Why the Viva Referral System?

Advertising is too expensive and doesn’t work. Television advertising worked in the 1950's and 60's but has become far less effective and at an exorbitant price. Direct mail has become so voluminous as to be discarded without being looked at, and yields a .02% response rate at best. Pay-per-click internet advertising has likewise become so ubiquitous as to be rendered ineffective. Discount voucher programs bring in new “patients” from areas not local to your practice, only to take advantage of the “Deal” and never return. Bottom line – the average cost of patient acquisition on average is anywhere from $200 - $500 plus per patient. The best form of advertising has always been and will always be WORD OF MOUTH REFERRAL. The VIVA REFERRAL SYSTEM is a culmination of 25 years of marketing in the dental industry. The program is simple – it is based on an aesthetically designed plastic card which has a high perceived value and helps to brand your practice. The card has an introductory offer to introduce new patients to the practice.  It is given to your existing patients to give to their friends and family, and you are able to monitor results through the VIVA dashboard.

What is Viva?

Viva is the most cost effective referral marketing program. It results in quality new patients for the office because all new patients are essentially referrals of the existing patients.

How Does It Work?

The employees of the office simply give the Viva cards (gift cards with the doctors information and offering) to the patients leaving the office to pass to their friends and family. The card has a magnetic strip, the employee swipes the card before passing it out to the patient and put her name on the card. The card will then be passed out by the patient to a friend. When the new patient comes in, the card is swiped in and the office can monitor different statistics of the campaign, for example how many cards are being passed out, how many patients are coming in with them, what offers work best, etc.

What are the main differences between Viva and other marketing programs?

In the Viva System, the cost to acquire new patients averages around $40 per patient, considerably less than the cost of direct mail or other types of advertising. Second, Viva focuses on the quality. Because it is based on referrals, patients passing the cards to their friends and family, Viva averages much higher in treatment plan acceptance than other modes of broad advertising that motivate a new patient to come in solely because of a free offering.

How do you know what percentage of distributed cards come in?

Viva's Dashboard currently tracks over 700 different offices. The average response rate of the cards internally distributed is 3%.

What is text activation and how does it work?

Every office has one or more unique text activation codes. The text activation system increases the response rates of the cards as well as allowing the office to monitor the effectiveness of each campaign. The code may be something like "CDD" for "California Dental Group." There is a sticker on the back of the card of California Dental Group that will say "please text 'CDD' to 84700 to activate your gift card." When the recipient of the card texts the letters 'CDD' to 84700, he will receive an auto reply on his cell phone with a message like "Thank you very much, your card has been activated! Someone from California Dental Group will call you in 24 hours to schedule you for your visit." In this way, the recipient of the gift card expects to receive a call for his appointment. The receptionist at California Dental Group receives an email with the cell number of anyone texting their code, i.e. activating their cards. This text activation system enables you to be proactive at setting appointments, as opposed to waiting for the patients to come in whenever they like to.

How do the appointment cards work?

The Viva Appointment Card solves the problem of distribution. It takes any thought or guesswork out of who and when to distribute Viva cards. Your office already routinely gives appointment cards to your patients – why not turn every appointment into an opportunity to get a new referral? The Viva appointment card, which is customized for your office, has a Viva Referral Card attached. When your receptionist gives the appointment card to the existing patient, she will automatically be asking for a referral from a friend or family. The card is perforated so the appointment card can be retained by the patient and your referral card can be given away.

What are Viva Mailers?

Viva sends beautiful, customized mailers to your patient database in clear plastic envelopes that are irresistible to open. It contains a card for the patient to give to a friend or family, or to encourage the patient to come back to the office to start or continue his  treatment. It also contains a personalized message from you. Viva mailers can be done as a general purpose mailing to keep you in touch with your patients, or can be sent at Holidays and special occasions.

Why would I want to mail a gift card to my existing patients?

Every day, doctors lose their patients to competing doctors. Communication with your existing patients helps you maintain loyalty. Word of mouth is the best source of advertising, and your existing patients are the very best resource for quality referrals.

What if, when a card is given to a patient to pass to a friend or family, he asks if he could have the gift card for himself?

This inquiry can be turned to your advantage by an approach such as telling your patient that the gift will be awarded to them when they refer someone to the practice. Another approach may be to allow your existing patients take advantage of the offer. It creates tremendous goodwill and many times leads to additional treatment.



The Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) governs many aspects of health care delivery. Of concern to Viva and its Clients are two elements of HIPAA, the “Privacy Rule” and the “Security Rule.”

The HIPAA Privacy Rule regulates the use and disclosure of Protected Health Information (“PHI”) held by a covered entity (Viva’s Client). PHI is any information held by a covered entity which concerns health status, provision of health care, or payment of health care that can be linked to an individual. PHI is interpreted broadly, and includes everything in a patient’s medical record or payment history – including their name and address.

The Security Rule complements the Privacy Rule related to PHI, and relates solely to Electronic Protected Health Information (“EPHI”). The Security Rule requires that a recipient of EPHI must have three types of security safeguards in place: (1) administrative, (2) physical; and (3) technical.

Viva’s Clients are allowed to share their PHI with Viva, because Viva is a Business Associate. Part of the Viva new Client package is a Business Associate Agreement.

As a Business Associate, Viva protects your patient’s PHI. This protection is overseen by Viva’s in-house attorney, who also serves as Viva’s HIPAA Privacy and Security Official. Questions about Viva’s HIPAA program can be sent by email directly to our Privacy and Security Official. Legal Contact

Viva maintains a Security Manual, conducts regular Risk Assessments, and maintains a HIPAA Training Program and Sanctions Policy. Technical Elements of Viva’s HIPAA program is overseen by our IT Department. These technical efforts include encryption of PHI and password protecting access to PHI.


Any Dentist considering a marketing program should be aware of Federal and State prohibitions on fee splitting and “kickbacks.” The meaning of these terms are quite broad for Dentists, and even a program that allows for a portion of a dental customer’s payment to be shared with a third party violates the anti-kickback statute and possible state anti-fee splitting statutes as well. [42 USC §1320a-7b(b)]. Viva has gone to considerable effort to ensure that its program is in compliance with these rules.

The Federal Anti-Kickback Statute prohibits any person from:

"...knowingly and willfully offer[ing] and pay[ing] any remuneration (including any kickback, bribe, or rebate)... to any person to induce such person... to refer an individual to a person for the furnishing or arranging for the furnishing of any item or service for which payment may be made in whole or in part under a Federal health care program." [42 USC §1320a-7b(b)].

The ADA Principles of Ethics and Code of Professional Conduct as well as specific laws in each state follow the Federal approach in prohibiting the sharing of patient’s fees with a third party. Click Here for links to the rules in your state

The Viva Program is in compliance with the Federal Anti-Kickback Statute, the ADA Ethics Code and the laws of each State because Viva does not split fees. Your charge remains the same no matter how many new patients you receive through your use of the Viva Program.

In contrast, in the Viva Referral Card system no compensation from a patient is received by anyone other than the dentist. Viva Dental is paid for the design and production of Viva Cards, for education and training of dental office personnel, and for costs of mailing. Viva does not induce or refer any person to a dentist. This is a key distinction between the legal and ethical Viva Referral Card system and other systems which are inconsistent with the law and ethical standards established by the ADA. [ADA Principles of Ethics and Code of Professional Conduct §4.E.1]

Similarly, when Viva Referral Cards are distributed by patients or other third parties to friends and family, they receive no compensation for distributing the Viva Referral Cards. Viva Referral Cards contain an offer redeemable only by the recipient, not by the person making the referral. Consequently, the transaction is that of traditional advertising and is consistent with Federal and State laws related to kickbacks and/or fee splitting.

Note: There are two relevant “Safe Harbor” provisions that allow a Dentist to split fees. First, a referral fee may be made to an employee of the dentist or dental office. [42 USC §1320a-7b(b)(3)(B)]. Second, “a discount or reduction in price” [42 USC §1320a-7b(3)(A)] may be offered. This means that giving a potential patient a reduced price offer is specifically allowed.


Advertising claims must be truthful and non-deceptive, must be made with evidence that supports their claims, and must not be unfair. At the federal level false advertising is enforced by the Federal Trade Commission. Similar laws exist at the state level. There is no inherent component of the Viva Referral System which gives rise to a potential false advertising claim. The concern here is that the offer made by a dentist for inclusion on a Viva Referral Card must meet the three requirements of all advertising.

The key component is that the dentist Client must provide accurate information for inclusion on the Viva Referral Card. This includes all terms and restrictions on the use of the offer, including the expiration date of the offer, and a fair valuation of the value of the offer. [See ADA Principles of Ethics and Code of Professional Conduct §5.F.2].

Most states also have truth in advertising requirements. For a state by state review client here.

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