This is our Deep Dive Into Local from May 30th, 2017. In our Deep Dive series, we take a closer look at one thing in local that caught our attention and deserves a longer discussion.
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Mike: Hi, welcome to this week's Deep Dive in Local. We have with us, Joel Headley, previously known as Joel Headley of Google. Now with PatientPop, a local medical practice marketing service. So, Joel, I've known you many years, obviously. I think the first time I was flown out to Mountain View in 2008 is when I met you, a long time ago. You were in Local at Google then, you stayed in Local for many years after that. But maybe you could fill in some of the details from that first meeting to when you joined PatientPop.
Joel: Yeah, so, I actually started at Google a few years before that, simply answering customers' emails about Google Maps and telling them why we couldn't update the address very well. And why it took six weeks or longer for any updates from the local business center to appear on the map.
Mike: They were rebuilding the world.
Joel: They were, they were rebuilding an index every six weeks. If we were lucky, every once and awhile, it would fail, and it would take 12 weeks to do it. And by every once and awhile, probably every two, second, or third index we were building. But I actually took a sabbatical from Local and worked in another geo product called SketchUp for a time. For a couple of years we were trying to help build models for Google Earth, so kind of locally relevant.
But as I came back to manage the maps and local teams, we did a few things. When I first started at Google, every email was answered probably poorly, and then they stopped answering all email completely. And then as Google started focusing on things, what they called Boost and Tags, these ads products, you could buy through -- I think it was called Google Places, at the time, for business. They realized helpful support would be nice, and so I was able to convince a few of the executives that we could provide some good support, successfully, and we were able to roll out some email support. Later we started phone support. That was fantastic, we had customer satisfaction scores above 90% for all that. And then I left the team, they moved it to India, and it got worse. So that was all after me.
After leaving the team, I focused on some more core search initiatives. I did a lot of work, actually .. some work in local, some work in transit. Some of the stuff I did in local was we were importing menus from Single Platform, Locu, and I was working on the technical integrations there. Later on, I started working on Google Now, and whether it was getting data from emails to show cards in Now, or getting data from websites and apps to show cards in Now. And then, eventually, I ended up working on core Schema projects to get more data into the knowledge graph.
Mike: So when did you move to PatientPop?
Joel: So, I moved to PatientPop in January of this year and PatientPop is a practice growth platform, so beyond handling kind of the SEO and marketing side for a practice or a provider, we integrate with their back-end office systems to be able to bring the patient into the practice through appointment reminders, online scheduling and booking, and then following up after the practice. So we want the provider to be able to focus on the experience with the patient, inside their doors, and we'd like to handle everything else outside their doors, to make sure the patient gets there and then returns, and then provides the feedback that they need to provide to the practice.
Mike: Just under full disclosure, I have had a long-term consulting relationship with PatientPop. So just so I don't run afoul of any trade communication rules.
Joel: And that's how I met. And that's how I met the folks at PatientPop was through Mike. So I appreciated that.
Mike: So, medical's interesting, particularly practices are interesting in Local at Google. It's interesting at the ecosystem level because every site handles it differently. Some sites handle practices, some sites handle practitioners. Google wants both but then there isn't an explicit parent/child relationship on the front end, but there may be one on the backend. Naming is an issue. There are a lot of times businesses have multiple unique business units within the practice, and then there's always the question of, "Do I promote the practitioner or the practice?" It's a very sort of...it's an area that can cost a lot because they're often...because of the way that Google has aggregated data, there's a lot of mess. So, I'm curious firstly...let's see with those in order. Naming multiple unique businesses within a practice and practitioner versus practice in terms of where do you focus first?
Joel: Yeah, so I think in terms of naming, it follows the basic guidelines around...I think the example in the guidelines are around like Allstate Insurance Agents. But you can have...
Mike: Not anymore, now, it's practice...I mean, now...it used to be practitioner:...practice: practitioner.
Mike: Now it's just practitioner, at Google.
Joel: Yes, so when...
Mary: Unless it's a single practitioner.
Joel: So what we call it at PatientPop, we have a solo practitioner with a branded practice. So, in healthcare for women, Dr. Mary, right? So, she provides health care for...her practice is named Healthcare for Women. She's the solo practitioner -- as Mary, MD -- and so all that name would go up on the listing. If it's a branded practice with multiple practitioners, you would have Healthcare for Women, then you would have separate practitioner listings: Dr. Mary, Dr. Mike, for example. And then when you get to multi-location this is where you think, "Oh, is this all really worth it?" Because you can imagine having to have three locations and three practitioners that each move around to those locations, you have on the order of 12 possible listings that you can put onto Google.
So, and then, what makes this worse, is that Google allows this in their guidelines, but when you try to submit a feed to Google, or a bulk upload and get the upload verified, they want you to have business hours for all those practitioners, specific to the locations and not overlapping. And so now you have this conundrum where real life is really the doctors go where they're needed, when they're needed and they want you to distinguish that in their listings and on their websites so that they can validate the fact that those practitioners can actually be at those locations at stated times. Which is craziness in my head, but...
Mary: So, may I ask how PatientPop deals with that? Do you go ahead and create all of those listings and try to keep them updated and if so, how do you do it?
Joel: In general, yes, we do. So, we haven't been successful using bulk upload and, it sounds bizarre, we've been more successful doing individually verified listings. Just because that's allowed and no human, necessarily, looks at that, so no one's contesting. And I think, unfortunately, these folks that are kind of reviewing these listings, are just poorly trained and poorly equipped to handle these new kind of modes of what Google is actually asking for. You know, you have someone written...that's writing the policy in Mountain View, and then three teams away is someone's supplying the policy and support, which is a bit unfortunate.
Mike: Yeah, in this theoretical world, they want people to be able to drive someplace and see their doctor. But in a real world, if you were to walk into a medical practice, even if one of these three locations, and it was an emergency, you may or may not see that doctor, you'd see whoever was available to see you, right?
Mike: And if it wasn't an emergency, you'd walk in, you'd need an appointment, right? So, it's like it's...particularly when it comes to doctors. I can understand it with lawyers because lawyers are out cheating the system so much. It's more complicated when it comes to doctors, the need to show when they're really open. Well, the doctor is...the practice is open when the practice is open, right?
Joel: Yeah, yeah. And you can't predict when someone's on-call, I mean, it's just the nature of the business. This model of being strictly there when you say you're there, does not work in healthcare, right? It's just impossible to say when someone's going to have a baby. And so you can't say, "I'm going to be here at this time every day of the week," it just doesn't make a whole lot of sense.
Mike: So given the...Go ahead, Mary.
Mary: Well, some of this seems to rise from the fact that Google wants the practitioners to be controlling their presence online, rather than the practice. Do you think that might be why you're having trouble bulk uploading practitioner listings?
Joel: I don't think so. I think...I would like...I don't think they're as...they're thinking on that higher level, those folks that are reviewing the bulk uploads. They're more concerned about matching the criteria that they set out that was based on like a lawyer, for example, or a real estate agent.
Mike: Okay. So, say patient-building gets complicated in this environment, obviously a practice needs to decide, "Are we do... You know, are we focusing... Are we doing all 12 possibilities, all three locations, each doctor at those locations." And, so, which sites do you focus on as most authoritative in this context and, you know, some are practice only, some are practitioner only, some are both. So how do you lay that out?
Joel: Yeah, so, I mean, I think...I think we see... What I see mostly in search results, are sites like Healthgrades, ZocDoc, and U.S. Health News -- U.S. News Health -- or whatever they call it, which is powered by Doximity. So, those seem to be kind of the top-ranking sites that I see. There's also other practitioner-only citations through RateMD, Vitals, WebMD, and MD.com. All those provide value, but I think from a visibility standpoint, you're really seeing the ZocDoc, the Healthgrades and the U.S. Health News.
Mike: Do any of those sites take spreadsheet uploads or do you have to sort of manually verify them?
Joel: So PatientPop does have relationship with many of these sites. ZocDoc is a pay-to-play site, so we don't deal directly with them, but I think they would consider themselves a competitor. So, you ... in some cases, you can do uploads to these sites, but they don't have great mechanisms for any given agency to step in and say, "Hey, I have a list of a 1,000 doctors, can I hand them to you?" They just don't do that very well.
Mike: So ZocDoc does a great job of search engine results but it's pay-to-play. How does Google look at that in terms of ... does a pay-to-play site transfer any authority back to a practice that's playing there?
Joel: I don't know the real answer to that. I suspect it does, based on what I've seen in search results. And I think the reason for that is that...and they have played with pay-to-play sites before. They've tried to do this on the locksmith side, and they try not to be very specific about this. I know there was...there's kind of identity issues using these pay-to-play sites because Google want it to be free for everyone, but they also want high quality. So they're balancing this, "How do we make sure we can have it accessible to everyone and, yet, still make sure it's of high quality." And I suspect, now, that Google is becoming pay-to-play in some of these verticals, they've kind of let go of that, let go of that dichotomy.
Mike: So on the review front, I hear ... you know, obviously there's different rules both state, there's federal HIPAA guidance as well as state marketing rules, you know, for doctors and professionals, that vary by state. So, quick, big question, any issue with doctors soliciting feedback on the reviews?
Joel: Soliciting feedback isn't a problem. Whenever you're having the patient divulge information, that's their information to divulge, right? So if a patient says, "Hey, I went in for this procedure, and they did this wrong," or that, "This was amazing, I really appreciate the results," they can do that. Where it gets more tricky is on the review responses. So, even if a patient has chosen to divulge details about any specific procedure online, a doctor still can't talk to that. So, they're un...without the patient's permission, and review platforms don't typically have a mechanism to, "Hey, can I talk about this in my response?," right? It's just not part of the platforms. So, in general, the responses, doctors need to keep their responses around their soft skills and their front office, and their feedback around that, like, "Thank you, I'm glad it went great for you." Keep it general and not be specific about what they call in the industry, "protected or personal healthcare information."
Mike: Although I've seen a number of doctors sort of jump into the fray and take direct responses to criticisms in that area. And HIPAA has not really been active in enforcing against that, as far as I can tell.
Joel: No, we haven't seen enforcement on reviews. There are groups of litigators that are creating class action lawsuits around HIPAA compliance and finding violators and...because it can be quite expensive for violations. And this is, in particular, they're looking more at communication, so like you can't send a text message, for example, to a patient without their permission and it has to be free. So you have to make sure it's not charged by their carrier for their text messaging. And there are groups of litigators that are finding...like, going out and doing exhaustive search for violations of these things to be able to litigate against them.
Mary: Yeah, and we kinda have to remember, too, how many people are, you know, they've made a FTC violation regarding reviews and it took years and years for the hammer to come down on them. So, it's not something I would toy with, especially with HIPAA compliance.
Joel: Yeah, so if there's money to be made in it, you can be sure some litigators going to innovate and find a great way to settle it.
Mike: So, in terms of advice to marketers, what would you say to them, in terms of your niche and being successful?
Joel: Certainly you want to solicit feedback, you want to also be responsive to that feedback. If you can privately be responsive to negative feedback, that's a great step forward. Again, there's...if you're private about it, there's no HIPAA compliance issues. You can't really do it over normal email channels, but there's ways to be private about it and still be HIPAA compliant. And if you do want to publicly respond to reviews, you can do so with general terms, thanking people for feedback and talking about how you do things generally, as opposed to talking specifically about that patient action.
Additionally, I think there were a couple other things that you touched on early when you first set up this, talking about multiple businesses within the practice. I think this is something that you're seeing...you're seeing doctors start out as a family practitioner, and then they decide, "Hey, I'd like to create a new revenue stream, I'm going to create a new business, and alter my business and create a new practice, and create a new...a whole new service that I've never done before." And I think, in general...I guess people new to online marketing, they think, "All I have to do is buy a new domain, and I have a new business." And I think Google doesn't really see it that way.
And, so, when you think about the trade-off of creating a new business versus creating a new service within your current business, you need to understand some of the pitfalls and opportunities there. In some cases, you can create a new business line, create a new file number, create, even, new signs on your location, or create a separate location, that can be successful. But, more often then not, Google will probably see if you're creating a new service, the same location, same provider, the same experience, Google expects that to be a single business.
And so approaching that with caution and awareness that just because you created a new website, Google doesn't necessarily think that's a new listing, you need to be aware of. And it can be done successfully if you're careful about not matching your categories, not overlapping your categories, and not servicing the same clients in the same way. And it can work out.
Mike: I would assume that the same applies to any time that a listing for a multi-practitioner practice has been suppressed, right? That Google, typically, just doesn't want to show two or three or four of the exact same thing, at the exact same location. So, you have any tips there, besides changing categories?
Joel: This one's tough and I wish I had a silver bullet to fix it. But we have large...we have practices that, you know, dentists [inaudible 00:21:14] their offices that are different businesses and Google just picks winners and losers, and there's no...you know, I kind of...I miss the measles, to be honest, I miss the kind of comprehensive view that you could see everything. I miss being able to do a star search and see everything in the area. I think, ultimately, and Joy's talked a lot about this, Joy Hopkins, you have to increase your prominence and relevance to stand out when you're faced against a situation where you might be filtered. And so that includes improving your online profiles through reviews and then improving your onsite SEO to make sure your website stands out in search results, too.
Mike: Well, on that depressing note, I think I have to go so we're going to call this a wrap. But thank you very much for joining us, I really appreciate it.
Mary: Thanks, Joel.
Mike: Thanks, Joel.
Joel: Thanks Mike, thanks Mary, I appreciate it.