Here at WebPT, we’ve been busy analyzing the results of our second annual state of rehab therapy survey—and it turns out that the patient retention problem is even worse than we thought (and we thought it was pretty bad). According to our data, only about 10% of patients—one in ten—actually complete their entire course of care. And this is only the tip of a very problematic iceberg for our industry—because when we don’t retain our patients, we:

  • don’t have the opportunity to help them achieve their desired outcomes, which means we
  • miss out on collecting the outcomes data necessary to prove the efficacy of our care, which means we
  • don’t garner the respect and recognition that we should from payers and the public, which means we
  • continue to be undervalued and underpaid.

Now, in some cases, patients may drop out early because they’ve reached (or believe they’ve reached) their functional goals, in which case we’ve done a poor job correctly projecting the required number of visits—or we’ve accepted a physician’s prescribed number of visits without using our expertise to provide a better estimate. While there’s no way to predict with 100% accuracy how long it will take for a certain patient to achieve his or her desired outcome, we should be able to get pretty close—if we use outcomes data combined with national plan of care benchmarks for different diagnoses (something most PTs haven’t been able to do in the past as a result of limited access to data). After all, insurance companies contend that they can accurately predict the number of visits each patient should require based on a claims data for certain diagnoses. That all being said, the big problem here is the patients who are bailing on therapy early—those who leave well before ever reaching their goals—and that’s what I’m discussing here today.

After all, if we can’t even help these patients, how can we possibly expect to reach the 90% of people who could benefit from our care, but never access it? How can we possibly expect to establish a brand that connects with prospective patients on a larger scale when we aren’t even connecting with our current ones? It’s a massive snowball—a vicious cycle—and one that must be addressed immediately for the sake of our individual practices, our profession, and our patients.

Most people in the PT industry have at least heard about the so-called "brand problem" that is plaguing the profession. But to many PT professionals, it seems too big to solve—that is, of course, until you break it down piece by piece. Because really, it's a chain reaction that starts at the individual patient level—and that's something individual practitioners and everyone else on staff can certainly impact. So, let’s start there—with patient retention at the clinic level.

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You have more power than you think when it comes to retaining your patients.

The key to solving the patient retention problem really comes down to value—specifically, ensuring that the value you’re providing aligns with what your patients perceive as valuable (and thus, are willing to continue paying for until they reach their functional goals). To put it simply, if your value proposition doesn’t align with your patients’, they’re going to go elsewhere to receive care that is a better fit. So, what is value?

Value has many components.

As Tannus Quatre and I discussed during this webinar, value consists of five main components: quality, brand, relationships, convenience, and price. While each component has a role to play, physical therapy patients don’t usually base their decision to select a particular provider—and continue seeing that provider throughout their course of care—on price or convenience alone. Sure, they’re both factors—which is why it’s still important to provide things like automatic appointment reminders and evening and weekend availability—but your brand, the quality of care you provide, and the relationships you’re able to build with patients and other healthcare providers are much larger pieces of the value equation. And that’s a good thing, because those are the components you have the power to impact the most. After all, in the current healthcare environment, there’s not a whole lot you can do to bring down the price of your services and still remain profitable. (As a side note, this is a common mistake for folks who are new to private practice. Bringing down the cost of your services—and/or offsetting costs by increasing patient volume—may seem beneficial in the short-term, but it becomes problematic and unsustainable in the long-term.)

You’ll never know what your patients value unless you ask.

While you may have a general idea about the things your patients value, there’s no better way to find out for sure than to ask—and then follow up to ensure you’re actually providing that value throughout your patients’ experience (more on the follow-up piece in a bit). As I’ve mentioned before, the initial encounter is the perfect opportunity to get to know your patients on an individual level. To do so, consider asking questions to uncover their true motivation for seeking therapy, their expectations regarding the process, and what they view as a successful therapy outcome. By doing so, you’ll not only have a clearer understanding of what your individual patients value, but you’ll also be able to identify larger trends that can help influence business and operational decisions. (Hint: You can also regularly scan your online reviews to identify value-based trends.) For example, if your patients value the expertise and knowledge of their healthcare providers, then you could expand your thought-leadership platform by providing well-written, well-researched content on your blog and social media channels—as well as via email at optimized intervals through a patient relationship management (PRM) platform. You could also point to this as a unique value-add for potential patients as part of your patient-facing sales and marketing strategies.

It’s imperative to level-set expectations.

While incredibly effective and long-lasting, physical therapy is not a quick-fix solution. In fact, depending on the presenting condition, it may take a while for patients to see noticeable improvements—and some may even experience more pain and less mobility in the beginning. That being said, more often than not, the benefits of a PT plan of care clearly outweigh those of pain medications, surgery, and injections. But when we fail to properly prepare patients for that time investment—or to clearly communicate that successful physical therapy treatment requires consistent engagement and home exercise program adherence—we’re setting our patients up for failure, too. Now, that doesn’t mean you should go about scaring patients from the get-go. It’s most definitely possible to level-set expectations in a way that generates intrinsic motivation and a commitment from patients to actively participate in their care journey. For these reasons, it’s also really important to celebrate milestones and data-backed progress markers along the way. Otherwise, patients can become discouraged and drop out during periods of slow progress.

The patient experience is holistic.

To be clear, the patient experience extends beyond the clinical experience. It encompasses everything from the moment the patient first begins researching a solution to his or her perceived problem to the very last interaction that he or she has with your practice, which may happen well after discharge. That means that every member of your staff has an important role to play in influencing the patient experience—and thus, patient retention. To gain a better sense of the experience you’re providing your patients, it can be helpful to map out the patient journey. That way, you can ensure that every touchpoint is optimized to deliver value to your patients. This includes optimizing your:

  • Online presence (e.g., website, social media channels, and online review sites), so you’re easily findable, and so patients can find the information they need to understand what to expect from your clinic;
  • Intake process (including procedural and payment policies), so patients understand their upfront financial responsibility as well as the importance of attendance;
  • Initial evaluations, so clinicians interact with patients as people first (before jumping into a clinical discussion of symptoms) and use jargon-free language to help patients understand the details of their care journey;
  • Staff interactions, so patients feel supported and connected at every touchpoint (think: greeting patients with a smile and by name and providing access to a regularly monitored secure messaging platform where patients can ask questions and receive feedback between sessions);
  • Schedule, so patients have access to appointments that are convenient for them and experience minimal wait times in your front office and between exercises;
  • Home exercise program, so patients can access the very best interactive, multimedia HEP anywhere that’s convenient for them, thus making it easy to remain compliant; and
  • Discharge process, so patients leave on a positive note and you ensure you have updated contact information to provide educational content on the topics that continue to be relevant (think: articles about preventing recurring injuries or updates regarding additional wellness services that might be of interest).

Loyalty matters.

The best way to ensure that you’re providing value in alignment with your patients’ expectations—and optimizing the patient experience—is to measure patient loyalty. Specifically, I recommend using Net Promoter Score® (NPS®) tracking. Unfortunately, traditional satisfaction surveys have too many flaws to truly provide an accurate picture of your patients’ perception of their experience. And in terms of survey administration, it doesn’t get much easier than sending patients one question—with an open text box to capture additional feedback—at consistent intervals.

Collecting this type of feedback is crucial, because loyal, pleased patients are significantly more likely to not only sing your praises to others, but also complete their entire course of care, thus increasing your clinic’s new patient volume and your patient retention rate (hello, revenue boost). Just be sure that you also implement a process for quickly reviewing and responding to patient feedback. If you ask patients to provide input regarding their experience, you better believe they’re going to expect you to follow up and address it. PRM software such as WebPT Reach can be a huge help here, too, because, you can use it to automatically send NPS surveys to patients at optimal intervals and alert you to review responses—in addition to its many other benefits.

The micro impacts the macro.

While our profession’s brand problem might seem like too big of a nut to crack, the individual clinic retention problem is definitely solvable—and it really comes down to some pretty simple action items. Namely:

  1. Own your value; ensure it aligns with what your patients value; and focus on quality, relationships, and brand.
  2. Make it a point to not only get to know your patients’ motivations, fears, and expectations—so you can provide care and motivate accordingly—but also communicate clearly about what the therapy process entails, including the direct impact that patient engagement has on positive outcomes.
  3. Prioritize the patient experience—and that means not only getting a baseline understanding of the patient experience you’re currently delivering, but also continually measuring your patients’ perception of their experience through NPS tracking so you can jump on opportunities to make improvements as they arise.
  4. Adopt technology to help you better connect with—and deliver value to—your patients, including an outcomes tracking tool, patient relationship management (PRM) software, and an interactive, multimedia HEP with a secure messaging platform.

To experience the change we want to see on the macro level—across our entire industry—we’re going to have to start at the micro level, in our individual clinics. Ultimately, it’s going to take every PT, assistant, tech, front office person, and practice owner doing his or her part to change the PT brand for the better, one patient—and patient experience—at a time. After all, I hope we can all agree that one in ten patients completing their course of care is simply unacceptable.


Who’s with me? What do you think about the PT branding problem? Do you believe we can positively impact the perception of our profession by individually committing to impacting the perception of our clinics? Do you think we have the power to keep patients engaged throughout the course of care? Tell me your thoughts in the comment section below.

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