Optometric Management Tip # 271 - Wednesday, March 28, 2007
Many readers were surprised to see preappointing listed in my top ten
misconceptions article. After all, as I heard from many of you, itís working
great in lots of practices. And I donít doubt that. I firmly believe there is
more than one way to build a successful practice. I would not recommend dropping
a preappoint system that works well. I really donít feel all that passionately
about the type of recall system used in a practice, as long as some system is in
Preappointing is not necessarily a bad thing at all, but it also should not be
considered as the ďkey to building a busy practiceĒ as I worded it in the
article. My own practice and many others that Iíve seen are examples of very
busy, high gross practices that use a mail recall system. That is why
preappointing made my list of misconceptions.
Weigh the good with the bad
There are pros and cons with all recall systems. Preappointing enjoys a higher
rate of return than other methods, but here are the negatives many proponents
- Lower revenue per exam. When your schedule has a higher concentration of
patients with no complaints, your average gross per patient drops. I like
some self-selection of patients so the people in the exam chair actually
want to be there or need to be there. I like to see an average gross per
exam of $450 to $500.
- No shows. Even with multiple confirmations, preappointing leads to
greater no shows and last minute cancellations. Some people will go along
with the program each step of the way, but if they really donít want to come
in (often a money issue), something will come up at the last minute that
conveniently makes them miss the visit.
- Awkwardness at checkout. Setting an appointment for three to six months
for needed eye health care is readily accepted by patients. We do this in my
practice all the time for glaucoma patients and other follow-up visits. This
is also why preappointing works so well in dentistry. But when your office
tries to set an appointment for a routine eye exam one year in the future,
the perception changes. Even with good education, patients want to think of
routine eye care as something under their control. They generally agree that
regular exams are important, but they want to decide exactly when to come
in. Part of the reason is financial, although no one wants to bring that up.
Most people need to plan for any purchase that runs hundreds of dollars.
- Is it an appointment or not? The more specific your staff is with the
future appointment (March 30 at 2pm), the more resistance they will feel
from patients. The trend is to keep it very general (weíll just reserve some
space for you next year); but that technique leads to some surprised
patients next year when they learn they have an actual appointment they
never agreed to. The very fact that most offices use the general approach is
evidence that their patients donít accept preappointing all that well.
- We need to save some space for you in our busy schedule. This is the
clever line that many offices like to use as justification for why they need
to set the appointment one year in advance. Otherwise they would just send a
postcard and leave it up to the patient to call. The problem is that it
lacks credibility. Patients know from other sources and from experience that
they could call up almost any eye care office and get an appointment within
a few days. It reminds me of those often-used ads by health professionals
with the line that reads ďNow accepting new patientsĒ. I think almost
everyone knows that very few practices donít accept new patients and it
seems kind of silly.
- It smells like a business strategy. Patients really are smarter than we
think and they can easily spot an effort to make them return for profit
reasons. We can see it in other businesses and they can see it in ours. Be
careful of overly aggressive pressure to return in the name of ďpatient
educationĒ. That can alter the image of the practice as money-hungry rather
than one with a primary concern for eye health and good vision.
- Resentment and patient loss. Realize that all practices have patients
who quietly leave them for other eye care providers. Itís hard to track this
group, but the effect is extremely important to practice revenue. Some
practices have a high dropout rate and some have a small one. Of course,
when preappointing is done well, it does not actually annoy anyone, but many
systems go awry over time. Many staff members simply canít implement a
system with subtle nuances flawlessly. A simple, honest procedure designed
to remind people when they are due for their next exam really canít be
- Staff hours. A well-managed preappoint system requires a lot of staff
hours. There are multiple phone calls and mailings needed to confirm,
reschedule and chase down the people who are hard to reach.
A mail/phone recall procedure
My preferred recall method is a letter or post card mailed one month prior to
the recall date, with a follow up post card one month later to those who do not
schedule. This approach is easily processed with every major office management
software program on the market.
To improve the recall success rate, a follow-up phone call to patients who do
not respond to either mailing can be added if the practice has a very friendly
and caring staff member. The phone call must be very non-confrontational and not
pushy. It is made to check that everything was OK with the previous service and
to ask when the patient would like to be recalled in the future. Many of these
will simply schedule on the spot.
The recall system should be set up to occur each year for at least five years,
unless the patient instructs your office to stop.
The key to a busy practice
So what is the key to a busy practice if itís not preappointing? Itís customer
service. Itís creating an environment where the patient knows their needs come
first and where eye care is different and exciting. A successful business is one
where customers want to return.
Best wishes for continued success,
Neil B. Gailmard, OD, MBA, FAAO
Chief Optometric Editor, Optometric Management