The Importance of Patient Retention

When speaking to therapy clinic owners, we always ask them the same questions: what are the top 3 metrics you track when assessing the health of your business?  The answer is usually the same – total visits, missed visit percentage (cancels and no-shows), and average reimbursement rate.  These are all crucial metrics for business success, and even slight changes in any of the above can cause significant movement in the business’ bottom line. One metric we don’t hear about that often, however, is Patient Retention Rate. The Strive Labs Team has admittedly become a bit obsessed with patient retention. And if you are running a clinic, here are a few reasons you should be, too.

Types of Patient Retention

There are two forms of patient retention, Course of Care Retention, and Clinic Retention.  Course of Care Retention Rate is the percentage of authorized visits a patient attends that the clinic is able to bill for.  If it is 100% for any given patient, your staff therapist has done an excellent job establishing your clinic’s value proposition, and that patient has clearly bought in to the services you provide.  A low retention rate however, is indicative of a patient who did not see the value of the provided services, and is likely responsible for driving up your cancel and no-show percentage, driving down total visits at your clinic, and ultimately having a negative effect on profits. Getting a handle on your Course of Care Retention Rate can offer a much more actionable metric than just cancels and no-shows alone.

Clinic Retention Rate is equally valuable. This metric looks at the percentage of your patients that 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 is an easy way to quickly survey the reputation your clinic has among your patients. These patients are often the best evangelists for your clinic, so knowing who they are and how they came to become a retained patient is crucial for repeating the process.

Developing a System:

Just like any other business objective you set out to achieve, it’s important to start out with a plan.  While it’s easy to understand the value of patient retention, many PT’s often ask us how to go about setting up a system that helps them consistently retain each patient.  For this, we’ve developed the Patient Management Process ™

StriveHub Reach

The diagram above breaks the patient management process into three main phases: Education, Engagement, and Empowerment. The circles represent key patient milestones along the way, ultimately ending with a retained patient. Let’s take a minute look at each step more closely.

1. Educate

As new referrals enter your system, register for their first appointment, and attend their initial evaluation, they are left with a number of questions. Questions about their diagnosis, how long their recovery is it going to take, where they should park, etc.. 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 are in your office. Providing resources to new patients in the form of frequently asked questions lists (FAQs) or having a new patient resource center on your website can be a great start. It’s even more important to provide a reliable method of contact to your patients. This extra step can go a long way in making them feel comfortable and at ease at the start of their treatment.

Still, education is more than just 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 is a great opportunity to put your customer personas to use.  As therapists we are great at setting a plan to reach a goal. Understanding your patient’s goals right from Day One and helping to educate them on the steps that will be needed to reach them are of the utmost importance.

Finally, remember that your actions can leave a lasting impression. Wow your patients with your service and your commitment to their recovery by providing them with resources that they can use on their own to better understand their diagnosis and begin their independent home routine. These resources can be as simple as websites, blogs, and YouTube videos, or they can be more interactive tools offered through vendors like TheraVid.

The key to education is ensuring that your patient knows you are doing everything you can to ensure their success, that they feel comfortable with the service you will provide, and they have left believing that physical therapy is the treatment of choice to improve their condition.

2. Engage

We’ve talked about the importance of patient engagement before, and it’s the cornerstone of the patient management process. In order to see consistent patient retention, therapists have to develop strategies to engage their patients. Before we go any further though, lets define it. But here’s a little secret about the healthcare industry: we’re really bad at actually defining what patient engagement is. In an entertaining piece, Physician Rob Lamberts opines over just how ‘buzzwordy’ patient engagement has become, stating, “What is patient engagement?  It sounds like a season of The Bachelor where a doctor dates hot patients.”  I will second this opinion.  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.”

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 lead 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, more engaged, in their course of care will have a better outcome, but the trick is doing so consistently and knowing how to measure it.

There is unfortunately no ‘magic bullet’ for improving patient engagement, and there is certainty not an app for that (the product I sell included). But to begin to improve it, the best place to start often times involves taking a look in the mirror and examining the following:

You aren’t engaging patients because YOU aren’t engaging:  Let’s face the facts, we’re bad at blaming ourselves for things. But truth be told, there is a good chance that if your patients aren’t engaged, you just aren’t that engaged yourself. 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.* Going back to Rob Lamberts position, to engage is to provide care. By listening to your patient’s challenges, goals, beliefs, and fears, and then offering relevance back to the patient in return, you’ve now created a dialogue, one centered around compromise rather than compliance, conversation rather than doctors orders.

be relevant

They’re just not that into you – So be RELEVANT: The key to providing value 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 the best diagnosis and treatment skills will fail to engage a patient if you can’t be relevant and offer them something they care about. For those of you looking for additional resources on this topic I strongly suggest heading over to Stephen Wilkins’s excellent blog, Mind the Gap.

Step up your game when it comes to behavioral change: In many ways, healthcare is in the business of behavior modification.  The problem is, most healthcare providers don’t have a clue how to do it 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. It turns out people aren’t great at following through with the healthy behaviors we try to help them practice when we create our care plans.  If you don’t know how to help them do so, there’s a good chance they are going to fail.  A perfect example – research shows that only about 35% of patients complete their home exercise program as prescribed.  As it turns out, only about 35% of the general population exercises regularly. Coincidence? I doubt it.

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 patients make the life changes that they so often will need to acclimate to in order to remain symptom free or see an optimal outcome. By knowing how to use tools like behavioral staging and self efficacy evaluations to improve your patients success, you’ve got a much better shot at achieving both desired clinical outcomes and improving patient engagement.

Measure what works:  You can’t improve what you can’t measure. 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, keep track of messages sent and received per patient. This can also be a great way of measuring engagement, after all, one of the best indications a patient is involved is if they are asking questions.  Determine what works best for you and find a good way to measure it.

3. Empower

The final step in the Patient Management Process is empowerment. Often overlooked, this strategy is the key to improving Clinic Retention 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.

Evaluate what you are providing your patients with at discharge. An HEP handout and a few resistance bands?  Providing true value comes through enabling your patients to reach their overall health goals and to continue serving as a resource even after discharge. While this may come in the form of a custom tailored exercise program, suggestions on activity modifications, or an adoption of new healthy habits, the most powerful resource you can provide is your continued knowledge and feedback.

It’s also crucial that all the tools you provide at discharge come bundled with an easy means for communication.  As the basis for sustained engagement, a communication channel that is easily accessible post discharge can be an incredible resource to patients.  With today’s busy clinics, sometimes a phone call can be impractical, so implementing a secure messaging system can be a great way to offer this service without having it interfere with your daily practice.  While some PT’s have been known to offer an email address or even their personal cellphone, make sure to consider the legal ramifications before utilizing these unsecure communication channels to your patients (read: you really shouldn’t do it).

To Wrap it Up: Improving patient retention can offer an incredible value to your clinic.  Having a process and a quality set of tools to help facilitate it is crucial.  Every clinic will find what works best for them, and the Patient Management Process is just one method of increasing both course of care and clinic retention. Educating, Engaging, and Empowering your patient’s 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.

Interested in finding out how well you’re retaining your patients?  Download our Free Patient Retention Rate Audit to Find Out!


Previous version published September 11, 2013 · TheraVid is a product of Strive Labs, Inc. 

Scott Hebert PT, DPT



Physical Therapist, Software Developer, CEO & Founder of Strive Labs, Inc. Lover of Buffalo Chicken Pizza.

Somerville, MA http://strivelabs.com