Patient Turnover

DPC is not like other practices.  Patients are paying monthly and will sometimes leave due to moving, insurance or just not wanting to pay anymore.  In other non DPC practices, they can stay part of the practice for three years before sometimes being terminated.  In other words, their turnover rate is very low.  Here we discuss the DPC patient turnover issue:

  1.  I have about 520 patients. I have archived 169. So about 700 have joined. Some are mistaken charts and redundancies but let’s say it is 150 that have left. Wow. On one hand I can say that maybe we need to do a better job but honestly, I don’t think we any glaring problems. There are a few pts that needed to go. There are few pts that we could never meet their expectations. There are some that moved. The others just don’t want to pay for their health. It just isn’t worth it to them to get the best care. They would rather be in denial and NOT know about their medical issues and just take that vacation, buy that car, etc. I am sure there are other reasons. The bottom line is that YOU WILL get turnover and it sucks. It is not like other practices. If you compare it to a gym then I bet we are pretty good. (looked it up. Gyms: 2/3 of people who get a membership in a gym never use it and 60% retention annually is good).
  2. actually think those are impressive numbers. 520/670=77+% retention rate. And remember we are asking people to pay out of their pocket for something that is relatively new and different from the current system. That’s *radical*, even though we are great and give kick ass service, and we know that.
  3. We have a pretty good retention rate. We clean house once in a while and discharge patients, then just accept new ones off the wait list. We counted the other day–we’ve got patients in 14 states!
  4. We have 462 pts,, have seen about 650 individuals. Some were one time visits in the beginning, so prob 600 total who said they would be members. The attrition is something we need to talk about so people can plan. And MAN the first 3 years are a f*ing CLIMB. a climb. The last 2 months I am cleaning house . We’re terminating patients who haven’t paid or stayed up on their balance and really tightening down our payment rules. I think this is going to help a ton.
  5. You’re not joking about the f’n climb. It is frustrating when we risked so much and some folks just don’t seem to care. We have never had a revolving door like this, so I have started to cut back on the amount of time I spend in the first visit which can be a huge time suck. I stick to the hx like an acute visit and just review their online registration when doing that note.
  6. Has anyone done any formal or informal “research” on the primary motivator for patients joining the practice or formal or informal exit interviews with patients to determine their reason for deciding to cancel their membership? If so, how did you do so and what did you learn from it? Trying to figure out what my patients are really looking to get out of their membership as well as how to retain my current members
  7. his thread has been really eye opening, I’ve been stressing about every patient who leaves (we are 6 months in) bc everything I had read quoted >90% retention rates for DPC and Concierge practices. We were counting on the “once you get ’em through the door they stay” mentality and it is helpful to know that all of y’all kick ass dedicated doctors have patients leave too!!
  8. Most of the people I have leave are moving out of town. Some of them we weed out. I remember freaking out everytime someone left but that fades
  9. My nurse and I were talking today…..it seems the people we worked the HARDEST to convince of our value are often the worst– high utilization, partial payments, use us then quit, more demanding…. The people who get it in the beginning tend to turn into the best patients. Our departures have moved, not paid or had an acute type issue, used our services a ton, then went awol. We’ve had about 3 total narcotic issues that led to terminations… Most are people who don’t get/ want the long term relationship or who simply can’t afford anything..
  10. Toughest part of the DPC practice is the roller coaster of patients. Too much turnover. I think, from what I hear from others, is that this is the norm. Patients forget how bad it was in the other practices. Or they just hate seeing the money come out of their bank account. Or maybe I am not giving them the service or care they need? Also, there are these fence sitters that you just know are ready to bolt if you screw up once. It can wear on you. Thought I would vent.
  11. Yup. Seems like every so often, we have to weed some of the folks who paid once and never came back because they either lost interest in continuing, never intended to stay after their needs were met initially, or don’t see any point in paying for DPC since they just got insurance coverage.
  12. We don’t have a ton of turnover, but we do have patients sign an annual contract. However, the annual contract definitely slows growth of the practice. Patients don’t feel comfortable signing a one year agreement, unless they know the doc. We have ways of working around that, but were thinking of dropping the one-year contract and going month to month. I worry about just the thing that mentioned, however. Thought about adding a $100 activation / reactivation fee so that if a patient just came in one time and disappeared, their out of pocket would be $160, which is about what we get for a level 3 office visit. Of course, the fee would also scare some people away.
  13. Yeah, I do the $75 per person registration fee up to a total of two per family. It does work. Nothing is perfect though. The reality is that there is more turnover in DPC because it is out of their pocket
  14. Last month I saw one guy who is several months in arrears. I leaned on him for payment. He hadn’t been in for quite a while to monitor his very high BP despite our efforts to get him in. His response, “It must be nice to get paid for not doing anything.” First, not my fault he didn’t come in. Second, he wasn’t paying me anyway. .
  15. Tell him he still pays for his cell phone when it doesn’t ring, and his electricity when all the lights are off, and his rent even when he’s on vacation. Watched Idiocracy with my 4th year med student tonight (part of my curriculum), your guy is an example of the coming stupidity.
  16. We hunt everyone down the moment they don’t pay. They never get two months behind or we dismiss them. Haters are going to hate. I do give away about 10% of my care for free so I have no guilt.
  17. I give them 2 months of non pay, then discharge them. My sign up fee is 50.00 per person, no discounts for family sign ups. That way I know they are invested. Also raised my re-sign up fee to 250.00 recently bc of some BS.
  18. We will steal some of the group member’s practices of suspending people who are 2 months behind, extend our commitment from 3 to 6 months, and consider an upfront registration fee.
  19. I do a significant registration fee, in person or phone intro visits and focus on getting my ideal patients into the practice. Slower growth but less turnover.
  20. I have heard this as well. I was struggling with what to actually do since I am just starting. I know that having a contract, charging more months at a time, or using an enrollment fee makes it more complicated and possibly slower growth, but at the same time establishing patients that never come back is extremely frustrating and a complete waste of time and abuse of our system. I decided on a registration fee at in the end but may change in the future depending on how things go. If you guys have any other tips definitely share them.
  21. No registration fee for us. We’re 4 minutes months in still in a strong initial growth phase as more and more people here about us. We’re also benefitting from our former practice being such a shit show that they’re driving patients our way. We’ve had a handful of early adopters leave after a few payments but they didn’t really understand the model to begin with so no worries (yet).
  22. My 2 cents- I think the minimum is a better way to go compared to a registration fee. Patients will see they are actually getting something for their money (“hey, I committed to paying 3 months so I might as well get care”) and then you have time to convince them of your value
  23. I don’t do a registration fee and it hasn’t burned me too bad yet, but I’m only 7 months in. I think for most people it adds trust to the relationship pretty quick. There will always be people that abuse you, but I’ve found it to be pretty minimal, usually 3-5/month that I drop. I tell patients my goal is to give them so much value that they would think it’s dumb to leave the practice.
  24. Every gym uses a registration fee and it does protect you from the one and done.
  25. 1: charge a sign up fee. we added that at about 18 mo mark for 3 reasons– it sets the prescedent that your patients pay you directly, it covers your first visit time (a little) and it’s a barrier to entry. We’ve had people come in for their establish visit and say “I don’t have the money right now but…. ” bad start. We’re going to raise our sign up fee for all of the above reasons, as well. For families we just charge one join fee. 2: ANY actual expense you incur that you are unwilling to pay out of your own pocket are due when they are incurred (labs, IMAGING, drugs.) unless you are CERTIAN the patient is good for it. 3: our drop off /terminate polulation is about 1% per month ( actually a little lower .. 1-5 people per month ) unless a family of 7 moves out of state. I know some people have in their contract that 30 or 60 days without payment automatically terminates the agreement. I’m kind of thinking of adding that in —
  26. We have an enrollment fee that is applied once per family/household. What may be more important would be a re-enrollment fee, to discourage the one-and-doners from leaving and thinking they can come back easily. Our enrollment fee +1st month of care is about equivalent to one urgent care visit, and we are much nicer and prettier, so initially we had a lot of that business happening. Once we weren’t so hungry for patients, we were able to screen much better on the phone. If the only question someone asks is “How soon can I be seen?” we usually discourage them from joining us.
  27. No enrollment on the advice to avoid putting up barriers to sign-up – but I’m starting from scratch, also. So far so good. Also my legal counsel advised no minimum time can/should be enforced dt ethical standards – I have an annual contract but patients can opt to leave at any point to the doctor of their choice (I ask for 30-d notice in terms of payment). So far haven’t run into any problem, and I “suggest” folks give it 3 mo to give it a fair shake – all so far have been willing. Also do have the re-enrollment fee – in the form of making up lost months if they leave and then want to come back.
  28. DPC has been a revolving door for some! We know who our at risk patients are: those who have no insurance and want to pay cash/money each month instead of credit card on file for autopay and those without insurance, who get employed with insurance, no matter how shitty the plan, they are happy as larks, and say they can’t afford to pay both. It’s definitely an adjustment for us having this type of turn over. We remain at a steady state in terms of practice size, but it seems to be the way it is in our area.