I’ve worked with a lot of therapy clinic owners over the years, and I ask each one of them the same question: what are the top three metrics you track when assessing the health of your business? The answers are usually the same: total visits, the percentage of missed visits (e.g., cancels and no-shows), and average reimbursement rates. While these are all crucial metrics for business success—and even the slightest change to any one of these indicators can impact a business’s bottom line—I’d posit that there’s another important metric that’s missing: patient retention. Truth be told, we’ve become a little obsessed with the patient retention metric around here. And if you’re running a rehab therapy clinic, you should be, too. Read on to learn more.
The Two Forms of Patient Retention
1. Course of Care Retention
Course of care retention rate is the percentage of authorized visits a patient attends for which the clinic is able to bill. If it is 100% for any given patient, then that patient’s therapist has done an excellent job establishing your clinic’s value proposition—and that patient has clearly bought into the services you provide. A low retention rate, however, is indicative of a patient who (1) did not see the value of the services your team provided and (2) is likely responsible for:
- driving up your cancellation and no-show percentage,
- driving down total visits at your clinic, and ultimately
- having a negative effect on profits.
In many cases, your course of care retention rate offers a much more actionable metric than cancels and no-shows alone.
2. Clinic Retention.
Clinic retention rate is equally valuable. This metric reflects the percentage of patients who return to your clinic for a new course of care. While this can be a bit more difficult to track, a high clinic retention rate clearly shows that that your clinic has a positive reputation among your patients. Patients who return are often the best evangelists for your clinic, so knowing who they are—and how they came to be retained patients—is crucial for repeating the process.
The Patient Retention Management Process
As with any other business objective you set out to achieve, in order to improve your patient retention, it’s important to start with a plan. While it’s easy to understand the value of patient retention, many PTs aren’t sure how to go about setting up a system that helps them consistently retain their patients. For this, we’ve developed the patient relationship management process.
The diagram above breaks down the Patient Management Process into three main phases: education, engagement, and empowerment. The circles represent key patient milestones along the way: new referral, current patient, retained patient, and patient evangelist. Let’s take a closer look at each phase.
As new referrals enter your system, register for their first appointments, and attend their initial evaluations, many have questions—questions such as what their diagnoses mean, how long their recovery is it going to take, and where should they park to best access your facility. Being a good listener and responding to patient questions as they come up is crucial. However, patients won’t think of every question they have when they’re in your office, which is why it’s a good idea to provide additional educational resources to new patients in the form of a frequently asked question (FAQ) list or a new patient resource center on your website. It’s even more important to provide a reliable method of contact to your patients, so they can reach you should additional questions arise. This extra step can go a long way toward making your patients feel comfortable and at ease at the start of their treatment.
Education is more than logistics; it’s your first opportunity to demonstrate value.
Still, education is more than mere logistics. This is your first opportunity to demonstrate value. Have you ever been frustrated with patients no-showing after their first visit? The truth is, often you only have one shot to get your value proposition across to new patients. This encounter is just as important as any marketing materials you publish—and it’s a great opportunity to put your customer personas to use. As therapists, we are great at setting plans to help our patients reach their goals. Well, understanding your patients’ goals right from the start and educating them on the steps necessary to reach those goals—including completing their entire course of care—are of the utmost importance.
Your actions leave a lasting impression.
Finally, remember that your actions leave a lasting impression. Wow your patients with your service and your commitment to their recovery by providing them with resources they can use on their own to better understand their diagnoses and begin their independent home routines. These resources can be as simple as websites, blogs, and YouTube videos—or they can be more interactive tools such as those available within the very best patient relationship management (PRM) software. Ultimately, the goal of your education endeavours is to make sure your patients know you are doing everything you can to ensure they succeed, feel comfortable with the services you provide, and leave believing that physical therapy is the treatment of choice for improving their condition.
We’ve talked about the importance of patient engagement before, and it’s the cornerstone of the Patient Management process. In order to experience consistent patient retention, therapists must develop strategies to engage their patients. Before we go any further, though, let’s define patient engagement—something that’s easier than said than done in our industry. In this entertaining piece, physician Rob Lamberts opines over just how “buzzwordy” patient engagement has become: “What is patient engagement? It sounds like a season of The Bachelor where a doctor dates hot patients,” he wrote. I second this opinion. And while Lamberts doesn’t directly define engagement, he does conclude his piece with one of the best definitions I’ve found yet: “Engagement is about interaction, listening, and learning in relationship to another person. Engagement is not a strategy, it is care.”
Engagement is a two-way street.
To simplify, engagement is all about communication, and it’s not a one-way street. While this definition is painfully simple, the truth is, we’re still pretty bad at engaging patients. This struggle is one of the factors that led Leonard Kish to pen the now-infamous proclamation that patient engagement is the “blockbuster drug” of the century. It’s no secret that a patient who is more involved—and thus more engaged—in their course of care will have a better outcome, but the trick is consistently getting your patients involved and knowing how to measure engagement so you can improve it.
Your patients’ engagement—or lack thereof—may be connected to your own.
Unfortunately, there is no magic bullet for improving patient engagement, and there is certainty not an app for that. But there are things you can do to help your patients take a more active role in their care. In fact, the best place to start is often looking in the mirror and considering whether your patients’ lack of engagement has something to do with your own. Truth be told, there’s probably a connection. All too often, we get stuck in a rut of documentation, overbooked schedules, and commonplace patient presentations that we forget that we’re treating a person, not a diagnosis. Patients care that we care about them. And, going back to what Lamberts said, to engage is to provide care. By listening to your patients’ challenges, goals, beliefs, and fears—and then connecting them to your treatment plan, thereby providing relevance—you create a dialogue centered on collaboration rather than compliance and conversation rather than a doctor’s orders.
They’re just not that into you, so be relevant.
The key to providing value to your patients is offering relevance. Patients don’t care that they lack full shoulder flexion, have an innominate rotation, or are suffering from a weak VMO. Sure, it’s important to explain it at some point, but what they really want to know is if they are going to go be able to play in their adult slow-pitch softball tournament next weekend (it’s the police vs. firefighters game, after all). Even with the best diagnosis and treatment skills, you will fail to engage a patient if you can’t be relevant and offer them something they care about.
There’s also room to step up your game when it comes to behavioral change.
In many ways, healthcare providers are in the business of behavior modification. The problem is, most of us don’t know how to apply behavior change strategies effectively. If terms like social cognitive theory and transtheoretical model only remind you of that one class in PT school you skipped a little too often, then it might be time for a refresher course, because it turns out that people aren’t great at following through with the healthy behaviors we try to help them practice when we create our care plans. And if you don’t know how to help them do so, then there’s a good chance they are going to fail. As it stands, only about 35% of patients complete their home exercise program as prescribed—and only about 21.7% of the general population exercises regularly.
Without understanding the processes most people go through when trying to develop a new habit or change an old one, we’re going to continue failing to help our patients make the life changes that they need to remain symptom-free or experience optimal outcomes. By knowing how to use tools like behavioral staging and self-efficacy evaluations to improve your patients’ success, though, you’ll have a much better shot at both achieving desired clinical outcomes and improving patient engagement.
Measurement is critical to improvement.
You can’t improve what you can’t measure. So, determine what meaningful patient engagement looks like for your practice, and measure it religiously. Some simple data points we like to keep an eye on are cancel and no-show percentage per patient and utilization of home program resources. Having a home exercise program that quantifies patient engagement can be immensely helpful for this. If you have a secure messaging system, then you should also track messages sent and received per patient. This is a great way to measure engagement; after all, one of the best indications a patient is involved is if he or she is asking questions.
The final step in the Patient Management Process is empowerment. Often overlooked, empowering patients is the key to improving clinic retention rates at large. As a physical therapist, you have the opportunity to be an incredible resource to your patients. Empowering them with the tools and techniques that will help them maintain a successful long-term outcome is one of the best ways you can provide unmatched value to the patients you treat. It'll also ensure that what they’re sharing with their colleagues, friends, family, and online networks is overwhelmingly positive, thus helping you reach even more patients.
Discharge presents a huge communication opportunity.
If you’re giving your patients an HEP handout and a few resistance bands before showing them the door, then you may want to reconsider your approach. True value comes through enabling your patients to reach their overall health goals and continuing to serve as a resource for them—even after discharge. Whether this comes in the form of a custom-tailored exercise program or guidance about activity modifications and new healthy habits, the most powerful empowerment tool you can provide is your continued knowledge and feedback. That’s why it’s crucial that everything you provide at discharge comes with an easy means for communication.
Continued communication is the foundation of engagement.
As the basis for sustained engagement, a communication channel that is easily accessible post-discharge can be an incredible resource to patients. But, with today’s busy clinics, sometimes a phone call can be impractical. In that case, implementing a secure messaging system can be a great way keep the communication channel open for your patients without having it interfere with your daily practice. While some PT’s have been known to offer an email address or even a personal phone number, make sure you consider the legal ramifications before using one of these unsecured communication channels (read: you really shouldn’t do it).
Improving patient retention can be incredibly valuable to your clinic. And having a process and a quality set of tools to help facilitate that improvement is crucial. Every clinic will find what works best for that particular organization, and the Patient Management Process is just one way to increase both course of care and clinic retention. Ultimately, educating, engaging, and empowering your patients is all about improving the relationships you have with your customers. By providing this level of service to go along with your incredible treatment techniques, you can ensure that every patient you treat gets the most out of every interaction with your clinic.