What if I told you that there is a common problem that costs clinics tens or hundreds of thousands of dollars a year, and most of them don’t seem aware of it? What would you guess the problem is?

If you guessed a patient drop-out, or a problem with patient retention, you’d be right. It seems that many clinics, especially those that may be struggling financially, put a lot of effort into and focus a lot of attention of getting in front of referral sources to increase the numbers of patients coming into their clinic door. They think they have a patient acquisition problem. But as I’ll argue below, they may more than likely have patient retention difficulties.

The Big Money Problem

Did you know that approximately 14% of therapy (PT/OT) patients do not show up for their follow-up appointments? In fact, between 20-30% will not show up to their third appointment and up to 70 percent of patients will fail to complete their full course if care [1]. That may seem like a staggering number, but it seems pretty consistent with what I’ve noticed during my time in the outpatient orthopedic rehab world.

That’s why clinics always try to pre-book (or book out) all the appointments in a patient’s plan of care. If they’re already on the books, there’s a higher chance they’ll show up to those appointments. Even this, though seems to fall short in getting patients to complete their plan of care. (I tend to think this has to do with clinicians not understanding some important factors in behavioral change)

But why, exactly is this a problem? Because decreased patient retention costs both patients and clinics…big time.

Financial Cost to Clinics

Let’s run some quick numbers on an a small/average clinic. This clinic employs 5 clinicians, each scheduled to see 10 patients per day (50 total patients per day).  Now according to GuideDoc, the average cost for a PT/OT visit is around $100. The average course of care in the outpatient orthopedic rehab world tends to be 12 visits. That means from a group of 50 patients, the clinic expects to generate around $60,000 (50 patients x 12 visits x $100 average visit cost).

Now lets factor in what happens if the clinic experiences the patient drop off described in the above-cited article. Let’s say that 20% of patients don’t show up to their third appointment, and that another 20% drops off every 4 appointments thereafter. Patient retention, starting with the original 50, would look something like this:

Patient Retention Financial Problem

As stated earlier, typical revenue expectations for the 50 patients was $60,000. However actual revenue after patient drop out was only $41,000That means this clinic actually experiences a $-19,000 loss for every 50 patients they treat.

So over three months (12 weeks), this clinic looses $19,000 on these 50 patients. Multiply that by 4 (to get 12 months in a year), and you get around $-76,000, and that is assuming the clinic only brings in 50 new patients every 12 weeks!

In total patient drop-out can cost average clinics around $150,000 per year (even more, if you’re running larger and/or multi-site practices!) In a world of constantly decreasing margins & reimbursement reductions, the last thing you need as a clinic owner is to be losing 6-figures a year.

Costs to Patients

It also costs patients because they often drop out of treatment before hitting their goals. They’re stopping before they’re pain free or are still experiencing limitations.

So what’s the solution? Well, obviously, we want more patients to finish their plan of care. But how, specifically, do we accomplish this? Research shows that increased patient engagement results in higher rates of treatment compliance & completion. Patient engagement hinges on the patient experience. If you’re interested in learning more about patient retention, read this article.

Patients that have positive experiences are shown to have higher levels of engagement. So it’s all about delivering impactful patient experiences.


When it comes to marketing your therapy business, there’s a lot of talk about allowable acquisition costs, conversion rates, and lead generation. And that makes a lot of sense. I mean, you need new patients coming through your door to keep the lights on, right?

But what about the patients you’re already seeing?

These patients have raised their hand, voted with their wallets, and come in to see you.

Are you really doing the best to not only serve them, but to retain them? Patients that do not complete their plan of care cost both themselves and clinics in terms of time and money. This usually results from a substandard patient experience and lack of engagement. It’s a common fact in business that it cost much more to acquire a new customer than it does to retain current ones.


…If your marketing plan is designed to fill your proverbial “bucket” of patients, does it make sense to spend time and money pouring those leads into a bucket with a giant hole in the bottom? Every clinic, regardless of marketing strategy or lead generation success would benefit from focusing on improving patient retention through engagement.

In fact you can click here, and see how we can help your clinic save money and increase patient engagement & satisfaction 

Have you made changes to your clinic to increase patient retention? Share any additional resources that you found helpful in the comments below!

For more informational reads, check out our Blog to see all the articles we’ve published to date. Click here to head over to our resources section and check out our variety of clinical and professional resources aimed at increasing your knowledge and skills. If you’d like to make some changes in your clinic or health center, and would like some help, check out our consulting and advisement services or contact us to see how we can help you break out of the norm and provide a truly impactful patient experience.

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 working for the State of Georgia’s DBHDD. He is also on the Board of Directors for NBCOT. He works to help healthcare clinics and organizations deliver uniquely impactful patient experiences by improving service delivery through training & advisement.

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

Schedule a call with him Here

Sign up to get the latest articles and resources!

You’ll also receive clinical bonuses not posted to the site!


[1] Jack, K., McLean, S. M., Moffett, J. K., & Gardiner, E. (2010). Barriers to treatment adherence in physiotherapy outpatient clinics: a systematic review. Manual therapy, 15(3), 220–228. doi:10.1016/j.math.2009.12.004