Common Questions from Our Physical Therapy Patient Retention Webinar

Introduction

Strive Labs co-founders Ryan Klepps and Scott Hebert recently joined WebPT president Heidi Jannenga for an insightful webinar about improving patient retention and reducing early patient drop-out. We know this is a super-relevant topic, especially because the cost of diminishing patient visits represents a $6 billion problem that not many people in the industry are talking about—at least not yet. As a result, we received a slew of great questions that we couldn’t get to live on the webinar. Below are the most commonly asked ones—as well as their answers:

Emphasizing Clear Communication

Which staff members should be performing patient outreach communication (i.e., which things can administrative staff handle, and which things should therapists handle)?

You can distribute patient outreach responsibilities across staff members—after all, this is a clinic-wide initiative. However, all questions, concerns, and content regarding clinical care and home exercise programs should be handled by a licensed therapist.

How should we handle patients who want preferential treatment because they personally know the therapist?

That would depend on the policies your practice has in place for friends and family members. Regardless of how you decide to handle these situations, though, be sure you’re clear and consistent in communicating about the services that you can and cannot provide—from a feasibility standpoint as well as an ethical and legal one. For example, you may be able to squeeze in a last-minute appointment request, but you may not be able to waive a copay.

What is the best, safest way to communicate with patients?

The best, safest way to communicate with patients is through a HIPAA-secure messaging portal like Reach. If that’s not an option for your clinic, then stick to a HIPAA-secure email platform or communicate over the phone after verifying you’re speaking to the patient.

Doesn’t using clinical terminology reinforce my expertise as a therapist?

When Jannenga practiced, she always took her patients through a model or example of their injury, referencing the medical terminology that they may have heard in their orthopedist’s office—before translating it into layman's terms. That way, her patients were able to connect the dots and truly understand the mechanism of injury as well as communicate what they learned to friends, family members, and caregivers outside of the clinic. While we would never recommend you dumb down your clinical expertise to speak with a patient, we do strongly advise that you use language your patients can grok. And, as Einstein once said, “The definition of genius is taking the complex and making it simple.”

How do clinics obtain written permission to send emails?

Every practice should have a notice of privacy practices (NPP) that patients sign during the intake process. It’s a perfect opportunity to outline how you use patient info, including email addresses. If you’re looking for an example NPP, Google “notice of privacy practices.”

What can we do about patients who refuse to schedule future appointments?

First, we recommend adding a checkout step to your patient visit workflow—one that requires therapists to actually walk their patients to the checkout desk. As Jannenga explained in this blog post, when her clinic implemented this change, “Not only did our cancellation and no-show rates decrease, but our collections rate also improved.” Furthermore, make sure everyone on your staff—including therapists and front office staff—can speak to the importance of regular appointment attendance in terms of ensuring optimal progress and outcomes. Finally, emphasize that if a patient fails to schedule appointments in advance, the schedule may fill up—which means his or her progress could get delayed.

Celebrating Patient Progress

What are the most effective ways to celebrate patient milestones? Should we stick to verbal celebration, or can we provide tangible rewards or gifts?

A small gift is a nice way to celebrate patient gains. You might consider offering a complimentary wellness service as a way to say “good job.” However, don’t feel obligated to give out gifts to every patient for every milestone, especially because you want to be fostering long-term, intrinsic motivation. Additionally, the Office of the Inspector General has some pretty strict rules regarding gift-giving, which we cover in this post. Ultimately, it’s not so much how you celebrate that counts; what matters most is that you take the time to acknowledge your patients’ hard work and commitment to therapy.

What tips do you have for communicating with patients who don’t feel like they are making progress—particularly when you know it is going to take a while for their function to improve? We find these patients often get discouraged and end up self-discharging.

Keeping patients motivated to continue their care when they’re not experiencing the progress they’d like can definitely be challenging. To help, be sure to set clear expectations upfront about the path to improved function as well as communicate the role that patient engagement and plan of care compliance—including home exercise compliance—can have on helping them reach their goals. Then, celebrate milestones—even small ones—to encourage patients to view their progress positively and continue with the program through what will surely be a temporary slump.

Tracking Loyalty Through NPS® and WebPT Reach

At what intervals should we be distributing NPS surveys?

As we explained in this blog post, “Conduct the NPS survey with a patient at different touchpoints throughout his or her episode of care. Perform the survey after the initial evaluation, and then again following a daily note visit, a progress note visit, another daily note visit, and finally, at discharge.” Measuring NPS throughout the episode of care allows you to identify trends around when, exactly, scores change—positively or negatively—which can help you uncover opportunities to optimize certain processes and elements of the patient experience.

How can we improve our survey response rate?

One way to improve your survey response rate is to let patients know during their in-clinic appointments that they will be receiving it via email—and when. That way, they will not only know that they should keep an eye out for it, but they’ll also be less likely to ignore it or assume it is spam.

Can we send NPS surveys via text?

Theoretically, yes, you could deliver NPS surveys via text if you have the technology to do so securely. To that end, WebPT is currently testing text-based NPS survey technology with the eventual intent of incorporating it into WebPT Reach.

Where did you find the NPS benchmarks you mentioned during the webinar?

The benchmarks we cited were based on our own analysis of Strive Labs data. You can learn more about that analysis in this post from Ryan Klepps.

How does the Reach platform incorporate NPS? How does it drive reviews?

At its most basic level, Reach is a messaging automation platform that sends the right message—with the right content—to the right patient at the right time. You can use it to set rules so that:

1. every patient receives an NPS survey after a certain number of visits, and
2. every patient who is scored as a Promoter receives a link to leave you a review on the same day.

How does WebPT Reach work, and do I have to use the WebPT EMR in order to use Reach?

There are three versions of Reach:

• Reach Standard is built into the WebPT EMR. That way, WebPT Members can easily monitor their patients’ experience, automatically reach out to pleased patients to request online reviews, and securely connect with patients between sessions to encourage engagement.
• Reach Pro and Reach Enterprise are for practices that want a greater degree of customization and features. These two versions are EMR-agnostic, which means they work with WebPT as well as many other physical therapy EMR systems.

We currently use satisfaction surveys, but we do not track NPS. Would distributing the surveys more often solve the survey bias problem, or do we need to start using NPS surveys, specifically?

Administering satisfaction surveys more frequently might diminish the sampling bias, but you would still need to account for the environmental one and ensure your surveys are sensitive enough to track meaningful differences in patient satisfaction levels. In our opinion, there’s a better way: and that’s measuring loyalty. As Hebert said during today’s webinar, “Satisfaction is easy to achieve: you simply meet a customer’s expectations. Loyalty, on the other hand, is a little harder won, because you have to exceed those expectations. And in today’s competitive and increasingly value-based, patient-centric healthcare marketplace, exceeding expectations is crucial.” To learn more about the pitfalls of satisfaction surveys, check out this blog post.

What if patients give low NPS ratings early in treatment because they haven’t had enough time to figure out whether they would recommend us? Shouldn’t we wait until later in the course of care to send our surveys?

As Klepps explained, here’s what we know from the data we’ve collected: when the first NPS survey goes out early in the course of care, 85% of patients have enough experience to rate you a 9 or a 10. When a patient submits a score under that threshold, he or she is asked to provide feedback as to why. Even if a patients say it’s because they haven’t had enough interactions with you to rate you higher, that should still be a red flag—because you haven’t wowed them, and that’s an indicator of early patient dropout. On the other hand, if you wait too long to send that initial survey out, you could miss an opportunity to retain a patient who’s already bailed.

What can we do to prevent patients who submit low NPS scores from dropping out of therapy?

This is precisely why we recommend adding a feedback text box to the bottom of your survey. That way, you can gain detailed insight into what, exactly, is influencing a patient’s low score—and take steps to correct it. For example, if the patient says that he or she feels no difference after treatment, perhaps the therapist needs to better communicate functional gains or set clearer expectations around how long it might take for the patient to experience progress.

Managing Online Reviews and Social Media Channels

Our patient population is older. How do we get them engaged online and eager to leave us a review?

First, we’ve found that many older individuals are quite active online. In fact, seniors are often more active on Facebook than younger people—and many have active email accounts. According to data from the Pew Research Institute published in this 2013 article, “among the 53% of adults ages 65 and older who go online, 86% use e-mail, 27% look online for information about health or medical issues, and 34% use social networking sites.”

To generate buy-in, be sure that when you request an email address, you provide a reason for doing so—and that advice stands whether your patient is 19 or 90. For example, you could say: “May I have your email address? I’d like to send you relevant information about the clinic as well as content to support your recovery process.” According to Klepps and Hebert, elderly folks are a very engaged cohort, and they’re highly likely to leave you a review—if you make it easy for them to do so. Instead of asking patients to take the initiative to create a Google or Yelp account to leave you a review, send an email with a link that allows them to review your practice with one click. (Hint: Reach can make that happen.)

How should we address negative online reviews that we know—and can prove—are false? The review site won’t let us remove them.

If it’s truly a defamatory review, you may be able to take legal action. However, we’d first recommend referring to the site’s help resources. Most include a section explaining the process for handling inauthentic reviews. You may also want to focus on increasing your positive reviews, which will help paint a more accurate picture of the services—and patient experience—your practice provides. Additionally, the most recent reviews are typically displayed more prominently, so as you garner more positive reviews, they will “bury” the negative ones.

What are your thoughts on therapists being friends with patients on Facebook and other social media channels?

Ultimately, it’s a judgment call that depends on the kind of relationship you want to have with each individual patient, but we would advise you to be thoughtful about your approach to connecting with patients using a personal social media account. After all, they’ll have access to everything you share. Jannenga, for example, keeps her personal Facebook page private and only accepts friend requests from close friends and family members. Klepps, on the other hand, sometimes accepts friend requests from patients—but only after they’ve discharged from his care. Regardless of what you decide, if you’re overseeing a clinic with multiple people on staff, then be sure to implement a social media policy that outlines clear guidelines for interacting with patients online. A good compromise may be setting your personal page to private and creating a business account from which to interact with your patients.

Still have a burning patient retention question on the brain that we didn't cover above? Leave it in the comment section below, and we’ll do our best to supply an answer.