Have you ever taken a look at any of these metrics in your practice?
- Average length of stay (how many visits to a SUCCESSFUL D/C)
- Average visit when patients drop off
- Number of cancellations per week / day / month
- Daily Arrival Rate
- Schedule Efficiency – what is the % of each clinician’s schedule that is full at the start of the day compared to the end of the day.
- % Prescribed – what is the average number of times a patient is attending therapy every week compared with how many times they SHOULD be attending weekly
What do these metrics look like in the average practice you ask? Well, the sad state of this is that in outpatient physical therapy, we do not do a great job in the above areas. And the bad thing about that is that it means that we are losing out on income that we should be capturing and keeping. And even worse, it means that we need to go find more new patients every time any one of the above metrics is down as it means the schedule is more empty as a result.
Did you know that there are 53 things that could be causing your schedule to be more empty and give you a false feeling that you need more new patients when in reality you don’t? What can you do to ensure that your patients finish a full plan of care? Like always, the list is very long but here are what I have found to be the top three things to keep your attention on:
- Your staff (all of them) need to be excellent salespeople.
This is something that might require you change your mind set about. Let’s look at that statement and ask, “are PT’s, front office, and even billing staff salespeople?”. I would say that the answer is a resounding “YES”. Not from the standpoint that they are pressure selling like maybe a car salesperson, but they are selling something. What are they selling? Well, they are selling the empty spots that are on the schedule, the fact that the patient needs to attend the appointment, the service provided in that appointment, and over the course of therapy they are selling and improved way of life (better mobility, less pain, improved function, etc.). So that said, we can either choose to get agreeable with all the reasons a patient will have like: “my kids have softball practice”, “I have a meeting at work”, “I’m not feeling well today”, “I’m feeling much better, I think today will be my last day of therapy”, the list goes on and on. So how your staff handle these types of objections will have a direct impact on how empty your schedule is whether it be cancellations, now shows, or just plain empty spots.
Being good salespeople is not something that comes naturally to most people, it is something that must be trained into them. So, as the owner or manager in a Private Practice you want to set up training for your staff that improves their ability to handle these situations and more. Initially this will involve training them in the actual steps of being a “salesperson”. There are some simple steps that every successful “salesperson” follows and when followed precisely lead to a “sale” or “close”. These steps include “building interest” in the product or service that is being sold. This step is accomplished by being INTERESTED rather than interesting. The most common mistake any salesperson makes is being interesting. So rather than asking questions like an INTERESTED salesperson would do, the salesperson starts to be interesting and tries to give all kinds of details about why someone should buy or do something. Details don’t sell the product of service unless they are real to the patient. Starting with being INTERESTED, so asking questions and finding out what is important to the patient will get the ball rolling at any point in the sales process. Another step that is commonly missed is “finding out what the objections REALLY ARE”. Whether you want to believe it or not, most patients will not tell you the real reason they are not scheduling, cancelling, no showing, or stopping therapy early. Let’s face it, as PT’s you are nice people, and you care about them. They sense that and they don’t want to hurt your feelings, so they don’t tell you that they feel the money they are paying for therapy is not worth it (copay, coinsurance), they don’t tell you that they just didn’t feel like coming to therapy today, so they said they “didn’t feel well”. But until we find out what the real objection is and handle it, they will continue to be a cancellation, no show, or early discharge. Again, successful salespeople are skilled and trained at discovering and HANDLING the real objection that stops patients from being successful discharges.
- Have policy in place that dictates care and outlines the desired outcomes for the practice.
Keep in mind that all your staff may be playing the same game “helping patients” but they may be playing by different rules. I have discovered in my years as a practice owner that staff can get a disease I call “STAFF THINK”. What I mean by this is that if we don’t give them a set of expectations or tell them what the desired outcome is, they will up their own desired outcome. This is where we get into the situation of patients discharging themselves early, therapists having patients come only one time per week, and all kinds of other things that “they think” will be okay.
In my practice we have instituted such policy as:
- All patients will be seen 3 times per week for the first two weeks. The reason we do this is that it allows us to fulfill #1 above and have a chance to really sell a patient on doing therapy, get them to start to see results, and much more.
- All evaluations will schedule their full plan of care at the time of their evaluation. This allows us to handle any objections the patient must therapy right up front. Additionally, by scheduling the full POC right after the eval, it makes sure that the patient plans the next 6 weeks (or whatever their full poc length is) of their life around therapy instead of the other way around.
- Any cancellation or no show will be made up no later than the following week. The benefit to this is multifold. If they have pain and problems now, they need the care now, not added on to the end of the scheduled visits.
The purpose of the policy is not to be a “dictatorship” but to make known what it is that you need your staff doing and working towards achieving as the intended outcome. With these policies you now can better direct the actions of your staff as you have set expectations. We have found it very helpful to actually discuss these expectations when we are interviewing potential staff. So, we ask questions like “tell me what you think about having a patient schedule their full plan of care at the time of the evaluation?”. Their answer most often leads to other questions and discussion about the matter, but it gives us a good idea of whether they agree with the policy or not.
The purpose of this policy is to ensure that our staff are all working towards the same outcome but also following the same “recipe for success”. Think of treating a patient like baking cookies – if we all follow the same recipe, we have a much greater chance of getting the same outcome more often. The ultimate goal as the owner is that the policy helps us to keep the schedule full and keep patients finishing their full plan of care.
- Track whether your patients are attending their plan of care appropriately.
What I mean by this is if we have prescribed for a patient to come 3 times per week, are they really coming 3 TIMES PER WEEK or are they altering their POC independently. This is one of the most common reasons for an empty schedule in a private practice. This brings me back to #1 above – that all staff need to be great salespeople. But more importantly, we need to have systems in place that allow us to know on a weekly basis whether a patient is attending their % prescribed care or not. When they are, great. But when they are not, we need to have a process to identify this and handle it.
In my practice we generate a tracking sheet every week to know how many times per week each patient should be coming and then we track whether they are actually attending those therapy sessions. We call this our % Prescribed. It takes about 2 hours to put it together and track it weekly, but it ensures that we consistently have a 95% or better rating of our patients attending their POC. So, the 2 hours that we “pay” a Patient Care Coordinator to put the sheet together and handle things related to it is well worth it when the patients that are not scheduled for the proper number of times get scheduled for the proper number of times. What our PCC does is get in communication with the patient, the therapist, or anyone needed to get the patient scheduled the additional times they are supposed to be scheduled for next week. It is amazing how many people try to sneak out of that 3rd or 2nd appointment for the week.
Handling this on a regular basis and getting the whole team involved in it is huge to keeping the schedule full on a regular basis.
This brings another thing to mind for me. We need to get our staff working to all make sure that patients are being seen with the frequency they should be being seen. There are all kind of actions that go into this. Here are a few questions for you:
- How often do you confirm a patients next appt?
- How do you confirm a patient’s appointments?
- Do your staff always know how many visits a patient has left and make sure that the patient knows as well?
- Do your staff make sure that a patient is always scheduled for the proper number of visits every week?
This whole section really brings us back to making sure that our staff are really good “salespeople”. So, in short, all roads lead back to #1 above.
I would love to talk with you one on one about how your practice is doing as well as trouble shoot through any issues that you are having in your practice. Feel free to reach out to me anytime via email: mike@fortisbusinesssolutions.com.
