As we roll into the final month of Q-1, Help Desk conversations with partners are reflecting two distinct trends in “changing of the tide” fashion.
One, we’re seeing a good many colleagues seeking additional doctors to keep up with appointment demand (as well as plan succession) and generally having a harder time getting someone hired than in times past. To be sure, this reflects the high tide of the past decade-plus.
At the same time, some colleagues are experiencing a mildly retreating tide, which, as retreating tide tends to do, has been first showing itself with detectably more no-shows and declining recall success rates, which has spilled into other measurables including overall revenue at the practice level and even fewer lens orders at the lab level. I’m certain these are early signs of recession and not a consequence of competitor pushes, changing consumer behavior or some other long-term trend. But whether what we’re seeing (particularly in the last couple months) reflects an oncoming recession or not, it certainly indicates we’re in a time to be paying very close attention to trends in our individual practices as well as across the Summit partnership.
I’ve long kept a simple way of thinking when it comes to practice success: The best way to be the best, is to STAY the best…
Bringing that into our conversation here, the best way to avoid any kind of weakening performance is to stay strong; and the best way to not be negatively impacted by a recession, which is not only looming but clearly actually here, is simply choosing not to participate.
Well how do we do that? How do we choose not to participate in a recession? Easy. We double-down on active participation AS A TEAM in the practice vital signs (metrics) that most impact sustaining and growing the practice in any economy. And the really good news is we can always impact those vital signs if we choose to do so.
Recession-Proofing Metric #1: Pre-Appointed Patients
Without a doubt, the single greatest strategy of all time for keeping the book full is pre-appointing. I don’t care if you leverage every technology and marketing trick in the book, pre-appointing well done will always, always outperform all other forms of patient retention and recall, and therefore, be the strategy most inclined to keep the book full despite challenges to make it otherwise. My objective for this metric is 90-percent-plus of patients pre-appoint their next planned wellness exam (I never use the word “routine” to describe what you do!).
So what constitutes pre-appointing well done? Three simple things:
1. What I call 4-Part Diagnostic Feedback during eye health testing for everything being examined in the eye health evaluation – specifically what you’re doing, for what you’re looking, what you’re seeing and noting for specific comparison next time, and when you want to do it (each part) again.
2. The DOCTOR, in the exam room, leading the patient to the pre-appoint. Simply put, none of us on the team can have the same impact when it comes to patients complying with setting up their next Vision Assessment and Eye Health Evaluation (note the two-part branding there), and that’s an exam room thing all day long. You address it, Doc, and it’s a done deal. Leave it to the front desk, and there’s a good chance of it not happening or ending up with a no-show.
3. A baton pass consisting of the doctor asking the appropriate staff person out loud, in the presence of the patient, if she/he would please get a Vision and Eye Health Appointment tine reserved for the patient.
Recession-Proofing Metric #2: Recall Success Rate
So Pre-Appointing is the most effective form of patient recall bar none, but however we’re dong recall, we need to be reporting as a team our success rate. Otherwise, how can we know how we’re trending and if we need to take initiatives to make our recall system better. I like an objective of 70 percent-plus of patients confirm (or reschedule for a different time) their planned wellness exam.
I prefer this vital sign reported specifically as the success rate on first patient contact, which is simply the percentage of patients who confirm (again, including rescheduling for a different time if need be) their scheduled yearly appointment on the first attempt by the practice. If your team keeps this another way, fine, as long as we know what we’re wanting to know – how well is our recall system (pre-appointing or otherwise) working and do we need to be taking initiatives or making system changes to improve results NOW.
Recession-Proofing Metric #3: No Shows
Ah those pesky no-shows, right? …Never are they not pesky, of course, but in times of broad recession and potential practice recession (which is NOW, Friends!), this one is particularly important and needs full team reporting and the full team’s attention every week. This is typically the first metric to send the signal that it’s double-down time on efforts to keep the book full, and like all practice vitals, I recommend we track outcomes on this one relative to a very specific objective, which I like to set at 5% and less (including the tough categories like Medicaid patients) to provide plenty of motivation for the team to really strive.
Important realization here. The number one reason for a no-show is the patient decided not to come. It’s not that they forgot or some conflict prevented them from coming (although of course both do happen, these reasons are often lies), it’s that something else beat you in a contest of value for the patient’s time, money or both.
Like all metrics, the key with no-shows is not so much the number, but the direction of the graph. It’s the TREND we’re seeking to impact when we manage metrics. If we see the trickle here, let’s avoid the stream, if we’re seeing the stream, let’s get back to the trickle, and strategies for doing so are the same we discussed above for pre-appointing. Although typically we look to staff when we think of appointments, it’s THE DOCTOR that can most influence our outcomes here with the case she/he makes for the patient being seen. Let’s make no mistake here.
Recession-Proofing Metric #4: Production Capacity
In all times, and especially in recessionary times, this is the metric most tell-tale of the immediate health of the practice, answering questions like will we make payroll, can we pass some of these labor and other inflationary costs on to our customer with a fee increase, should we drop a vision plan, should we hire staff, get an associate, take a partner, open another location, add specialty or even should we take out a personal loan for a home or car? Production Capacity – how booked-up we are – is the very best and most immediate indicator for these questions and most others.
Like the other recession-proofing metrics, Production Capacity is about patient retention. We obviously want and need new patients as well, but if new patients are the bulk of or even 30% of the schedule (provided the practice has been operating 5 years or more) and we’re still able to see everyone, we have a patient retention issue that needs the team’s attention and initiatives accordingly. I like an objective of 95 percent-plus on this one (which means some days might be 105 percent), and when we see this one hovering right around 100%, which of course brings it’s own challenges (but much more desirable ones than holes in the schedule), practice recession won’t be one of them. The keys, of course, to this kind of outcome are exactly the things we’ve highlighted here– pre-appointing, strong patient recall system, patient education on vision and future of vision, etc.
Recession-Proofing Metric #5: New Patients
Although most of the schedule in a successful and well established, practice will be established patients, New Patients is important to maximizing Production Capacity as well. This vital sign is also a major indicator of what things look like for the practice a year from now and out.
I’ve long held the New Patients metric is the practice’s future-telling crystal ball for practice growth, expansion and even practice transition, but it’s also important to the practice’s outcomes today. I like an objective of 20 – 30 percent here, of course a good bit higher for newer practices (100 percent new patients in the very early going!). This is where we leverage our internal marketing strategies for increasing referrals (which we can typically increase 15 – 25 percent with a strong Referral Enhancement Program), as well as our branding, signage, digital and external marketing strategies to reach out beyond our current patient base and walls of the practice.
Recession-Proofing Metric #6: Revenue-per-Patient
Then, of course, comes Revenue-per-Patient, and an interesting thing indeed is the relationship between this vital sign and Production Capacity. Oftentimes, the closer we are to 100 percent Production Capacity, the lower a practice will see it’s Revenue-Per-Patient. So interestingly, when we see a recession impact of lowered patient volumes, we might actually see higher Revenue-per-Patient that comes with having more time to spend with patients.
That said, a recession-tending economy can certainly negatively impact the so-called average spend about everywhere, including the practice. And the beautiful thing here is that if we just stay focused on the practice mission – the highest quality of life we can give our patients – even double-down on our efforts and initiatives like multiple functional recommendations and strong product baton pass, we can typically keep this one healthy.
The most encouraging practice economy of all is when we see a strong Production Capacity metric (over 95 percent), a strong New Patients metric (over 20 percent), and a strong Revenue-per-Patient ($475+). That’s when we’re a steam train that will be hard for recession to slow down. Again, the best way to be the best is simply to stay the best. Just don’t stop being that. Control what we can by doubling-down on full-team management of all six of these recession-time key economic indicators for the practice, and let’s throw a defiant chin at the recession!
And by the way, Colleagues, this all being said, what a great opportunity we have to detect trends and manage outcomes together with the Summit/THRIVE MetCHECK Metrics Tracking! If you’re not yet doing so, this is EXACTLY the time to start sending in your metrics each month as we benefit from the colleagueship of Summit!