Retention vs. Acquisition

First, I know as clinic managers and owners, we’ve all got a lot an our plate. Whether it’s managing staff, handling back office problems, or just figuring out how to get yourself new referral sources, there always seems to be more work to be done than hours in the day. So why would you even care about patient retention? I mean, you already have those patients in your clinics, receiving services, and providing revenue. Shouldn’t you worry more about getting new patients in the door?

You would think so, however the data suggest that it can be 5x more cost effective to retain existing customers than to acquire new ones [1]. Despite this fact, only about 16% of businesses actually employ a primary marketing strategy aimed at improving patient or customer retention. According to some studies, increasing patient retention by only 5% can increase profits by at least 25% [2]. Understanding the importance of patient retention, it should be clear that knowing how to define it,  calculate it, and improve it would be a worthwhile investment for any clinic owner or manager.

Defining Patient Retention

There are 2 type of patient retention that every therapy clinic should be aware of and actively tracking: 1) Course of care retention and 2) Clinic Retention [3].

Course of Care Retention

Course of care retention simply refers to the number of  visits a patient attends versus the number of indicated or authorized visits. It is usually calculated as a percentage. This is also referred to as the Patient Retention Rate (PRR) calculation.

For example, let’s say a patient is evaluated in your clinic, and the evaluating therapist recommends 10 visits to complete the course of treatment. The patient only attends 8 visits before discontinuing care (self-discharging) and did not reach their goals. Let’s brush off some basic math skills: 8÷10=0.8, which is equal to 80%.

Now, the best thing about this PRR calculation is that it enables us to see the revenue that is lost due directly to patient drop out. So for our previous example, of a PRR equal to 80%, that means this clinic is operating 20% below maximum revenue.

What if you were able to improve this clinic’s PRR by half? What could that 10% do for that clinic’s business?

Every clinic should track PRR for each individual patient as well as track the overall clinic PRR. If you are only tracking visits per case, you could potentially be overlooking the underlying reasons that patients self-discharge from your clinic. More on that later.

Clinic Retention

MarketingClinic Retention refers to the number of patients who return to your clinic for a new course of care. This can be harder to track, but it is worth it to better understand how to get “return customers” into your clinic. Perhaps a patient was being treated for shoulder pain and he/she is now back to be treated for wrist or back pain. Whatever the case, it means that this patient had a good experience at your clinic and your clinic made a positive impression on him/her.

What is also common about patients who return to your clinics for new courses of treatment? They are often your biggest fans, telling everyone they know about how great you are and how much you helped them. If they were referred to your clinic by a PCP or Specialist, they likely have told that doctor about their experience with your clinic. This can lead to that referral source feeling confident in referring more patients to your clinic. These patients can also influence their friends if/when it comes time for them to seek therapy services.

So, overall, you want to be able to identify these patients and understand what caused them to return to your clinic. That way you can replicate that process with as many patients as you can. A simple method to track this could be implementing a patient survey system that gathers data at the time of an initial evaluation and time of discharge.

Increasing Patient Retention

So now that we know how important patient retention can be for your clinic, how do you go about improving it?

It all starts with the first experience a patient or potential patient has with your clinic and continues until you at last discharge that patient from your services. Improving your clinic’s patient retention is a continuous process of building trust and relationships with potential, current, and former patients. Some refer to this process as “patient relationship management” or “patient engagement”. I like to refer to is simply as “Patient Focus”. It all revolves around the experience your patients have in your clinics.

Patient Experience: Contact Points

Regardless of your area of expertise, patient population demographics, or referral sources, one thing is for certain: the Patient Contactexperience your patients have with your clinic will greatly affect not only their retention, but it can even affect their perception of your service delivery. That means if your patient has a lousy experience at their first appointment, they re less likely to complete their course of treatment, and if they do, they will perceive the services you provide as average, mediocre, or even non-effective.

The first step in creating an outstanding patient experience is to first take a look at all the ways that patients and potential patients interact with your clinic. This list should cover everything from what happens when a patient gets referred to your clinic up to the time they are discharged from your services. It takes some time and attention to detail, but what you want to do is get on paper every single point of patient (customer) contact with your clinic.

The next step is to break down each contact point and look for ways to either improve it or differentiate it. For example: when a patient shows up to your clinic for their first appointment, what happens? Do they get a stack of paperwork to fill out? Insurance card, copy of their ID, past medical history, blah blah blah. I think everyone who has ever been to any healthcare appointment is familiar with that routine. What can your clinic do to improve that process? Perhaps emailing or mailing the paperwork to your patient ahead of time is an option. That way, your patient can just show up, turn in their packet (or maybe they’ve already emailed it to you and the therapist has been able to review it), and wait to be seen. Anything you can do to take the pain and drudgery away from that first appointment paperwork packet will help you create a different and outstanding experience for your patients.

Patient Experience: Education & Engagement

When patients show up to your clinic, it can be assured that they will have questions for you. At the minimum, your clinic staff or therapists should be able to answer the 5 Most Important Questions that your patients will have, but it is also good to provide each new patient with a FAQ sheet (or have one on the website or emailed to new patients) that can cover everything from where to park to some basics about your clinic’s rehabilitation process. In addition, it’s a good idea to ensure that your patients have some reliable way of getting in contact with you in case they have questions the day after their appointments. This can be telephone, email, secure messaging. There is a plethora of options out their. I’d suggest to look at selecting one that will improve and differentiate your patients’ experience.

Patient education isn’t just about getting some facts across to your patients. It’s also one of the best ways that you and your clinicians can demonstrate value to your patients. The reality is that, often you only have one shot to show your patient the value you bring to the table. If you can’t convince them on day one, at that first appointment, that your services are important and can make a difference, the odds are that they will be semi-compliant at best, and will not complete their course of treatment at worst.

When communicating with your patients, try to use emotional language. For example, try and think of it like this: You do not provide therapy services in your clinic. You provide a single, one-word emotional outcome to your patients. What is it? It could be relief (from pain, limitations, dysfunctions, etc.). It could be freedom (to participate in their chosen or meaningful activities). What emotional impact does your clinic or practice provide to your patients?  Your goal should be to communicate this to every single patient that walks into your clinic in a way that shows them you truly care about them, their situation, and their recovery.

In fact, the way you communicate with your patients directly impacts their overall engagement during their course of treatment. Therapists who actively listen and communicate with their patients find that their patients are more compliant with recommendation and home exercises and generally have a more positive experience throughout the therapeutic process. Actively listening to your patients’ concerns, questions, and difficulties helps you build a trusting relationship with them and also helps you provide services that are relevant to each patient’s specific situation. Think about how many patients go to their therapy appointments every week, get heat, run through their cookie-cutter exercise program, and then go home. It’s no wonder these patients don’t feel engaged in therapy. They probably don’t see the need for even showing up anymore.

But what if their therapist listened to them and their situation, then at their next appointment, that therapist had developed a personalized and tailored exercise program specifically designed at addressing the concerns they had expressed? Odds are that patient would be blown away. They’d know that this clinic was different. And they’d probably tell everyone they know about the great care they received. That’s what you want: patients that turn into raving fans; little mini-megaphones that shout your praises. It’s in no way easy, but incredibly with the effort. Going above and beyond to provide real value and an outstanding experience pays dividends in the long run.

For some more practical tips and strategies to improve patient experience, check out our free report: Patient Experience.


If you’d like to learn more, grow your clinical skills and expertise, and become an expert who can easily answer the tough questions, head over to our resources page and check out what we’ve got to help you reach your professional and clinical goals.


Rafael E. Salazar II, MHS, OTR/L is the president and CEO of Rehab U Practice Solutions. He has experience in a variety of rehab settings, working with patients recovering from a variety of injuries and surgeries. He worked as the lead clinician in an outpatient specialty clinic at his local VA Medical center. He also has experience as an adjunct faculty instructor at Augusta University’s Occupational Therapy Program, as a Licensed Board Member on the GA State OT Board, has served on several committees for the national OT Board (NBCOT), and as a consultant for the State of Georgia.

Read his full bio Here. Read about Rehab U Here.



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[1] Customer Acquisition Vs. Retention.https://www.sailthru.com/marketing-blog/written-customer-acquisition-vs-retention-infographic/

[2] Strive Labs. The Physical Therapist’s Guide to Patient Retention. 7/17/16. http://cpaprivatepractice.ca/the-physical-therapists-guide-to-patient-retention/

[3] Herbert, Scott. The Importance of Patient Retention. WebPT. 11/24/14. https://www.webpt.com/blog/post/importance-of-patient-retention