I don’t know about you, but I have a hard time with endings—even the end of a good book can leave me feeling melancholy for a few days while I process the fact that my newfound friends are continuing to live their fictional lives without me. While you may not experience pangs of loss over a well-developed character, I’d lay a wager that you feel the pain when a patient bails on you before his or her treatment plan is complete. And that type of rejection can hurt more than your feelings; it can shred your bottom line and negatively impact your patients’ outcomes. So, what’s a conscientious therapist to do? First, get to the bottom of why your patients are leaving (a.k.a. churning)—then, stop them before it’s too late by prioritizing patient engagement and satisfaction. Here’s how:

1. Understand churn.

According to Strive Labs CEO and Co-Founder Scott Hebert, DPT, patient churn—which can be quantified as the percentage of patients who leave therapy before completing their plans of care—“is one of the biggest problems facing PT businesses, but unfortunately it often goes unnoticed.” The fact that this issue is regularly overlooked is particularly unsettling considering Hebert’s estimation of average churn: he says about 70% of all PT patients end up churning—20% actually drop out before their fourth visit—costing “the average PT practice upwards of $150,000” annually. As WebPT’s Kylie McKee reported in this post, another 20% of patients stop attending therapy before their seventh visit—and it’s unlikely that this many patients are fully recovering within only six sessions. “Simply put,” Hebert wrote, “patient churn is too big of a problem to ignore, and it can have a profound impact on your clinic’s bottom line.” In addition to the rather obvious missed revenue opportunity a churning patient represents, he or she can also prove to be a liability, because an unsatisfied patient is significantly more likely to leave you a negative review online—or turn the experience with your practice into a cautionary tale for friends and family members. Either way, that’s bad for business—and your reputation.

Measure your own rate.

To calculate your practice’s churn rate, Hebert recommends subtracting your actual visit count from your expected visit count and dividing that number by your expected visit count multiplied by 100. The actual equation looks something like this:

Churn Rate = (Expected Visit Count – Actual Visit Count) / (Expected Visit Count x 100)

Interestingly enough, according to this patient retention infographic, the “normal attrition rate” for a healthcare practice is between 10 and 30%—significantly lower than Hebert’s estimate for PT practices, which raises questions about patients’ perception of physical therapy versus other medical services. That being said, as with all metrics, the best thing you can do is calculate your practice’s rate, set a new goal, and make the necessary improvements to reach it. Then, repeat.

2. Find the problem.

Before you can improve anything, though, you first must find out why your patients are running for the hills—or falling off the map. While you may have a hunch as to why your patients are failing to return—perhaps you know that your front desk isn’t making a stellar impression or that your therapists could use some help communicating with patients in jargon-free language—there’s something to be said for actually asking them. According to Hebert, one of the best ways to do this is to begin tracking your Net Promoter Score® (NPS®)—and we couldn’t agree more. As WebPT President Heidi Jannenga pointed out in this post, every rehab therapist should be tracking this super-simple, yet powerful customer satisfaction metric—otherwise “you’re missing out on a veritable goldmine of mission-critical information about how your practice is performing from your patients’ perspective.”

Implement NPS tracking.

So, how do you get started with NPS tracking? By regularly and consistently asking your patients one question: “On a scale of zero to ten, how likely is that you would recommend our services to a friend?” In terms of collecting more specific actionable feedback, you can leave an open comment field on the survey form and/or follow up with patients after the fact. According to Hebert, “Promptly following up with patients [who are unlikely to refer your services to a friend] can be an incredibly successful method for addressing patient issues and ensuring that they are retained in care.” In fact, “this strategy is especially effective when initiated early in care (i.e., within the first three visits),” he wrote. “That way, you can get an early pulse on which patients are most likely to drop out and why.” To learn more about implementing a comprehensive NPS program in your practice—and acting on the results—read Jannenga’s article in full here.

3. Make things better.

According to the above-cited infographic, 30% of all patients who leave treatment do so because of a life event, such as a move or job change; the other 70% leave “because they feel they’ve been treated with indifference.” Ouch. That’s a huge number of patients who feel like their healthcare providers simply don’t care about them. So, in addition to addressing the specific patient concerns that surface as a result of your NPS tracking program, consider adopting some of these best practices to “combat the perception of indifference” (adapted from the same infographic):

  • Prioritize meaningful communication. That means communicating using language that the patient understands—from the first interaction to the last. It may also mean collecting patient-reported outcomes data and sharing progress information at every session to foster the patient’s engagement and active participation in his or her care. According to the infographic, “communication equals connection.”
  • Engage patients between—and after—their appointments. Whether you reach out to provide additional instructions for a home exercise program or to share relevant content after a patient discharges, connecting with the patient outside of your clinic’s walls can improve patient satisfaction, encourage plan of care compliance, and increase the likelihood of past patients returning to your clinic should they need therapy care in the future.
  • Enhance the patient experience. In addition to ensuring that your office is warm and inviting for patients—and that you’re providing exceptional patient care and bedside manner—be sure that your staff is comfortable having challenging conversations with patients in a calm, respectful manner. It’s also important to schedule in such a way as to maximize therapists’ calendars and minimize patient wait times. (Hint: send automatic appointment reminders to reduce no-shows and cancellations and thus, improve operational efficiency.)
  • Get social. Many current and potential patients will check you out online, and negative reviews or a lack of responsiveness on your part can send otherwise satisfied patients scurrying. Thus, be sure to stay on top of all your social media channels—and always remember that what you post online is there to stay.

Evaluate your processes.

Now, not all churn happens as a result of patient dissatisfaction. Some may actually occur because you’re missing an important step in your checkout process. In this post, Jannenga wrote that when she was a clinic director, she found that a whopping 87% of patients weren’t showing up for their scheduled appointments—despite positive patient satisfaction ratings. However, after adding “a checkout step—which required patients to stop by the front desk before leaving [and confirm or book their next appointment]—to our patient visit workflow,” show rates improved, as did collections. To evaluate your own workflow for missing pieces, check out this post.


There you have it: why patients churn—and how to stop them. How have you addressed patient churn in your practice? Tell us what’s worked and what hasn’t in the comment section below.