The Next Level of Tools and Solutions to Combat Cancellations and No-shows (2)
Finally, let’s look at cancellations and no-shows from the patient’s perspective. Here is a down and dirty listing of why they fail to appear for their appointments:
Relying on an automated system to confirm your appointments: Speaking to an appointed patient for treatment creates accountability with the patient while making it difficult for them to cancel. A human being is the only thing that works to stymie reluctant patients from cancelling with a software program. The patient wants an easy way to skip out of an appointment. That is almost impossible with a well-trained staff member who has all the answers and knows the “whys”.
Money or not sufficiently helping the patient to budget the expense of their dentistry: Yep, money raises its ugly head again. Money and the cost of services will always be a concern to our patients. Your job is to offer solutions for making the investment for dentistry fit into their already tight budget. While I wish Fee-For-Service practices was an option for every dentist, I would be foolish to think that being in-network wouldn’t help more of our patients fit the costs of dentistry into their already tight budgets.
Time: Consumers are educated, and competition is growing. If you constantly can’t find a spot for someone to come in during the peak demand times that they require, this will only result in more cancellations and no-shows. You must build your practice around consumerism. Great practices make sure that they can get any patient in within 4-10 days during a peak demand time. If you cannot do this, you are in a complete blockage for health growth and giving patients what they want, when they want it, at a price they can afford.
Scheduling more than 4-10 days into the future for clinical treatment: Cancellations and no shows will double if you can’t get your patients back in a timely fashion. The inability to get them back within 4-10 days (calendar days, not working days) is the sign of a terminal capacity blockage. Check your schedules and make sure you have capacity. If not, act to correct it now. Inability to meet this goal is not the sign of a busy practice, but a poorly run practice that has not engineered their team, facility, and systems to accommodate the demands of patients in this new dental economy.
Fear: Patients will always shy away from their appointments if you don’t address their fears of pain. With conscious sedation and nitrous oxide, and the availability of Anesthesiologists to come to your office to sedate patients, this should no longer be a challenge. The challenge is having your staff pick up on this as being a barrier to the patient having treatment done in the first place. If you cannot give painless injections with profound anesthesia, you will never progress in our profession. Use the X-tip and Stabident to ensure that everyone is quickly and completely numb.
Lack of Trust: This is the granddaddy of all cancellations and no-show issues. Once again, you and your staff must be experts at reading non-verbal communication clues from the patient. You must take the time to develop the rapport you need in order for them to trust your diagnosis and your office with the health and treatment of their mouths. Far too many times I see that employees, as well as the dentist, think they are doing a great job with “trust” and fall miserably short. Only the patient gets to vote on this. Go back and reread about the Donor and Recipient Practice in the Super General Dental Practice in Chapter 8. Every one of the symptoms mentioned for a Donor practice could be caused by a lack of trust.
BONUS: ATTRITION, THE SILENT KILLER OF DENTAL PRACTICES
I love mechanical toys. Nothing better than a great bike ride, or racing motorcycles, or hunting. If you accumulate things like I do, you notice they all tend to deteriorate over time. Your air conditioner wears out or your hot water heater springs a leak. You forget to clean your shotgun or wash off your dirt bike and things seem to fall apart. A great example is rust. There is always humidity in the air or moisture in our environment. This same water that you can’t live without over about 3 days, silently corrodes metals. Rust can be a silent killer of anything mechanical.
In our practices, there is also a silent killer, like rust, called “attrition”. I cannot remember a time, that I can recall, that I have seen an article or talk about this pervasive killer of dental practices. The definition of attrition is: The action or process of gradually reducing the strength, effectiveness, or numbers due to external and internal causation. Attrition rate for our purposes could be referred to as a “churn rate”, measuring the rate at which people leave or silently never return. This could be applied in our practices as the number of staff or patients who leave. I just spoke with a fee-for-service practice owner that averages 80-100 new patients a month and has no hygienists – and no one ever comes back. Basically, a large front door where the patients enter, and evidently the entire back of the building is wide open because no one returns. Just saying, that is weird.
In the constant striving to attract more patients, far too many offices forget to cultivate the patients they have. From a statistical point of view, 67% of all the clinical work you will ever do is from recall patients. The logical next thought should be: Wow, I need to spend as much time keeping and cultivating my patients as I do chasing new ones. Think about the lifetime value of a patient that is inspired and impressed with your office and tells everyone they know about you while never missing a recall appointment. We are talking tens of thousands of dollars in your pocket, as well as an ever-increasing pool of patients coming from direct referrals from these raving fans. Patients are the life blood of a practice and your recall/reactivation percentages are the pulse of whether or not you are doing things to inspire your patients and your systems are designed to keep them coming back.
Every practice management software can give you the number of active patients and the number of active patients that do not currently have an appointment. From my experience, few if any offices look at these numbers. Since your goal in life should be to have 100% of your current patients on a consistent recall, you should be horrified to know that the average practice only has a 42% recall percentage. The goal should be 90% plus. Why not 100%?
At a time when everyone’s overhead is continuing to creep ever higher (average is 67%-75% plus), each of us should take a look at what we spend on marketing and at least a third of that expense should be getting patients of record to return every 6 months. The obvious killer in attrition or having patients not to return is the office and doctor. Add to that list the lack of consumer hours, convenience, and a wide range of services for a wider range of ages and you can see how patients move away and never make a fuss. They just end up at the office down the street. I am happy to say that most offices become aware of things that patients don’t like but some doctors just assume that what they do and how they treat patients is great, even though a large percentage of patients never return. Tip a mirror up and take a look at yourself and your results.
Here’s a little homework. Take the number of new patients you average per month and total it for a year. 30 per month would be 360 patients for the year. A pretty average number. This would be your traditional average office with one hygienist. NOTE: A normal hygienist who sees about 25-30 new patients a month along with an excellent recall, can only treat about 600 patients if she sees them twice a year. So do the math. How many new patients do you see a year? In our example of 360, that office should need to hire another hygienist every 24 months just to take care of the new folks coming in – if they return. Now look at how many hygienists you have. If you just have one and you are average at about 25-30 new patients a month and you’ve been doing this for years but have not hired another hygienist, you can bet your bottom dollar you are a donor practice and you have as many patients leaving your practice as are coming in. Patients that don’t come back will never be a referral source. Patients that never come back are an indication that you are not doing as well as you can do. Patients that don’t come back rob you of the profit you could have made from recall dentistry that you never had the opportunity to present. Overall, a bad attrition rate, with a solvable solution.
There is another attrition rate with an entirely different cause that everyone should be aware of. Often times, doctors will brag to me about their new patient numbers but seem to never understand that in addition to people not coming back because of internal problems in the practice, there is an external reason, like rust, that undermines our profitability and recall. Demographics are strange in the way they can affect your success. None is more important than the fact that nation-wide the average percentage of patients that leave your practice because they move is 12-15%. In McKinney, Texas, which is a bedroom community for Dallas, the rate is almost 22%. In other words, every year a practice in McKinney will lose 22% of their patients of record from them moving to another location. While yours may be at 12%, remember that to average 30 new patients a month, part of the problem is that you are replacing those that left. Add to that anyone that was not impressed with your office, and we sometimes see offices in a state of stasis where the number leaving is about equal to the number of those coming in. The sad fact is that the average dental practice in the US has a recall rate of 42%. If you are not growing, they are not coming back. If they are not coming back there is always a reason for it. Since 67% of the dentistry you will ever do comes out of hygiene recall, the loss of a patient of record is a huge hit to your bottom line. Factor in the lifetime value of a patient and it can mean millions of dollars over the life of your practice.
If you have gotten this far, I hope you are checking your own office’s performance and considering making recall, reactivation, and attrition a topic for your upcoming team meetings. Being aware and acting quickly is how you learn to Summit. Each new stop on the 180 Degree Journey means a new perspective along with the tools and understanding to implement them. There is no learning without application.
Michael Abernathy DDS