When I started managing the revenues for this practice, we were at 4 provider FTEs.

Granted, I wasn’t thrilled about the provider utilization and thought that we could do more towards it.. But a month ago, we took on 3 more provider FTEs… and of course, another $4MM added to the quota.

As you can tell, that wasn’t the most comfortable moment for… anyone 🙂

Much of our business comes from physician referrals… that’s the bulk of it.

We had recently added digital marketing / lead generation to the mix of it as well .. that’s still in infancy stage and I will go into it later..

Quick, back of the napkin calculation gives me 7 FTEs * 4 appts/ hr / FTE * 8 hrs / day = 224 visits to generate per day.

Keep in mind that we are open on Saturdays as well (not all our locations).. But even if I ignore Saturdays, this means we need 224 * 20 days = 4,500 visits per month..

A quick look at our cancelled + no-show rates tells me that it’s less than 30% (70% of our patients show up)… a number I refuse to believe and will have to confirm later after poring through the reports from our EPM and EMR.. don’t ask me why they are two separate entities… just go with it.

So, that means, we need about 4,500/0.7 … about 6,400 appointments on the books every month… to achieve 100% provider utilization.. (yes, it’s a pipe dream, but you gotta start a year with dreams)..

Hmm.. OK.. fine..

OK, first things first – let’s get a handle on what the baseline is.. In other words, how many appointments we are doing right now. A cursory look tells me we are hovering around 2,500 appointments per month.

2018 YTD numbers in Sept

  • 25,473 total Appointments
  • 6,677 Cancelled
  • 292 no shows
  • 12,092 confirmed
  • 12,092 new patients

2017 numbers

  • 27,727 total Appointments
  • 7,408 Cancelled
  • 817 no shows
  • 9,285 confirmed
  • 9,285 new patients

So… that needs to, magically, become 6,400 appointments / month?

Let’s quickly go over some conversions & utilization data we have on hand.

2018 YTD data

  • (6,677 Cancelled + 292 no shows) / 25,473 total Appointments.. 73% conversion
  • 4 docs, 18,500 appointments over 36 weeks (180 – 200 days) = 20-23 appointments per doc per day (78 % utilization)

2017 data

  • (7,408 Cancelled + 817 no shows) / 27,727 total Appointments.. 70% conversion
  • 4 docs, 19,500 appointments over 50 weeks (250 – 300 days) = 16 appointments per doc per day (50 % utilization – hey, we got better 🙂 )

What can I do right now to get a better handle at this?

Well, let’s look at where our appointments come in from

  • Call-in w/o Referral
  • Call-in w/ Referral
  • Walk-in w/o Referral
  • Walk-in w/ Referral
  • Referrals we call
  • Zocdoc
  • Patient recall (or reactivation) – found out that we have zero
  • Organic (Website) – found out that we have zero
  • Paid media (ads/PPC) – found out that we have zero
  • Earned media (mentions) – found out that we have zero

Now, let’s look at the breakdown of “Referrals we call” (keep in mind only Appointments made end up in our EPM – the rest are LOST)

I still have no good handle on the following…

  • Referral outcome
  • Referrals that didn’t convert to appointments
  • Top referrers / referral volume by provider/facility
  • Splitters (Physicians referring to competitors as well as us)
  • Loyals – ours, Loyals – competitors’

Options to consider:

  1. Increase the number of appointment requests generated by digital marketing (adwords)
  2. Increase the number of referrals from our physician partners (can’t quite predict this with any accuracy, nor influence it too heavily as they are “channel partners”).
  3. Reduce the no shows (tough one to do with our patient population)
  4. Convert more of the incoming referrals into patient appointments (I know we didn’t do a good job at this and were missing out).
  5. Run a patient reactivation campaign to get some of the patients

I set to looking at “Short term improvement opportunities”

First up was our “referral pad” opportunities

  • Research shows 35-45% of referrals actually reach us. I.e out of 100 “referral pad” referrals, 40 patients call us.
  • Assuming half of all appointments were from faxed/called-in referrals
  • Means 14K/40% = 35,000 referrals from physicians were made (40% reached us to make an appointment)
  • We missed (35K – 15K) = 20K referrals/leads. This one hurts.. Really, hurts..

Referral pad issues.. When you have referral pads (that’s how business runs really), we don’t know

  • Who is sending us referrals
  • How many patients they are sending us everyday
  • How many patients are not calling to make an appointment

Darn – this really ticks me off. So much revenues are leaking out..

Next up, let’s look at “faxed referrals” opportunities

  • Assuming the other half of all appointments were from faxed/called-in referrals
  • Our staff claims they convert only about 20-30% of incoming referral faxes/calls (we don’t have the correct numbers yet)
  • Means we were sent 14K/25% = 56,000 faxed/called referrals from physicians.
  • We missed (56K – 14K) = 42K referrals/leads.

OK, can we say yikes??

Then again, there’s faxed or called-in referral issues to deal with..

  • Typos or wrong info and we need to call each patient (no one dedicated to doing this).
  • Staff reaches only 20-40% of patients on phone (voicemails). Call pending volume adds up per week
  • Too many missed leads/opportunities

A simple look at our backlog looks like this for “faxed referrals” – (sample weekly backlogs.. just numbers to show what backlog can turn into)

Who in the world is going to call that backlog every day and every week?

Next up on my list was to look at “Cancellations” – opportunities.. In other words, how many of these cancellations can I convert back to appointments on the books?

  • Are we rescheduling cancelled appointments when they call? Don’t know

If not.. Why not??

  • Are we calling cancelled appointments later to reschedule? Don’t know

If not.. Why not??

  • Missed opportunities based on 2017 and YTD data (6,677 Cancelled + 7,408 Cancelled)

Best case – 100% conversion = 14K appointments

Worst case – 20% conversion = 2,800 appointments


I turn to looking into “Patient recalls” – opportunities

According to our EMR – 24,004 patients (lifetime – it’s a young practice really)

What are our Patient recall / reactivation opportunities here? Basic back of napkin numbers tell me

  • 50 % recall – 12K new appointments
  • 5% recall – 1.2K new appointments

Are we maximizing patient recalls/reactivations? (are we doing any?)

  • Pre-schedule phone calls – yup
  • SMS based recalls /reactivations – nope
  • Postcards/mailers – nope
  • Increase points of contact (takes avg 5-7 contacts for a patient to notice you) – not really, who has the time?

My next task was to add them up – game of numbers really 🙂

  • Referral pad opportunities – 20K referrals/leads.
  • Faxed referrals opportunities – 42K referrals/leads.
  • Cancellations opportunities – 14K leads
  • Patient recalls opportunities – 24K leads
  • No shows – TBD (I don’t trust the numbers yet)

By doing these.. What can we expect?

  • Net-net = 100K leads
  • Can we convert 10%? (uplift of 10% is reasonable)
  • Can we get a 10K uplift?
  • Can we improve our top line by 35%???

Stay tuned.. this is going to be fun.