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The Business Side of Balance: Marketing Issues

The Business Side of Balance: Marketing Issues
Richard Gans, PhD
August 12, 2002
Specialize in treating balance disorders? Opportunity awaits, IF you effectively market your services.

Richard E. Gans, Ph.D., FAAA

American Institute of Balance
11290 Park Blvd
Seminole, FL 33772

More and more audiologists are involved in the diagnosis and treatment of dizziness. However, there' s a lot more to diagnosing and treating dizzy patients than meets the eye, and the wise clinician will cautiously research and evaluate the opportunity before jumping in! There's a saying that dizzy patients don't get better - they simply keep going to different doctors. The average dizzy patient, in fact, sees 4.5 physicians before getting a diagnosis, let alone proper treatment.1

If you specialize in dizziness and balance disorders, opportunity awaits. However, high-quality programs are not the only factor in a successful practice. In fact, many well trained professionals with well equipped balance facilities haven't survived in the competitive and restrictive markets in which healthcare practices exist.

Undoubtedly, many reasons account for these failures. Nonetheless, clinicians often neglect the business side of balance -- namely marketing! Even if you have the best knowledge, competence, and equipment, your facility is set up for failure if no one knows about it! Marketing is every bit as important as clinical competence, and your marketing abilities often determine success or failure in healthcare businesses. This article will address a few of the issues that are paramount to a successful marketing program.

To develop a marketing strategy, you must first create realistic goals and objectives. What is your vision of your balance center? Will it become a local, regional or national center of excellence? Will it handle a few patients a month from one or two referring physicians? Whatever your objectives, be realistic and do your homework. This starts with analyzing your community.

Harvard Business School professor Michael Porter has written extensively on analyzing competition.2 Using Dr. Porter's model, I've developed a few questions you should ask about your competition before undertaking the venture. You must understand what is going on in your community. If you don't, the economic and political landscape may not be suitable for the project, so you may need to adjust your fiscal projection.

Your marketing analysis should include the following:
  1. Are similar services currently being offered in your community?

  2. If yes, by whom?

  3. What is their reputation?

  4. What is their quality of care?

  5. Their location?

  6. Their accessibility?

  7. Their political impact?

  8. Their financial strength?

  9. If they advertise, to what extent, where and how?

  10. Do they have built-in referral sources that could be redirected to you?

  11. Consider all forms of competition, including medical or specialty healthcare professionals who offer traditional diagnostic therapeutic management.

  12. If no services are currently available -- ask yourself -- why not? Even if you determine that you currently have no competition, expect competition! Others in your community will enter the market as soon as you have some success. Being first will not guarantee you a monopoly, nor will it guarantee you dominance in the market. Your competition will watch what you've done, try to emulate you and improve on your success while avoiding the missteps. Have an anticipated plan for new services and be ready to kick it up a notch when competitors arrive.

  13. Who pays for health care in your community?

  14. If your region is dominated by managed-care organizations, can you become a provider? While you may be in a perfect demographic area with a high density of geriatric patients, do not assume all (or any) managed care organizations will place you in their provider network. Do some advanced investigative and explorative work. Set up meetings with medical directors or contract specialists before you open your center. Let them know the cost/benefit of effectively treating equilibrium disorders, and listen carefully to their responses.
  15. Once you have completed your analysis, you will be in a better position to make realistic and intelligent decisions about the feasibility of the project. You can then develop a business plan that will accurately reflect the financial road ahead. Within the business plan, you should address potential sources of referral.

    There are essentially two different potential referral sources to be evaluated and managed.
    They can be categorized as:
    1. Professional referral sources.

    2. Consumers (direct to consumer initiatives).
    I recommend you target your marketing initiatives towards professional referral sources. Although each category (see 1 through 10 below) has its own unique marketing strategies, attributes and issues, consider the following.
    1. MDs:
    2. Market to medical doctors with large geriatric demographics. Certainly you should consider otolaryngologists, neurologists, rheumatologists, orthopaedic surgeons, geriatric and physical medicine specialists and ophthalmologists too. In fact, almost every medical specialty (except perhaps pediatrics and anesthesia) are potential referral sources.
    3. Dentists:
    4. Older patients with positional vertigo often avoid regular dental care because they are afraid of becoming dizzy during positional maneuvers in the dental chairs. Dentists and hygienists would be appreciative to have their dizzy patients return for dental care, particularly without dizziness!
    5. Podiatrists:
    6. Many older adults with foot problems and concommitant balance problems have lower extremity neuropathy and consequently, they see podiatrists.
    7. Chiropractors:
    8. Treating Benign Paroxysmal Positional Vertigo (BPPV) using Canalith Repositioning Maneuver (CRM) may appear similar to chiropractic manipulation. Many chiropractors have learned to perform CRMs or are interested in having their patients with BPPV treated so the patients are more comfortable during chiropractic treatment. Chiropractors can refer patients for diagnostic testing and treatment of BPPV or vestibular rehabilitation therapy (VRT).
    9. Audiologists:
    10. If your audiology colleagues are not actively involved in vestibular diagnostic or VRT, they may serve as an excellent referral source. Naturally, these colleagues will potentially view you as "the competition" and may require your assurance that you will return the patient to them for their audiologic and amplification needs.
    11. Physical and occupational therapists:
    12. Most therapists are involved with many therapy specialists, other than VRT/balance. Educating colleagues about the nature of your specialization offers a collegial referral pattern. This may open mutual referral patterns as you refer to other facilities for specialties that may not be part of your program.
    13. Nurses.
    14. Nurses often play a significant role in the triage of patient care. In physician offices, nurses often will direct patients to labs, specialists, or treatment facilities. In community or home health situations, they often assume the role of primary care or gatekeeper, particularly for the elderly.
    15. ACLF/Nursing home directors:
    16. Falling is a great concern for administrators of facilities for the elderly. Risk management strategies may include providing an analysis of the facility's environment, particularly lighting and surfaces. These facilities and their professional staff may direct patients to you, particularly if their residents exhibit dizziness or have begun to fall.
    17. MCO medical directors/contract specialists:
    18. Undiagnosed and untreated equilibrium disorders cost managed care millions of dollars. Offering an efficient and cost-containing management strategies for these patients will definitely interest MCO medical directors. Using clinical pathways and reporting treatment outcome studies will greatly enhance your presentation.
    19. Attorneys:
    20. Defense and personal injury attorneys often need subtest and quantifiable data from diagnostic-evaluative specialists to support their case or to negate the defense of their opposition.
    Networking with professionals works. After you develop an excellent working relationship with these professionals (above) do not be afraid to ask them if they have colleagues who might benefit from your services. Additionally, when you call or write the new referral contact, be sure to mention the referring professional's name. People tend to do business with people they know and like, and the name recognition of their colleague will enhance your credibility.

    To reach professionals, consider the following methods and techniques to market to professional resources:
    • Newsletters:
    • Informational and educational newsletters provide professionals with a simple and easy-to-read format to learn about vestibular and balance disorders.
    • Lunch and Learn:
    • Lunch is an excellent forum to spend 30 or 40 minutes with a professional and their office staff to discuss your services. Pharmaceutical companies have used this approach successfully for years. Although your budget may not allow you to compete with the marketing strategies of the "big guys", you certainly can budget pizza, sandwiches, or a tray of lasagna.
    • Patient follow-up letters:
    • This is an excellent way to let all professionals know you have seen their patients. By relaying successful treatment outcomes, you are establishing credibility and making sure the professionals know all aspects of their patients' health care.
    • Lectures and in-service programs:
    • Anytime you have the opportunity to speak to a group of professionals, take advantage of the invitation - whether it is a nursing group obtaining CEUs, or a physician luncheon at the local hospital.
    • Journal articles:
    • Because most advertising budgets cannot tolerate extravagant printing costs, consider using journal articles as part of your marketing effort. These articles scientifically address the topic and can educate your referral sources. I also include a brief handwritten note and highlight salient points. (I don't expect the physician to read the entire article.)
    • Patient endorsements:
    • I encourage my patients to talk to their physician about their experience with us. Because our specialty may be unfamiliar to many doctors, it helps if they hear good things about us from their patients.
    • Referral kit:
    • Make it ease for physicians and other professionals to refer their patients to your facility. Print referral and Physicians Order form pads. Include a map or directions to your facility. The easier you make it for physicians and other professionals and their patients to get to you, the more likely they will refer to you. Leaving them a handful of cards, which may be tossed in a drawer, is not appealing. We drop off pads along with a box of chocolates or cookies near Valentine's Day, Fourth of July, and Thanksgiving. By selecting these "off-peak" holidays, you can place yourself in the spotlight.
    The following are strategies to market your services to the consumer. Remember, you do not have to spend much time and money explaining the symptoms of dizziness, vertigo, imbalance, and falling to your potential patients. They are already too well aware of the problem, and typically they cannot find anyone to help them. Keep your message straightforward regardless of the medium you choose. Here are some options:
    • Television:
    • Spot cable advertising has made TV advertising affordable. Older adults, however, do not respond to the "sound bite", as do younger people. Carefully select time slots and programs that have the proper audience demographics for older adults. We erroneously selected airing our commercials during the "Larry King Show" because we thought it had wide appeal. Unfortunately, it had poor older adult viewership because the 9:00 p.m. time slot was too late in the evening.
    • Radio:
    • Rather than using a "canned" taped commercial, have the talk show host read the radiographic studies spot live. Listeners identify with the host, enhancing the credibility of your message.
    • Internet:
    • Young and old patients and consumers surf the Internet for information on health care. Many adult children of aging parents seek competent health care professionals for parents residing in different cities or states. Our website receives more than 200 hits per day from around the world. You may want to consider creating your own website, or getting a link through destination sites, such as Audiology Online ( or their "sister site" which focuses on the consumers and patients, called Healthy Hearing (
    • Newspapers:
    • Older adults constitute the largest readership of local newspapers, despite dwindling readership. Often, patients will clip articles or advertisements and carry them for weeks or months before calling to schedule an appointment.
    • Health fairs:
    • Participating in large health fairs can often be frustrating because you are competing with the giants of your community, which may be the largest hospitals or managed care providers. Often the attendees are more interested in the free give-aways than in your message. The expense, therefore, may not have the desired results in sufficient new patient numbers to warrant the cost and personnel needed to staff the event.
    • Lectures and screenings:
    • Providing a lecture and screening on dizziness, balance problems and falling is useful. In our experience, one-third of all attendees make an appointment after these lectures. Be sure to bring plenty of interesting reprints along with your brochures and business cards.
    Although there is no magic formula which guarantees success, a combination of professional marketing and clinical excellence will help assure that your practice has the maximal preparation and opportunity for success.

    1. Li JC, Epley J, and Weinberg L (1999, November). Cost effective management of Benign Paroxysmal Positional Vertigo using Canalith Repositioning. Otolaryngology Head and Neck Surgery, 122, 334-339.

    2. Porter M. (1980). Competitive strategy: Techniques for analyzing industries and competitors. (Republished with a new introduction 1998). New York: The Free Press.

    3. CLICK HERE for more information on DIZZINESS.
      CLICK HERE for more information on the AIB Education Foundation.
      4 live webinars | January 22 + 29 | February 19 + 26 | 12:00 pm EST | Adult Perceptions of Cochlear Implants: Helping Your Patie

      Richard Gans, PhD

      founder and executive director of The American Institute of Balance

      Dr. Gans is the founder and executive director of The American Institute of Balance;one of the country’s lardest balance disorders treatment centers.  He received his Ph.D. from The Ohio State University in Auditory and Vestibular Physiology.  Dr. Gans has been a leader in the development of vestibular evaluation and rehabilitation techniques.  He has presented or published over 100 programs and papers in the area of equilibrium disorders and is a frequent lecturer at national and state meetings.  Dr. Gans is the author of several books including, Vestibular Rehabilitation: Protocols and Progrms and is completing VOG/VNG: A Clinical Workbook published by Singular/Thomson Learning.  He is adjunct professor at the University of South Florida and Nova Southeastern University.  He teaches vestibular and balbnce courses for three distant Au.D. programs including University of Florida, Arizona School of Health Sciences and Pennsylvania College of Optometry-School of Audiology.

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