Friday, July 01, 2005

Boehringer, Bayer to launch clinical trials Web sites

Boehringer, Bayer to launch clinical trials Web sites

 

Boehringer Ingelheim and Bayer joined the ranks of several other pharmas by announcing plans for their companies' clinical trial Web sites. Boehringer's will include all trials started today and after, and the company will post all ongoing trials by September 13, it reports. Results of completed trials will be posted one year after the drug is first approved and marketed in any country or within one year of the trial's completion. Boehringer says if a product is codeveloped or marketed with another company, the license holder will have the responsibility for providing trial information. Bayer's site will initially include information on 10 trials started after January 6, 2005, and will add trials started after today within three weeks of their start date, the company announced. By mid-September, Bayer says it will list all ongoing trials, concentrating mainly on phase III and IV trials, except in "exceptional cases," such as cancer research, which will include phase II information. Bayer also says by March 2006, all completed trials started after October 1, 2002, will be listed online. 

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Wednesday, June 29, 2005

Zoomerang offers tips for healthcare industry online surveys

Zoomerang offers tips for healthcare industry online surveys

Healthcare companies increasingly turn to the Internet to conduct consumer research, according to Web survey software firm Zoomerang, which counts Wyeth and Johnson & Johnson as clients. Its online poll of healthcare industry professionals shows that 63% of respondents are shifting away from using paper surveys and 37% are moving away from the phone in favor of the Internet. When deploying online surveys, Zoomerang says companies should clearly define the survey's purpose; keep it short, simple, and focused; and use closed-ended questions whenever possible. Companies should also keep rating scale questions consistent and make sure their questions flow logically. For best results, companies should pretest the survey and deploy it on a Tuesday, Wednesday, or Thursday. Finally, Zoomerang recommends sending completion reminders and offering incentives for participation, which usually boosts the response rate by about 50%. To read more about using Web-based surveys, go to Zoomerang.com.

 

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Poll: Healthcare Companies Say Online Research Displacing Phone and Mail Research

PR Newswire via NewsEdge Corporation :

MILL VALLEY, Calif., June 28 /PRNewswire/ -- Healthcare companies and organizations say online research, one of the most affordable and effective marketing tactics, is displacing phone and mail research, according to a recent Internet survey by Zoomerang, maker of the leading global online survey software.

Based on the study, more than 3 in 5 healthcare industry professionals involved in online research (63%) report shifting from paper or mail research to the Internet. In addition, nearly 2 in 5 (37%) are moving away from phone research in favor of online research.*

Zoomerang Vice President and General Manager Paula Rivers explains, "Healthcare professionals are shifting from traditional research methods towards online research because, simply put, it makes great business sense. They are realizing that the tool can potentially expand their ability to make informed decisions and help grow revenue, lower costs and increase productivity."

Among those healthcare professionals in the survey who are benefiting from productivity gains, more than 2 in 5 (43%) say that productivity has increased by more than 20% over the previous year. Also, among those who are benefiting from cost savings, nearly 3 in 5 (59%) report lowering costs by 10% or more over the previous year. Similar trends are cited among those who are benefiting from increased revenues.

Online survey usage has penetrated 20% of the healthcare sector and is growing steadily among adopters. Nearly three-quarters (74%) of health care industry professionals involved with online surveys report increased usage of this technique over the previous year.

Online surveys are an easy way for industry decision-makers to obtain the feedback they need to help them make critical decisions. Through online surveys, healthcare organizations large and small can query their customers about their satisfaction with care or services, accomplish a host of human resources-related functions or even obtain feedback about education and training efforts.

Top Ten Tips

Obtaining quality feedback means asking the right questions. Here are 10 tips from market leader Zoomerang for creating effective surveys:

1. Clearly define the purpose of your survey.

Spend time up front to plan objectives. For example, you might want to find out if your customers are satisfied with your company's service.

2. Keep the survey short and focused.

It shouldn't take a respondent more than 10 minutes to complete a survey, so it's generally better to focus on a single objective.

3. Keep the questions simple.

Make sure your respondents will understand the questions. Don't make the questions complex and avoid the use of jargon.

4. Used closed-ended questions whenever possible.

Closed-ended questions make it easier to analyze results and can take the form of yes/no, multiple choice or a rating scale.

5. Keep rating scale questions consistent.

If you use rating scales -- for example, rating customer service on a scale from 1 to 5 -- keep them consistent and make sure the meanings of high and low remain the same.

6. Make sure your survey flows in a logical order.

Start with the broader-based questions, later moving to those that are narrower in scope, and make sure that one questions naturally leads into another.

7. Pre-test your survey.

Before launching your survey, be sure to pre-test it with a few members of your target audience to help you uncover glitches and unexpected question interpretations.

8. Schedule your survey by taking the calendar into account.

Keep in mind that Tuesdays, Wednesdays and Thursdays are the best days to deploy your survey -- you'll generate more responses than if you send it out on one of the other four days.

9. Offer an incentive for responding.

Incentives typically boost response rates by an average of 50%. However, if you do decide to offer an incentive, be sure to keep it appropriate in scope.

10. Consider using reminders.

While not appropriate for all surveys, sending out reminders to those who haven't yet responded can often provide a significant boost to your response rates.

About Zoomerang

Zoomerang is the leading online survey software and the most popular tool around the globe for obtaining vital feedback at rapid-fire speed. Since its 1999 debut, it has quickly gained momentum, growing a "fan base" of users in over 200 countries worldwide. To date, over 1 million Zoomerang surveys have been launched and over 27 million responses recorded.

Zoomerang customers range from multinational corporations to small businesses and nonprofits. DuPont, Johnson & Johnson, Wyeth Pharmaceuticals and United Way are just a few of its many high-profile clients. Zoomerang is owned by MarketTools, Inc., a leading provider of full-service, online market research services headquartered in Mill Valley, California. For more information on Zoomerang go to www.zoomerang.com.

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Consumers say e-newsletters, samples would help Rx decisions

Consumers say e-newsletters, samples would help Rx decisions

Forty-seven percent of surveyed consumers said informational Web sites are their preferred online format for receiving drug information, according to a survey of more than 2000 respondents from e-mail marketing and customer acquisition firm Prospectiv. An additional 37% said e-mail is their preferred online method. Prospectiv, whose clients include Pfizer, Procter & Gamble, and Schering-Plough, also found that 92% of respondents would be likely or very likely to visit treatment Web sites and 83% would be interested or very interested in receiving educational information about drug treatments. When asked about offers from pharmas, 51% of surveyed consumers would prefer free samples and 34% said educational e-newsletters would be most valuable in helping them make their drug buying decisions, according to the survey. To learn more about the survey results, go to prospectiv.com.

 

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Prospectiv Survey Shows Growing Consumer Preference for Learning about Pharmaceutical Drugs Through Online Resources; Consumers Express Preference for More Information via Educational E-Newsletters and Informational Web Sites

Business Wire via NewsEdge Corporation :

WOBURN, Mass.--(BUSINESS WIRE)--June 28, 2005--An increasing number of consumers are looking to online resources for accessing information about drug treatments relevant to their ailments, according to results from a Prospectiv Consumer Preference Index (CPI) poll conducted last week that gathered responses from more than 2000 consumers. The poll results also showed that physicians remain the primary resource for pharmaceutical drug information.

Prospectiv's CPI shows the majority of respondents; at 73 percent, currently look to their doctors as their primary source of information for drug treatments, while websites and email came in second at 14 percent, and mass market vehicles including television, radio, magazines, newspapers and books; at 10 percent. When consumers were asked how they would like to receive information in the future, websites and email increased to 17 percent, while magazines, newspapers and books declined slightly to 3 percent, and television and radio declined to 1 percent.

When asked about their preferred online vehicle for receiving drug treatment information, informational web sites, at 47 percent, and email at 37 percent were the top selections. Ninety-two percent surveyed said they would be very likely or likely to visit a website focused on treatments for their ailments. Eighty-three percent responded that they would be interested or very interested in receiving educational information about drug treatments.

Prospectiv's CPI also revealed that in terms of preferred offers from pharmaceutical companies that would most likely peak consumer interest in drug treatments, 51 percent would prefer free samples, while 34 percent identified educational e-newsletters as most valuable in helping them make drug purchasing decisions.

"These results confirm what we see as a growing trend for pharmaceutical marketers to leverage online technologies and communications to build closer and more direct relationships with the consumers who can benefit from the drug treatments they have to offer," said Jere Doyle, Prospectiv's president and CEO. "As a result, we've seen many of our pharmaceutical clients allocating more marketing resources on building their direct-to-patient databases through online channels."

For more information about these results, please contact Tom Francoeur at 781-388-7900, ext 205, or by email at tfrancoeur@topazpartners.com

About Prospectiv's Consumer Preference Index (CPI)

Millions of active, self-profiled consumers have registered at Prospectiv's vertically-targeted online properties - Eversave.com (connects consumers with quality offers from leading brands), TheKnowledgeStop.com (premier resource for online and campus-based education and degree programs), and Healthy-Individual.com (online resource focused on health and well-being offers) - enabling Prospectiv to compile insightful survey data for advertisers and marketers. Prospectiv's 20-point data authentication, cleansing and validation process ensures the database of self-profiled consumers is current, active, and accurate in order to deliver the highest quality data to clients.

About Prospectiv

Prospectiv provides industry-leading customer acquisition, email marketing and data analytics solutions to leading consumer brand marketers. The company's solutions enable the world's best brands to find and build profitable relationships with the right customers through multiple online channels, proprietary optimization technology, and comprehensive data validation. Prospectiv generates more than 50 million pre-qualified responses per year on a pay-for-results basis for clients, including many Fortune 1000 companies such as Procter and Gamble, Wal-Mart, Pfizer, Dell, General Mills and Schering-Plough. Founded in 1999, Prospectiv is privately-held and is based in Woburn, Ma. Please visit http://www.prospectiv.com for more information.

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Monday, June 27, 2005

Wall Street Journal (June 23, 2005): Marketers Scan Blogs For Brand Insights

Marketers Scan Blogs For Brand Insights

By WILLIAM M. BULKELEY
Staff Reporter of THE WALL STREET JOURNAL
June 23, 2005; Page B1

Many marketers suspect there are probably some valuable insights contained in the Web logs produced by the estimated 12 million online diarists. But in the cacophony of trivia, vitriol and bombast that fills the blogosphere, useful nuggets have been hard to find.

Now, a growing number of marketers are using new technology to analyze blogs and other "consumer-generated media" -- a category that includes chat groups, message boards and electronic forums -- to hear what is being said online about new products, old ad campaigns and aging brands. Purveyors of the new methodology and their clients say blog-watching can be cheaper, faster and less biased than such staples of consumer research as focus groups and surveys.

Blog watching helped advertising giant WPP Group PLC craft a new promotion aimed at teenagers for its Chicago-based client U.S. Cellular Corp., says Bethany Harris, senior vice president of WPP's G Whiz Entertainment unit. Using technology from Umbria Communications, a Boulder, Colo., company that aims to identify demographic groups online based on their speech patterns and discussion topics, G Whiz concluded that teens were "really anxious" about exceeding their cellular minutes, often because parents make them pay if they talk too much. The teens also resented being "ambushed" by incoming calls that pushed their minutes up. Ms. Harris says that led U.S. Cellular to offer unlimited "call me" minutes.

Marketers say bloggers' unsolicited opinions and offhand comments are a source of invaluable insights that are hard to get elsewhere. "We look at the blogosphere as a focus group with 15 million people going on 24/7 that you can tap into without going behind a one-way mirror," says Rick Murray, executive vice president of Edelman, a Chicago public-relations firm.

Walter Carl, a professor at Boston's Northeastern University who has studied "word-of-mouth" communication and marketing, says blog-watching services "are very useful for quickly getting the lay of the land" in trends and consumer reactions. Still, he says, it isn't clear how closely online comments mimic the 80% of "word-of-mouth" that still occurs face-to-face.

Not everything bloggers have to say about brands correlates to the real world. Last summer, Umbria, working for a fast-food client, was monitoring Burger King Corp.'s Angus Burger and found it got some bad reviews from bloggers. Some were deriding Burger King's tongue-in-cheek TV ads that called the burger a diet food. Bloggers notwithstanding, the Angus Burger has become a hit.

Blog-monitoring services typically charge big companies $30,000 to $100,000 a year. They say their technology goes beyond basic tools, such as keyword searches or counting links from one Web site to another, both features available at no charge from online services such as Technorati.com and Yahoo's Buzz Index.

Intelliseek, a Cincinnati firm started by veterans of Procter & Gamble Co., has a free Web site, BlogPulse, where users can enter up to three keywords and see how they compare. Before the latest "Star Wars" release, mentions of Natalie Portman briefly topped those of Paris Hilton, indicating the movie's pre-release marketing was making an impression.

[Web Buzz]Intelliseek and most other blog-watching services combine technology with some human analysis. They say their full services provide more insight than a simple keyword count. Some companies have developed text-analysis techniques as the result of funding or contracts from the Central Intelligence Agency and other intelligence services that monitor newspapers and other media. The technologies make use of software technologies known as "natural-language processing" and "unstructured-data mining" to understand even ungrammatical writing.

Bernice Cramer, vice president of market intelligence for Polaroid Corp., a unit of Petters Group Worldwide, says she uses Intelliseek's service. "If you look for it manually, you'll spend months searching through a lot of junk," she says. Polaroid recently found that consumers online frequently discuss photo longevity and archiving, making that an important issue in product development.

Sometimes blog watchers spot trends before they emerge in mainstream media: Pete Blackshaw, Intelliseek vice president, says blog mentions last summer of the Swift Boat Veterans ads against Democratic presidential candidate John Kerry indicated their claims were a big issue three weeks before the Kerry campaign finally addressed them.

Mr. Blackshaw says companies used to dismiss vocal complaints from one or two consumers as an aberration. But now, they have to pay attention because now those complainers may have blogs. "Those folks have influence with others via the Internet," he says. PR firms are hiring Intelliseek to monitor their clients, he adds, because once-obscure consumer issues are surfacing at awkward moments, such as CEO interviews with "reporters who go to Google and type in a brand and [then] ask tough questions."

Umbria, with clients including Sprint Corp. and Electronic Arts Inc., says its natural-language analysis can determine blogger demographics based on language, subject matter and acronyms. OMG ("oh my God!") or POS ("parent over shoulder") are expressions defining Generation Y girls, or those ages 10 to 25; FUBAR ("fouled up beyond all recognition") is often used by male baby boomers.

Such analysis can be important. Umbria says Laker guard Kobe Bryant has lost his cachet with most bloggers, but he is still the No. 2 National Basketball Association personality, behind LeBron James, among the boys of Generation Y, important buyers of videogames, sneakers and basketball jerseys.

David Rabjohns, president of blog watcher MotiveQuest, calls the field "online anthropology" and says he regards his firm as "almost a mouthpiece for the consumer." The Evanston., Ill., firm's clients include Motorola Inc. and Citigroup Inc.

For a Japanese auto maker, Mr. Rabjohns says MotiveQuest studied online postings about minivans. Soccer moms said their young children love minivans, which they regard as "a playhouse on wheels," but teens regard them as lame and want SUVs. MotiveQuest recommended developing a loyalty program to persuade minivan owners to buy the company's SUVs, rather than trying to get them to buy another minivan.

 

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When You're Sick, Mammahealth.com Is There

 

When You're Sick, Mammahealth.com Is There

TechwebNews.com via NewsEdge Corporation :

Even as adults, we sometimes go to our mammas for help. Now Mamma.com Inc., a company that provides meta-search-engine and Internet-retrieval services, is hoping that consumers will look to it for health information, one of the most common uses of the Web by the public.

Mamma this week launched a "deep" Web and meta-search service for health information. The new Mammahealth.com site is the first of several specific search sites Mamma plans to unveil this year, company CEO Guy Fauré says. One such site will focus on travel, he says.

The Mammahealth site searches content of several popular health and medical sites, including HealthAtoZ.com, HealthDay, eMedicine.com, Mayo Clinic, WebMD, and government health sites such as MedlinePlus, which is operated by the United States, and NHSDirect Online, which is operated by the United Kingdom.

Mammahealth sends queries to the multiple data sources and then aggregates and formats real-time information in a number of ways. For instance, a search of a topic such as "acne" would give information results in a format that includes an overview, causes/symptoms, treatments, news, and frequently asked questions. Users can click to the Web page of information from those sites providing the content.

The site also includes a "second opinion" link that allows users to link to alternative sources of information about a topic.

Mammahealth doesn't featuring ads or banners from companies marketing health products because Mamma is looking to provide "a public service" for health queries, Fauré says. However, other future vertical sites, such as travel, will likely feature consumer advertising, he says.

Brian King, an HIV-prevention educator who used the beta version of Mammahealth, says the search results filter out marketing information and instead provide valuable medical information. "Searches bring up medical information from reliable sources, not ads or marketing literature for drugs or other companies trying to sell something," which is frequently the case when King does health-related searches on Google or Yahoo, he says.

Mamma, based in Montreal, is a publicly traded company that posted revenue of $15.8 million and net income of $1.1 million in 2004, Fauré says. The company employs 60 people in Canada and Florida. Launched in 1996, the company's revenue has tripled over the last three years.

<<TechwebNews.com -- 06/24/05>>

 

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Thursday, June 23, 2005

AMA holds off on backing ad ban, will study effects of marketing

AMA holds off on backing ad ban, will study effects of marketing 

 

After considering backing limitations on consumer drug ads, the American Medical Association (AMA) voted this week instead to authorize a comprehensive study on the effects of DTC advertising, according to the Chicago Tribune. The study will examine whether DTC drug ads lead to higher costs, unnecessary prescribing, or other negative results, AMA's House of Delegates decided during a meeting in Chicago. Although the AMA says backing a ban is not out of the question, the report will give a more balanced look at how drug advertising affects consumers as Congress debates restricting the practice, the Tribune reports.   

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Acquire new consumers using trusted online third-party relationships

Acquire new consumers using trusted online third-party relationships 

 

Pharma marketers should use online third parties that have existing relationships with their target markets, such as WebMD and Yahoo! Health, to turn those consumers into users of their drug, Rich Benci, president of consumer health media company RealAge, said yesterday during the ePharma Summit. According to Benci, the at-risk patients who have not yet been diagnosed with a particular condition represent a large market that pharmas can tap into using trusted third parties that already have relationships with consumers. As online marketing budgets grow, it's inefficient to only expand existing Web efforts, such as banner ads and keyword optimization, Benci said. Instead, pharmas can leverage the trusted relationships that consumers already have with third parties to identify at-risk patients, introduce the brand, drive revenues, and produce measurable results. RealAge has relationships with more than 11 million consumers, Benci said. To learn more about leveraging third-party relationships, go to realage.com.

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Serono launches MS site; marketing VP says find "purple cows"

Serono launches MS site; marketing VP says find "purple cows"

 

This week biotech Serono launched a new Web site for its multiple sclerosis drug Rebif in its effort to build relationships with patients and caregivers and identify its "purple cow." During yesterday's opening address at the ePharma Summit, David Stern, vice president of marketing for Serono, said pharmas need to get on board with more "e" to enhance their marketing mix. "Pharma e-marketing is at the tipping point, but we're not there yet," he said. "We need to take the next step." Stern identified one of those steps as creating remarkable products--or purple cows, as discussed by Seth Godin in his book, "Purple Cow"--that the right people will seek out. Stern also suggested "dating" your customers--in other words, building a relationship with them before asking for a commitment. Inform and engage them by using online tools that are fun and interactive, he said.

 

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Pharmaceutical Marketing Online (more info)

Demographic Profile

Forrester Research has found that US consumers who do take the time to research health information—whether it is online or offline—tend to be more comfortable with new technology and have more education and higher household incomes than those consumers who do not conduct health-related research.

Interestingly, Forrester found that just 7% of those people who have recently done some health research have only visited 'general health Web sites' such as WebMD, while 18% have gone to both general health Web sites and offline publications, and 20% have turned to health magazines or publications alone.

As might be expected, a high proportion of health researchers told Forrester that they had been diagnosed with a disease or medical condition. Furthermore, more than two thirds of consumers who had looked for health information said that they were regularly taking prescription medication.

When asked about their opinions of advertising in general, a similarly high percentage of respondents said they "agree" or "strongly agree" that there are too many ads in the media today.

Fewer consumers said they find that advertising prevents them from enjoying what they are reading, although at least half of consumers agreed with this point of view. Users of general health Web sites were more likely to find such advertising distracting, with as many as 42% indicating that they had gone so far as to install software to reduce the number of ads they see.

In a separate profile of those consumers who go online to specifically look for prescription drug information, the Pew Internet and American Life Project found that 28% of 40 to 49 year olds had done so, as compared to just 8% of people who are 69 years and older, and 17% of those who are between the ages of 18 and 27.

These results should come as little surprise, since older Americans are less familiar with the Internet than their younger counterparts, while younger people are less likely to use prescription drugs. As might be expected then, people between the ages of 40 and 58 are the primary users of online prescription drug information, since they are familiar with the Internet, and most likely to have a need to access such information—whether it is for themselves, their children, or for their elderly parents.

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WWW/Rx: The Prescription for Healthy Sales

WWW/Rx: The Prescription for Healthy Sales

Published: June 23, 2005

A new eMarketer report examines why pharmaceutical companies are shifting a significant portion of their marketing focus and dollars online.

According to data from the Pew Internet and American Life Project, 45% of American adults, or 91 million Americans, regularly consume prescription drugs. And Manhattan Research estimates that as many as 45.7 million Americans go online to search for information about pharmaceutical products in particular, while other industry observers estimate that millions more Americans use the Internet to look for health information in general — either for themselves, or on behalf of friends or family members.



"As a result of this growing Internet audience, pharmaceutical companies are continuing to shift a significant portion of their marketing attention and advertising dollars online," said Steve Butler, Senior Analyst at eMarketer and author of the report, Pharmaceutical Marketing Online.



As pharmaceutical companies build on their past online advertising experience, many are doing a better job of integrating online tactics with overall brand strategies. Nowadays, for example, television and print advertisements typically include a Web site URL where consumers and physicians can go for more information about a particular pharmaceutical product, or get instructions on how to obtain free product samples.

"Beyond these basic measures, the industry's leading advertisers no longer view the Internet as a special niche area of their overall marketing strategies," said Mr. Butler. "Rather, executives now see the Internet as an essential element of their broader marketing plans, operating under the assumption that most advertising campaigns will have an online marketing component. This in turn has required marketing executives to become more familiar with the broad, and sometimes more complex, range of online marketing tactics."



In light of the growing importance of the Internet as a marketing channel, eMarketer believes that pharmaceutical companies will continue to allocate a greater share of their advertising dollars to the Internet over the next several years. Within this general category of online marketing spending, pharmaceutical companies will likely increase their investments in search engine marketing and behavioral targeting.

"There is one apparent contradiction in the online pharmaceutical world, however," said Mr. Butler. "Despite the fact that many consumers are comfortable with using the Internet as a resource for information on prescription drugs, fewer than 10% of US consumers actually purchase medication online."

That is likely to change by the end of this decade as the baby boomers begin to move into their peak demand years for prescription medication, while also bringing their online experience and relative comfort with using the Internet — something that the current generation of seniors age 65 and over do not have.

eMarketer believes that the combination of improved online customer service by established retail pharmacies and the growing pressure by employer health plans for consumers to purchase prescription drugs via mail order services (for 90-day refills, in particular) will lead to a notable increase in Americans' online prescription drug purchasing habits over the coming years.

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Tuesday, June 21, 2005

Medtech marketers share their winning strategies for successful campaigns

ADVERTISING, DISTRIBUTION, & SALES / December 2004

Medical Device Marketing

Medtech marketers share their winning strategies for successful campaigns.

Courtney Harris

In today's landscape, medical technology marketing is experiencing change. New FDA policies regarding direct-to-consumer (DTC) advertising, for instance, are forcing marketers to adjust their approach. Fortunately, there are expert agencies that are ready to meet these demands.

Each year at its annual meeting, the Medical Marketing Association (MMA; San Francisco) presents the winners of its International Awards of Excellence (In-Awe) competition, honoring the best agencies and campaigns in medical marketing. In this article and accompanying sidebars, winning medical device marketing agencies describe their campaigns and strategies for success. For descriptions of more winning campaigns in the 2004 In-Awe competition, visit the expanded version of this article on the MX Web site at www.devicelink.com/mx. A complete list of In-Awe winners in medical device categories can be found in the sidebar.

MMA also presents a medical device marketer of the year award. This award recognizes exceptional leadership in results-oriented, strategic marketing programs conducted in the previous year. This year, that honor went to Lauren Kanner, vice president of marketing for ophthalmic device manufacturer Refractec Inc. (Irvine, CA). Refractec developed a campaign to launch its conductive keratoplasty technology, which treats vision loss due to the age-related eye condition presbyopia. According to Kanner, the campaign helped the company to capture a market share of about 11.5% in its first year, exceeding expectations by about 30%.

"It was a challenging launch because the technology was entering a market in which a very similar technology had previously fallen flat on its face," says Kanner. "We were introducing a technology that did the same thing, but with an energy source different from the prior technology. And although we had some distinct benefits—including a little more predictable outcome and a little more stability with the procedure itself—the marketplace was still wary.

"I like to say you advertise from the day that you stick a physician on the podium," says Kanner. "Probably a year out from our approval, we knew we were going to go out with a very controlled approach," she says. "Because we were entering a skeptical market, we decided to maintain an initial customer base of only 50 physicians. And we were going to maintain that base for about six months.

"We profiled those surgeons well," Kanner says. "We sparked enough interest to triple the number we needed for our initial rollout, but then went back and really profiled each doctor to find out if they were going to be a beacon for us. If they had never implemented a new technology in their whole career, well, it takes a lot of work to do that."

Marketplace Identity

According to Kanner, it was important for Refractec to spend time educating the marketplace to explain why its technology was different from those of its competitors. That education included traditional marketing tools such as advertising, as well as several different Web sites that were optimized to educate patient and physician populations. "For physicians, we created educational tools that they could gain access to with an extranet," says Kanner. "Within FDA guidelines, physicians could request information, and we could send them to a secure site and provide them with answers and be able to track that information for them."

Aimee Roca, account manager at Photosound Communications (Princeton, NJ), agrees that creating differentiation from competitors is crucial. "The market is very competitive. At a congress, the show floor will be full of companies highlighting their products," says Roca. "The challenge is to stand out, and a key way to do this is with consistent branding.

"Clients sometimes feel that they need to change campaigns on a regular basis," says Roca, "but the danger of that is losing an identifiable and unique personality that their target market associates with them."

Communicating to Physicians and Patients

Crafting messages to physicians and patients requires a balance in communicating specific, tailored messages to the separate audiences with an overall coherent, consistent message for the product.

"At Refractec, we had similar messages to our patients and physicians, but not identical messages," says Kanner. "Physicians wanted to know about precision, stability, and whether we offered a high-tech device that would provide them with certain outcomes. They also wanted to know if it would be an affordable procedure."

For patients, she says, it was important to emphasize that Refractec's technology was not only effective but also safe. "Safety was huge for patients," she says. "On the other hand, physicians knew it was safe. During presale we didn't even need to tell them about it, but during postsale we had to remind them to tell patients about the technology's safety."

Kanner says that Refractec's patient population had to be educated in the same way as Lasik patients—even though the Lasik procedure is not a competitor for Refractec's technology.

"Our competition within our marketplace was nothing at all—it was just plain old reading glasses," says Kanner. "But so many people are educated about Lasik procedures; for patients who need glasses their whole lives, that is a great option. Refractec treats the other end of the spectrum. Our patient population includes people who have had great vision their whole lives, then turn 40 and suddenly have to strap glasses around their necks. It is a different marketplace, one that's never been marketed to before.

"Even though our patients may not be candidates for Lasik, they're still sold to the same way Lasik patients are. Our patient population still hears the same news about how wonderful Lasik is, how everybody can see 20/20 because of its high-tech lasers," she says. "That message gets to them. So we still had to educate our patient population on why Refractec's technology is good for them, even though it isn't a Lasik procedure. That was a challenge, because for years this patient population had been told that there's nothing available for them. We had to say, 'Yes, there is something new now.'"

According to Spring Utting, account director at Anderson DDB San Francisco, it is important to look for synergies in creating messages for physician and patient audiences, so the messages can support each other. However, she says, the apertures for each audience are usually different, "so we craft messages based on insights into the needs and issues of each target audience.

"Generally, the problem being solved is the same problem, but the perceived need is different," says Utting. "For example, with a blood-glucose monitor the problem for the patient may be that the product hurts, while the problem for the healthcare provider may be compliance. But the solution for both may be creating a less-painful finger stick that solves both problems by taking away a barrier to increasing compliance."

In-House Agencies versus External Agencies

"At Refractec, we take a total team approach," says Kanner. "We had great partners in our campaign, including advertising agency Ignite Health (San Clemente, CA) and PR firm Goolsby Group (Newport Beach, CA).

"I have worked with in-house agencies and external agencies, and I do think there is some benefit to an in-house agency, because it is going to be extremely knowledgeable about its product line," says Kanner. "But if you approach a campaign from the perspective of a partnership, everyone has a piece of the puzzle—and the bottom line is the puzzle is interlocked. If my PR representative didn't know every single thing I was doing from the advertising agency side, then our materials might not have looked coherent."

Photosound Communications has experience developing comprehensive marketing campaigns, working with in-house agencies, and working in conjunction with other external marketing agencies, Roca says. "We always begin the relationship with our mutual client clearly defining the roles and dynamics in the group and setting out the time frame that all work needs to be accomplished in," she says. It's a good idea to hold a kickoff meeting for all parties involved in the campaign "to get the ball rolling and begin to develop the 'team' ethic," Roca adds.

"The development of trust and an open line of communication are the strong foundation to the successful completion of all of the projects that we work on," says Roca.

Collaboration is a key goal, agrees Norman Sherman, executive vice president and director of healthcare at Hill, Holliday (Boston). "As an outside agency, what we attempt to do in 100 out of 100 cases is to collaborate with in-house agencies because they have certain skill sets which are additive to ours, and vice versa."

Hill, Holliday frequently works with the in-house marketing services group at U.S. Surgical (Norwalk, CT), says Sherman. That group takes care of many of the day-to-day aspects of a campaign's execution, including creating sales sheets, business cards, and brochures, he says.

When Hill, Holliday was hired to do the overall branding and design for Syneture (Norwalk, CT), a U.S. Surgical company, it knew Syneture's in-house marketing services group was going to be the recipient of its work. "For the next however-many years into the future, they were going to have to translate and interpret a lot of what we did," says Sherman. "So in many cases, rather than doing all of the execution, we created templates for them. We viewed their work as an extension of what we did."

"In-house agencies can be an efficient, economical, and therefore critical resource to marketers," says Howard Meditz, president of Marquardt & Roche and Partners (Stamford, CT). Another advantage to in-house agencies, Meditz says, is that they know their products and company's style intimately. "They also need fewer approvals on the production line, so they're likely to be able to respond more quickly than an outside resource," he says.

Nevertheless, says Meditz, external agencies are perhaps an even more critical resource because of their unique position. "Unlike customers and other outsiders, external agencies know enough about marketing in general, and a client's market in particular, to provide meaningful insights. And unlike internal associates, external agencies are not as steeped in a firm's view of the world, so they're less likely to fall victim to a firm's intellectual prejudices when considering the pluses and minuses of a communications strategy."

Practically speaking, says Meditz, this means that an external agency is more likely to deliver a creative concept that is valuable to a target audience.

"Finding the right balance between a company's and customer's view of the world is critical—and it requires a company to step outside itself," he says. "That's where an outside agency lives. Even the most brilliant clients I know occasionally have their judgment tainted by virtue of striving so hard to serve their companies."

However, even in their quest for collaboration, companies should feel free to argue aggressively with external agencies, says Meditz. "This dialogue is critical because a really good external agency will keep working at things in an effort to combine the best of a client's thinking with the best of its own resources. That's a collaboration that doesn't really exist with an in-house agency. And it's a collaboration that can go a long way to differentiating a company in the competitive marketplace."

Crucial Tools

Skilled marketers know that having an innovative arsenal of tools is critical for retrieving strong results. In medical device marketing, experts consider certain mechanisms to be crucial components of a successful campaign.

"I am a firm believer in traditional and nontraditional market research," says Kanner. "For example, I really favor on-line techniques because it doesn't have to cost a fortune and or take months for results, which is what marketers have all had to deal with in the past."

According to Kanner, Refractec had a fluke incident occur with regard to on-line market research—an accident that turned out to be a blessing. "We had a PR representative—the ophthalmologist on Extreme Makeover—as one of our clinical investigators, and he had gotten himself on Extra, unbeknownst to us," she says. "We were at a management meeting when the woman who answers info@refractec.com came in and asked, 'Do you know something I don't know? I've had 100 e-mails in the last five minutes, and they're not stopping!' And then our computer system crashed."

Kanner says the company then regrouped and got its system working again by the next day. "We quickly decided to set up a Web site and categorize the e-mails into three basic questions, which we answered on our home page," she says. "But because we suddenly had the attention of all of these interested consumers, we asked them to tell us what they considered to be important in a vision correction procedure.

"And then, in what has now become known as the market research questionnaire that ran amok, it became a 40-question survey. But the patients were highly motivated, and, as it turns out, 80% of the people answered all 40 questions," says Kanner. "We filtered the answers and captured what ultimately became our direct-to-consumer (DTC) message. It cost about $1 a patient to capture this market research. And you couldn't have gotten that information if you had hired the best market research company in the world."

Kanner says that although Refractec was lucky to get access to those patients up front, it's also an example of how on-line market research can be inexpensive and can be a good way to capture information, provided a company can find its patients.

"Subsequently, we have done additional market research through a Web site called AllAboutVision.com. We've asked 12 questions and gotten 500 answers in less than a month," says Kanner. "The answers are tallied in a database and are easy to query—it's just phenomenal."

Another important tool in medical device marketing is developmental research, says Utting. Sometimes agencies fall into the trap of testing concepts or executions against each other, which can be useful at the correct stage but not always at other times, she says. "Using different kinds of research (e.g., ethnographies) can help agencies to discover an insight that would have remained otherwise hidden," says Utting. "Testing ideas against each other only tells agencies what works within the ideas that they already have; it doesn't necessarily unearth a new, unique approach."

At Hill, Holliday, a critical tool is to view the sales force as a media vehicle, says Sherman. "Everything that we do needs to be embraced by how a company's sales force goes to market, so there is consistency with the image that we're trying to put out," he says. "Because if they aren't saying the same thing that we're saying, we're not helping one another. It is crucial to get the internal people who deal with prospects and customers on the same page as what an agency is trying to do to communicate externally."

Today's Challenges

It is commonly agreed that DTC advertising is on the horizon for medical device manufacturers. Consequently, marketers must adjust their strategies to comply with new FDA regulations regarding restricted medical devices and TV, print, and broadcast communications.

In February, FDA issued three draft guidances intended for the medical technology industry that are in part designed to improve DTC advertising for restricted medical devices.1–3 The guidances were prepared in part based on discussions and presentations that took place at a public meeting on consumer-directed advertising that FDA held in September 2003.4

"Medical device marketers are much more regulated than they used to be," says Kanner. "Medical device companies used to have more free rein. Now, a lot of the same pharma restrictions are applied to what you can and can't say about a medical device. This doesn't make things worse; it's just different for marketers."

Medical devices arrive on the market more quickly than drugs because trials are shorter and the market changes so rapidly, says Kanner. "Also, the life cycle for a device is much shorter than that of a drug. And so that, coupled with new regulations that marketers aren't accustomed to and new scrutiny by regulatory officials, has made things more challenging."

"I think the most important thing that is going to be happening in the world of medical devices is DTC promotion," says Sherman, citing Stryker Corp. (Kalamazoo, MI) as an early example. Stryker released a TV and print ad campaign last year that featured golf legend Jack Nicklaus as a spokesman for its hip-replacement implant.

"Medical device manufacturers are going to follow the lead that pharma took and start to market their products and services to consumers, to try to influence what consumers are requesting from doctors. I expect that over the course of the next two to three years, this will really explode," says Sherman.

This phenomenon is going to require a tremendous amount of learning, much like there was in pharma, he says. "In pharma, companies were previously only marketing to doctors and were not well equipped to market to consumers," says Sherman. "Most of their work was pretty ineffective. But then they started bringing in people who were consumer experts and consumer advertising agencies rather than just professional agencies.

"Over time, the pharma companies have gotten significantly better at practice, although there is still a tremendous potential to grow and learn," says Sherman. "Medical device manufacturers will go through a similar kind of process."

 

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Medsite, Yahoo! partner to bring Rx info to 50M consumers

Medsite, Yahoo! partner to bring Rx info to 50M consumers

Marking an industry first, Medsite has launched a partnership with Yahoo! Health to bring physician-level drug information to consumers, Medsite reports. Still in its pilot phase, the consumer detailing, or "cDetailing," product will reach more than 50 million Yahoo! consumers worldwide and allow pharmas to partner with Medsite to give consumers in-depth drug information previously available only to doctors, says the report. The new marketing platform will allow pharmas to use rich-media advertising and educational programming to better inform consumers about their drugs. Medsite's content "ensures maximum impact and retention. We work with our clients to customize content approach for each individual brand," a Medsite spokesperson tells ePharmaceuticals. The product will be available to the public in the near future, the spokesperson says.

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Tuesday, June 14, 2005

MarketingSherpa's 10 Best Blogs for 2005

Congratulations to MarketingSherpa's 2005 Best Blog winners, and thanks to the 2,065 tough judges who carefully evaluated 52-nominated blogs to pick them:

Best individual's blog on the general topic of marketing and advertising

Awarded to: Seth Godin's Blog
http://www.sethgodin.com/sg/blog.html

Honorable Mention: Adrants
http://www.adrants.com

Editor's Note: Both these Blogs won last year, albiet in reversed positions. In a world where the average Blog lifetime is something like six months, we're impressed and inspired by two bloggers producing award-winning work year after year. So many bloggers start red-hot and then quickly run out of steam. Seth Godin and Steve Hall beat the odds and we salute them!

Best group weblog on the general topic of marketing and advertising

Winner: MarketingVOX
http://www.marketingvox.com

Honorable Mention (Tie):
Marketing Genius http://marketinggenius.blogspot.com
Church of the Customer http://www.churchofthecustomer.com

Editor's Note: Congrats to Tig Tillinghast of MarketingVox who has kept the editorial quality high while going through business model and management changes. MarketingVox is one of the few completely self-sustaining Blogs we know of. And, we've heard Tig's expanding his formula to new industry niches shortly, including a blog for defense industry news.

Best PR-topic blog

Winner: Media Guerrilla
http://mmanuel.typepad.com/media guerrilla

Honorable Mention: Strategic Public Relations
http://www.prblog.typepad.com

Editor's Note: Even if you're not into PR, definitely check out Mike Manuel's Media Guerrilla Blog to see one of our fave Blogger self-photos. If you're going to post a photo of yourself on your Blog -- which is a great idea -- this is one to be inspired by. Also, the writing and hotlinks rock. Mike deserved this award win.

Best B-to-B marketing-topic blog

Winner: Guerrilla Consulting
http://guerrillaconsulting.typepad.com

Honorable Mention: B-to-B Lead Generation Blog
http://blog.startwithalead.com/

Editor's Note: If you're in the consulting business (or you daydream about leaving your corporate job for a freelancing someday), check out this year's B-to-B category winner for genuinely useful advice and links on how to score clients.

By the way, we hear a new hardcover book is coming out soon by the author of the Honorable Mention Blog in this category, proving a blog can lead to fame in more ways than one.

Best blog on small business marketing

Winner: Duct Tape Marketing
http://www.DuctTapeMarketing.com/weblog.php

Honorable Mention: Small Business Trends
http://www.smallbusinesses.blogspot.com

Editor's Note: Wow! Duct Tape Marketing won hands-down for the second-year running, gaining more votes than any other blog in any category in the entire contest.   Most bloggers can only dream of such a huge and passionate fan base.

Best blog on online marketing

Winner: Chris Baggott's Best Practices in Email
http://exacttarget.typepad.com/chrisbaggott

Honorable Mention: Charlotte Li's Blog
http://blogs.forrester.com/charleneli/

Editor's Note: As a leader at a fast-growing technology company, Chris has an insane travel schedule. Kudos to him for keeping this effort up for 18 months now. If you're trying to convince a C-level exec at your organization to start a Blog, and they say, 'I'm too busy", taunt them with Chris' example.

Blogs on Search Marketing

Winner: Search Engine Roundtable
http://www.seroundtable.com

Honorable Mention: Brad Fallon
http://www.bradfallon.com

Editor's Notes: We adore the unusual editorial tactic for the winning Blog in this category -- instead of linking to news sites, the authors comment on and link to the very best new threads on search marketing on discussion boards all over the Web. So, it's a true insiders-insider blog, and a reflection of what people are realy talking about (vs what the media thinks.)   

Best Blog on Niche Marketing

Winners (tie):
Ypulse - Media for the Next Generation
http://www.ypulse.com/

WonderBranding - Marketing to Women
http://michelemiller.blogs.com/marketing to women

Honorable Mention:
Lipsticking- Smart marketing to women online
http://windsormedia.blogs.com/lipsticking

Editor's Note: All three of these blogs are not only useful for advice on their topics, but also worth watching if you plan to launch a Blog to promote yourself as a niche marketing consultant. (P.S. Whoa, get ready for neon-pink and orange when you visit Ypulse.)

Best non-English-Language Blog

Winner: MarketingFacts (completely in Dutch)
http://www.mediafact.nl/weblog.php

Honorable mention: Media Culpa (in Swedish with some English)
http://www.kullin.net/

Editor's Note: We only wish we could read them for ourselves. Many thanks to the European MarketingSherpa readers who evaluated these blogs for us.

Top readers' choice write-in vote

Winner: Easy Bake Weblogs
http://easybakeweblogs.com

Honorable Mention: Collateral Damage (CMO Magazine)
http://www.cmomagazine.com/blog view.html?ID=401

Editor's Note: Fascinating that these two winners, both with more than 50 write-in votes in a category that generated more than 500 nominations, represent the two ends of the online media spectrum.

Easy Bake is by a self-publishing entrepreneur, who hopes you'll like his Blog so much you'll buy his also-self-published book. Collateral Damage is by a professional journalist who was asked to write a Blog as part of her editorial duties at CMO Magazine which is published by the gargantuan trade magazine company IDG.

 

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Wednesday, June 08, 2005

Pay-for-performance: Federal Proposals Could Reshape Physician Incomes Dramatically

Federal Proposals Could Reshape Physician Incomes Dramatically
Christine Wiebe 

Introduction

By now, most doctors have heard of "pay for performance" programs that reward providers for meeting certain patient care goals, but many think the concept is simply being tested in isolated areas. If Medicare has its way, all doctors eventually could be paid on the basis of their performance.

The Medicare Payment Advisory Commission, or MedPAC, is recommending an expansion of pilot projects that link physician payments to performance goals. Officials would set aside a portion of the money budgeted for physician services, and doctors would have to earn those funds by demonstrating they are following established medical guidelines. Doctors who meet the goals would earn more for treating Medicare patients than those who fail.

Advocates of such incentive programs note that many other industries, such as automakers, have adopted similar strategies with great success. In fact, some private sectors of the healthcare industry already are testing performance programs, and initial reports suggest they are achieving their goals.

"It's a direction that's long overdue in health care," said Steve McDermott, Chief Executive Officer of Hill Physicians Medical Group, an organization that includes 2600 doctors in northern California. The group introduced its own performance incentives 8 years ago, and joined a larger California performance program 2 years ago. That program, called the Integrated Healthcare Association, and another in the Midwest called Bridges to Excellence, are pioneers in performance pay systems and are reporting early success.

Medicare, by virtue of its size and clout in the industry, will fuel that trend if it adopts recommendations outlined in MedPAC's annual report. Federal officials already have expressed their commitment to moving in that direction.

In fact, another MedPAC proposal could further differentiate physician payment levels by imposing new standards on office-based imaging services. Those services have become a growing source of revenue for doctors, and Medicare officials would like to contain that growth. Stricter standards would mean fewer doctors could offer such services in their practices.

Taken together, those two proposals represent a sweeping overhaul of how the federal program pays doctors.

"They take Medicare in directions that it's never been before," said Hoangmai Pham, a senior researcher at the Center for Studying Health System Change in Washington, DC. Although some physicians undoubtedly will object to such changes, current research supports the need for them, she said.

"MedPAC is reflecting a growing consensus among policy analysts and some policy makers -- and probably some physician leaders -- that the current system is irrational," she said.

Providers currently are rewarded for doing more because they are paid for each service they provide, whereas a performance-based system would reward outcomes. For instance, a doctor could earn a bonus for helping diabetic patients manage their blood sugar levels, regardless of how often they came to the office or needed medical intervention. That could not only improve patient care but also hold down costs.

 

Winners and Losers

Even enthusiasts acknowledge, however, that significant hurdles remain before performance-based systems can be expanded to the broader physician population. The Medicare demonstration projects currently involve 10 large multispecialty groups, which are not really representative of the profession, said researcher Pham.

"Those groups have more capital, so it's easiest to start with them," she said. Participating groups have had to invest in information technology, for instance, in order to collect and report information required for the bonuses. Smaller groups and solo practitioners may have more trouble paying for such systems, she said.

In addition, doctors who currently are not meeting clinical guidelines will need help improving their care processes, which should be a goal of quality improvement programs, Pham said.

"If you pay for performance without providing support, they will continue to perform poorly," she said. That could widen the gap between successful and struggling practices.

In the Hill Physicians network, some practices receive as much as 10% less than comparable practices if they don't meet the broader group's internal standards, said McDermott. He meets with leaders of the struggling groups to discuss ways they can improve their care systems and qualify for the bonuses.

"That's a great conversation," he said. "They're all striving to do better next time." He has heard no complaints about the payment structure, which he attributes to widespread acceptance of the performance standards.

In the Medicare demonstration project, participating groups proposed their own methods for achieving efficiencies, such as implementing disease management programs that improve patient outcomes, and thus reduce the need for services. Groups will share in the savings when they receive their performance bonuses.

Some critics say such efforts amount to pay cuts for doctors, not true financial rewards. The American Medical Association has urged Medicare not to impose further demands on doctors but rather to provide new funds to help them achieve quality improvements.

In fact, the MedPAC recommendations would tie initial performance awards to adoption of information technologies, phasing in patient care measures a few years later. That could require significant investments for some doctors if they hope to capture the financial rewards.

Although Medicare plans to set aside a relatively small amount of its budget for performance pay, even a 1% to 2% pool could amount to $5-$10 billion. And, it would increase over time.

Officials make no bones about the fact that a performance-based system will result in different pay levels for different doctors.

Mark Miller, Executive Director of MedPAC, recently told a Congressional committee, "It is time for the Medicare program to start to differentiate among providers when making payments."

 

Restrictions Could Shut Down Some Services

Some doctors undoubtedly will bristle at such pay differentials, but the proposal to restrict office-based imaging services will generate even stronger opposition, said researcher Pham. The very notion of limiting which doctors can provide such services and make money off them deviates from longstanding traditions in the federal program.

"Medicare has never, ever excluded physicians from participation," she said.

The proposal strikes at a rapidly growing sector in healthcare spending. In recent years, many doctors have looked for other revenue sources to offset declining clinical incomes, and many began integrating imaging services into their practices. From 1999 to 2003, Medicare's payments to physicians for imaging services grew twice as fast as for other medical services. Currently, doctors can bill for ordering a patient's diagnostic test, performing the test, and then interpreting the test.

Cardiologists have been particularly successful at tapping into the technical fees, said Fred Simmons, Chief Executive Officer of Clearwater Cardiovascular and Interventional Consultants, a group of 18 cardiologists in Florida. Other specialties that have prospered by moving services out of the hospital and into their offices include ophthalmologists, orthopaedic surgeons, and oncologists, he said.

His group decided several years ago to make the risky investment in diagnostic equipment, and that move has paid off, he said. He is not concerned about new Medicare restrictions because he is confident the group will meet the standards.

"If physicians are going to provide services in their offices, they need to be able to provide a high-quality, efficient service," he said.

Studies have found serious deficiencies in some office-based imaging services, however, and regional variations also highlight a lack of control over that sector, the MedPAC report concludes. It recommends using private organizations to develop and administer quality standards. Any doctors whose services did not meet those standards would not receive Medicare reimbursements.

In addition, MedPAC recommends tightening other controls over imaging services. It would more closely scrutinize claims to detect charges for services that are inappropriate or that duplicate each other. For instance, separate bills for a patient's head CT scan and face CT scan would be bundled into a single claim.

The advisory commission also is recommending that federal officials close a loophole in physician self-referral regulations, which currently allow doctors to invest in companies that provide services to imaging centers where they refer patients. For instance, a doctor could buy MRI equipment and lease it to an imaging center, then receive a reimbursement each time it is used.

MedPAC also wants to extend federal ethics standards, known as the Stark law, to cover nuclear medicine and PET scans, which were excluded from current regulations designed to eliminate conflicts of interest for doctors.

A Silver Lining

As physicians ponder the looming changes and consider the impact on their own practices, they can take solace in at least 1 proposal that could boost their pay levels. MedPAC included in its recent report a recommendation that the federal program raise physician fees by about 2.7% for 2006.

"MedPAC taketh away," said Pham, "but they also giveth back."

The current formula for establishing physician payments calls for a 4.3% cut next year, followed by more cuts in subsequent years. Congress would have to approve the change.

In fact, the proposed pay increase is only a short-term solution for a physician fee schedule that everyone agrees is flawed. MedPAC officials have expressed their intention to re-examine the federal program's entire payment system in the near future. Without an equitable payment baseline, experts say, any other changes such as performance-based programs are less likely to succeed.

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