It happens to us all – we look at the schedule at the end of the day and immediately zero in on the cancelled, missed and no-show appointments that light up the screen like a Christmas tree.

The staff makes a couple of attempts to contact them and get them back on the books; sometimes there’s success and other times it becomes a ‘wait and see’ if they call back scenario.

Then, every once in a while we ask our front desk “hey what ever happened to Ms. Jones? Oh, and what about that new one that came in last week?”  Once again an, often random, attempt is made to contact these M.I.A. patients and the pattern repeats week after week.

The cost of these scenarios is a huge part of the reason why many clinics are not making nearly the income they could and should? If you average $100 per patient visit and have just one missed appointment per day that is not rescheduled for that same day or week, in a 20 workday month that’s a loss of $2,000 for that month.

And what about those patients that fall off the books and never call in again?…not because they don’t like you but just because they get busy. If the average patient comes to your clinic even just 10 visits per year, at $100 per visit that is $1000 lost per patient per year. Multiply this across losing even just 2 patients per month into the abyss and you can see how it adds up – that’s 24 patients lost per year x 10 visits each = 240 visits lost. At $100 average per visit we are looking at losing $24,000 a year.

Now, I’m using conservative missed appointment numbers but you can see how the loss really starts to add up.


The Solution

The reality is that we all have patients that no-show, cancel and don’t reschedule or just for whatever reason disappear. And most of us also have our staff make an effort to get the lost patients back in. In most cases however I find that effort to be haphazard at best.

To truly keep a full schedule where patients are put back on as fast as they fall off requires a rock solid never-miss system.

My suggestion in putting together your own foolproof system is first to divide it into two parts. The first part is a Recall System.


The Recall System

Your Recall System is a set protocol your staff will follow each day to get patients back on their treatment schedule. I recommend you structure this so that the patient is contacted daily in some way (call, email, etc) or some combination of ways.

Do this for 3 to 5 days depending on how aggressively you want to pursue those patients that have fallen off the schedule.

The 2 essential components of a successful Recall System are

1. TRACKING: It is the process of tracking each patient each day that prevents one from slipping through the cracks and getting missed on the daily follow up. Make a special column on your schedule or a spreadsheet to put the missed appointments on until they are either=

a.  re-scheduled or

b.  through your entire Recall process (at which time they are shifted to a next follow up protocol I’ll explain below)

2. ACCOUNTABILITY: By this I mean that each day’s ‘recall’ activity must be noted and initialed so that you and other staff people know who performed each follow up step.

The second critical part of your No-Patient-Left-Behind campaign should be a Reactivation System.


The Reactivation System

Most of us chiropractors would define our ‘Reactivation System’ as a protocol or effort put forth to get patients who have gone missing back onto the schedule as an active patient. Those efforts may consist of various methods including

– Calls
– Letters
– Emails
– Text messages and so forth

Which of these is best to use? They all work well IF you use them. The main problem I find with chiropractors I work with is that while they make reactivation efforts, they don’t have their staff using an actual ‘reactivation protocol.’

The key is to get organized. A simple way to start is to create a spreadsheet of all patients that haven’t been in for longer than 6 months and just start a campaign to contact them in one or multiple ways. Just as with the recall system, the key to success is ‘tracking’ (so no steps are missed) and ‘accountability’ so the clinic owner can see what’s been done, when it was done and by whom it was done.

Perhaps the most important, yet most overlooked, aspect of the Reactivation System is that it should actually tie onto the end of the Recall System. That’s essential for you to understand and put in place to develop a foolproof protocol. The Reactivation system must start where the recall protocol stops. In other words…

… every patient that your staff does not get rescheduled through your recall system should be ‘picked up’ by the reactivation system.

So if your recall protocol runs for say 3 weeks with calls staggered in certain intervals, at some point those patients that are not rescheduled should be shifted out of the Recall System and be picked up by the Reactivation System at which time those efforts begin on that patient.


In summary, a perfect Recall and Reactivation System should have these components:

1.  A step by step method of tracking every missed appointment that is not rescheduled the same day [Do not just leave this up to your staff to handle as they desire… Big mistake! Have a step by step system] 2.  Every time a staff person makes an effort within either system they MUST in some way denote what was done and who did it [Accountability is essential] 3.  The system must be consistent. For example, each missed appointment is contacted daily for X number of days and then contact in X weeks and then in X months
4.  Have scripts that you practice with your staff on what to say and how to respond to common questions or objections
5.  The system must seem helpful to the patient, not bothersome!

While implementing a system to retain the patients you have is not nearly as exciting as discussing some new ‘surefire’ marketing angle, I hope I have impressed upon you how vitally important this is to your bottom line.

This is not something to put off until tomorrow. This needs to be the very next thing you fix in your clinic! Just like we tell our patients also applies to our own schedule – “you need a solid foundation (be it spine or schedule) in order to build a stable house” (be it health or a busy and successful practice).

It’s the cracks in the ‘foundation’ that are costing you a fortune! Mend every crack and you will succeed in keeping every patient you work so hard and often times spend so much money to attain.

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