A new referral won't fix a leaky plan of care

Visits are down.

The first instinct is almost always the same. Call the referral sources. Buy lunch for the surgeon's office. Spend more on marketing.

Sometimes that's right.

But a lot of the time, the visits you're missing aren't in someone else's office. They're in your own EMR. Patients you already evaluated, already wrote a plan for, already earned the trust of.

They just stopped coming.

No call. No discharge. The next appointment never got booked, and nobody noticed until the schedule had a hole in it.

That isn't a referral problem. It's a plan-of-care problem. And more new patients poured into a leaky plan of care just leak faster.

The back door is quiet

A cancellation shows up. It's on the schedule, it's on the report, somebody sees it.

A patient who self-discharges doesn't show up anywhere. There's no missed visit to count, because no visit was ever booked.

So let's put a number on it. These are placeholders. Use yours.

Let's say you start 20 new patients a month.

Five of them stop coming with four visits still left on the plan.

That's 20 visits a month.

240 a year.

At $100 a visit (use your own net revenue per visit):

$24,000 a year.

From patients who already chose you. No referral needed. No marketing spend. Just care that was prescribed and never finished.

Book the plan, not the next visit

Many drop-offs start at the front desk, not in the treatment room.

The patient finishes a visit and gets booked for "next time." One appointment. Then the next one gets booked at checkout, if it gets booked at all. Miss one checkout and there's nothing on the calendar.

Book the frequency the plan of care prescribes. If the plan says twice a week for six weeks, the patient walks out of the evaluation with those visits on the calendar.

They can move them. They're far less likely to vanish from them.

Call before they're gone

A missed visit is the first sign. A patient with no next appointment is the second.

Both deserve a call the same day, not a note in the chart for later.

And when you call, ask why.

It's easy to blame the copay. It's rarely the whole story.

People will move mountains for care they believe in. They'll pay the copay, rearrange work, drive across town.

When they stop coming, it's often because they stopped seeing the point. They felt better and figured they were done. Or nobody told them what the next four visits were for.

That's fixable. It starts in the treatment room, with the therapist explaining where the plan is going and what each visit is for.

You can't fix every reason. You can fix the ones you hear about.

Pull one list this week

Pull every active patient with no future visit on the books.

That's it. One list.

Look at how many visits each one had left on the plan. Hand the list to your front desk lead and have them start calling.

You'll learn more about your schedule from that list than from any referral report.

The honest part

Not every early exit is a leak.

Some patients get better faster than the plan expected. That's a good outcome. Have the therapist discharge them properly, document it, and count it as a win, not a loss.

Payer and diagnosis matter too. A Medicare low-back patient and a post-op ACL patient don't run the same length of care, so don't compare them to each other.

And the goal is never more visits than the plan calls for. The goal is the plan, finished.

That's good care. It also happens to be good business.

New patients feel like growth.

Finished plans of care are growth.

Close the back door first.

Dash