An SEO Eyeful: Interview with Ronald Herskowitz

Some SEOs choose to specialize in particular fields. Ronald Herskowitz focuses on the eyes — literally. In this interview, you’ll find that even the specialists learn plenty of tricks that can be generalized to many different kinds of web sites.

Ronald Herskowitz is of Medical Management Services Group, L.L.C., actively and other refractive surgery services for dozens of individual Ophthalmology practices. Now based in North Andover, his previous practice as an optometrist gives him a unique set of skills to oversee the content and development of the portal, six ophthalmic directories and 110 individual sites for medical news and individual practices.

Having known Ronald for many years, I have learned a lot of specific search engine optimization tips from him. I recently had the opportunity to spend more time with him and learned more about his broader Internet and search engine marketing practices in which SEO techniques play one role.

This interview reinforced for me many tried and true tenets in marketing such as knowing your market, knowing their needs and constantly working to stay relevant. Further reinforced is the fact that while SEO rules and tricks can be used on any web site, they only serve the broader business purpose of the site owner. Although Ronald’s business practices serve a highly specialized niche, his general methods can serve as a model to anyone interested in search engine marketing.

What is the mission of your business?

Our business is a non-equity based physician practice management company limited to the development, operation and management of elective services lines within medical practices. Our specific concentration is in the sub specialty of Ophthalmology in the service lines of refractive surgery, including corneal laser eye surgery and lens replacement surgery for vision correction.

What is your Internet strategy?

As part of the services we provide, marketing plan development and execution is a key area in practice development. Since 1998, the use of the Internet in health care has grown so significantly across all age groups that it has become a core part of the overall marketing strategy. From our own research, we know that in the past 5 years 78% of patients have used the Internet one or more times during their information gathering to learn about physicians, practices, costs and technical issues.  

More recently, if we look at some of the research published by Focalyst, which is a joint venture between AARP, Inc. and Millward Brown, indicates that seniors consider the Internet to be the second most important source health care information after face-to-face interactions. What makes that even more important is that over 50% of people age 42 – 72 report that they are regularly online. Of those, 6 of 10 report using search engines to learn about various aspects of health care. This demographic cannot really be ignored when developing marketing communications for eye care. They are not just looking at pictures of their grand kids! 

So, as part of the marketing mix, the use of the Internet has just become more important and we believe will continue to do so. In order to serve our clients’ needs, we’ve been active in helping them develop and execute Internet marketing strategies across multiple vehicles on the web. Most practices today either have a web site or would like to have a web site, but the understanding of how to use the web site for patient communications, building brand awareness as well as creating direct response is pretty limited. And, unfortunately, most of the web designers and web developers that seem to be active within the medical community don’t always find the right balance. Those web developers with the consumer community seem to go a little too far the other way. 

We have carved out a niche in helping people design, develop and optimize sites that blend that medical-retail continuum that elective procedures fall into. We use the development and optimization of an individual’s site as the core of the strategy by using ongoing SEO to build visibility across research-based keywords and phrases which are relevant to the consumer behavior we see across these service lines.

The second part of the strategy that we typically help practices implement is based on the fact that an individual practice site is likely to encounter difficulty achieving first-page ranking for relevant, consumer-driven keywords. Terms such as lasik, lasik surgeon or cataract surgery are extremely competitive terms and it is unusual to see an individual practice site rank within the first two or three pages, rendering it useless for generating traffic or brand awareness. 

So we maintain a refractive surgery portal that integrates hundreds of pages of continuously updated content as well as a geographically exclusive physician directory for the clients. We take the responsibly for ongoing search engine optimization, content generation and updates. The final part of the Internet strategy is building, maintaining and using targeted email databases for conducting ongoing health information awareness as well as conducting highly targeted direct response and inquiry to specific practices.

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What do you call your Internet strategy?

The broad strategy of development, patient education and patient acquisition is Search Engine Marketing. Within that structure is a piece that specifically addresses the making of information available to consumers in a way that fits their thought process.

What is your definition of Search Engine Optimization?

SEO is a process by which you combine an understanding of consumer behavior with the technical and mechanical elements of search both in terms of user interface and algorithms that explain how the various search engines will view your information, and then providing that information, through various web vehicles, to facilitate the recognition of the material.

It is not just coding, tagging and whatever. I built a site that we tagged completely wrong. It was technically correct, but the client didn’t understand what the consumer was thinking about. We blew the first phase of the research. We did what we thought was a thorough evaluation of online keyword utilization coupled with what we would normally do in consumer research to see if those words truly connected the consumer with what they were looking for. We got part B wrong.

When you get SEO right, you get the words and phrases that resonate with consumers that have longevity in their core of search terms that they are going to use. See, it is very easy to use Keyword Finder and come up with a list of keywords relevant today. It takes you a month to build the site, get it indexed and the client plans to use it for years. As the consumer is exposed to other sites, other forms of media and patient education, sometimes their keywords and their thought processes about it begin change. So as you do the research, you have to balance the currency of keywords versus how consumer thinking will evolve. 

For example, in 1994 people spoke about PRK. That shifted because the procedure evolved into Now, PRK is a small search term. If you didn’t contemplate change and build the site to prepare for change, it became obsolete. It requires careful monitoring; years ago when we saw the evolution of the term lens replacement surgery, we began building in this term and the words around it for our clients even though it had and still has a small share in the vision correction market.

How did you learn SEO techniques?

My initial education came from understanding and being involved in some seminal consumer market research in the area. Back in the early 1990s I got to watch first-hand how consumer language developed cognitively. At that time this was considered important only in general marketing terms.

In the late 1990s as search started developing as a form of information exchange, I was with people who were really good at search. They were very algorithmically inclined and had a good foundation in semantics, but didn’t necessarily have a good understanding of consumer behavior. Being online, I got involved with a couple of guys from Olympia, WA who had extreme knowledge of the technical aspects of search. They knew the algorithms, the mechanics and the patents and seemed to be very tied into that world of search.

By working together with them, I taught them what I knew and they taught me what they knew. We have worked together since then, exchanging information and validating each other’s work.

The other way I learn is research: reading the patents, the webmaster guidelines and exploring the SEO chat rooms. 

The important thing is everyone has the potential to become an SEM specialist by using SEO. If you have core business knowledge in any discipline, be it early childhood education or car sales you can take the core knowledge you have about how your customer behaves and how they think and match it to the technical and the mechanical aspects of search. You can do good things for your customers and clients. I’ve been asked to create sites for other types of medical practices, but I have turned them down because I don’t know the content as well as the niche I have created.

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Where do you learn about new SEO developments?

I think we are always conducting consumer research. We are always looking at consumer behavior trends within our field. Then we are always looking at new Google patents and changes in site ranking behaviors. From that, we keep an ongoing list of the attributes which affect the site. We constantly keep these lists updated and try to determine where their relative importance is. Then we do constant experimentation.

How do you test your strategies?

We, in fact, have a pretty fair number of "demo" sites which we operate specifically to test formats, and changes on an ongoing basis to see the effect in the search engine rankings.  

Do you always look for the achievement of number one ranking to measure the success of your test?

Not really. We might be looking for the impact on relative movement, both up and down. Sometimes we do things because we think it will make a more positive user experience and it will actually create a negative effect in ranking. 

So how do you balance the goal of customer education and recruitment with the goal of achieving high organic search results?

Sometimes you can’t. Sometimes you have to compromise one for the other. There is a balance, but sometimes you have to absolutely compromise one to do the other. I find that to be the rule, rather than the exception. 

That also goes for balancing the characteristics of each search engine. The compromise often comes in the internal structure where we have to make the content readily available in places where the consumer can access, but may not be treated very favorably by the search engines. That process by which we compromise or sacrifice a ranking versus the information delivered on that page ties back to original strategy for that particular site

When we do the initial design session with the client, we get a firm set of priorities from them on what’s important. Sometimes we find that does not match what the consumer wants. Just yesterday I had a practice who wanted to prioritize things that are of little value to the consumer or search engine for whatever reason, probably to stroke their ego.

Do you market to specific search engines?

Yes. Even though they have slipped a little bit, the quality of searches returned by Google in terms of patient education and information is clearly better than the quality of information provided by other search engines. Yahoo varies between fair to good. MSN is not quantifiable. So we prioritize accordingly.

Given your definition of SEM, shouldn’t you be marketing to the engines you think your market base is using rather than which gives the best results?

Yes. Even though Google is currently cited by the Pew Internet & American Life Project as capturing about 62% of all search in health care, my belief is that it is higher. The rest is split between Yahoo and MSN. 

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Do you optimize for Yahoo and MSN and are those techniques at odds with those for Google?

Yes, that is part of the compromise. MSN doesn’t seem to look as hard at body text and content whereas it seems to be an important factor for Google. MSN seems to really only look at links and not even the quality of links. Clearly the big difference between Google and the others is their prioritization of keywords in tags and text as well as the quality of the links pointed at the site. We’ve done experiments where we intentionally bombarded a test domain with links and not necessarily high quality links. The effect of the Page Rank system Google uses on discerning link quality is an important and distinctive feature. 

We optimize around Google and work around the others. Depending on what you’re doing, you can do fairly well. When there is a decision to be made, it is made in favor of Google.

Are there specific techniques you use to optimize for Google?

I have those attributes posted on my web site for review. Beware though. I’m not sure that from month-to-month, or even day to day, these don’t change in importance. I’m not sure that from data center to data center they don’t change in importance a little bit. I’m not sure that some person in Mountain View doesn’t wake up and say, "Let’s scramble this today. Let’s take 75 data centers and do this and see what happens." I’m not sure that doesn’t happen. So, it’s a game.

What do you see in the future of search?

The big unknown is how to really utilize social networking sites integrated into the whole SEM process. It seems a lot of the stuff has been hashed and rehashed, but the big question is how the playing field will allow us to use social networking sites to accomplish marketing objectives. I am not sure the consumer cognitive process has developed to the point where someone could match a marketing strategy to that. 

For us, it is all about the consumer and how they are thinking which drives everything else.

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