Depending on who you ask, it can be any patient who’s been in for some kind of service in the past year or two. From my experience, it’s normally defined as a patient who’s been in within the last two years.
OK then. How would you define an “inactive patient”?
Using the criteria above, this would default to someone who hasn’t been in the office within the past two years. You could also add patients with whom it is confirmed that they will not be returning (moved, etc.).
In the case of buying or selling a practice, I’d have absolutely no problem using these definitions when working to establish the sale price.
However, if you’re using these criteria in managing your practice – I believe that you’re making a grave mistake.
From my experience, the most common reasons patients are termed “inactive”by a dental office are:
- The patient says they don’t want to come back,
- The patient has passed away,
- They’ve moved out of the area,
- They’ve changed insurances and are now on an HMO or PPO plan for which the office is not a provider and
- The patient misses their recare (or other) appointment(s), the office tries to contact them a few or several times to reschedule and if they cannot be reached, they are deactivated when the office does chart audits.
Reasons “1” through “3” make sense. Number “4” is not an absolutely “black or white” issue and I’ll cover this later in this article. Reason number ”5,” however, makes no sense.
Based on personal experience and observation, along with numerous discussions with dentists, reason “5” above is the most common reason a chart is made “inactive.” In other words, in many cases the majority of a dentist’s “inactives” fall into this category.
Usually after a patient misses or cancels their recare visit, there’s some follow-up – a few phone calls, a postcard or two. But in the main from what I’ve found it’s not much. I’ve seen cases where the patient wasn’t followed up at all, only to be “deactivated” two years later during a chart audit.
In my discussions on the subject with doctors and office managers, I’m always assured that these records are kept handy and that if any of these patients happened to call back in, they would, of course, be scheduled for an appointment. Unfortunately, the consensus is more or less that once a patient is made inactive, there’s no real effort to contact them.
For a practice to spend however much it spends marketing for new patients, or in the case of referrals, the time and effort building enough goodwill to get them, it makes little sense to turn around and “drop” a patient after a few phone calls go unanswered or unreturned.
The Incorrectly Labelled “Inactive” Patient
Have you ever had a patient come back to the office after being gone for two, three or maybe more years? Chances are you have.
Now, did that patient ever think of themselves as an “inactive” patient due to their absence from your practice? Probably not. In their mind, they just hadn’t “been there in a while.” I think you’ll find this to be the case with most patients who you consider to be “inactive.”
Look – people get busy, life happens, things happen. They tend to forget about things. It happens to the best of us. Don’t take it personally when a patient hasn’t been in for a while and write them off as “someone with a low dental IQ who doesn’t care about their teeth.” Instead, take a different viewpoint – they are your patients whether they are showing up or not and your office’s job is to work with them to get them in and help them.
From a business standpoint, approaching it any other way means that, at best, you’re wasting a portion of your patient base and any goodwill or potential referrals they might bring.
And keep something else in mind: you’ve probably had a patient or (twenty) that, despite your best efforts, hadn’t been in for years. All of a sudden, they have a problem – toothache, etc. They show up, you take care of them and find they experience resurgence in their desire to take care of their dental health. They come in for a new initial exam, follow through with their treatment and become a regular patient. We’ve all seen it. While they were initially motivated to take action because of a problem, they followed through with the rest to avoid future problems due to a renewed sense of importance for their dental health.
With all of this in mind, let me pose two scenarios:
In Doctor “A’s” practice, they “deactivate” a patient if they haven’t been in for two years. No communication follows. They file the chart away or deactivate it in the computer.
Patient “X” has been deactivated. It’s been four years since he’s seen Dr. A. He gets a toothache. Having heard nothing from Dr. A for about two years, there’s a fair chance he’ll call another dentist.
In Doctor “B’s” practice, they stay on top of patients who aren’t scheduled with regular communication and mail (letters, newsletters, etc.) regardless of how long it’s been.
Patient “Y” hasn’t seen Dr. B in four years. He has a toothache. He’s received regular mail and occasional phone calls (as part of a reactivation program) from the office to schedule an appointment. He never appointed, but always appreciated the calls. The regular mail and newsletters from Dr. B have in effect kept Dr. B’soffice “on the brain.” Who do you think Patient Y calls for his toothache? Most likely Dr. B, as “Dr. B is his dentist.” He hasn’t been “forgotten about” even though he hasn’t shown up.
Now, of course, this is simplistic. Other issues such as customer service and whether the patient actually liked the office come into play. But I hope you see the moral here.
In Patient “X’s” mind, Doctor A is a dentist he saw four years ago.
In Patient Y’s mind, DOCTOR B IS HIS DENTIST.
When to Deactivate a Patient?
For MGE Clients, we suggest a simple philosophy as to when to “deactivate” a patient:
- The patient doesn’t want to come back.
- The patient has moved very far away (i.e., out of state) and has said they won’t be coming back.
- The patient has passed away.
- You decide to dismiss a patient.
And that’s about it.
Note: If you find yourself dismissing a patient, make sure it’s for a good reason and always ensure you do it per the letter of the law as outlined in your state’s Dental Practice Act or other applicable laws. I would also suggest consulting your attorney and/or malpractice carrier if you wish to dismiss a patient to ensure you’re doing it right.
What about Patients Who Join an HMO or PPO?
Of course, you may run into issues where a patient joins an HMO or PPO in which you don’t participate. Does this mean you should drop all communication and “deactivate” them? Not necessarily.
In the case of PPO patients, there might be no problem at all, depending on your fee schedule. HMOs may be a different story.
While you would take a patient who’s left your office to go a participating dentist off of any recall lists, you can still keep them on any lists for newsletters and any type of seasonal mailings you might do. So, while you may not follow up with phone calls, they could still receive regular communication (mail) from your office.
It’s a lot more common than you might think for a patient to leave an office to go with a participating dentist, only to come back to their original, nonparticipating dentist. The reasons vary – they liked the old office better, the HMO office made them wait too long, etc. Either way, if there’s a chance this might happen, regular mail only facilitates this process. At worst, you might get a few referrals from this ex-patient.
Very often, I’ve found that marketing to past and present patients gets a higher response than to potential new patients. Why? At least your past and present base have an idea of who you are and have actually been to your facility. Potential new patients have never met or seen you before. This doesn’t mean you don’t market to new patients. It means that you shouldn’t ignore your existing base.
If you would like some direction on this issue, ask for a copy of our “Reactivation Program.” It includes a step by step procedure for reactivating your patient base, along with sample letters and the like.
If you really want to go all out, come and do the MGE New Patient Workshop. We’ll show you how to cover all the bases – internal marketing and external marketing for new patients along with information on how to reactivate your existing patient base.
Just remember, whether a person shows up regularly or not, they are still your patient. Treat them that way.
Wishing you the best!
Jeffrey Blumberg provides this general dental practice management advice to furnish you with suggestions of actions that have been shown to have potential to help you improve your practice. Neither MGE nor Mr. Blumberg may be held liable for adverse actions resulting from your implementation of these suggestions, which are provided only as examples of topics covered by the MGE program.