Physical Therapists’ Guide to Patient Relationship Management (PRM)

Introduction

Although physician referrals may never go away completely, this is no longer the only way new patients enter the physical therapy funnel. Today’s patients are more tech-savvy than ever—regardless of age—and are often turning to Dr. Google for their health-related needs. Couple this with ever-expanding direct access laws and you’ll find the time is ripe for a more direct approach to how you establish and manage new and existing patient relationships. And fortunately, Patient Relationship Management (PRM) software can help with that. Let’s dive in!

What is Patient Relationship Management (PRM) software—and why does my practice need it?

With the rise in high-deductible health plans—as well as the push for more patient-centered care—patients are taking a much more active role in their healthcare decisions. As a result, they’re displaying many more consumer-like behaviors, including: 

• Performing a significant amount of online research prior to selecting treatment options and providers;
• Assessing the dollar-for-dollar value they’re receiving from their healthcare providers; and 
• Prioritizing an experience that goes above and beyond excellent clinical care (which is quickly becoming a multimedia PT-specific HEP program baseline expectation).

With all of that in mind, savvy providers would be wise to establish processes for optimizing their online presence, upping their value proposition, and improving the patient experience—in the clinic, between sessions, and after discharge—to keep these patient-consumers connected, engaged, willing to return, and eager to share their positive experience with their social networks. Small practices may be able to provide this level of one-on-one attention in the form of exceptional clinical care plus:

• billing and insurance support;
• appointment reminders;
• regular updates about clinic happenings and new offerings;
• relevant, valuable content specific to each patient’s condition;
• a multimedia, PT-specific HEP program and progress checks between appointments;
• a secure, open communication channel; and
• re-engagement emails to get prior patients back in the clinic.

But, mid- to large-sized clinics—or any clinic experiencing higher levels of growth—should consider adopting technology to help automate these tasks. That’s where PRM software—an adaptation of the customer relationship management (CRM) software many organizations outside of the healthcare space use to build and maintain relationships with their customers—comes into the picture. It can be an incredibly powerful tool—if you select the right tool, that is. To that end, be sure that your PRM software:

• is designed specifically for rehab therapists,
• enables you to monitor the patient experience and act on feedback in real-time, and
• seamlessly integrates with your EMR, so that the systems can work together to ensure none of your patients fall through the cracks.

How does PRM software work?

PRM software essentially provides a secure messaging platform that enables you to send the right message—and the right content—to the right patient at the right time in order to optimize patient engagement. In other words, you can use the software to establish rules so patients receive regular check-ins—and valuable and relevant content that relates to their specific injury or condition—at specific intervals. This allows you to better connect with your patients, ensure they feel cared for between sessions, and stay top-of-mind post-discharge should they (or someone they know) need your services again.

According to WebPT and Clinicient’s Patient Experience Report, patients took a more active and engaged role in their care when providers communicated with them in between appointments. And we all already intuitively know that the shared decision-making that occurs between an engaged patient and their healthcare provider produces the most favorable patient satisfaction levels and treatment outcomes.

If you’re still unsure about the importance of patient engagement, consider this: 20% of all physical therapy patients drop out of therapy within the first three visits, and 70% never complete their full course of care. As you well know, discontinuing therapy preemptively negatively impacts patients and PT businesses. In fact, in this post, Strive Labs co-founder Scott Hebert explained that early patient dropout can cost an average practice $150,000 a year—and that’s a conservative estimate. In this post, we took that a step further based on WebPT’s market research: there are about 30,000 to 40,000 physical therapy practices in the US, which means that “this problem is costing this country’s PT industry around $6 billion a year.” And the source of the problem is due to a variety of factors that include: 

• “the overprescription and widespread demand for invasive treatment options like surgery and pharmaceuticals;
• the proliferation of high-deductible health plans that have placed more out-of-pocket financial burden on patients than ever before; and
• the ubiquitous, yet enigmatic physical therapy ‘branding problem.’”

Admittedly, these are all “large-scope issues” (meaning that they’re going to “require large-scale resolution efforts”). But, there are things that individual practices can do to mitigate the early patient dropout problem in their clinics—namely, prioritizing the patient experience and improving engagement by adopting PRM software that enables them to:

Provide valuable and relevant content at specific intervals—like between sessions, after discharge, and when patients fall off the schedule.  

The very best PRM software allows you to build emails based on already-written content you find online—although you have the option to do it yourself. In fact, the software will actually pull in text snippets from blog content of your choosing, so you can create uber-relevant templates for specific injuries, demographics, and patient characteristics. For example, if you find an article that promotes physical therapy for heel pain, you can use it as the foundation of an email to send to current patients you’ve flagged as runners who are possibly at risk for plantar fasciitis. And in doing so, you’ll be providing relevant, value-added content that could be instrumental in helping them prevent a future injury. 

You could even use this type of content as fodder to restart a conversation with patients who have been discharged—or fallen off the schedule—to get them to return prior to an upcoming event or maybe for a new issue. Because the very best PRM software integrates with your EMR, you can create a rule that triggers the system to send an email to patients a certain number of days after discharge—or to should-be-active patients who haven’t visited your practice in a certain number of days. In addition to providing valuable targeted content, you can send updates about your clinic and any additional wellness services you’re offering. This can help entice past patients to return to your practice in addition to encouraging current patients to take advantage of the non-therapy services available to them.

Maintain an open, secure communication channel between and after sessions.

Today’s patients want to be able to reach their providers between sessions—but providing your personal cell phone number or email address is a surefire way to confuse professional boundaries. Furthermore, not all email clients are optimized for HIPAA security. Instead, opt for a better, safer, more secure method for staying in contact with your patients outside of the clinic: the secure messaging functionality of your PRM (which your patients will be able to access via a patient portal and/or mobile app). With this type of communication channel, your patients will be able to send you a message from anywhere, at anytime with questions about their care—or to provide feedback about their home exercise program (HEP)—and you’ll be able to securely respond, thus improving engagement and fostering active patient participation. (More on the role of PRM and HEP at the end of this post.)

Collect and act upon patient feedback in a meaningful way.

Disloyal, unengaged patients are significantly more likely to leave your practice early (and maybe even physical therapy altogether) than their loyal, engaged counterparts. But, how do you know who’s disloyal—and what can you do about it before a patient bails on you for good? See the next section to find out how best to collect and act upon patient feedback in a meaningful way.

What’s the best way to measure the patient experience?

As explained in this webinar, traditional satisfaction surveys have a less-than-stellar reputation for several reasons, including the fact that organizations that measure satisfaction (as opposed to loyalty) often experience a significant ceiling effect, meaning that most receive relatively high satisfaction scores that don’t mean much because they don’t accurately represent their patients’ actual experiences. In addition to not being sensitive enough to collect meaningful differences between patient scores, traditional satisfaction surveys often can be inherently biased.

Avoid sampling bias.

Most PT practices distribute their satisfaction surveys at discharge. But, given what we know about the majority of patients dropping out before completing their course of care, only a small minority of patients will actually ever receive a satisfaction survey to complete—and most of those patients are probably pretty pleased on their last day of therapy, considering that it’s their last day of therapy and they have presumably reached their treatment goals. The right PRM software, however, will reduce sampling bias and capture patients at intervals prior to—and including at—discharge.

Eliminate environmental bias.

PT practices that hand out surveys to patients while those patients are in the clinic may also receive uncharacteristically positive reviews. That’s because it’s much harder to provide critical—albeit honest—feedback when you’re in the vicinity of the people you’re supposed to be evaluating. Most of us don’t want to hurt others’ feelings, and these artificially inflated scores can make it seem as if your practice is providing a better experience than it actually is. While you could continue to measure satisfaction—if you account for the above-mentioned biases, that is—we believe there’s a better way. And that’s measuring patient loyalty.

Implement NPS^®.

In our experience, we’ve found that Net Promoter Score^® (NPS^®) tracking is the most valid and reliable method for measuring loyalty. (In fact, WebPT uses NPS to measure customer, and employee, loyalty.) And NPS is so simple that it’s literally one question (with an open text field to capture specific feedback), making it easy for patients to complete: “On a scale of 0 to 10, with 10 being most likely and 0 being not at all likely, how likely are you to recommend our practice to a friend or family member?” Then, based on your patients’ responses to that question, they’ll be scored and categorized into three groups:

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

How to Calculate Your NPS

To calculate your Net Promoter Score, simply take the percentage of Promoters and subtract the percentage of Detractors: NPS = % Promoters – % Detractors.

How NPS Works Within PRM Software

The very best PRM software comes stocked with built-in NPS tracking functionality, so you can automate the entire process—including setting alerts for someone on your staff to review individual feedback and respond in near real-time to patient concerns. Here’s how NPS works via PRM software, WebPT Reach:

1. The system emails an NPS survey to every patient at intervals of your choosing.
2. The system collects responses, calculates each patient’s score, and buckets patients into three groups: Promoters, Passives, and Detractors. The system then also uses comprehensive data to provide an overarching NPS for your practice.
3. The system flags Passives and Detractors and alerts your staff to review their feedback and reach out to them to respond and/or initiate your clinic’s patient recovery process. 
4. The system automatically emails Promoters a request to complete an online review to share their positive experience at your clinic with their network—along with a link that enables them to rate your clinic with one click. 

As a result, not only will you ensure that every patient has the opportunity to provide valuable feedback at consistent intervals throughout their course of care, but you’ll also have actionable data that will enable you to make meaningful improvements to the patient experience. Now, even if you decide to forgo the software-assisted route at this time, there are still plenty of benefits to tracking NPS. Here’s a checklist to help you implement NPS in your practice.

How do I use PRM software + NPS to improve patient experience?

Benchmark.

Because NPS is a standardized tool, you can compare your practice’s NPS score against national averages. As noted during a presentation at WebPT’s 2017 Ascend event, the average NPS score for physical therapy practices is 84. If your score is less than 75, you’re in the bottom 10% of all practices; if it’s greater than 90, you’re in the top 10%. While this type of comparison can help you determine how your practice stacks up against its competitors—as well as set overall goals—the most meaningful way to benchmark is by comparing your first score with your next, and then your next, and so on. That way, you’ll be able to measure the impact of any improvements you make. Because you must continually strive to foster patient satisfaction and loyalty, you’ll want to continue responding to feedback, optimizing the patient experience, and tracking your scores indefinitely. 

Respond to problems in real-time.

According to this resource, one to three bad online reviews are enough to deter most potential consumers from a particular business. So, if you use NPS to identify your Detractors—as well as your soon-to-be Detractors—you’ll be in a much better position to work with them directly to improve their experiences and foster engagement. As an aside, this can help to mitigate your risk of a future lawsuit, too. This type of outreach is a more effective approach than attempting to solve a patient’s problem long after they have left your practice. It’s important to remember, though, that if you ask your patients to provide feedback, they’ll expect you to address it.

Leverage your pleased patients.

While Detractors may have one foot out the door, Promoters have both feet firmly planted within your practice. According to this resource, these loyal customers are:

• Five times more likely to see you again.
• Five times more likely to forgive an issue. 
• Four times more likely to refer you to a friend, family member, or colleague.
• Seven times more likely to try a new service or offering.

With that in mind, it’s clear that the more Promoters your practice has, the better. Thus, your goal should be to move all patients up the scale—by listening to their concerns and acting on their feedback. From there, you can leverage your large pool of promoters to take advantage of more services and provide positive online reviews, thereby boosting your revenue and expanding your reach. 

According to this Harvard paper, a one-star improvement on an online review site—such as Yelp—can generate a 5 to 10% increase in revenue. This brings us back to the importance of optimizing your online presence, because the more positive reviews you have, the easier it will be for your prospective patients to find you online. The process for getting your already-pleased patients to write you a review is super easy: all you have to do is ask. And if you’re using PRM software, the system will make the ask for you by automatically sending a note to your Promoters asking them to take a minute and complete a review of your services.
Even if you treat mostly elderly patients, cultivating positive online reviews is still important. After all, many senior citizens are active online these days—and if they’re not, then their younger family members and caregivers will be. All in all, senior citizens are a highly engaged cohort than most people think and are very likely to leave you a review—if you make it easy for them to do so with one click.

Identify global trends.

While responding to critical feedback in real-time is imperative to a clinic’s success, so is zooming out to assess the data in aggregate. By analyzing the patient experience data you collect at scale, you’ll be able to identify common trends that may be contributing to your patients’ positive or negative experiences. And from there, you can implement data-driven process changes in all aspects of your clinic. Changes in patient feedback in these areas can help you determine which changes are having the desired effects—and which ones aren’t. 

Just as you could—and should—mine your online reviews for valuable information that points to what your patients value most, do the same with your NPS data. As we explained here, “If numerous patients are discussing the intangibles of their experience—in addition to the quality of the clinical care they’re receiving—then you know that developing your practice’s culture around a value system that supports those qualities is crucial.” Additionally, “If speedy, accurate billing—or the lack thereof—is mentioned frequently, then you know patients prioritize smooth payment processing. That, in turn, may encourage you to develop new billing-related content or hire additional billing personnel to assist you.” Or, if a particular therapist is receiving a higher number of low scores than his peers, then you may want to have a senior staff member sit in on that therapist’s appointments to identify any challenges he or she may be having with patient care or communication.

Regardless of what you learn, though, the key is to not take critical feedback personally. And definitely don’t act rashly based on what you learn. Instead, view it as super-valuable information that you can use to improve retention and revenue (information that you may not be able to get from patients directly). Remember, the goal is to always improve.

Get your team on board.

Anytime you implement something new, it’s imperative that everyone on your staff is on board—or at least aware of, and willing to participate in, the new initiative. After all, friction can dampen morale and negatively impact the patient experience. As explained during this webinar, this is a huge part of the leadership strategy here at WebPT: “To avoid friction—and improve team morale—[we recommend] having a conversation with staff members about the impending change, emphasizing how it’ll directly benefit them.” (This type of open communication has helped WebPT navigate through big changes—and extreme growth.) 

It’s also important to remember that change of any kind can trigger fear, so the leadership team must set an example by being calm, cool-headed, and collected when responding to pushback, because there may very well be pushback—at least at the beginning. But hopefully, in time, everyone at your clinic will be eager to prioritize the patient experience, patient retention, and loyalty tracking, especially when you communicate the benefits to their take-home pay and your clinic’s finances. 

As noted during the webinar, “Data is just data unless you’ve got the whole team on board and willing to act on it.” In fact, Spooner Physical Therapy, which recently adopted PRM, saw massive improvements in retention and revenue with NPS, but only after the leadership team talked to their staff about why they were making NPS a priority—and the downstream benefits to patients and staff. The team also “implemented NPS as a KPI, created playbooks and talk tracks for dealing with low scores, and established a process for sharing NPS reports with everyone on staff and rewarding folks who were responsible for patients’ positive feedback.”

What role does HEP play in PRM?

It’s a rare student—or patient—who enjoys receiving homework. But, as we explained here, a physical therapy home exercise program (HEP) is a crucial piece of any successful PT plan of care. While you may not be able to forego giving your patients homework, you can improve upon the traditional experience of paper printouts—more likely to be lost or thrown away than used—and use a PT-specific PRM software that comes fully stocked with a customizable and trackable multimedia HEP program. Plus, switching to a HEP program that’s accessible from any Internet-enabled device means your patients will be able to complete their HEPs at home, at the office, or while traveling, thereby improving compliance. They’ll also be able to use the secure messaging feature we mentioned above to let you how they’re progressing, share feedback about the level of difficulty of each exercise, and ask questions to help them confidently complete their exercises. That way, you can respond and make changes to a program in real-time, instead of waiting until the patient’s next appointment. You can also set up alerts, so you get notified with updates—for example, when a patient logs an activity (hello, building intrinsic motivation through progress tracking) or completes his or her program. 

(Note: If you select a PRM version that doesn’t include a built-in HEP, you can implement a separate, but fully stocked and integrated one—like the WebPT HEP—to get all of the same benefits.)
Another bonus to a digital PRM software with HEP components is the ability to capture patient data and track their progress. And when integrated with an approved medical device, these efforts can be documented and billed as RTM services—opening up a new revenue source for your practice while advancing patients through the continuum of care when they’re not in the clinic.

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There you have it: everything you need to know about adopting PRM software in your rehab therapy practice.

See WebPT Reach—the very best PRM software on the market—in action.