As a Private Practice Owner, one of the things you end up having to deal with is preventing cancellations, no shows and early or self-discharges. If not kept under control they can cause all kinds of problems that will either immediately, or eventually, effect the bottom line of your business. Whether you realize it or not they all can lead to lost income, early discharges, low staff productivity, low staff morale, and much more. Many of us are actually pretty good at “getting new patients” but when push comes to shove, we are not so good at “keeping them” and truly helping them get to what we want, a “SUCCESSFUL DISCHARGE”. The main reason why most practices don’t do well at keeping their schedule full and their staff busy is that there is not a system or process for staff to follow when any of the above things happen.
To control cancellations, now shows and self-discharges, we must first acknowledge them for what they are: lost income as a business owner and a lost opportunity to truly help a patient achieve their goals. It is that simple. Whether they didn’t come in because they were sick, or they had a meeting at work or whatever the reason, it is lost income that we need to think about as a private practice owner. Think about it; if your average reimbursement is $75 per visit (as an example) then every empty spot (for whatever reason) is a loss of $75. That is typically what you pay a PT for about two hours’ worth of work, or a front office staff for about 4 – 5 hours’ worth of work.
So how do we control and better yet prevent cancellations that possibly are causing you to lose sleep, worry about making payroll, and ultimately effecting our profitability as private practice owners?
- SELL THE VALUE OF WHAT YOU DO AT EACH TREATMENT. This brings us back to the fact that PT’s need to be awesome salespeople. In short, we need ALL OF OUR STAFF to be able to create value for what we do and be INTERESTED in the patient getting in for therapy that day and finishing the full plan of care. This often times means that we have to slow down and actually LISTEN to what the patient is telling us. For example; a patient who doesn’t come to PT today because of a meeting at work is telling us that there is something more important than getting his shoulder better. I get it, work is pretty darn important but what I want is for whatever we are treating him for to be just as important. So as a PT and an owner, my expectation is that when he has a meeting come up at work, he will call the office and reschedule to a different time ON THE SAME DAY. Anything else is a bit of a warning sign that something may be off as far as his perception of the value of the treatment.
As PT’s we spend a lot of time training to be good clinicians, but we also need to train to be even better salespeople. I always tell my staff that treating a patient (regardless of diagnosis) is 80% mental and 20 % what you do with them in treatment. If you listen, patients have a lot of objections and reasons why they can’t make it to therapy. Truth is they are being bombarded with so many requests for their time, their money, their energy. When they cancel, they are telling you indirectly that they didn’t place as much value on your services as they did on something else; whether it be that cup of coffee every day, eating lunch out, having a fancy phone, watching Netflix when they get home from work, or whatever their excuse is for not making it to therapy. A good salesperson will be able to really ask the right questions and listen to the patient and then handle those issues fully.
So, when a patient cancels or no shows for an appointment, we have to look at it as a “check engine light” sort of thing. This is the first sign that a self- discharge or an early discharge is looming. What if I told you that as few as one missed appointment could mean that a patient’s success rate drops from 93% to 67%? What if the patient knew that there was a 67% chance that they could buy a cup of crummy coffee from their favorite coffee shop? Would they still be as apt to buy it? What is happening in a patient’s mind whenever they miss an appointment for whatever the reason is one of the following two things:
- They realize that when they missed therapy things didn’t get any worse. Now this is really good as far as we, the PT are concerned, but as far as the patient is concerned, they start thinking differently. They start to think “well maybe I only need to go once” or “maybe I can do this on my own from here out”.
- They realize that when they missed therapy things got worse. This is the worst one because now they make the decision to “go back to the doctor” or “therapy isn’t working” or “my problem isn’t that bad, I can just live with it”. Now as a PT we would say “well just tell them that’s why they need to come to PT”. But time is our enemy, during the time that they missed that appointment we lose a lot of control and who knows where their mind goes.
The key to keeping a patient all the way through to a successful d/c is staying in regular communication with them. This is easiest when they attend their therapy as scheduled with regular appointments. But the moment that a cancellation or no show come about we have to understand that they are falling off the bandwagon and less likely to be a successful discharge.
So, we need to have a system in place to prevent this and it involves asking questions. Here is what happens in my practice:
- EVERYONE (front office and clinicians) are constantly asking questions of our patients. Questions such as:
- “what problems are you still having with your ________?”
- “what do you think we still need to work on in order to achieve ______ (patients goal)?”
- “what has gotten better since you started PT?” followed by – “why do you think it is better?”
- “what do you think would happen if you stopped PT now or if you missed an appointment?”
- When they cancel or no show we ask such things as:
- “Joe, is everything ok? I notice that you canceled / no showed and you didn’t reschedule. Why is that?”
- “what do you think will happen if we don’t make up the appointment you missed?”
Remember, we all got into this to help people and we need to stay focused on that ALL THE TIME. We don’t want to get agreeable to the patient missing appointments – we have a responsibility to help them handle those objections.
- HAVE A CANCELLATION POLICY IN PLACE. I don’t mean a policy that is meant to punish the patient or charge them a ton of money but a policy that tells them what is expected of them as a patient in your clinic. Yes, this means you have to assign a “punishment” (lets say $50) to a now show or late cancellation but what it really means is that you want to educate your patients on what you want them to do and WHY. Over the years I have discovered that patients don’t buy what you do, THEY BUY WHY YOU DO IT. The purpose of the “cancellation policy” is to allow us to educate our patients on what we expect them to do, what we need them to do when they can’t make an appointment for any reason, and best of all UNDERSTAND WHY THAT IS SO IMPORTANT. They can’t get better if they don’t come to therapy regularly. I always relate it to a patient like taking antibiotics. Your doctor gives you antibiotics, you don’t take them only when you feel like it and expect to get better. You take them as directed and low and behold you get better. PT is the same way – don’t think of it any differently.
If we never tell our patients what we want them to do and WHY they will make their own decisions. In my clinic when we are registering a new patient and getting them all checked in on their first visit we spend a few minutes “hatting” them on what it means to be a patient. The Patient Care Coordinator (PCC) goes over the cancellation policy with them and tells them what we NEED them to do when they can’t make an appointment for any reason (sick, work, etc). What do we expect? We expect that they reschedule for the SAME DAY. Okay, if they are sick, we expect them to reschedule for as soon as they are better – so basically 3 times next week to make up for the one that was missed this week (it does us no good to “add the appointment on to the end of the POC” – they are already better then). Next, the PCC explains why we NEED them to do this – it increases the possibility of them recovering fully and getting the full value of the care they are paying for in time and money. Now when the PCC is finished explaining what we NEED the patient to do and why, they then ask a series of a few questions:
- “why do we not want you to cancel your appointments?” To which the patient will usually say “but what happens if I am sick”. The PCC then asks “are you sick frequently?”. “No, but what if I am sick?” “Well, what would I want you to do?” To which they reply “reschedule the very next week”. The PCC then asks “and why do I want you to do that?” BOOM problem solved
- Now when they call to try to cancel an appointment the PCC reminds them of the above and says “got it you need to cancel 2:00 so I have 5:00 instead”
- As for the PT while doing the evaluation, they basically follow the same process. “Now it is important to me that you get better and I can’t get you better if you don’t come to ALL OF YOUR APPOINTMENTS. What do you think might get in the way of you attending all ___ appointments that I just outlined for you?”
- Additionally, the PT explains why they want the patient to schedule ALL of their appointments right now. And when I say ALL, I don’t mean the first 10 and “we will see what happens”, I mean ALL THE VISITS THE PATIENT MIGHT NEED (it is better to schedule too many and not need them than to schedule some and not be able to get them to agree to the extra ones).
- TRAINING. We must train ourselves, our staff, and even our patients in order to be successful in controlling this aspect of our clinic. As I said earlier, as PT’s we were never trained to be salespeople and our front office staff have never had any true training on their position as well. Our patients have also never really been taught to be patients and so we all run around like squirrels wondering why we don’t get what we thought we would get out of an experience. TRAINING is vital to anyone being better at what they do. Look at a professional baseball player with regards to hitting. The play 162 games a year, sometimes day after day on end, yet they still hold batting practice before every game and have practice on the days they don’t have games – and they are professionals. Why would we not want to train the same way and improve our batting average. Even a few percentage points of an increase will improve the bottom line. TRAIN YOUR STAFF.
In my practice we spend a minimum of 30 min every week with every staff member doing drilling and training. We drill over things like I have mentioned above but we also drill over things like
- What to do and say when a patient says:
- “I think today will be my last day”
- “I’m going to wait and see what the doctor says”
- “I can’t schedule all my visits right now, I don’t know what my schedule is next week”
- “My shoulder is feeling better”
- How to handle a patient who doesn’t see the improvements that they are making in therapy
- How to handle the issues of money and time.
This “practice” prepares them for what they will encounter at any possible moment in the future. This way when a patient says whatever they say, and wants to discharge themselves from therapy early, or cancel, or whatever, they are prepared to handle the situation and get a good outcome – one that allows them the opportunity to REALLY HELP THE PATIENT.
This is something I am passionate about as a practice owner. Early on in my practice ownership years I learned this data and put it to use. We have grown our business by a minimum of 20% every year over the past 14 years. For two years straight I dedicated myself to learning and training my staff in the systems to use to achieve all of the above. Putting these three aspects in place was how we grew our business significantly for two years straight – just by improving arrivals, reducing cancellations, and stopping early discharges – we didn’t need a single extra evaluation, we just needed to keep them for their FULL PLAN OF CARE.
I would love to hear your thoughts and any ideas you have. I would also be happy to talk more in detail with you about this or any other issues you are having in your practice. My passion is helping other private practice owners have the success and FREEDOM they are looking for in their practice. Feel free to email me anytime: mike@fortisbusinesssolutions.com
Here is to the FREEDOM YOU DESERVE as a Private Practice Owner.
