Ajay: You’re most welcome. And thanks for being a part of our podcast. So, I can see that for three-years you have been doing this practice. Give us a little more background as to where you went to medical school and how long you have been practicing or not.

Dr. Rapoport: I trained at Northwestern. They had an Honor’s combined medical program for undergrad and medicine. I did a Master’s in Public Health at the same time. I took a year off to do a large research project in India and in Ghana. And it was there that I discovered my love of ophthalmology and cataract surgery.

And I can talk a little bit about that later. And then I did my residency training at Vanderbilt and my fellowship in cornea and refractive surgery at Harvard, and I’ve been practicing in New York City for the last five years. And I started my own practice a little bit over a year ago, right before the pandemic.

So, very interesting time to start but we’re growing rapidly just expanded to our second location. And it’s very exciting, there’s a lot of growth, there’s also a lot of room for more growth as well and we’re very excited about the next few years.

Ajay: Perfect. So, how many – when you’re saying that you expanded to new locations; how many providers are there? Do you have more ophthalmologists?

Dr. Rapoport: It’s just me, a technician, our biller. We have a whole team, but I’m the only physician at this point. It’s not full time at either location, so we split our time between the two.

Ajay: Okay, perfect. I totally understand that. And we’ll get to your specific question, but can you share with us, what you are doing for marketing right now?

Dr. Rapoport: Sure. Most of our new patients come from the best way, I think, which is word of mouth. You do a great surgery with a patient and they send their family, they send their friends. So, it’s organic. And I think that’s excellent and that’s initially how you start off.

I think in terms of what we’re actively trying, a little bit of physician relationships, which isn’t quite marketing however I can meet new referring doctors I think that’s an excellent way because I know that the physicians I refer to, I trust a lot and vice versa. We have tried, recently, doing a few email marketing campaigns to our existing database, and they did not go over well.

It’s a fine line, because what we provide are medical services. Some of what we provide are elective services, like Lasix, medium cataract surgery. But it’s a fine balance because I don’t ever want to be selling something to a patient. I can recommend certain things, and we can market our services because I take great pride in my surgical skill and in the whole office’s ability to take care of patients. But we don’t want to be selling services in the same way of Bloomingdale’s sells shoes, for example.

Ajay: Okay.

Dr. Rapoport: So, we tried email marketing, didn’t respond very well. We are now starting to try Facebook ads and Instagram Ads, it’s interesting to think about which patient demographic would respond better to which? Different age groups are on different social media platforms.

I think younger people are on Instagram or Tik Tok or Clubhouse and some of our older patients are on Facebook, too bad Myspace is dead, the things of the previous generation. And we did do Google and Yelp ads for a while. I don’t think we got very high ROI, so that’s really it in terms of direct marketing that we’re doing at this time. I was thinking of going to local optometry schools and trying to market there, but then the pandemic happened so nothing was in person anyways.

Ajay: Okay. Good, you are on top of – at least what you’re doing, and I know that you had some specific questions for me. So, let’s talk about the question that you had.

Dr. Rapoport: A lot of what we do also revolves are HIPAA because we want to protect, No. 1) we wanna protect patient data, it’s different in a non-medical business.

So, my initial question was how do other practices manage their attention email marketing with patient email addresses, and are there specific HIPAA hoops, privacy hoops that we need to follow to make sure that patient data is safe? And do most other practices use their practice management system for both clinical information and promotional information?

Ajay: Okay, I can share with you about our clients. So, first let me tell you what, generally, speaking they do with the email addresses that they have, and then I’ll tell you how they are doing it. One thing that we always recommend to everyone is to send out a regular newsletter. Once a month is good enough.

Just to be in front of your patients and generally speaking when there’s a relevant newsletter, and the newsletter is not sales speech. Generally speaking, you’re talking about the latest information and obviously once in a while, it’s perfectly okay to have an ad in the newsletter itself. But having a regular newsletter, it helps because the patient gets into the habit of getting something from you regularly.

So, even if you, once in a while you will send something, they will still open it and they will respond to it afterwards. So that’s something that they are doing. Then you can use some mass communication tools but anything, any regular information that is relevant in their area. So, obviously all of your patients – so there’s no HIPPA about telling someone that, ‘Hey, this is the latest issue.’ I’m just making it up, but the Corona Virus seems to have this kind of impact on the eyesight.

Anything that is relevant, you can communicate with the patient so that they will set up. It could be as simple as why regularly, we recommend that you regularly get your eyes tested, or whatever. Something that you are sending everyone. It’s a kinda extension to the newsletter but it is something very specific. Newsletter is more like it says, news. This is something that you are addressing to them, to the patient. Again, all non-HIPAA. So, the HIPAA issue only comes in when you are using the patient specific information, right? Talking about their issue, so long you are just talking about general issues, there’s nothing to do with HIPAA.

And the third thing that you can do, definitely, is get into – and these are automated. So, they’re tools to automate the system. But just sending them, so you will have their birthday. Not date, but their day. So, just sending a ‘Happy Birthday’ ecard, or ‘Merry Christmas’ or these holidays, holiday season greetings, have a great Labor Day. These are very automated systems that you can place. So, the idea is that you want to be in front of patients all the time.

The ones that have already seen you, because that way they get into, you want to get them into the habit of listening to you. So, this is how you want to do it because anything else on their attention emails, these are the things that you do for attention, and also like I said, so long as it is all relevant and it is not to them, and it’s not selling. Obviously, a birthday card you’re not selling anything, right? You’re sending someone a ‘Happy birthday’ or some greetings, or newsletter you’ll have one ad, but a lot of information that you can add.

Dr. Rapoport: Yeah, interesting point.

Ajay: So, that is what our clients are doing, generally speaking. And that seemed to be effective. And again, one thing that I will tell you that other than talking – when it comes to RY, these are things, what I just told you, you can obviously always check and see what kind of effect it has. But this is more of retention and getting the top of the mind earnest ideas rather than selling. Because the thing that never works is –

Dr. Rapoport: Right.

Ajay: Just suddenly they got an email, and say ‘Now, I am offering this. And you get a 50% discount.’ People tend to ignore it, but when they are in the habit of seeing your brief, regular touch-points, then ever when you sell once in a while, a marketing campaign is more effective.

Dr. Rapoport: Fair enough, excellent points. So, just be constantly on their mind, I think the newsletter’s a great idea in terms of here, so many technologies just out on the market, this is a I find this interesting from a medical point of view and I just want to share because I want my patient base to be informed about the latest technologies and I find it interesting. Those are excellent ideas, Ajay. I like those a lot.

Ajay: Good.

Dr. Rapoport: I think my other question was; outside of Google and Facebook, or maybe even Instagram, which is owned by Facebook. What do you think is the next best, high, RY channels for specifically driving Lasix sales? You’ve seen the statistics this past year, Lasix is up 30%, patients are tired of wearing glasses from the masks, everyone’s at home on the computers and tired of wearing contact lenses. So, to the extent that people want to get Lasix, how do we drive those patients to our site and to our practice?

Ajay: Okay, very good question. So, I will tell you, there’s two other channels that everyone things, ‘Google’. And yes, Google is the most dominant player, but there’s a Bing also, and there’s DuckDuckGo.

Dr. Rapoport: Okay.

Ajay: And these two are track very different target audiences. So, Bing attracts older people, believe it or not. They tend to go on Bing, so if you have older patients, then that’s a target. And DuckDuckGo is more about people who are very concerned about the privacy and all that. Right?

Dr. Rapoport: Privacy.

Ajay: So, those immediately I would add to it, but other than that, I will tell you that the highest RY that you will get is No.1) you need to have an online representation management process. Which means, there’s seven platforms that we focus on these review platforms and you want to make sure that you are getting reviews on all those platforms on a regular basis.

Because what happens, when it comes to a new patient, especially when they’re looking for a provider, so in their decision process, selection process, these reviews play a very big role. Literally, about 40% of the people trust review more than a referral from their physicians. And then the other challenge – I’m saying challenges for provider like you is, out of the seven review sites, they may go typically one or two.

And you almost have to be on all of them. So, suppose you have really good reviews on Google, but no reviews on say, ‘WebMD’. Now what happens is someone is checking on Google will find you, but if someone is checking for review son WebMD, they don’t find you. And no reviews, today, is as bad as a bad review. So, the number one thing that you should focus on when you are trying to acquire new patients is you make sure that you have a lot of reviews. On all review channels, okay?

That’s one thing. The second, I would say is – and it almost follows it, because you need to have good reviews in order to get this one. But the SEO, and I don’t know if you search in an organization, right? Are you aware of what SEO is?

Dr. Rapoport: Of course, yes.

Ajay: So, SCEO is in the long run, has the highest return. Because what happens is the cost of SEO is same, and then the return just keeps on improving over a period of time. It’s not like – it is only limited to the number of searches ultimately. But that also gives you a very high return. So, I would say right now, first things first you want to make sure that you have really good reviews on all the review sites, okay? And then second, I would say SEO.

These are two things that will give you the highest return, other than Google, Facebook; you said Yahoo, DuckDuckGo, Bing. Those are the PPC, but even there also, Dr. Yuna, is what will happen is it your only reputation is not very good, then you again, your return is not going to be very good there either.

Because people will find out about you, but trust me, before they contact you, they are just going to be checking the reviews. And that is true for, I think, 90 plus percent of the patients now. The first step they do is they go and check the review of the providers.

Dr. Rapoport: Right, I think you couldn’t be more right. And we actually do work on that quite a bit. I think Google, what were the other ones you said? You said Google Reviews, WebMD, I know I have a lot of reviews on –

Ajay: Yeah, so I will tell you. So, you have Google, you have Facebook obviously, then you have Yelp. You’d be surprised, Yelp is the very small percentage of people go on Yelp looking for physicians, but still, it’s there. Then you have WebMD, you have Rate MD, then you have Healthgrades, ZocDoc, and there’s one other vital. So, these are the eight –

Dr. Rapoport: I’ve heard of these.

Ajay: You’d be surprised, we did a very extensive market research last year, and I think we have to redo it again. We did 1,500 of patients all over the country. And the usage of which review sites, we just wanted to see what percent, what is their behavior?

How are they using reviews? And we were just surprised to find out how much. Older people will go to WebMD more, younger people on Google, then in the nineties it looks like a lot of people go on Rate MD, but is says in midwest Vitals says more popular. It’s kinda mix match, so what you may want to do is make sure – the bottom line is, I would say because a certain percent of the people is going on all the review sites, having a process that you are getting regular reviews on every site is a great thing that you need to do.

And again, Google is obviously is the most dominant. 60 something percent of the people who will check your reviews on Google. So, Google reviews are very important. What we have seen is Google is more –

Dr. Rapoport: And have you?

Ajay: Yeah? I’m sorry.

Dr. Rapoport: Go ahead, this is very helpful. So, Google is most visited?

Ajay: And then after Google is your WebMD, and then I think it’s Facebook.

Dr. Rapoport: Okay.

Ajay: And then you have Health grades. Your Yelp is like second last. But again, if you have to have three or four sites, you want to make sure that Google, Facebook, WebMD, and Health grades. You definitely want to be there, but on the rest also. Now ZocDoc is becoming up, so you want to be there also. I mean there is no recipe from this thing. You just want to have a process in place so that it’s automatically you are getting reviews on different sites from people.

Dr. Rapoport: This is super useful. And then sort of a piggyback question on that; how do you then recommend we ask for reviews? We send an automated email after every patient visit, whether it’s in person or telemedicine. We get a very low hit rate, very few people actually click on the link and leave a review. Even if we know they had a great experience.

Ajay: So, what happens, Dr. Yuna, is back in 2014 when, in our marketing, we sort of realized that reviews are so important, we can do whatever we can and get all these providers in front of the patient. But unless there are good reviews, we can’t help them. So, we created a platform where what we do is first, we ask for their satisfaction. What happens when you really go and ask automatically for review, then again, they are not excited.

So, what we did is we created a process where every day, all the patients that go to physicians, we will send them just a one-question satisfaction survey. It is like, ‘Would you recommend your friends or relatives based on your experience today?’ kind of thing, right? And when the people, the ones that rate very high, we ask them for the reasons so that you are also getting, all sort of new testimonials from there.

Because we ask them, can we share? When someone is very happy. But when someone is saying they are very happy, which we always ask, 0-10 scale and I can explain why 0-10, not 1-5. But when someone says it’s 9-10, then we ask them, thank them, and say would you mind sharing your experience? So, first thing, right there they shared, and then we make it very easy for them to click on any of the review sites and write it.

What happens is if you are sending someone an email, right? Say, ‘Would you please write a review?’ You try to write a review on Health Grades and it’s they all have to write it, and there’s an email code and anything, and on Google. So, they have to first find you, right? And then – so it’s a lot of work. So, we make very easy for them by saying, ‘Just click here.’ And it takes us straight to your profile, and write a review.

Dr. Rapoport: And we are already doing that, and we’re still finding – go ahead.

Ajay: So, what percent? What we are seeing is about 40% of the people respond to the initial survey about their satisfaction level, and then out of that 40, 30% or so will share that review. Because what we do is, we ask for their feedback right there, and then when they will write the review, we just make it very easy. If they want, they can just click ‘Copy/Paste’ automatically just paste it.

So, it makes it super easy for them to do it. So we are, on average, I would say that 8% of the patients are writing reviews. So, like I said 30 to 40% will respond to the survey, and out of that, 20% or so will go and 20-25% will write the review. So, about 8% of the patients are writing review. Now, the good news about review is, you don’t need millions on those.

You want the minimum 10, is what people expect and then the reviews become very important. So, the review is, if there are 15 reviews and three of them were done in the last one month, or last two months, that is good enough. You don’t need millions of reviews there for people. So, it seems to work. If you are seeing, I don’t know how many patients that you see.

And again, depending on the procedure, if someone has – if you have performed a cataract surgery, and someone is very happy, the chances of them writing a review are much higher than you are a primary care physician, and someone just went in for a checkup, right? The bottom line is that you want to automate. So, you already have it automated, right?

You are sending emails, I guess the only thing you are not doing in the process, is you are not first asking for their response in how satisfied you were with the visit. So, that part I do ask is that also in your process?

Dr. Rapoport: We are. We basically send a brief email that says, ‘Were you happy today? Yes or No.’

Ajay: Okay.

Dr. Rapoport: Yes, and then it would direct them to say please leave a review, or please share your experience, with a direct link to Google and Yelp, and they can pick one. No, it directs them to leave a private message that goes directly to use, so we can take that feedback and learn from it. So, that’s how we do the automated system.

Ajay: So, by the way, Dr. Yuna, I will tell you that for the Yelp it’s a no-no. So, if the Yelp finds out, like you said not a lot of people are writing it. So, Yelp forbids you to directly ask for it that way. So, for Yelp you almost have to drive them to your website to click on that. So, Yelp is pain in the neck, but the good news is that your prospective patient is not checking Yelp anyways, so that is the advantage with Yelp.

Dr. Rapoport: Okay, okay.

Ajay: And the Google, are you getting on Google also? With your process?

Dr. Rapoport: We are, we don’t have many. I’m looking it up right now. We have something like 40, it’s basically a five-star rating a 4.9 rating. So, it’s an excellent rating.

Ajay: So, 40 is fantastic.

Dr. Rapoport: It’s just not many.

Ajay: But you don’t need more than that. So, you’re very good. Just make sure that now you have to start getting it on other platforms, like Facebook.

Dr. Rapoport: Other platforms.

Ajay: WebMD, and Rate MD and all those also.

Dr. Rapoport: Okay, good. Interesting. It’s good to diversify, that’s very helpful. Thank you.

Ajay: Okay.

Dr. Rapoport: This was very, very helpful. And what are your thoughts on some of the newer platforms like Tik Tok or Clubhouse, or these fads? Because some doctors are on all of these as well. What are your thoughts on these?

Ajay: So, we, generally speaking, we don’t go for the latest fad. We don’t chase the latest shining object. So, we have not really, until it establishes, what will happen is – in terms of the effort that you make versus the response is not going to be very high, just because it is not – for Tik Tok right now, it is not established in terms of who is the target audience there, right?

Dr. Rapoport: Right.

Ajay: So, until you know the target audience, and that’s why Facebook for example and Instagram is so effective because you can really narrow target the audience there. So, I would say instead of those, maybe what you want to do is you look on Twitter, by the way. Twitter is again, it’s not like you will get a lot of business from there, but Twitter is also targeted and it helps you with your branding, so I would say –

Dr. Rapoport: Yeah, I’m on that.

Ajay: And then retargeted advertising if you’re not using it. That is something that you can try so when you’re doing paid advertising or when someone visits your websites right through SCO, and if they don’t convert immediately, the retargeted advertising will chase them. So, they could be on New York Times and they see your ad there. It is a constant reminder. I would retarget advertising is something you should look into.

Dr. Rapoport: Retargeted advertising, okay.

Ajay: And the couple of things that I will also suggest, which is in return very effective; is one thing you want to create an automatic process for asking for referrals. Since you’re already asking people, ‘Are you happy, not happy? Yes, no.’ So, the ones who said yes, you don’t ever do that immediately but you can have it in the database and then later on, just ask them for referrals. The magic of a referral is that you have to ask them, ask for it.

Dr. Rapoport: You mean ask directly, in person?

Ajay: Yeah, no by email. And give them – so what we do is we will ask them for referrals on behalf of – our client will ask them for referral by email, but right there – make it really easy for them. All they have to do is add the name and email address.

Along with that, there’s form that they just add the name and email address of their friends and then just say ‘send referral’ which is basically submit what you call. And an email goes from them, to their friends introducing you but you also know. So, you know that Ajay recommended me to Pauleen. So, one thing that you can do is say, ‘Thank you, Ajay.’ And reach out to Pauleen directly by email, by phone or whatever.

So, that is one thing that you should do and then the other thing is since you are already doing, and going after the referring physicians like you said initially; almost like I would say, automate the process. What you can do is you can have a content along with your reputation score and stuff like that, and Pauline send Dr. Yuna the – what to we call that? Reputally link.

So, what that will do, Dr. Yuna, you can see overall the score, how you do compare to how your peers, and then you can use things like that and your credentials which is fantastic credentials that you already have. And then you can just automate the system where you have the list of referring physician, by email you can introduce yourself. Then they can get added to your, when they are open, they can get added to your newsletters, right? Again, the idea is that you want the top of the mind of earnest.

So, that when they have a patient that requires your expertise then they remember. They go, ‘I can send you to Dr. Yuna.’ That’s the main thing, so I would – the more automated marketing that you can do, the easier for you, because you don’t ever think about it. You don’t have to do anything, the patients are getting requests and not everyone will recommend, but you will start getting referrals from patients that way.

Automatically through emails, and then you – always a trickle of new things that’s coming. What I have noticed about marketing is there’s seldom you hit home run.

Dr. Rapoport: It’s cumulative.

Ajay: Exactly it’s cumulative. In the baseball term, I’ll say you’ll get singles and doubles mostly rather than home runs. But those will keep on adding into runs and runs and runs, and that’s how you win.

Dr. Rapoport: Great, I love that analogy. That’s very helpful. Thank you so much for such an interesting conversation and discussion. I really appreciate all of your insight, it’s so data backed and data driven which is very helpful of course. So, I really appreciate your time and your expertise.

Ajay: Perfect, and it was wonderful talking to you.

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