DX / Differentials / ORTHOPEDIC & MSK
D-04 — MULTI-LOCATION MARKETING · ORTHOPEDIC & MSK
One playbook, different results by location — orthopedic and MSK
One playbook, and clinics that behave nothing alike
PRESENTATION — WHAT THE OPERATOR SEES
Same brand, same protocols, same spend per site, and the sites do not perform alike. In this category the single largest driver of the spread is one number that nobody reports next to volume: the wait for a new patient appointment.
DIFFERENTIAL — LIKELY CAUSES, MOST LIKELY FIRST
- 01
Access time varies by weeks between clinics and the media does not
One clinic sees a new patient in three days and another cannot for a month, and both are being bought media as if they were the same. The group pays the same price for demand one site can absorb and the other cannot.
Time to next available new patient appointment, per clinic and per provider, is a schedule query and is almost never reported to whoever buys the media.
No published distribution — ADMEN source register, /sources/
NOT THIS IF — Access is inside the same band at every clinic and the spread survives.
- 02
The direct-versus-referred mix differs by site and is not held constant
A clinic that is 70% referred and one that is 30% referred are two different businesses. Ranking them on total new patient visits, or on cost per new patient, compares things that are not comparable.
The split is recorded at intake and is rarely carried into the comparison, which is what makes the league table misleading rather than merely noisy.
No published distribution — ADMEN source register, /sources/
NOT THIS IF — The comparison already holds the mix constant.
- 03
Condition mix differs by site and the reporting does not say so
A site heavy in sports medicine and a site heavy in spine will differ on volume, on conversion and on cost, for clinical reasons rather than marketing ones.
Condition mix per clinic is in the billing data. Without it, a variance report attributes to execution what belongs to case mix.
No published distribution — ADMEN source register, /sources/
NOT THIS IF — Condition mix is similar across the sites being compared.
- 04
Referral relationships are local and the reporting is central
Referral volume is the sum of individual relationships with individual practices. A central report cannot show that four practices near one clinic stopped referring, which is exactly the sort of thing that produces a site-level collapse with no marketing cause.
Active referring practices per clinic per quarter is countable and is the local number a central report structurally cannot carry.
No published distribution — ADMEN source register, /sources/
NOT THIS IF — Referring-practice counts are already read per clinic and are stable.
HOW TO TELL THEM APART
How to tell these apart in your own numbers
Each of these is a measurement you can run yourself, without us.
01 · Access time varies by weeks between clinics and the media does not
Time to next available new patient appointment by clinic, weekly, plotted against new patient visits and spend per clinic. Access is the first instrument in orthopedic and MSK marketing because it explains more of the between-clinic spread than the media does.
CONFIRMS IF
Volume and conversion track the wait across the network.
EXCLUDES IF
Access is uniform and the spread persists.
02 · The direct-versus-referred mix differs by site and is not held constant
Rebuild the clinic comparison on the direct half only, then separately on the referred half.
CONFIRMS IF
The spread narrows sharply once the halves are separated.
EXCLUDES IF
Both halves show the same spread.
03 · Condition mix differs by site and the reporting does not say so
Condition mix per clinic from billing data, then re-rank clinics inside comparable mix bands.
CONFIRMS IF
Ranking changes materially once mix is held constant.
EXCLUDES IF
The ranking survives the adjustment.
04 · Referral relationships are local and the reporting is central
Distinct referring practices and volume per practice, per clinic, eight quarters.
CONFIRMS IF
A site's decline coincides with a small number of practices stopping.
EXCLUDES IF
Referring counts held at the sites that fell.
WHAT RESOLVES EACH
What resolves this, and how you will know it resolved
| Access time varies by weeks between clinics and the media does not | Rx 03 · patient conversion → | Access measured per clinic and per provider, reported next to volume, and demand routed to the sites that can absorb it. |
| The direct-versus-referred mix differs by site and is not held constant | Rx 04 · marketing attribution → | Every per-clinic comparison run on the direct half and the referred half separately, never pooled. |
| Condition mix differs by site and the reporting does not say so | Rx 04 · marketing attribution → | Condition mix carried into the variance report so execution is not blamed for case mix. |
| Referral relationships are local and the reporting is central | Rx 03 · patient conversion → | Referring-practice counts read per clinic monthly, with the referring physician's experience treated as a product at the local level. |
WHAT "RESOLVED" LOOKS LIKE — Spread between clinics on direct new patient visits, mix held constant
MEDIAN
Not published for this category.
TOP DECILE
Not published for this category.
TARGET
The group's own distribution once access, mix and condition are held constant. Resolved means the adjusted spread narrows while the network median holds or rises.
No published distribution — ADMEN source register, /sources/
HOW THIS DIFFERS BY SCALE
How this differs by scale
| Single site | Not applicable with one site; the variance is between providers and between referring relationships. |
| Group | This is the highest-value presentation for a group, and the one a pooled report cannot show. |
| Platform | At platform scale access routing across sites is the largest unclaimed volume in the business. |
OTHER PRESENTATIONS — ORTHOPEDIC & MSK
- Cost per new patient is rising and the two halves of the business are being averaged
- New patient visits are short and the schedule is the reason
- Visits are flat and the cases are where the money is
- Visits are documented and the case pipeline is not
A differential narrows the field. It does not replace the examination — that is what the six weeks are for. Every figure above is an industry reference range, not a client's numbers; those stay sealed. Sources are set out at /sources.
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