How to Be Moses: Lead Patients to Cash Pay Medicine
“If you can’t explain it simply, you don’t understand it well enough”
-Albert Einstein
You’re resolute in following the path to cash pay medicine. Bravo. But you might want let the patients know about that. Our practice labored over the best ways to get the word out. We could have done better. Learn from our mistakes and old processes below. Let the message be clear so you may guide patients like Moses did for his people.
Today’s TLDR—do’s and don’ts of a cash pay announcement to patients
DO: use multiple channels in parallel (mail, email, social media, meetups)
DO: clearly articulate the benefits patients will have in your cash pay system—frame the transition in a positive light
DON’T: assume that patients will read 100% of what you send
DON’T: be grandiose with the announcement—this takes away from the substance which should deliver the impact on its own
Letting the people know
During the prep stage in August 2019, we drafted the cash pay announcement based on how we thought the patients would react. As you’ll learn soon, that was mistake number one. No medical dermatologist in our metro area went 100% cash pay before. Although we stayed confident, the unknowns still bothered us. Would all the patients just up and leave? Would our loyal Medicare-aged patients—who got used to paying ~$0 for their visits—cause a revolt? My habit to plan for the worst spawned a little fear of the future.
My physician partner and I wanted to ease the blow as much as possible.
We clearly spelled out the health plan decoupling planned for January 2020. We also committed to opening more clinic hours in the run-up to the change. The letter was sent out with three months’ notice. Here’s the main clipping from the announcement letter:
The uncertainty of the outcome bled into our writing, creating the shock value we meant to prevent. Some patients thought we chose to quit on them! We hosted three open houses designed to answer questions about the transition while celebrating 20+ years of care at the clinic. Thankfully, we were better at telling our story in person than in writing at the time. We did a good enough job to maintain a successful cash pay clinic since then. But let’s do a post-mortem of our old strategy so you can do even better.
Beware of… envelope
It turns out that every patient’s nightmare is a letter from their favorite doctor opening with “Dear patients.” We overestimated people’s ability to read a letter. Whenever a well-regarded physician over the age of 60 makes a general announcement, here’s what happens to your message.
The real letter: “Dear patients, I plan to change my practice to XYZ…”
What patients see: “Dear patients, I’m retiring! See ya!”
We spent hours crafting a consistent note, but did not anticipate these perceptions.
Our past outreach strategy with justifications at time:
Snail mail
Allows for a personal message better expressed on paper than over email.
ISSUE: mail doesn’t always reach its destination and patients don’t always check their mail, leading to inconsistent expectations. Do not assume established patients know about the changes when they call you, even if they did receive mail.
Open houses
Gives you a chance to address specific questions in person that writing can’t express.
Demonstrates to patients that you care about their opinions/comments/concerns.
Gives everyone an excuse to grab a bite and share a few memories.
ISSUE: this may not be appropriate for your office’s location. Our clinic resides in a private building unaffiliated with a massive health system—it was easier for patients to gather there.
Again, we still pulled off the move to cash pay. We could have mitigated the above issues by using other media in parallel. Imagine when cars replaced horse carriages. You still, of course, need to explain the private pay system for patients more than a few times on this journey.
If we turned back the clock…
We’d like you to kick-start your private pay office with a bang, not a hiss. This is how our clinic would handle an announcement strategy today if we had a DeLorean time machine. The best part is that you get to skip the time travel!
Snail mail, part II: Unlike how we drafted our letter in 2019, articulate yourself in terms of what resources you give the patients to act, instead of react. This is more than just going over cash pay’s benefits and stopping there. Illustrate hybrid arrangements (e.g. patients seeing an in-network provider full-time but also visiting you once a year for more thorough/complex care). Give patients concrete avenues to transfer their records if they wish.
Side note: it’s up to your clinic whether a mail merge (i.e. the letter is addressed to the specific patient) or a generic greeting is ideal. Adjust for nuances in speaking to one person vs many.
Email blast: Although we doubted email in the past, there’s no denying that its accessibility and speed makes sense for other clinics. Your office may already have an optimized email list. Use it!
Website + local business profile update: We elected to save our new website for just prior to the cash pay implementation date. However, you can also have your website landing page generate a pop-up link related to the change.
Leverage the channel attracting the most traffic. Have a brief one- to two-sentence message about the clinic’s transition with a button for more details. Said details can be on a non-indexed webpage.
Other clinics prefer using their Google My Business profile or social media accounts. We learned to squeeze all the juice from those lemons a bit too late. Harvest organic traffic.
Directories like Google My Business also let your staff respond to patient questions. Craft an FAQ list on your website to anticipate patients’ needs.
In-person communication: After finishing the first mail/email/postings, use word of mouth. Educate your patients about the transition at their next visit. If your staff are in tune with the practice, they will adjust their manner and content with each individual patient. Have a longer execution window (six-plus months to go cash pay instead of three months like we had) if possible so the conversions feel less rushed. This high-touch approach is ideal, especially when hosting an open house doesn’t make sense.
Cash pay announcement methods pros/cons
Don’t talk about it—be about it
Be proud of your preparation. No need to be sheepish with patients. If you’re embarrassed to break the news, patients feel empowered to leave. It’s not a matter of “you’re going to pay out of pocket for me.” A better message is “the care you get from me is going to be incredible now because of X, Y, and Z.” Practice your tone. Reach us on Substack or contact me directly @caretocash on x.com to address questions for your practice or search for a great doctor.