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A colleague recently asked me about the patient recall system I use in my practice and he mentioned that he did not remember seeing a tip article on the subject. He's correct that I don't write much about recall methods, even though it is a very important procedure in practice management. To me, the type of recall system utilized is an individual practice decision and I'm not out to change your mind on which method is best. Recall procedures should fit the personality of the practice. Having said that, I'll review the options available and discuss the nuances of each system. No matter what recall method you use, it's very important to do it well.
Recall starts in the office
Successful recall begins with the patient in the exam chair, regardless of the method used. It's too late to begin a recall effort one year later when the patient is due for reexamination. One of the most important ingredients for improving success is for the doctor to tell the patient the reason the next exam is needed. That will vary on a case by case basis, of course, but it should be part of the case summary and recommendations for every patient.
Staff members play an important role in recall management, but the doctor is the one who decides when and why the patient should be seen again and the message has maximum punch when the doctor discusses it. There is often more than one reason for the next exam, but it's effective to single out the main factor for the patient. Ocular health concerns are far more effective than refractive issues if you have multiple diagnoses. The doctor may say, “Jim, I want to see you for another exam in one year so I can monitor your risk factors for glaucoma. My office will send a reminder card when you are due for your next appointment.” Following the statement, look for agreement from the patient.
It's very helpful for technicians to reinforce the recall message by mentioning that key tests should be performed yearly or more frequently, as the case indicates. Receptionists should review the recall date and how the patient will be notified or reminded.
For patients who have completely normal visual systems, you should decide on your philosophy for regular eye exams and share that with the patient. Some doctors feel the intervals should vary by age group, but I generally recommend a yearly eye exam.
Setting up the next appointment before the patient leaves the office is a popular recall system and doctors who use it are often strong proponents. Here are a few thoughts:
Preappointing is generally regarded as having the highest recall success rate.
There is an art to presenting the concept to the patient, especially if the case does not have a serious medical diagnosis. Some patients will embrace the idea of setting up an appointment a year from now, but many will feel like it's pushy. Patients often don't reveal their true feelings at the time; they may go along with the office routine just to be congenial. If preappointing is perceived as a way for the office to generate business more than serve the patient's need for eye care, the image of the practice will suffer.
Is it a real appointment or not? Many offices obtain good acceptance of preappointing by making it seem less specific. “We'll reserve some time for you in our schedule for next year and we'll confirm the date and time when it gets closer” is a typical statement used by receptionists. Patients may not think they actually have a firm appointment.
The appointment schedule should have some way to indicate which appointments were preappointed a long time ago and which ones were actively made by a patient who called on the phone
Preappoints must be confirmed and reconfirmed. Some practices send a written notice of the appointment date and time and ask the patient to call to reschedule if needed. Patients who don't respond are called by the office staff to confirm. These calls must be made far enough in advance to allow vacated appointment slots to have a good chance of being filled by others. A final confirmation call may be done the day before the appointment.
Even with all the confirmation effort, preappointing usually results in a higher no show rate than a conventional appointment system where people call to schedule themselves. Some patients are not really ready to spend the money for an exam or optical materials but they go along with the process until the very last minute, when any little thing comes up and prevents them from keeping the appointment.
Preappointing may result in more appointments, but many of them result in no Rx change in glasses or contact lenses because a larger percentage of patients with no complaints are seen. The average gross revenue per patient is often lower with preappointing.
Preappointing may be used for all visits that are needed within less than one year (three month or six month checks), but a different system is used for yearly recalls.
A good technique is to offer either preappointing or conventional mail reminders and let the patient choose.
The simple post card is still widely used and has some advantages. There are many suppliers of cards for eye care with lots of choices for message themes, ranging from eye health to funny cartoons.
Processing is easy since there are no envelopes to stuff or seal and no letters to print. The office management software program can print sheets of address labels for patients whose recall date is due. Staff members apply the labels to the recall cards.
Postage cost is less with postcards than envelopes.
High monthly card volume can be handled easily with a postage meter and automatic feeder.
If the patient does not respond to the initial recall notice by scheduling the appointment, a second card may be sent in the following month. This second post card increases recall success significantly.
The card is a handy tangible reminder that patients often keep (or place on the refrigerator) until the appointment is made.
Software systems allow sophisticated personalization of recall notices, which can be effective. By placing each patient in a recall category at the time of checkout, a specific recall letter may be printed that targets the reason for the next appointment. You may print different letters for patients with eye disease, children, contact lens wearers and even people with vision plans.
Some practitioners use a letter first and follow-up with a post card reminder one month later if there is no response.
Telephoning the patient to remind him that he is due for the next eye exam could be the main method for recall, but it's more often used in conjunction with another method. If your staff calls patients out of the blue to ask them if they want to schedule an appointment, it may be regarded as a solicitation and could be too aggressive. Much depends on the demeanor of the staff member who makes the phone call.
Friendly follow-up phone calls in conjunction with preappointing or mail recall can be a very effective method of increasing recall success. Staff members should be well-trained to not appear aggressive and to always be understanding and caring of the patient's preferences. The purpose of the call may be to determine if the recall notice was received and if the patient was intending to schedule an appointment at this time. The staffer should be well-prepared with the reason the visit is needed for this patient and may offer some basic patient education about eye health. If the patient declines making the appointment, the staff person can determine if the patient wishes to receive future reminders. If there is some dissatisfaction with eye care services, the staffer is in a great position to find out about the problem and correct it.
Sending appointment reminders via email is a growing trend in eye care which brings benefits and challenges. Saving the postage cost of snail mail is a plus, but doctors who use the technique find that email is more reliable for some people than others. Anti-spam filters, changing addresses and family members who open messages but don't save them can cause issues.
When does recall end?
I've seen many practices that make a recall effort one time and if the patient does not respond, no further communication is attempted. I think that's missing a big opportunity. Many people don't see their eye doctor as frequently as they should, but will return for care if they are reminded again and again. I recommend that your practice management software settings automatically reactivate the recall date each year for five years if no appointment is scheduled.
Best wishes for continued success,
Neil B. Gailmard, OD, MBA, FAAO
Editor, Optometric Management Tip of the Week
Dr. Gailmard's new book, Practice Management in Optometry: A Blueprint for Success Based on the Optometric Management Tip of the Week, is now available on Amazon.