s a misnomer to think that's the main reason. Here are nine reasons why patients aren’t proceeding after initial consultation.
Poor Prognosis
Emotionally overwhelming (nervous, anxious, distraught, etc) The process is a lot to handle. And if multiple people need to get on the same page, that’s multiple sets of beliefs, cultures, thoughts, and emotions.
Uncertainty of patient action - there’s not a clear next step leaving the patient unsure what to do next. Humans retain very little of what they hear, and have further questions that come to mind after the consultation.
Paralysis by analysis (indecision) - 3 IUIs or direct to IVF? In disagreement with their partner? Donor egg or try one more round? These decisions are serious and it takes time and in-depth discussions to make them. And it’s often not made in the 2 - 4 week window before the patient needs to call on day 1 of their period
Incomplete testing - did the female partner finish her testing, but the male partner didn’t complete his Semen Analysis? Did one of the partner’s only complete half of the labs?
Financial barrier- it’s not always whether or not patients can afford treatment (although this can be true) - it’s whether or not they want to spend it on this exact treatment and understand how to pay for it
Little sense of urgency - for egg freezers especially, they don’t believe putting off their procedure for another year will impact results.
Disappointment in patient experience - likely results in choosing a competitor clinic. Disappointment can be a result of many things, but to understand the “why”, the post consult patient satisfaction surveys in Phase 3 must be conducted.
Pregnant Naturally - This is the best thing that can happen for the patient. Wish them the best and hope they speak highly of you, or reach out if they need assistance.
Now that there’s an understanding of why patients aren’t moving forward with treatment, how can we use this knowledge to get to our IVF goals? In order to attain the goals, you must be able to set benchmarks and measure them accurately. Here are the four key performance indicators that lead to your IVF goal (ranked accordingly):
New Patient Volume
IVF Conversion Rate (%)
Online Rating (Public-facing reputation)
Patient Satisfaction Rating
All four leading indicators impact your total IVF or retrieval goal. Because new patient volume is often a separate goal all together, we’re going to focus on the latter three.
IVF CONVERSION RATE
IVF Conversion rate is the second most pressing indicator in reaching an IVF goal. While you can’t reach an IVF goal if you don’t have a proportional number of new patients, you also don’t achieve it when you don’t convert enough new patients to treatment. If you are busy with new patients, but your IVF volumes are lower than desired, you need to focus on this KPI.
There are different ways to measure IVF conversion, but most of them are cumbersome. So we’re going to give you an easy formula with its limitations.
IVF Retrievals over 12 months / New Patients over 12 months = IVF conversion rate
You’ll find that this calculation is accurate within a few percentage points, if done over a twelve month time period. The formula does not work with one month’s or quarter’s data because IVF cycles can lag 2 - 6 months from first appointment.
The formula is also less accurate if your center does a lot of egg banking. If your patients often do multiple retrievals before proceeding with a transfer, this formula will cause an inflated conversion rate.
100% of patients should not proceed to IVF. We can’t opine on the clinical side of this argument, but we know that conversion rate should never be 100%. If you’re not in a mandated state, or one where employer coverage through Progyny or Carrot is commonplace, the 70% IVF conversion rate isn’t realistic for you. Here is the range of IVF conversion % in the United States from the 40+ practices we’ve worked with:
20%=very poor
30%= poor
40%= good (non-mandated, low employer coverage)
50% =very good (non-mandated, low employer coverage), average for mandated, high-benefit
70%= very good for mandated, high benefit group
ONLINE RATINGS
IVF volume’s first two key performance indicators, New Patient Volume and IVF Conversion Rate, while “sales and marketing” metrics, are also primarily operational figures. The latter two are not. Yet online and patient satisfaction ratings are leading indicators of IVF volume because they account for the content and systems that qualify patients, and move the right ones to treatment more readily.
We’ve separated online reputation from patient satisfaction because even though online review platforms label themselves as reputation management, online reviews are only part of your complete reputation.
Online reviews provide evidence that the third phase in the Fertility Patient Marketing Journey does not live alone in a vacuum. Rather, consult-to-treatment is affected by aspects of the preceding and subsequent phases as well. Online reviews serve a greater purpose than simply getting new patients in the door. People will still schedule a new patient visit even when concerned about negative reviews and low ratings.
However, when it comes closer to committing to a decision, increased doubt can set in. The hardships of dealing with infertility become reality, struggling with cost, insurance coverage, injections, uncertainty of outcome, a clunky patient portal, and the overwhelming number of steps in the process. When continuing to research both the clinic and the details of the treatment, all reviews on public platforms are often displayed next to the Google search results. And if the online reputation displays specific, negative information about a physician or staff member it can be the deciding factor in swaying the person to choose another clinic, or continue with indecision. And if the reviews are positive, showcasing glowing reviews of those who have triumphed over the very hardships they are facing, it’s likely to convince the prospective patient that your clinic, and you as a physician, are the right choice to bring them one step closer to their future family.
Sites such as ZocDoc, HealthGrades, Fertility Authority, Vitals, and even RateMDs simply aren’t as high-authority as they once were. As of writing, the online review platforms to measure your online reputation fall in this order:
Google
Facebook
Fertility IQ
Yelp
If you have a 5 star rating, it’s likely you need more reviews.
4.5 or greater helps you
4.0-4.4 is neutral
3.0-3.9 hurts you
<3 really hurts you
PATIENT SATISFACTION RATING
A positive relationship with your patients is one of the key elements to having a successful practice. You’ll always have the squeaky wheels that make both positive and negative satisfaction known, but the large majority of patients stay silent with their grievances. And even with a successful outcome, silent patients do not necessarily equal a high level of patient satisfaction. Practices must set proper expectations from the very beginning - through the first touch point with your staff, through the welcome sequence, written website content through the physician consultation. And the best way to measure if you are meeting the patient’s expectations is to ask - by sending patient satisfaction surveys at the two key points in the patient’s treatment:
Post Initial Consult
Post Egg Retrieval
Patient satisfaction must not be confused for the public facing online ratings. They are two very separate entities.
Online reputation and ratings can be incomplete or misleading
Soliciting patient feedback internally allows you to quantify issues, prioritizing real concerns from squeaky wheels
Feedback allows clinic’s to address issues before becoming public
The journey is not black and white, but the goal is to capture the not so great parts of the patient’s journey through internal surveys instead of reviews because:
You can ask for more context and understand the needs of the patient in a private setting, giving you a chance to genuinely address the needs
You can improve the experience for the next patient
It’s a chance to reduce or eliminate patient drop-off, rather than the patient going into the post consult black hole
To begin gathering patient satisfaction surveys, you must first choose a software and ensure the process is automated. Triggering an event that happens at the end of the patient consultation or retrieval through your EMR or CRM is always recommended as the EMR is the source of truth.
Patients should be asked no more than 10 - 12 questions and the survey must take no longer than 5 minutes. Each question should allow the patient to leave comments so they can share their experience in relation to the question. Scores should then be aggregated and any question less than a 4.5 should be seriously addressed internally. The five underlying metrics that should be measured during a patient satisfaction survey are:
Ease to Make An Appointment
Transparency and communication between care provider and patient
Interpersonal skills displayed by physician and supporting staff
Quality of Care Received
Financial aspects of care
You must survey by physician and location. And you, as a physician, must look at the reviews and comments about yourself every month. Don’t just look at them as an individual. It’s best practice to share reviews in front of your colleagues if you want a cohesive well run practice. In a multiple physician practice, looking at each physician’s reviews as a group will allow you to see if there are consistencies and missteps in workflows. For example, if there’s consistency in patients complaining about medical assistants doing blood draws, the partners must address this at the highest of levels, but you may not know about that if you look at your reviews individually. Utilize this opportunity to become the best practice possible, and understanding what’s really happening outside of your immediate vantage point has a direct impact on retrieval numbers, IVF conversion rate, online ratings and word of mouth referrals.
Last but not least, patients who share grievances in internal surveys are less likely to write negative reviews publically. This is where automation and software comes back into play. Those who score positively on survey responses are your clinic’s biggest supporters, and if they leave glowing reviews in a survey, they are willing to leave you an online review.
So why don’t they currently? They are not asked. This is your opportunity to ask for the review. The patients that had a positive experience genuinely want to support you. These are the patients who become your biggest fans and tell their friends about your care at the dinner parties, mom’s groups and still the most important referral source - their OB/GYN.
You’ve now come full circle and are into the fourth phase of the patient journey - “Patient Delight”.
Imagine this graphic is a 3D print out and craft it into a circle. By doing this, the patients that have had success and are now in the fourth phase are the ones that will funnell new patients into the first phase. While referrals from the OBGYN still rank supreme, referrals from a friend (word of mouth referrals) are the second most influential factor in a patient’s choice in choosing a fertility clinic. By gathering their input in patient satisfaction surveys, you’ll be able to better understand both what to continue doing, but also, what to improve upon in order to become a world class fertility clinic.
MOVING THE “RIGHT” PEOPLE TO IVF
When you want to increase IVF volumes, without necessarily increasing the number of new patients you see, focus on the third phase of the Fertility Patient Marketing Journey - Consult-to-treatment. But remember that segments of all four phases are necessary to increase IVF volume. Rather than chase a magic demographic of IVF-ready patients, optimize your marketing system to qualify and nurture patients to move through treatment, while keeping in the mind the 9 reasons patients don’t move to treatment immediately post-consult. Beyond new patient volume, the three key performance indicators that drive your IVF volume are IVF conversion rate, online rating, and patient satisfaction rating.
Not all fertility patients should move on to IVF. Pushing people into IVF when it is not their best interest is both unethical and bad for business. Instead, impact these leading indicators for IVF volume by reducing the confusion and fear that prevents people in need from pursuing the treatment option that is best for them.
If you’re stuck with any of the four indicators that lead to increased IVF volume:
New patient volume
IVF conversion rate
Online rating
Patient satisfaction rating
and you would like our strategies for them, we can provide you insight into what may be missing by signing up for the Goal and Competitive Diagnostic here.