You’ve been on this journey for a while, and we want to make sure we keep in touch with everyone we left behind. There is this subtle crack that forms within everyone’s systems. It is these cracks that swallow up our patients in the form of losing patients, and not closely following and pursuing these lost souls in the form of a reactivation protocol. Far too often, doctors look for marketing ideas to increase their new patient numbers. At the same time, most offices have way below 50% direct referral rates, and most don’t even track the number of active patients (that number should only be people that have seen you in the last 12 to 13 months). Thinking that patients who have not been to your office in 24 months or 36 months are still active is a joke in this new dental economy. If they have missed two cleaning appointments, they are clearly not active. We spend money trying to attract more patients but fail to guard and keep the ones we have. 67% of all the dentistry that you will ever do in your practice will come out of hygiene recall. That percentage should be well over 80% but the average dental practice is lucky to get 41%. Bottom line: People that don’t come back don’t like you, don’t refer, and are the most likely to sue you. Maybe, just maybe, we have our eyes on the wrong thing. Your goal is to inspire every person you see in the office, including your employees. This would be “remarkable”, and if you are not remarkable, you are invisible to the public. No one needs another average dental practice.
Why do we see so many patients never coming back into our offices? Patients leave or don’t return to your practice for a reason. It is often caused by a CA/NS that is not then followed up to determine the cause and get them back on our patient roles. As a point of review for CA/NS, study the four reasons most people cancel and don’t come back to your office.
- Time: Your hours are not consumer hours. You can’t get patients scheduled within 4-10 days during a peak demand time.
- Money: You fail to help patients fit their treatment into their budgets. You are out-of-network. You could just be more expensive than anyone else and the informed consumer deems this reason enough to visit the dentist down the street.
- Fear: You failed to pick up on the fact that the patient is reluctant to do dentistry because someone hurt them. You don’t use nitrous, oral sedation, or IV sedation. You struggle with profound local anesthesia, etc.
- Trust: The big one. Like the percentage of direct referrals you have, lack of trust is a primary indicator that you failed the sniff test: Poor systems, dated office, mediocre staff with poor people skills, lack of identifying and understanding personality types, poor communication, and the inability of drawing out the things your patients want to tell you to feel this trust.
On the other hand, there are times where attrition from moving or lack of contact information causes patients not to return. As we said in the past, attrition is always there eroding the actual number of new patients we need. In “average town USA” you are going to have about a 15% attrition rate which has nothing to do with the previous causes of not returning to your office.
Patient is angry: Fix it (we cannot have them saying bad things about us). They may not like us, but they need to respect us. Refund money or do it over. Honor your guarantee of meeting their needs and satisfying their dental expectations. Always do an exit interview if you have a patient leave your practice. 90% will come back if given the chance to vent. We use our Comment Card (see sample on Part 34) to make sure that everyone has the opportunity to let us know about things we could improve.
Forgot: People just “fall into cracks”. Use the purge sheet and call list to ensure that when they do forget, you follow up or purge (deactivate) them from your true active patients.
No need. Remind them of undone work and the last time they came in. We will discuss this as we look at the actual tactics in “reactivation”.
No money: Even with the best intentions, people may want something at the same time they have a personal financial blockage. It could be a divorce, pandemic, unexpected health issues, etc. Don’t be afraid to help them work their dental needs into their budget. It is OK if the patient cannot do everything this year. Just prioritize and do the most pressing things first. It may take a year or two, but eventually you will be able to finish their case.
Before we discuss the actual reactivation strategy, I thought I would touch on relationships. People do business with people they know, like, and trust.
Assuming you agree with this statement, the question becomes: How can you get to know people and how can people get to know you? To get to know people, you have to get out and network. Marketing has gone full circle and attracting new patients has come 180 degrees and is back to relationships. You have to attend those Chamber of Commerce meetings, join the Lions Club, Rotary, and PTA, coach little league, and get to know those folks at church. You have to volunteer on the committees that have people involved who either could be patients or know people who could be patients. You need to live where you work. People do business with people they know; get to know people.
There are a lot of people I get to know, and once I know them, I don’t like them. Probably the people that don’t like you have many of the same traits you don’t like in others. The bottom line is this: You need to work on being interested, not interesting. Those who ask questions in a social setting and don’t talk about themselves are the people others tend to like to be around. This isn’t something you can pretend you like doing. It’s a trait you can develop and is exposed once you are confident enough in yourself. People go to a dentist they like; be likable.
People do business with people they trust. There are two very simple ways to get people to trust you: You do what you said you would do, or DWYSYWD, and you tell the truth 100% of the time. People do business with people they trust. Give them tons of evidence you can be trusted and never give them a reason you can’t be trusted, and success will find you.
People do business with people they know, like, and trust. It might seem like success in Dentistry could not be defined so easily, but I truly think it can be. For over forty years this has been my secret ingredient to successful dental practices. You cannot just throw money at problems. You need to develop the need to be respected by your peers and liked by your patients.
Another point of review is to make sure that your hygiene department is part of the solution and not part of the problem. In an abbreviated way, allow me to restate a few points that we visited earlier in our 180 Degree Journey.
I recently received a call from the front desk staff member that worked for a long-term client. She wanted to know how to improve her recall for hygiene. They were using EagleSoft, and the doctor wanted to know what reports to use, and if they could improve their recall strategy. This front desk person had worked in the practice for 2 years and was following the directions of the previous person who occupied her job. They were pre-booking 90% of their hygiene patients and then using the computer or third-party software to generate texts, recorded calls, email and recall cards at the due date, and if they failed to show, they would send another card or message 1, 2, 3, and finally 12 months. Guess what: Very efficient but terribly ineffective. They were doing everything wrong for the right reasons. They had a strategy, but it just was not working. At this time in Dentistry, we can ill afford to spend time and energy doing things that do not yield the results we want. They were doing what they always did. We must go to a results-based strategy. If we can get the result that we want, then we are operating the correct strategy.
Let’s start from the beginning. She asked: “What reports should we run?” Answer: Only the ones you use. Don’t assume that just because your computer is capable of rearranging numbers into countless reports that you should print or try to use them. Always begin with the end in mind. What are you going to do with the report? You may find that a computer might not be the best strategy. Maybe in this case we need a little old school as well as advanced technology.
Let me give you the answer by the numbers:
- Pre-book at least 90% of your recall patients. It is best to do this chairside if you have computers in the operatory. Who better to re-schedule the patient than the person who just treated them? It may take a longer or a shorter amount of time for the next appointment. It eliminates one hand off when dealing with the patient and therefore will eliminate one possible error. Recall should never be booked as a fixed time for every patient. It is customized for each patient (an hour for some, 30 minutes for others, or any amount of time that is actually required to engineer the hygiene schedule).
- Only pre-book 70% of any day in the future. We need the other 30% of open appointments in the future for new patients and follow-up treatment like soft tissue appointments. Nothing is worse than working with a patient to understand a soft tissue problem and have them accept treatment recommendations, only to find that you cannot see them again for 4 weeks. You tie urgency to the treatment and now you cannot get them in quickly. Boom: Cancellations and No-Shows skyrocket. Another reason revolves around marketing for new patients. You spend all that money, they call to make an appointment, and you do not have a place to put them for 3 weeks. More CA/NS. We cannot be productive in hygiene by just having 8 recall patients per day. We need room for substantial cases like quadrants of sealants, soft tissue management cases, and impressions for TAP and snore guard appliances.
- Understand “peak demand times”. Capacity is being able to deliver a service when the patient wants to have it delivered. Any front desk person can tell you that patients want to come in early or late. From about 7-9 AM and 3-6 PM. We call these peak demand times. Those are every day during the week, Monday-Friday (Not Monday-Thursday). You can also add all day Saturday to the list of peak demand times. Monday, Friday, and Saturday are your best days. No one wants to start the week with a toothache or go thru a weekend with one. Everyone wants to come in on Saturday, so they won’t have to take off from work and expose themselves to the risk of another layoff. This is “consumerism”. With this in mind, when we pre-book our patients of record, we should try to encourage them to take non-peak demand times. These patients already love and respect you. The new patients do not have this trust or bond to the patient. If you use marketing to attract new patients, you must have peak demand times open. No peak demand times, no marketing.
- Use the Hygiene Report Card to create more value to the hygiene appointment. It is not just a cleaning. This card, developed by hygiene consultant Annette Ashley Linder, goes a long way to helping patients understand what is done during the appointment. A sample was included in Part 35. Keep in mind that we are not keeping this in our records. It is given to the patient to take home in order to create a better understanding and appreciation for the value of a hygiene appointment.
- Have the patient address his or her own hygiene recall card in the operatory while waiting for the doctor to check. Everyone opens their mail over the trash can. When they see their own handwriting, they are sure to stop and look at what it is. At least it will be read.
- Use oversize cards for recall. The larger the better: Less chance of being misplaced or slid into a magazine or other mail at the post office. It needs to stand out.
- Address correction requested. This should be printed under where the postage goes on any mail used to contact your patients. This will ensure that if the patient has moved and forwarding mail has expired, they will return the card or letter with the correct address. How stupid is it to keep sending correspondence to someone who does not reply if you do not even know if it is reaching them? This assures you have an updated patient address. If they have moved, stop sending the cards. If you have the incorrect address, change it.
- Have the hygienist write a personal note to the patient on the recall card at the same appointment. Six months later they receive the card and can’t believe that the hygienist actually remembered about their niece and cheerleading. See, they think the note was added two days before the mailing. This will go a long way in eliminating CA/NS or ever needing to reactivate someone.
If they have failed to respond to the texts, emails, calls, and recall cards, you will need to craft a reactivation letter. Run a list from your computer of every patient who has not been in for 13 months: They have missed two cleaning cycles. We will talk about the actual letter and give you an example in a moment. The strategy here is to assign this responsibility to one specific person. This person performs this task first thing every morning. We will send out five to ten reactivation letters every day. The number sent out would reflect the number of patients that you could actually schedule during a peak demand time within 4-10 days of receiving the patient call. This could be different in every office. The hope is that you will be able to reactivate at least 30% plus of the patients the letter is sent to. Lack of capacity (you can’t get them in within 4-10 days during a peak demand time) indicates the need for additional ops or employees. The goal here is to make sure if they call due to the letter, you can get them in quickly. Fail at this, and you have added one more nail to the coffin lid of a failing office. To repeat: You send out the letters every day. The trick here is that in one week following the letter being sent, this same person will call the person and all they have to do is say: “Hi, this is Kathy at Dr. Great’s office, and I was just calling to make sure you got our letter”. They will answer yes and if so, you ask if they or anyone in their family would like to take advantage of the offer in the letter. Make the appointments and you are done. They could say no they don’t want to hear from your office, and you must deactivate the patient which would clean up your computer data. If they say that they did not receive the letter, then just say you’re sorry and ask if the address you have is their current address. Make the correction and tell them that they should get the letter in a couple of days. This will update and make current your software for further marketing outreaches. The trick is to work the list, do the letters, make the calls, and reap the profits it generates.
The letter should be in an envelope with only your return address on it (do not put your name or the office name), and address correction requested typed under where the stamp will go so the post office will return the letter with an updated correct address for this patient. It should be hand-addressed (they will open this before a typed or labelled letter address). The letter should be crafted to reactivate a lost patient. I would include an offer that would be impossible to ignore. Something like a cleaning, x-rays, exam, and consultation for $50-$60. It must be something aggressive. Don’t skimp on this offer. It is not an offer that you would make to the public. It is an offer that rights a perceived wrong and brings this lost patient back into the fold. You need to tell them that you know what a financial challenge the economy has been, how difficult it is to stay on budget, and just outline that it has been ___months since their last cleaning and at that time they needed _________________. You need to mention about how much worse putting off treatment can be, and close with the offer. Sign the letter and place a PS that says something like: If you still feel like you cannot budget your dental care, at least come in and let us take a couple of x-rays and do an exam for $1 so you do not let anything get out of hand. The only other thing you can do to make the letter get opened is to make it lumpy. I once put a peppermint in the letter and started off by saying “Here’s a sweet deal”. We need to be very proactive about getting these patients back in the fold.
Always keep in mind: You can’t get better giving patients what they do not want. If you are not growing (increased CA/NS, and decreased NP, and Doctor and Hygiene production is down) you are not inspiring your patients. Your systems will ultimately determine the number and variety of patients you will be able to inspire. Nothing is sacred when it comes to systems. Everything needs to change and keep up with current conditions. Make changes to get the results you want.
Michael Abernathy, DDS
Here is an example of an effective letter. (Customize the offer to fit your demographic and make it something “valuable” to the patient.)
I’ve got some really great news for you! But first I have a confession to make. Here’s my confession: I always thought I really cared for my patients. But then, as I was thinking about you the other day, it hit me: If I really cared about you, when you didn’t come back for your routine cleaning, oral cancer screening, consultation, and dental evaluation, I should have called or written you to see what happened.
But I didn’t.
When you didn’t respond, I should have done whatever it took to find out why you didn’t come back. Was it a money problem? Was it fear? Maybe we somehow dropped the ball?
It wasn’t enough to send a postcard of make a routine phone call to remind you to come in for a six-month checkup.
If we really cared we should have called out the Boy Scouts, the FBI, the Marines…whatever it took to find you and get you back here and save you from all those nasty consequences of delaying treatment… and get your smile in 100% working order.
But I didn’t do any of those things. Please forgive me and accept my apology.
And now for the good news! Just give us a call and make that appointment for that cleaning and consultation. Bring in this letter, and we will … (Examples: Cleaning, exam, consultation for $59, Free take home bleaching trays, automatically give you a 15% discount for that appointment.) You know you need to come in, so why not give us a call, and get started on your healthy smile.
Yours for the greatest smile ever,
Michael Abernathy, DDS
P.S. Doggone it all. Have I done enough here? I’d sure hate to have almost convinced you to come in and get this work done, but just not quite enough to actually come in. Tell you what: We’ve got a really great gift for you. You’ve always wanted to have a beautiful bright smile, so if you will pay for our VENUS bleaching system, we will do your spouse or friend at NO COST (zilch, nada, nothing, free). Don’t wait! Give us a call today!
P.S.S. If all this didn’t still quite do it, please, please, at least phone and tell us: What it will take to get you in here?