Don’t Crash, Burn, or Churn: The ROI of Patient Retention

At Strive Labs, we’re all about creating and retaining loyal customers. That’s how we help you grow your business. We know that all of the hard work you put into branding and marketing your practice is useless if you are unable to attract your target audience, assist them in the successful completion of their plan of care, and then send them out to become your raving fans.

What we find quite often in our conversations with practice owners is that they have a heavy focus on new patient acquisition, but no real strategy aimed toward the successful retention of patients. We know that this situation leads to lost opportunities to grow a loyal customer base, and therefore lost revenue. We understand, because we're PTs too! We’re here to help!

Data shows us that it can be up to five times more cost-effective to retain an existing customer than to acquire a new one; yet, only 16% of companies put their primary marketing focus on customer retention. Additionally, data tells us that email marketing is the most effective marketing tactic for customer retention (yet most practice owners don’t have an automated platform for providing the right information to the right patient at the right time). These statistics are especially concerning because we know that increasing customer retention rates by 5% increases profits by 25% to 95%.

Understanding Churn to Understand Retention

Scott Hebert, Co-Founder and CEO of Strive Labs has said this in the past: “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 but it comes back to this: educating, engaging, and empowering your patients is all about improving the relationships you have with them. By providing this extra level of service, you can ensure that every patient you treat gets the most out of every interaction with your clinic.”

To understand patient retention, we first need to know what the opposite of patient retention looks like. In PT, we call it patient churn. Churn rate is the percentage of patients that drop out of physical therapy before their course of care is complete. Unfortunately, the data in PT is not pretty.

On average, 20% of patients drop out of care in the first three visits. Another 20% will drop out before their seventh visit. That’s 40% of the patient population that is dropping out prior to completing their course of care. While we always advocate for getting a patient better as quickly as possible, the unfortunate truth is that it's very unlikely that 40% of patients are actually reaching full functional recovery within the first six visits.

What does such a high churn rate tell us, other than that much of the time, patients are leaving care early?

  • Patients are not engaging with their care.
  • PTs are not effectively demonstrating the value of completing a course of care.
  • Clinics are losing a staggering amount of money to patient churn.

It thereby stands to reason that if you can improve the patient management process at your clinic, you will end up with more satisfied, loyal patients and increased revenue for your practice. That is the true power of patient retention.

We crunched the numbers at Strive Labs and found that on average, 70% of patients don't fully complete their course of care. While that number is staggering to begin with, there is an even worse subset of that population that needs to be looked at.

By examining 30,000 outpatient episodes of care, we found that over 20% of all patients came for three visits or less. While a certain percentage of patients experience quick recovery, I think we can all agree that 1 in 5 patients requiring less than three visits is unlikely. We can come to the conclusion that a large subset of patients is failing to see the value of physical therapy for one reason or another, and are failing to complete their course of care all the way. This can drastically affect your bottom line and leave you in a constant state of anxiety as you frantically market to bring new customers into your practice.

We want to help practice owners improve retention rate by decreasing patient churn and increasing their percentage of loyal customers. Critical to the process are effective engagement solutions that monitor the patient experience and allow you to intervene before a patient drops out of care. We utilize hard data to help you flag your patients that are at a high risk of dropping out of care. This data drives process change over time to increase patient retention.

Using NPS® Data to Drive Process Change

Strive Labs does this centered around the NPS®. The Net Promoter® Score was developed by Bain and Company in 2003 to help businesses measure and monitor customer loyalty. The NPS® was developed because businesses were finding that traditional satisfaction surveys are basically useless. Across the board, businesses report average customer satisfaction scores of 98%, which means that likely, they're asking the wrong question. The NPS® looks at customer loyalty instead of customer satisfaction. We discussed the NPS® itself in more detail here.

The NPS® asks just one question: “How likely is it that you would recommend [Blank Physical Therapy] to a friend or colleague?”

Based on a 1-10 scoring scale, patients fall into one of three buckets:

  • Promoter – score of 9-10
  • Passive – score of 7-8
  • Detractors – score of 6 and below

We know that patients who fall into the Detractor category are at a high risk of churn, and are also more likely to leave a bad review for your practice on Yelp and other online rating platforms. On average, Detractors attend five less visits than those who score higher on the NPS®.

Since we know that a high percentage of patients are at risk of dropping out of care in the first three visits, we recommend delivering the survey early in the course of care. Using StriveHub, you can automate sending an email with the NPS® to patients after their third visit. Once patient responds with a numerical score, they are asked a follow up question:

“What is the most important reason for your score?”

This follow up question captures valuable qualitative data for you, which can drive process change going forward.

When a patient gives your practice an NPS® score of less than 7, an email is automatically triggered to alert you. You can view this data in real time, not retrospectively, so that you can make an effective and timely intervention to decrease that patient’s risk of dropping out of care.

Additionally, StriveHub presents your NPS® scores in a dashboard to give you an idea of what you need to do to drive processes at scale to increase customer loyalty across your organization. Our platform allows you to manage trends and break down Net Promoter* rank by:

  • Therapist
  • Location
  • Body Part

With this information, you are empowered to examine the data to see which of your locations is performing at a less than optimal level (if you have a multi-location practice), and drill down even farther to determine each physical therapist’s NPS® by body part treated. This can serve as a KPI for your staff review process, and guide you in recommending continuing education specific to the needs of certain therapists. Click here for an example of how San Francisco Sport and Spine Physical Therapy utilizes this aspect of StriveHub.

Data derived from NPS® surveys can also help you identify growth opportunities for your practice, since your growth opportunities “live” in your Promoters. In our next post, we’ll explain how to harness the power of your Promoters for new patient generation.

If you would like to learn how StriveHub Reach can help you increase patient retention and earnings for your business, please click below:

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Ann Wendel



Physical Therapist, Writer, Speaker, Consultant, Kettlebell Lover. Director of Brand Marketing for @strive_labs and @APTAtweets Media Spokesperson.