This original article is featured in the February 2022 issue of the American Chiropractor

Keeping existing patients is more straightforward than getting new ones. We all know it’s true. In fact, from a business standpoint, keeping existing patients is not only easier, but it’s better. If we all know this to be true, why do most offices not prioritize this? Why spend time and money getting new patients if you don’t keep them?

Don’t get me wrong, I want chiropractors to help as many people as possible, and getting new patients is a big part of that. Financially though, your practice should not depend on new patients constantly walking in the door. 

Retaining existing patients is your best-kept secret for growth, financial independence, and better outcomes. A loyal patient is 80% more likely to choose you over competitors and two times more likely to recommend you to others. Moreover, they are likely to spend two times more than a new patient! If implementing strategies and solutions to retain patients is the foundation for long-term success, what is it costing you not to keep patients? 

If you’re still not convinced that it’s better to keep patients than depend on new ones, it’s been shown that it’s 700% more expensive to get a new patient versus keeping an existing one.

Now, you may be thinking this desire to increase retention is all about “money.” It’s not! We can all agree that patients not following through with recommended treatment plans is one of the main reasons they may not get the best results from your care. 

Doing what you can to help a patient stick to the care plan is just as important as the care itself. If not, it’s all just a waste of time if the patient drops out prematurely. And yes, when your patient retention goes up, that’s more often than not reflected in your bank account. 

Now that we know how important retention is, let’s dive into what makes it so easy! Several things all play a role, but the biggest and most impactful can be broken down into four principles. I call these the 4 F’s of Patient Retention. Again, we will review a few other vital elements, but without these four, you’re leaving a lot of danger zones where the patient may drop out throughout their journey in your practice. 

The 4 F’s of Patient Retention are: 

• Feedback that is intuitive and demonstrates the need for care, and tracks progress throughout care. 
• Forecasting Care ensures a clear path to wellness and doesn’t leave the patient confused about the game plan for treatment. 
• Frictionless Payments take the financial discussions out of the equation and remove the thought of money.
• Frequent Contact that allows for automated education and marketing.

Let’s start with Feedback that’s intuitive.

We may place a lot of emphasis on the word “feedback”, but don’t skip over the word “intuitive”. Most doctors use x-rays and scans to show the patient the clinical and unbiased need for care, and they should! 

However, the patient isn’t usually trained or educated on reading and understanding these things. Although we do our best to explain these in layman terms, it’s just not something they are used to. When they get home and try to explain it to their family, they probably miss a few key aspects, and the main points don’t come across. Feedback is intuitive when the patient can easily understand and comprehend their findings in a way that makes sense to them. 

In my practice, we gave patients report cards with a letter grade. We all received report cards in school, so it’s something patients understand! It turns the conversation into, “Doc, what do I need to do to get an A?”

On top of the Feedback being intuitive, it also needs to be repeated during re-exams so patients know how they’re progressing with care. If they started as a D, you can show them how working together got them to a C, then a B, and so on.

Do you ever have patients coming to you that left another chiropractic office? I bet you do! If you ask them why they left the other office, I’m sure you’ve heard them say something like, “I never knew how I was doing over there.” That’s a significant signal of why they lost the patient. Giving Feedback that’s intuitive throughout their care solves that! 

Now, on to the second retention principle: Forecasting Care (aka care plans!).

Forecasting Care is the foundation of building patient loyalty. One of the most common concerns with chiropractic is, “I heard if you go once, you have to keep going” or “They always wanted me to keep buying more packages.” These are all an effect of not Forecasting Care right from the start. This is all about care planning. 

Patients don’t want to feel constantly sold to, and we want to remove the situations where they need to ask themselves whether or not they want to pay more money to continue care. Tell them exactly how much care they will need upfront, and then there are no surprises along the way. Patients appreciate that – especially when coupled with convenient and affordable payment options!

Still not convinced? The numbers don’t lie. Based on the business model you apply, your retention is significantly impacted.

• Pay per visit patients tend to stay for an average of 12 visits. 
• Blocks of service (10-12 visits purchased in a block) patients tend to stay for an average of 24-36 visits. 
• Prepay patients tend to stay for an average of 75-100 visits, depending on the length of the prepaid plan. 
• Patients that pay with an automated monthly payment tend to stay for an average of 125+ visits. Once they have completed their corrective care plan that we forecasted, they are ready to transition to an indefinite, month-to-month wellness care plan.

In my own personal practice, with the 4 F’s applied, patients stayed for an average of 300 visits over five years. That’s 24 times the national average of just 12 visits!

Other Article: Formulas for Doubling Your Referrals

This brings us to the third retention principle, which is Frictionless Payments. 

So you’ve forecasted care, but now you need to complete that step and automate how you collect payments. Why? As mentioned in the bullets above, patients that pay with automated monthly payments stay the longest. In my practice, the only time the patient pulled out their wallet to pay was at the initial visit and to put their card on file. After that, everything was automated! I wanted to remove all repeated thoughts of money. 

This, coupled with Forecasting Care, will have the most significant impact. Just think of the patient knowing exactly how many visits they need and scheduling their monthly payments and then never having to talk about money again until it’s time to transition them over to wellness.

This transition is easy because their care has been built into their monthly budget, and when transitioning to wellness, that monthly payment goes down! It’s a no-brainer! They get excellent clinical news from the Feedback that their grade is now an A or a B, along with the good financial news of a lower monthly payment.

Now for the last retention principle, Frequent Contact for marketing and education.

I like to keep my marketing and education as straightforward as possible. All new patients get assigned an email campaign that automatically educates them on the benefits of chiropractic care once a week.

When people transition to their wellness care, they get assigned a campaign that automatically emails them, educating them on the benefits of wellness care. Our weekly newsletter matches the handouts we give people in the office and matches the topics we discuss while adjusting. The more automation, the better! 

You didn’t learn the wonders of chiropractic all at once, so don’t expect your patients to. Slowly and frequently educating them helps them retain and understand it. This method also allows us to remain top of mind. 

What else can you do to build retention?

In addition to the 4 F’s, there are several things that you can easily do to make sure you keep your existing patients. 

If you are in an office with staff, one of the biggest things they can do to help you retain patients is to have them become loyal patients. It helps if you have a team that is walking the walk and talking the talk. How can you expect them to help you retain patients if their message isn’t congruent and they don’t practice what you preach? 

Having a team that understands chiropractic is huge! What’s more, having a friendly and happy team at each interaction is incredibly vital to the practice. People come to us to feel better, and we want them to feel loved and cared for, and know that we are happy to see them. If you can’t hear the smile in your CA’s voice when they answer the phone, it’s time to put a mirror in front of them so they can look at themselves while they answer and self-check that they are smiling. It sounds silly but it does work!  

Another danger I see a lot that causes people to leave is not having convenient hours or not respecting the patient’s time. Having morning and evening hours helps a lot! And it gives you a nice long lunch break so that it’s sustainable for you and your team.

If your patient has to wait 20 minutes before they even see you, you need to re-evaluate how you organize your schedule. I like to cluster book a few patients at a time. I love my patients dearly, but if they need extra time to chat longer than the standard adjustment time, we schedule that outside of our regular adjusting hours so that it doesn’t slow things down. Then, you can give them the time and attention they need without having a reception room full of people that need to get back to their days.

As you can see, you don’t need all the bells, whistles, and shiny objects that money can buy to build a high retention practice. Keeping your existing patients can be as easy as applying the four retention principles I’ve outlined, and then making sure you create a welcome and efficient environment in your practice. Doing this will turn getting new patients from a necessity into a blessing! 

Check out our other articles!