Patient financial records a disaster? Here's what to do

In our last post, we discussed some ways to organize your receivables system to make sure that you get off to the right start to control past due amounts and deal with any amounts that may become delinquent.  

But what about a situation where you initially did not have a plan or execute a plan?  The aging analysis has never been reviewed, there’s been no follow up, patients are seen without regard for their financial status. The assumption is that everything will work out OK.  And in a lot of cases, you don’t know what to collect because you have no idea what is owed.  That’s certainly not an ideal situation, but fear not.  Do not abandon hope.  The situation can be salvaged and turned around. 

Take the following steps as soon as humanly possible:

Practice rescue: the nightmare dissapates

So, there we were, in a beautiful, fully staffed, heavily advertised, yet almost empty, office.  And we had our data showing a 4.5% conversion rate which was heavily driven by the fact that only 20.2% of patients showed up for their appointments.

Now, when it comes to getting patients to show up for their appointments, a number of different options emerge.  Some experts will advise you to offer something to patients to entice them to show up (a gift, a chance to win something, etc.).  Others say that you shouldn’t give something away when patients should already be fulfilling commitments made to show up.  Others have specific guidance on when and how to contact patients.  As a more general rule of thumb, find a system that you think will provide the best possible customer service, implement it and monitor it.  

In this case, we simply wanted the office to have a system of some kind to follow up on consultations.  They had none.  We asked that the office take 3 simple steps:

Practice rescue: the nightmare opening

Our next story delves into what I consider to be a practice’s worst nightmare.  Here’s the basic situation: a practice puts big money into a great location, builds out that location with no expense spared, spends big dollars on a high profile marketing campaign, opens the doors and…crickets.  You can see the visual right? Nothing but tumbleweed rolling by the office.

We had this very case in a fine Midwestern city. A brand new strip mail had opened up and this practice had put a gorgeous new 4,000 square foot orthodontic and general dental practice in there.  The initial marketing campaign was strong with TV ads, a nice price promotion, radio promos and a semi-formal grand opening (one can only assume that the champagne was Korbel).  With 8 operatories, this place was ready for the flood of patients that would surely be on the way.  

Except that there was no flood, or a nice stream or even a small babbling brook.  The practice had 0 new patients in month 1, 1 in month 2 and 2 in month 3.  Not exactly a rousing start.  On top of that, the practice was fully staffed anticipating a great start so costs were substantially higher than one with a more modest opening.

Practice rescue: Bringing the patients back

When we last left our story, we had a problem with the front desk staff turning off patients by being dismissive and generally unpleasant.  The doctor was busy in the back trying to treat patients and tended to steer clear of the front desk in his quest to provide the best patient care possible.

Very clearly, our first task was to address these individuals who probably had skills applicable to other areas, but it appeared that making folks feel at home was not one of those skills.  Seemingly, the most obvious solution would be to simply terminate these 3 people and replace them with others who had more of a friendly demeanor about them.  

As a general rule, I do not enjoy firing people nor do I ever look to that as a first solution to a problem.  Personally, I've been fired without having the chance to make a situation right, and it sucks.  In addition, these people had experience in the practice and may have had skills applicable elsewhere.  We’ve dealt with a number of staff people who aren’t the super friendly type when patients walk in the door, but may be absolute superstars when it comes to financial, technological or receivables matters.  That should definitely be explored.

The conversation with the front desk staff began very frankly with a discussion of what we had heard and observed within the office.  That was followed by the standard denials and pushback.  That’s never an issue.  No one likes to hear that they are considered to be the source of a problem, but once we let the dust settle a bit, we were able to get into a discussion of the problems.

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Practice rescue: Where did all the patients go?

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:

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Practice rescue: Steps to start fixing a failing practice

Today, we kick off a recurring series that we like to call “practice rescue.”  In this segment, we discuss stories and lessons from practices that have been struggling to the point of potentially shutting down or downsizing substantially and the steps we have taken to turn things around.  

While we fully recognize that by the time we get to some practices, they have passed the point of rescue, or in some cases, the solutions and/or personalities may not be a great fit.  What you get there is an unsuccessful or laterally moving mess.  And in the coming posts, we are certainly planning to discuss some of those.

In the majority of cases, however, opportunities can be found and grabbed or weaknesses can be rectified.  Then one morning, you take a look at results and you have the makings of a successful, happy practice.

To start, we’d like to discuss some of the key principles employed in effecting a practice rescue.  I am not outright suggesting that anyone use this as a path to implementing their own practice rescue, but if you wish to do so, so be it.

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