Tammy, have you tried adding consulting services? If I do a marketing I usually focus on consulting to get my foot in the door. I don't believe the EMR/EHR vendors have any advantage at all over those of us who have been in business and have built a good solid reputation. Shift the focus of your marketing to MORE than just billing. Think outside the box. Also don't be afraid to send out your resume, I still do to every potential client!