One of the most perplexing problems for any practice is one in which new patient flow was strong for a period of time and now that patient flow has steadily or suddenly dried up.
From my perspective, this is even more challenging than the office that throws open its doors and no one shows up from day one. In that case, you need to change everything up and try a fresh approach. In the case of a declining practice, you are tempted to hold onto what worked for the practice in the past. Maybe that’s a good idea and maybe it isn’t. Figuring out what to change and what to keep in place is a challenging exercise.
To discuss this problem, I’d like to introduce a orthodontic practice that I’ve worked with recently. In the late 2000’s the practice was humming along nicely signing 20-25 new patients per month. In 2010, that number dropped to 15-20, and by 2012, the office was consistently under 10 new patients per month.
In mid 2013, results weren’t getting better so our group took a look at things. Here are some details on our practice rescue:
Quite obviously, we needed to start by finding the reason or reasons for the decline. The basic numbers will not tell us a ton. Yep, consultations and contracts are down. That’s why we got called. The batting average was down a bit, but the consultation drop was the big reason for the problem. We started by talking to the doctor and staff to find out why they thought business had fallen off.
In these situations, 9 times out of 10, the reason cited for a new patient decline is the economy. The explanation goes along these lines: “The economy locally is struggling. Large business X moved out. Our city is different than any other in the world and you don’t understand how the people here respond.” Certainly, every city is unique (Facebook is blanketed with My City is the Best City posts that prove this fact). But in many ways, especially for business purposes, things are very consistent. Unless something dramatic happens in that city, things tend not to vary wildly from the state or even, national economic picture. In this case, we had growth in both the national and state picture so the economy reason couldn’t be 100% of the problem.
The second most-oft cited reason is the competition. Doctor Y moved in nearby, set up a 4,500 square foot Taj Mahal complete with waterfall and interactive games and now he’s taken our patients. If the competitor is nearby and going after the same patient base, this can usually be a driver of a practice decline. However, the reason isn’t usually that waterfall and gaming system. The reason is that the new office is offering something of value that you are not. It may be pricing or the opportunity to see multiple specialists at one location or convenient office hours. In this case, our client practice was open 9-5 to Monday-Thursday while an office 2 blocks away had started offering evening and weekend hours. That was noted as a possible cause.
The third most often cited reason is that the population has moved away from the office. This does happen and this does have an impact. Developers and major retailers may decide to locate on the other side of town. Families and ancillary businesses move there as well. Businesses near yours relocate and the area around you falls into disrepair. You don’t have the money to relocate so you are stuck in a declining area. This wasn’t the situation in this case, but we will discuss this in a future practice rescue piece.
Next, we started to tie specific marketing initiatives to consults to get a feel for which marketing efforts worked and which ones didn’t. ID numbers were assigned to each ad and requested when a patient would call. Here, we were able to get a return on investment number for each marketing plan. Services like Marchex and Patient Pursuit will help by assigning individualized phone numbers to enable tracking, but this practice wasn’t large enough to merit this investment. While this helped us to identify what did NOT work, it did not do enough to address the overall decline.
Finally, we decided to do our own observation by simply watching a patient day or two to see if anything unusual happened. Usually, you can’t get a truly complete feel for the patient day because when anyone is being observed, they’ll usually alter behavior in some way because of that fact. Back in college, I never seriously cleaned up my dorm room until I knew the RA was going to inspect each domicile. It’s just human nature.
Fortunately for us, the staff was completely unfazed by our presence. And thank goodness because the experience was eye opening. The people responsible for dealing with new patients at the front desk could not have been more dismissive of the patients or less interested in creating a friendly office environment. They didn’t acknowledge the arrival of people and simply threw a stack of forms at them. One woman had to ask 3 times for the location of the restroom! By the time these people got to the doctor, I can only imagine how desperate they were to get out of there. The doctor was in the back seeing patients and trying to provide the best possible patient care. He was unaware of the damage done by his front desk staff.
This led us to dig deeper into the front desk problem. We talked to patients that had shown up and decided not to sign a contract and nearby business owners. Over time, these folks had developed a reputation for being a bit surly with patients. Dentistry and orthodontics is all about smiles and good results. No one wants to be talked down to or ignored.
Now, we had something really useful to act on. In our next post, we’ll talk about the rescue itself.
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