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NPS® in Health Care: Leveraging Loyal Patients to Drive New Business and Improve Revenue

If you're not measuring patient loyalty with NPS in healthcare, you should be. Leverage loyal patients to drive business and improve revenue.

Ryan Klepps
5 min read
April 6, 2018
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Most rehab therapy business owners, executives, and administrators understand the value of happy, loyal patients—especially given that a patient’s attitude toward, and relationship with, his or her provider can majorly impact the outcome of that patient’s treatment. But, did you know that you can use Net Promoter Score® (NPS®) tracking to systematically identify your already-pleased patients and leverage them to drive new business and improve your revenue? This powerful metric can also help you learn about, prioritize, and address the issues that are negatively shaping any less-than-pleased patients’ experiences, thereby boosting the number of promoting patients in your practice. And you can do it all with the help of one incredibly well-designed question:

On a scale of 0 to 10, how likely are you to recommend our practice to a friend or family member?

While it’s beautiful in its simplicity, the NPS packs a meaningful punch, because—when implemented correctly and consistently—it can help you tap into a wealth of actionable data. And you can use that data to improve patient outcomes, minimize patient dropout, and mitigate litigation risk. With that in mind, here’s what you should know about implementing NPS in your healthcare organization:

There’s a difference between measuring satisfaction and loyalty.

While you may be thinking that the difference between satisfaction and loyalty comes down to semantics, that isn’t the case. Just ask author, speaker, and business trainer Jeffrey Gitomer, who said, “Customer satisfaction is worthless. Customer loyalty is priceless.” There are quite a few reasons for that distinction, including the fact that organizations that measure satisfaction experience a pretty significant ceiling effect. In other words, they all have relatively high scores that don’t necessarily reflect their customers’ true experience. Here are three reasons why:

1. There’s usually a sampling bias.

Most healthcare organizations conduct patient satisfaction surveys at discharge—and that often leads to sampling bias. Why? Well, given that 20% of rehab therapy patients drop out during the first three visits—and 70% don’t ever make it to a formal discharge—rehab therapy practices end up with a pretty limited set of survey-takers. And those survey-takers are very likely to be pleased on the last day of their treatment. After all, they presumably met their treatment goals. So, as you might expect, this produces overwhelmingly positive results—with very little meaningful information on which to act.

2. There’s often an environmental bias.

Organizations that distribute patient surveys while those patients are in the clinic run a very real risk of experiencing an environmental bias. That’s because patients are significantly more likely to skew their responses in a positive direction when they’re surrounded by the people they’re supposed to be evaluating. This artificially inflates satisfaction scores and creates the illusion that your organization is doing better than it actually is.

3. Most satisfaction surveys aren’t very sensitive.

Most standard satisfaction surveys aren’t designed to capture meaningful differences between patient scores—and that can be a challenge for organizations that are using such surveys as a quality metric. The truth is, if the tool you’re using to measure patient satisfaction isn’t sensitive enough, you can’t be sure the data you’re collecting is actually worth anything. And while a general positive score might be a nice morale boost, it’s not all that great from an actionability standpoint.

You must earn loyalty.

While you could certainly continue to measure satisfaction—if you account for all the above-mentioned biases, that is—there is a better way: measuring loyalty. Satisfaction is easy to achieve: you simply meet a customer’s expectations. Loyalty, on the other hand, is a little harder won, because you have to exceed those expectations. And in today’s competitive and increasingly value-based, patient-centric healthcare marketplace, exceeding expectations is crucial.

That’s where NPS comes in.

If you’re not already familiar with NPS, here’s a quick summary of how it works: you ask your patients the question I mentioned at the beginning of this article: “On a scale of 0 to 10, how likely are you to recommend our practice to a friend or family member?” (The survey also typically includes a text box in which patients can provide a detailed explanation of their response.) Patient responses are then categorized into three groups:

  1. those who score 9 or 10 are “Promoters” (loyal);
  2. those who score 7 or 8 are “Passives” (satisfied, but not loyal); and
  3. those who score 0 to 6 are “Detractors” (dissatisfied).

To calculate your Net Promoter Score, simply take the percentage of Promoters and subtract the percentage of Detractors:

NPS = % Promoters - % Detractors

Every rehab therapy organization should be tracking NPS.

The most inherent benefit of NPS—in addition to its brilliant simplicity—is the wealth of valuable loyalty data it provides. In fact, I would posit that every rehab therapy organization should be tracking its NPS. Here’s why:

  • It’s easy to digitize, so you can send surveys to patients after they’ve left your office, thereby eliminating the environmental bias.
  • It’s highly sensitive, so you’ll be able to identify subtle—but meaningful—differences in patient responses.
  • It makes it easy to identify trends, which you can then act on to make positive changes in your organization.
  • There are benchmarks available, so you can see how your clinic stacks up to others in your area (hint: the average NPS score for rehab therapy practices is 84).
  • It’s only one question, which means you’ll have a better response rate—and it’ll be easier to administer at several points throughout the course of care, so you can eliminate sampling bias.

It’s important to know who your Promoters, Passives, and Detractors are.

Once you know which patients fall into which responder category, you can take appropriate action. Promoters are your brand evangelists; they’re the ones who are already loyal to your practice. As a result, they’re significantly more likely to:

  • rave about you to friends and family;
  • complete their course of care; and
  • come back in the future.

Obviously, the more Promoters your organization has, the better. Thus, the goal is to move all patients up the scale—by listening to their concerns and acting on their feedback. Then, you can encourage your large Promoter pool to take advantage of more of your services as well as provide positive online reviews, thereby driving new business and improving revenue. In fact, according to a Harvard Business School paper, a one-star improvement on an online review site such as can translate into a 5 to 10% increase in revenue.

Detractors attend five fewer sessions than Promoters.

If you’re still unsure about the benefits of knowing who your Promoters, Passives, and Detractors are, consider this: On average, Detractors attend five fewer sessions than Promoters—and that can dramatically (and negatively) impact your top line revenue as well as those patients’ outcomes. Detractors also are significantly more likely to complain to friends and family members—or to the general public in the form of online comments and reviews—which can be very damaging to your reputation. By implementing NPS, though, you’ll be able to identify your Detractors early and work with them directly—often in real-time—to improve their experience and keep them engaged in their care (which also mitigates your risk for a future lawsuit). That’s a significantly more effective approach than attempting to solve a patient’s problem long after he or she has left your practice.

NPS is easy to implement—and there’s software that can make it even easier.

Full disclosure: I am the co-creator of a patient relationship management platform that enables rehab therapy providers to design and implement patient engagement, retention, reactivation, and referral campaigns to grow their practices—and a huge component of is NPS tracking. We do some really neat things in terms of automating the entire process to help make it seamless for administrators, clinicians, and patients alike. But regardless of whether you opt to use a software or go the DIY route, there’s a huge benefit to tracking NPS. Here’s a checklist for implementing your own NPS campaign:

NPS Campaign Must-Haves

  • A HIPAA-compliant method for sending the survey via email or text message after the patient leaves your office.
  • A process for consistently sending the survey (and follow-up communication) based on specific rules and events—such as after an initial evaluation, at a certain number of visits, and after discharge.
  • A dashboard that enables you to identify trends and act on the information you receive.

NPS Campaign Nice-to-Haves*

  • The infrastructure necessary to alert someone when a response comes in, so he or she can address it.
  • A software platform that integrates with your EMR (it’s the best way to accomplish every other bullet point on these lists), and it’s the fastest way to organize all your patient contacts.

*Note: These will quickly become must-haves if you’re looking to scale this process.

There you have it: Everything you need to know about NPS in health care. Now, you know how to use this simple tool to drive new business and improve revenue in your rehab therapy facility. Interested in learning more about the very best, EMR-integrated, completely HIPAA- and HITECH-compliant patient engagement software platform—which can help you automate the entire NPS process? Then be sure to request a free tour of WebPT Reach today. Using this platform, clinics have been able to decrease early patient dropout by up to 20% and increase patient referrals by more than 5%, all while reducing clinical and administrative staff workloads.


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