So many of you requested more details on Sales & Marketing strategies for the mobile ultrasound industry, so on today’s episode we are breaking down an overview of the 5 step sales process we teach in-depth to our Ultrasound Business Academy students. 

Transcript:

Jen (00:00):
Hello and welcome to the Talking Tech Podcast, the sonographer’s guide to entrepreneurship. I am your host, Jennifer Lindsey, and today we are chatting about sales and marketing. I put a poll on Instagram and Facebook stories the other day and asked what you guys wanted to hear about this week. And I gave you the choice of sales and marketing or legal because I get so many questions about both of those. And overwhelmingly, you guys wanted to hear about sales and marketing. So that is going to be the topic of today’s podcast. I’m also doing a video too that I’m putting here on YouTube. So if you guys like to consume content that way, we are here on YouTube, and I’m trying this out a couple of different ways to see the best way to make sure you guys have the content you need in the way you need it.

(00:49)
So, I’ve got my notes here. First, I wanted to chat a bit about the business overview. Now, I know most of you who have been following along for a little while have probably heard this, but for those of you that are new or for those of you that need a quick overview, I think this is super important to understand so that you kind of understand the gist of what we’re talking about when we’re looking at the five different steps we take our students through, for the sales and marketing process. So when we set our students up, the way that makes the most business sense is to set things up where you, as the mobile provider, are going into the physician practice with service contracts where the doctor’s office is billing insurance, they receive the reimbursement back from insurance, and then they are paying you a service fee for coming in and providing that service inside their office.

(01:46)
So the average in the industry now, east coast, west coast, some of the bigger cities in the Midwest, like Chicago and that type of thing, you guys will have a little bit of a higher reimbursement rate. And so your rates will likely be higher than this. But I like to give a good solid average so people can know what type of revenue stream they’re looking at—one of the most important things to consider when considering starting a business. So the average to charge is $125 an hour, and we suggest setting up half-day or full-day blocks for your physician clients so that you’re not driving for one patient here and one patient there. It makes the most sense to set them up in a block of time so that your doctor’s offices can just know that Advanced Imaging comes every Tuesday from 8 to 12 for our mobile business. They put all their patients on for that week in that time block; we go in, provide the service, bill ultrasound or the insurance company directly for the ultrasound, and then pay us a fee for the time we were there.

(02:58):
So at a half-day time, block a four-hour time block at $125 an hour; that’s an average of $500 gross revenue back to your company. And then at $1,000 for a full day for an eight-hour day is a full day’s rate for the gross revenue back to your company. So if you multiply all that out at an average of 20 service days a month, you’re looking at about $20,000 a month in gross revenue if you provide services five days a week in physician practices. And some of your offices will be small. We have some physician offices that are tiny one-doctor practices, and we may go in a couple of half days a month. And then, we have other practices that may have multiple locations. Lots of physicians, we may go in a couple of full days a week. So it just depends on the practice. And we’ll go over today how to find out what their patient load looks like so that you can determine how to schedule out those days.

(03:55)
So that gives you kind of an overview of the business structure. Now, I always have to have this caveat in here. You have to have contracts when you are providing services. The moment you bring your ultrasound machine in with us, the tech, there are a ton of laws that now apply. So as a sole person just going out and providing staffing services where you’re not bringing in the ultrasound equipment, you can charge by the patient as soon as you bring in that ultrasound equipment that is considered per click. It’s not legal; it’s also not legal to do these services without a contract because many different exceptions within the Stark and Medicare laws have to be met. And those all have to be written out in a contract. If Medicare came in and at an audit on a physician’s office that you’re working at, you’re bringing in yourself as the tech and the equipment, and you guys don’t have a contract, there are very stiff penalties for that physician.

(04:59)
You’re not the one that’s going to get in trouble cause you’re not billing; it’s your doctor’s client that’s going to get in trouble. And there are civil and criminal penalties for these types of things. So do not do business without a contract crafted by a healthcare attorney. Some people called me, saying, hey, I have a business I just started. I’m providing services. And either they tell me they don’t have a contract, bad, or they have a contract they wrote up. Bad also bad. So you have to have a contract that needs to be crafted by a healthcare attorney. And I always use this analogy when I’m explaining this to people. If you’re an ultrasound tech and you went to school, you may let’s say, have learned echo as an overview. And let’s say you’ve been a tech for ten years and haven’t done it.

(05:49)
Would you feel confident doing that if someone asked you to go in and do a full echo? Probably not. And you’d likely have to do a ton of research and hope that everything worked out okay. And so I liken that to asking a business attorney to create a healthcare contract that applies to many different laws. That’s not their area of expertise. And it’s either egg and a take them a lot longer because they have to do more research, aka it’s going to cost you more, or they’re going to accidentally leave some things out because they’re not well versed in where they, they should be looking for all of these laws. After all, there are a lot of different things that apply. So, the contract itself is one of the most expensive startup costs you will likely face. And that’s why we include those in our Business Academy Course for our students because they can get our business academy for less than what they pay an attorney to make their contracts.

(06:49)
So I just have to have that caveat. You have to have contracts. Listen to this podcast; please use this information. But just know you have to have contracts to be able to provide these services legally to your clients. Okay, so the cool thing about this business is that the sales and marketing portion doesn’t require a whole lot of money. We don’t have to, like most businesses have radio advertising and TV advertising and spend thousands of bucks in Facebook and Instagram ads and all of those types of things that most businesses have to do because selling into the medical community is so much different than selling anywhere else. And so, really, what we’re talking about here is creating relationships with these physician practices and going over certain things that you can provide to their practice to help benefit them and their patients in a way that is going to provide revenue back to their office.

(07:46)
It’s going to provide a scenario where the patient is paying a lot less for their ultrasound than they would if they went to the hospital. And so it’s about if you think about it as more of building a relationship rather than selling it makes it a little less scary because, honestly, that is one of the things I often hear from people. Most of our students are ultrasound techs, as you can imagine. And they don’t have experience at all a lot of times in sales and marketing at all. And so, in our ultrasound business academy, we dive into these five steps very specifically. We tell them what to say when they get in front of the doctor. We tell them what to say when they make those prospecting phone calls. Today we’ll go over a basic overview of everything, but I love that we can delve in really, really deep with our students to explain that because we put this together in our Business Academy as if people had never been in sales before.

(08:44)
So it’s very specific and gives them a ton of information. So let’s talk about the five steps we teach our students in the sales process. Now, most physician offices have a separate calendar for vendors. So this is important to note because if you’ve not done this before or looked into this before, you may not realize that’s how you get access to the physician. Some doctors will see people and vendors walking in off the street, right? So they walk in pharmaceutical reps, for example, and they can head back and speak with a physician about any updates on their drug and give them samples. Some offices have special meeting times only for vendors. And so they may have breakfasts, lunch, and meeting times throughout the day. Now, if you’re scheduled for breakfast or lunch, they expect you to purchase lunch for their entire office.

(09:49)
And so, while this seems annoying, it is just if you switch your mindset to, this is my sales and marketing budget each month; you can set this out whatever you want. So we tell our students that you could set it as low as a hundred bucks a month. We suggest maybe about a $500 a month average for the lunches and breakfast because a lot of times because there are so many reps vying for physician’s attention, there’s, you know, a short amount of time for them to be able to speak with vendors. And so often, they only see reps and vendors through those breakfasts or lunch appointments. And so if you set that aside and realize that’s my sales and marketing budget, I don’t have to do TV advertising or radio advertising; this is my budget to provide those services.

(10:39)
And then what happens in those lunch or breakfast meetings is you will order a lunch, bring it in, and the entire staff will come in and get their plates. Sometimes they’ll sit in the lunchroom with you; other times, they’ll go back to their desk, and then the physician’s office, the physicians from the office will come in then and listen to your sales presentation. And so that’s kind of how that works. If you haven’t been in an office yourself where you are well-versed in what vendors are doing when they’re coming into the practice. So just have that in your mind as I go through all this information. But the first thing we need to do when we are marketing is we need to find out who is qualified to use our service. So by that, I mean we don’t know; we’ve got a list of physicians.

(11:28)
So you can look those up in multiple ways to get local doctors. You’d want to have a list of all the doctors local to you within a, let’s say, 10-mile radius to start with. You’d make that list, and then we have no idea what goes on in those specific practices without delving deeper. The first step in the sales process is prospecting. So we need to find out from that list of people that we’ve found that are in our area who is qualified to use our service. We don’t want to waste time driving around to every physician’s practice. And so if we can, delve a little deeper into who can use our service specifically, that’s going to narrow that down. And so what we want to do for that is do a prospecting call, and we want to find out who is independent because it’s easiest in the beginning, especially to start with independent doctors.

(12:29)
What I mean by that is not owned or employed by the hospital because doctors employed by the hospital have to go through the hospital to find out if they’re allowed to use outside vendors and those types of things. So it makes it easier. That red tape can take a long time. Trust me; I know from personal experience we have our own mobile ultrasound business here in Indiana, and we have multiple hospital clients for things like staffing. Then we do a bunch of different things for our hospitals. But it takes a long time to get those contracts finalized cause it has to go through their legal department and signatures by the executives. So that can take months. So I don’t suggest starting with those physician practices; I suggest starting with those independent doctors.

(13:14)
They may be one doctor’s practice, but multiple independent physician offices are also bigger. So I don’t think we should discriminate between small and big offices. I think all of them provide an opportunity. If you think about it from this perspective, a one-doctor practice, while they may not have a big volume, you’re starting to fill up your calendar if you get 10 of those at a couple of half days a month. Whereas one big practice, you may be going in a couple of times a week, that’s great. But it’s nice to have a bunch of different-size practices so that if someone gets bought out by the hospital, you’re not losing three or four days a week right away. Does that make sense? So it’s nice to have a mix of different types of physician practices so that you aren’t relying on one for your entire income.

(14:05)
Does that make sense? So what we want to do is narrow those down. The hospital employs doctors that the hospital doesn’t own, so independent doctors and groups that don’t already have an ultrasound in their practice. You’ll want to ask those two questions when you call that office and gather more information. And again, we dive deep into this in the ultrasound business academy, but that is an overview of what you want to do for that list to narrow it down to people that could use your service. This is where selling into the medical field is different than anywhere else because now we’ll have to go out to those physician practices and talk with the doctors. So that initial visit to the office takes a few times because if you walk in and the doctor sees reps from walk-ins, that’s great.

(14:58)
We can head on back there, and we can speak with the doctor. We don’t have to wait for an appointment, but you may go into the office and find out that that particular practice requires a lunch appointment. And so you have to hop on their vendor calendar, and sometimes they’re open next week, and sometimes it may take a little while to get in. I’ve had offices where I’ve gone in to schedule a lunch appointment, and it’s taken a couple of months for me to get in. And so again, that’s why you want to have a lot of these different offices, especially when you first start marketing in your pipeline so that you are meeting with many different physicians regularly. So you’re not waiting two months to go out and prospect to your first physician. You have all of these other little offices in between.

(15:46)
Um, and so that is the best way when you, when you start setting up those initial appointments to do that, is going out to the physician practice, finding out how they set up those vendor appointments, and then getting on that calendar if you can’t just walk in and see the physician. So step one is a prospecting call, step two is going out to the office, seeing if you can chat with them that day when you go in, and if not, scheduling something to be able to meet with them later. Now once you get in front of the physician, that’s when you need to give them that sales pitch. And again, this is something we dive into with our students today. I can’t do that because I am giving some free training here, but I want to let you guys know there are main bits of information that you want to be able to give them.

(16:34)
So you want to go over the type of service that you provide. Obviously, you’re coming in and providing a service where they can receive revenue for something they’re already ordering, right? So they’re already ordering an ultrasound; we’re not asking them to do anything different. They are ordering an ultrasound, and instead of sending it out obviously to an imaging center or the hospital, we are basically setting up an ultrasound department in their office, and they are bringing the patients right back into the office where the patient feels more comfortable and where the doctor then can receive revenue. Some of you may not know this, but stark law, so anti-kickback and all of that, prevents physicians from sending patients out as a referral and receiving money back from that referral destination. So if they’re sending out to the hospital or to an imaging center, those locations where they’re seeing their patients for that imaging, they’re not allowed to give them a dollar for sending those people to them.

(17:36)
That is an issue with the anti-kickback law. So they receive nothing but a report when sending these patients out. We’re not asking them to do anything different by having you come in. They are bringing their patients back into the office. You are doing all the work, they’re basically scheduling and then putting a line item on for billing, but you’re doing all the work. You’re getting the patient from the waiting room, providing the service in the room with them, and sending images over to radiology or cardiology. As the business owner, you should be making sure that those reports go back to the physician’s practice, just checking in on that good customer service there. But you’re basically providing that ultrasound department right in their office. So now, because it’s in their office, they’re able to receive revenue back. So they are not only getting a report but also money for something they’re already doing.

(18:25)
And I think in the time that we’re in right now, as I’m recording this, we are all kind of hunkered down with this coronavirus pandemic. I had someone email me yesterday that I’m going to get back to her in a little bit today asking, is this a good time to start a business with all of this going on. And you know, of course, none of us know what is around the bend, but I can say from our business perspective that we’ve seen some of the ultrasounds that aren’t emergent go down. So our numbers, total numbers, have gone down. But we’ve also seen a lot of our groups maybe where we’ve chatted with in the past or had maybe just agreements where we’re doing simple staffing when they’re there, people are on like maternity leave or vacation or those types of things.

(19:10)
Those people call us saying we need help because we are moving our employees around. One of our hospitals is doing a one week on, one week off to help If they’ve got people that end up getting this virus, their entire employee system doesn’t collapse, so they want to keep people on and off every other week. And so now we’re on call for some of our hospitals. So I think that there’s an opportunity here, and I really think once we all kind of get over this hump, where we’re not in lockdown everywhere, I think that everywhere, including physician offices, everybody’s going to be looking for ways to bring their revenue back up. They’re going to be looking for additional ways to make revenue. And so I think around the bend, we’re going to see offices wanting opportunities like this for us to come in and say, Hey, we’re going to be doing all of the work you guys are providing us, the patients you guys are billing and receiving the revenue back. Now they can add a revenue stream into their practice that they didn’t have before in times when all of us will want additional revenue after we get out of all of that.

(20:23)
So I think that was a great question, and I wanted to add that in today because I would imagine a lot of you are probably thinking that same thing too. I think we’re all going to see that it will be something where that’s what people will want after this is over. So I digress for a moment, but I just wanted to mention that because I thought it was a wonderful question, and I wanted to give you guys my opinion. But what are we explaining to the doctor once we get into the physician practice? So let me get back to that. I already made a few points there, so now we can bring revenue back to their practice, and it’s a lot less expensive for the patients. I did a blog post on this, so if you guys need more information on how that works, as far as insurance goes, I’ve got a blog post that you guys can go take a look at.

(21:15)
Go to aic-blog.net, and you can check that out there because it’s just really interesting how insurance works. And a lot of times, doctors forget, and they think, oh well, if my patient has insurance, it doesn’t matter where they go because insurance is paying and it is, but everybody has a co-insurance portion, so most plans are 80-20 plans, meaning 80% of the service that is covered by insurance is paid by insurance, but the patient owes a 20% co-insurance. So go check that out if you guys have questions about that, I go into that a little bit deeper in that blog post, but it saves patients money, whether they’re self-pay, have HSA plans, or have a super high deductible. This is a huge benefit to the patient. Not to mention that patients love coming back to their physician practice where they already feel comfortable.

(22:11)
They don’t want to go to a big imaging center or a hospital if they can help it and have to find parking and go into a new place, try to figure out where they’re supposed to be going, and fill out a bunch of extra registration paperwork, they wouldn’t have to do any of that by coming to the physician practice. Because it’s the place they’re already registered, they’re already good to go, and you are just an extension of their staff. So those are a few great points to make to the physician when you’re chatting with them. And then the point of that meeting with the doctor is to get them interested and then to be able to get more specific information about their practice. So now is when we want to find out about how many ultrasounds they’re doing they’re ordering per month, and what types of ultrasounds those are because what we can then do is find out the average reimbursements for those types of ultrasounds, figure out how much money overall they’d be bringing in, subtract out our fee, subtract out interpretation fees if they can’t read their own studies and give them an idea of what kind of net revenue they can be bringing in by providing these services in the office.

(23:20)
So we want to gather that basic information at this first meeting with the physician so that we can come back at another meeting; we’d set the meeting then for the next time we would come in and do a revenue analysis for their practice. And so this is often interesting to physicians; they want to learn more. It’s a win-win kind of all the way around. You know, you’re gaining accounts win for you, the physician is making money win for him, and the patient’s saving money win for them. So it’s a win-win all the way around. And so I see when I go out and market that most doctors are interested in finding out more about how this would work in their practice. And so to gather that basic information’s going to give you what you need to create a revenue analysis, but it will also let you find out how often you would need to be in their practice because you know how long it takes you to do each of the ultrasounds they’re telling you, right?

(24:14)
And so now you can divide that out by how long it’s going to take and figure out how many hours a month you would need to be in there and then put those into blocks of time. So like I said, a small physician practice, maybe you’re going in a couple of times a month for half days or full days, whatever that may be. For other physician practices that are bigger, you may be going in a couple of times a week. But that information you’re going to gather at that first appointment will help you create those revenue analysis streams. So after that appointment, you would want to schedule the next time to come in and speak with the doctor to go over that revenue analysis. And the way to put that together, and again, we dive super deep into this with our students; you would want to find out the average allowable reimbursement from insurance that the doctor was going to get for each of those exams.

(25:06)
You’d add that all up. So that would be their gross revenue. Then you’d figure out how long it’s going to take you to do each of those scans. So you’d have a total amount of hours you would need to be there for the month. You would multiply that out by what you’re charging. So 125 an hour is, like I said, a good industry average for you. And then you’d subtract out also what radiology and cardiology are going to charge them if they can’t read their own studies. This is a question I get a lot, too, so I’ll make a little side note on this. If the doctor can’t read their own studies, they are going to get money from insurance for both the ultrasound and the read. Now there are ways to do that, and very specific laws have to do with that; that’s something that we go over in our ultrasound business academy.

(25:56)
But as a general bit of information, they’re going to get money for both. And so out of that, they are the ones that are going to pay for the read, not you. Many people ask me how much will I have to pay out of pocket for the interpretation? And that’s not something you pay for. So just as a side note there, it’s something the doctor would pay for. So you would take that out on that revenue analysis that you’re going to give them if they can’t read their own studies. So you would have the gross revenue they’re making from all of the ultrasounds, you would subtract out your fee, and you would subtract out interpretations if that’s something they need. And then that total then is their average monthly net revenue back to their practice for having you come in.

(26:42)
And so at that meeting when you’re presenting that you are closing at this point. So that is the close of the sale. So you’re saying here are all the things that we can provide to your practice. It’s less expensive for the patients. We do all of the work except scheduling and the billing portion. You know, we’re providing an exceptional service inside your office so that the patients can come right back where they’re already feeling, feel comfortable. All those points make this understandably a great service for them in the office. They’re only using it when they need it. So it’s not something they’re paying, they shouldn’t be looking at it as an expense, and that’s how you should be presenting it. It shouldn’t be looked at as an expense. It should be considered as bringing in net revenue into the practice because they only use it when they need it.

(27:30)
They’re not paying you while you’re sitting at home or while you’re doing something at another physician’s practice. They’re paying you only when you’re coming in and are scheduled to provide those services in the office. So it keeps them from having to purchase capital equipment. It keeps them from having to hire staff; it keeps them from having to manage any of that. Having this in the office is a big win for the physician practice. And so when you review all of that with them at this meeting, then you can go into the revenue analysis. Hey, doc, I took the information you gave me at our last meeting. I put something together here so that you can see that we can provide these great services, and here is the type of revenue you can generate by bringing us in the practice, which you cannot do when you send them out somewhere else.

(28:17)
You’re getting a report only by bringing us in, you’re getting the report, and you’re also getting revenue back to the practice as well as helping your patients save on their ultrasound. And so that’s when you then want to make those closing statements. Does this look like something you’d like to move forward with? Are there any questions? Sometimes they’ll want their attorney to review the contract, which I think is fine. I never sign a contract without reviewing it. So I think that’s something where you’re not necessarily going to get a signed contract at that meeting, but always have a contract with you to present. And then schedule that next appointment to be able to come back, finalize the contract, and then move through all of that. So we’ll quickly review the five different steps that we suggest are prospecting and so grabbing a list of physicians that are local to you.

(29:07)
I would start with a 10- or 20-mile radius around where you live and where you will be. And then once you’ve marketed to all those, you kind of expand, but it’s good to start kind of close to you and get that list of doctors. Then you will make that prospecting call to find out more about their practice. Does the hospital employ them? Do they already have ultrasound in their office? And then, you narrow down that main list to the list of doctors you will go drive to see and hopefully meet with that day if you cannot schedule that vendor appointment with them. So that initial office visit is going out to either speak with the doctor or schedule an appointment to be able to speak with them. Then once you are in front of the doctor, you are giving your sales pitch; you’re talking about the type of service you’re providing and what it can do for their practice. You’re grabbing that essential information that you need to be able to put together a revenue analysis.

(30:05)
So the types and numbers of ultrasounds they’re doing on a regular basis, average per month. And then you’re scheduling at that initial meeting with the doctor; you’re scheduling your next appointment. Four, the revenue analysis, presentation, and closing. So those last two, four, and five happened at the same appointment. And that closing, as I said, can take a couple of different appointments if needed because when you present that revenue analysis to them and give them the contract, they will want to review it before signing. So you’re going to want to set a next, next appointment then to grab that contract. And then there are quite a few things that we suggest once you get that contract set up to be able to make sure that when you implement it into their practice, it is as seamless as possible. We’ve got a whole section in our portal for our students with a list of what we put in our binder for our offices because we like to have an implementation meeting about a week before we start the service so that everybody that has any hands-on ultrasound at all in their office.

(31:10)
So schedulers, billers, the office manager, front desk people, anybody that the office manager wants in that meeting with you, you can go over exactly how the service is going to work, what you need from them when you come in, what they should expect from you and have a binder for them to be able to grab at any time should they have any questions. We go over exactly how they should be billing all of that information. And so it’s nice to have all of that in a specific binder for them when you do that implementation meeting. And then that way, when you go in for your first day, it is as smooth and seamless as possible because that is how you keep clients for the long term. You make it easy. Every time we go into practice for the office, we want to say, oh man, advanced imaging is great.

(31:57)
I hardly know they’re here. They take great care of our patients. I always get my reports when I need them. They’re right on it if I have any questions or problems about anything. And so those are just things that customer service wise you want to make sure you’re keeping up on because the sales and marketing part is great, but keeping those clients long term is what is going to be as easy as possible because it’s cheaper and easier to keep clients for the long term than having to keep getting new ones. So those are the five steps in the sales process that we teach our students, and I’m so excited to share those with you today, especially since we did that poll, and that is what you guys overwhelmingly asked for. It was

(32:38):
Basically, a 70-30 to the legal. Now I think the legal is important, too, so I’ll likely do a podcast on that as well. But I appreciate your input because all of this information we put out is specifically and especially for you. And so if you have questions, you guys know how to get ahold of me; I got ways to connect with me all over the place. You can do that on our website too. If you go to aic-ultrasound.com and click on the About section on our website, you’ll see a picture of me, and there is a section underneath “Ways to Connect,” and I’ve got my email address, Facebook, and Instagram pages, all of that stuff’s right there for you. I would love to hear from you guys any questions that you have. Any suggestions you guys have for future podcasts; I want to make sure this is tailored and geared specifically for what you need. So until next time, we’ll see you guys later.