That's what a board-certified reproductive endocrinologist (RE) told me over lunch at the 2016 American Society for Reproductive Medicine (ASRM) annual scientific congress. "The patient experience doesn't matter. The only thing that matters is if they get a baby or not." My efforts to show him all of the evidence to the contrary were fruitless. That was the end of the conversation. Why try to convince the inconvincible?
This is my third annual recap of the Midwest Reproductive Symposium international (MRSi) , so I'm going to have a little fun with this one. I don't feel like writing another list and I think there's a more valuable point I can convey to you. As of right now, MRSi holds the title for my favorite meeting in the field of reproductive health and I want to use it nudge other meetings to follow suit. I should be a fair judge, I go to almost all of them.
It certainly doesn't hurt that it's on Lake Michigan in Chicago in the summer time, and Dr. Angeline Beltsos knows how to incorporate an interesting theme. Those are pluses, but not enough to make a meeting my favorite. It's big enough to have a diverse range of programming and small enough to be very collaborative and social. People get to know each other and build meaningful relationships. I truly understand how important that is for the field. Louise Brown, the first baby ever born from IVF was a guest at the conference.
We didn't plan it this way...really. Yet still, there was a theme.
The Association for Reproductive Managers (ARM) is the practice managers' professional group within the American Society for Reproductive Medicine (ASRM). As a group, we meet in person twice per year: at ASRM in the fall, and at the ARM Annual Meeting in the spring. We just wrapped up our 2017 meeting on April 28 at the Hotel Chicago (guess which city).
Jackie Sharpe is Regional Marketing Director for HRC Fertility in Southern California. Once, at an Association for Reproductive Managers (ARM) marketing meeting, I asked Jackie, "Is it easier, or harder, to track the effectiveness of marketing today than it was several years ago?"
I could tell she had thought about it before. "It's harder," she replied.
Harder? We have every tool under the sun, from Google Analytics to every kind of Customer Relationship Management (CRM) software and marketing dashboard. We can track every click, page view, Instagram like, Yelp review...everything down to how many minutes the average visitor spends on our website. How is it not easier than ever to track our ROI? Yet, you know what? She's absolutely right.
When a fertility doctor (or any business owner for that matter) hires a marketer, they very often want to know, to the dollar, what the results will be.
Imagine if I bragged, "My company will increase your new patient visits by 40%!" Would they know, even remotely to the number, what a 40% increase looks like? Would they know to what they could attribute the increase? I've found that the answer is almost always no, because in the fertility field, we rarely have the data we need to gauge the effectiveness of our marketing. Even less often is that data readily accessible. I called this The Biggest Marketing Challenge Facing Fertility Centers, back in 2016. Unfortunately, not much has changed.
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.
Who knew this hyperbole, coined by Harry Selfridge in 1909, declaring his department store's commitment to customer service, would go on to become a thorn in the side of employees everywhere? It's a terrific internal mantra to aspire toward, but it can be very harmful when interpreted as a universal rule. Customers, or in our case, patients, may sometimes project their frustrations on to you or your staff and no one has the right to be abusive to your team members. Maintaining the notion that a single patient's point of view is infallible can put unfair stress on our employees. Gordon Bethune, former CEO of Continental Airlines, says that when companies don't support their employees when a customer is out of line, resentment results and service deteriorates. If we don't care for and support our staff members, how can they in turn care for and support our patients?
I don't know if I ever had a conversation with anyone struggling with infertility (about the topic) before a few years ago. If I had, I probably would have said something silly like the above. I would have said it with the best of intentions, and hopefully, I would have kept an open mind. I knew nothing about infertility. I had barely heard of IVF. I had no idea what a reproductive endocrinologist (RE) was. I am a young male with zero medical background and no personal connection to infertility. On paper, I was the least likely person to become an ally of the infertility community. And that's the very reason it seemed so important to become one.
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.
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.
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."
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.
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.”
“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.
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.
"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."
"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.
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:
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!
What a day. Legislation hasn't been this much fun since School House Rock. RESOLVE, The National Infertility Association, held their 2016 annual Infertility Advocacy Day at the Capitol on May 11. Over 200 advocates came to Washington, DC to meet with their legislators regarding a few key issues that deeply affect both the infertility and military veteran communities. This was the largest advocacy day that RESOLVE has hosted to date and we hope it's only a glimpse of the momentum that is building for the future. If the relationships made between advocates are any indication, this is a movement set for growth. If you've ever wanted to connect with the infertility community, you need to come out for Advocacy Day; plain and simple. Read on to determine if it's the right fit for you. Let's start with some background on the issues for which we went to advocate:
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
Last night I had one of the coolest conversations that I've had in a little while. The best part, is, we recorded the whole thing. This week is National Infertility Awareness Week and I wanted to participate in the #startasking dialogue, not just with sound bytes or with a scripted narrative, but a candid, meaningful conversation between people who really want to see the infertility community receive the recognition they deserve. So I invited a few cool people to chat on Blab.
What a world it is where patients can form an opinion about their fertility doctor before they even schedule an appointment. A 2013 study shows that 90% of respondents reported that online reviews influenced their purchase decisions. Through public feedback from their peers, people dealing with infertility have a plethora of information to make their decision from online review sites that exist for the benefit of the patient. Here's where it gets interesting. Fertility centers can also benefit from online reviews--good, bad, or neutral--by using them to deeply understand and adapt to patient habits. By carefully examining the online reputations of the most highly rated fertility specialists in the country, we have further decoded the messages that patients are sending loud and clear.
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.
If I asked you to name what comes between September and November, you might answer Breast Cancer Awareness Month (BCAM) before you say October. Is there any oncology center in America that doesn't participate in breast cancer awareness month? Is there anyone who doesn't recognize those pink ribbons? Over 1.5 million people participate in the Susan G. Komen races alone. With major partners like the NFL and Proctor and Gamble, the month is almost too popular; to the point where criticism is made that brands exploit the cause for their own profitability. Meanwhile, all the infertility community wants is recognition of their disease and the resources to treat it. Yet of course BCAM is so much more widely known than National Infertility Awareness Week (NIAW). After all, statistics show that 12% of all U.S. women will develop breast cancer in their lifetime. That's dramatically higher than the 11.9% of women who receive infertility services within their lifetime.
How do people feel about the financial charges associated with IVF? I don't know, you tell me.
"Incompetent or possibly fraudulent insurance practices"
"Almost a year later I am still unable to officially take care of my billing issues"
"They have no problem with asking me for money but pointing out there was a descrepancy [sic] in billing no one would answer"
All of these comments come from real fertility clinic reviews. Is this frustration familiar to you? Financial stress is one of the biggest pain points in dealing with infertility and it sometimes negatively influences your relationship with your fertility clinic. As if infertility didn't already give you enough to deal with, its best medical solution is one of the most expensive endeavors you'll ever face. Some people talk about the cost of IVF in terms of financial infertility, because it is the most common obstacle that prevents couples and individuals from seeking treatment. We frequently see GoFundMe and other crowdfunding campaigns to raise money for IVF. In most U.S. states and Canadian provinces, the expense of IVF is paid out of pocket. Even in the United Kingdom, where the National Health System (NHS) covers most health expenses, there are still many people in the U.K. who don't qualify for the terms of coverage and they too have to pay from their own accounts.
Organizations like RESOLVE advocate for broader and deeper coverage of fertility treatment and you can join them for their 2016 infertility advocacy day on May 11. Still, even in states like Massachusetts where insurance companies are mandated to offer IVF coverage, you find plenty of complaints about billing and unexpected charges. At issue, there are many items you can be charged for because needs vary from patient to patient. It's not uncommon to see posts from people who say they've spent over $50,000 on costs associated with IVF. That's a wide leap from the IVF packages listed at $7,500.
This variance poses a problem to you as you search for information to properly plan your budget. In the spring of 2015, I surveyed a small group of people dealing with infertility who listed cost confusion as one of their three most common pain-points in dealing with their clinics. You want a clear answer. You want the transparency that you enjoy in almost every sector in which you spend your money. You instantly pay for everything else at fixed prices from Amazon, Priceline, Fandango, and Blue Apron. Why can't you get a straight answer about how much IVF will run you? You need to know what costs you'll incur and how much of it will be covered by insurance in order to budget for your treatment. Why aren't clinics more transparent with you?
The answer is multi-faceted, so let's dig into it.
Let's start with one of the very few, axiomatic, incontrovertible laws of the universe: insurance is a nightmare. Remember the national debate we had about healthcare coverage just a few years ago? Effectively, the arguments centered around whose solution would make our horrible payer system even more horrible. The problem certainly isn't unique to fertility care; all of healthcare is plagued by the problem of cost uncertainty. A study conducted by Consumer Reports shows that billing disputes are the third most common complaint Americans have about their doctors. Why can't a provider tell you how much a service will cost before you decide to go through with it? CEO of tech startup, PokitDok, Lisa Maki, says that people "are trapped by a system that requires that they agree to a service with no knowledge of what the outcome or what the consequences might be to them financially". It's a conundrum. Put yourself in the position of the billing manager; they hate it just as much as you do.
Glad you asked. Every U.S. state and Canadian province is different. In the United States, some states have mandated coverage. If you don't know the universal definition of mandated coverage for infertility...it's because there isn't one. It's helpful that RESOLVE grades states based on how much coverage is mandated. Some states like New York and Texas may be considered mandated states, but their coverage varies. In New York, insurance companies are mandated to cover certain treatments like IUI, but not IVF. In Texas, insurance companies are required to offer coverage in plans to employers, but employers do not have to purchase those plans.
Even in states like Massachusetts and Illinois, the law doesn't apply to certain types of employers, such as those who self-insure. What's more, you may live in a mandated state, but if your employer is not based in that state, then your home state's coverage doesn't apply to you. Don't forget about deductibles, either. You may need to spend a certain amount before insurance will pay for anything. Certain tests and medications might be covered and some might not. If you'd like to take a look at your clinic's website to see what insurances they accept, that won't help much. Every person's coverage depends on their individual plan. What might be covered for your co-worker might not be for you.
Is your head spinning yet? We'll table the idea of insurance for the moment. Let's approach this as though you're paying entirely out of pocket. What other costs might you incur in addition to the price of the IVF cycle?
Tests. Ask your IVF coordinator if your package has a limit on labs or ultrasounds during treatment. If there is a limit, how many labs and ultrasounds are included and how much is each additional?
Medications. Which drugs are included in the package and which are not? How much do they cost? Is your doctor able to prescribe generic or other brand labels that might be covered by insurance? Are you allowed to buy them on your own?
Labs. Does your clinic have an in-house endocrine lab or are your labs sent out to a third party? Labs will be drawn throughout your treatment that need to be resulted the same day. If your labs are sent to a third party, there may be an additional cost to you.
ICSI. Is Introcytoplasmic Sperm Injection included in the package? According to Sher Fertility Institute, ICSI is often required when cases involve the severest degrees of male infertility.
Embryo freezing. Some clinics will store your embryos in cryopreservation for six months after your IVF cycle, and some might include it for a year. How many months are included in your IVF package? What is the fee for each additional month of storage?
There are even more potential costs associated with IVF
Anesthesia. If the clinic doesn't disclose whether or not anesthesia is included, it is likely that they charge an additional fee.
Donor eggs. Donor egg prices are not included in IVF packages unless specifically mentioned in separate pricing. The clinic may have their own donor bank or they may use a third party. If this is a need of yours, it will mean additional costs.
Surrogacy. If you have this need, the total cost of surrogacy may be as high as $150,000.
PGD. Preimplantation genetic diagnosis can greatly improve pregnancy success rates by carefully selecting embryos. For older women, and women who have suffered early pregnancy loss, PGD may be all but necessary. Rarely do IVF packages include the cost of PGD.
See? Now you understand why it's so hard for clinics to quote one all-encompassing price for IVF, beyond the most basic IVF package. Rachel Gurevich of About Health reports that the total cost of IVF treatment averages around $20,000, as opposed to the $12,000 average cycle price. There are so many moving parts, it's virtually impossible to give you one set price. As far as clinics are concerned, they need to start displaying "sample pricing". As far as you're concerned, it's better to estimate very conservatively.
This is a great question and it's part of the reason I wrote this post. Fertility practices need to get better at educating prospective patients on cost complexity. From my observation as a marketer, some fertility centers aren't good at discussing finances for two main reasons.
Doctors don't like to talk about money. Generally speaking, they find it unbecoming of the conduct of a physician. They hold the patient-physician relationship to be very sacred and they don't want to cause you to think otherwise. They want you to know that they are invested in your care and not the financial arrangement behind it. I see two scenarios play out in online reviews--one that validates physicians'reluctance to talk about money and one that reveals an adverse effect. In the first scenario, the doctor is perceived as "money-grubbing" or trying to "sell" IVF. In the second, people are surprised by a bill and they lash out at their practice for a charge they weren't expecting. Finance isn't an easy subject to bring up, and that's why most physicians leave the discussion to their billing department. The appropriate sales conversation for infertility treatment is content for another post.
Clinics are afraid to be punished for doing the right thing. What happens when a fertility practice tells you to budget $20,000, and you get a quote of $8,000 from one of their competitors? To a degree, this concern is justified. Tests show that, if not supported by the necessary context, pricing can sometimes drive people away. I would know. I am not the cheapest marketer that someone can hire and I never want to be. When I quote someone for a price, I want to include everything they might need. If I tell someone they should budget for a marketing strategy at $6,000/month, I include an advertising budget, graphic design, web development, etc. Someone else might tell them that they charge $600 per month for marketing services. That $600 doesn't do much but it sure sounds better than $6,000. No matter the service, people often ask about price before considering the total value being offered. This creates an undesirable cycle: you won't tell me your pricing until I'm more interested; I'm not interested until I know your pricing. This is very annoying for both parties involved, fertility centers and their patients.
So why should your fertility clinic show you detailed sample pricing? Are they trapped in a catch 22? Tests prove that the advantages of publishing prices far outweigh the disadvantages Think of it this way. Do you ever stop shopping before you know what the price is? What is the cost of a ride across town? You won't know until the cab stops and adjusts their meter. So you choose Uber, because you see the price in advance, and peer reviews validate the experience you're looking for. To compete for your selection, fertility clinics need to be more upfront with pricing. Leave that part to me.
For your part, the more educated you are as a patient-consumer, the more information practices will have to provide to you ahead of time. You are now conversational in the basics of infertility financing. You will be fluent by the end of your journey. To start, you have some background knowledge of which costs to investigate. Clinics are reluctant to share more information on pricing, partly because they are concerned that their competitors will get away with cost ambiguity. Don't let competing fertility clinics win by giving you less information. As an educated patient-consumer, you have the power to let transparency rule the day.
"They treat this place like a baby factory. Doctors spend so little time with patients."
Factory. This is a word we hear very frequently when people are unhappy with their fertility centers. Do you feel like your fertility clinic is a factory? Do you see your doctor as much as you expected you would? Are your phone calls promptly returned? Do the staff remember your name? Now, some of these issues matter more to certain people than they do to others. Some people are perfectly happy with a "baby factory", provided that the factory produces a healthy baby. Some are really only concerned with the final result and less so with the process that leads to it. From a small group of patients I surveyed, slightly more than half would have preferred a doctor with an atrocious bedside manor but with exceptionally high success rates. The other half preferred a personable, compassionate doctor whose success rates were well within the standard of care. Surveys conducted by Dr. Francisco Arredondo of RMA of Texas conclude the same. There is no right or wrong decision, so long as you are perfectly aware of the decision you're making.
I've been writing a lot for clinics recently and I owe a lot more content to you, especially when you have big choices to make about which fertility specialist you're going to see. It's not an easy decision and it's not one a referring doctor or even a close friend can make for you. The choice is yours. This is the value that I've proposed all along; help practices improve so they can attract more patients and help patients be wise and clear with their decisions so that practices have to continually improve. Though I haven't created much content for you in the last several weeks, I have been doing a lot of listening. I really appreciate the feedback you've given me on Instagram about how you found your fertility clinic and what factored in to your decision making process.
In the summer of 2015, I asked my e-mail list of fertility doctors if if they had any questions about the Health Insurance Portability and Accountability Act (HIPAA) as it relates to internet marketing. Except I didn't write HIPAA. I wrote HIPPA. Thankfully, someone who read the e-mail, corrected me. I was a little embarrassed. I knew what the acronym stood for, but I still wrote it incorrectly. Why would I spell it that way?
