Preappointing is extremely popular among optometrists in private practice. Data is a bit fuzzy because ODs often use more than one recall method, but the Management and Business Academy estimates that 44% of practices use preappointing. This method of giving the patient their next appointment at the conclusion of each exam visit is generally regarded as the most effective method of recall; meaning the recall success rate is higher than with post cards, email or telephone reminders. But even if that is true, we should acknowledge that preappointing does have its weaknesses.
In my consulting experience, doctors who use preappointing often have fairly strong opinions about how good it is. This is an aspect of practice management that I’m fairly neutral about. There are some good and bad aspects to every recall system and I think the practice owner should choose the method that best suits his or her philosophy. I’m not out to change anyone’s mind on their recall method of choice, but I do think we should be very objective and aware of any shortcomings. By being objective, you may be able to initiate procedures and staff training that improve the results.
I’ll acknowledge that preappointing has some strong practice benefits, but this article will only focus on some potential pitfalls that you may not have realized.
Preappointing as a recall method is great if it is designed and managed well, but it usually isn’t. Success with preappointing requires a very vigilant staff that always follows all the procedures. If steps are forgotten or if shortcuts are taken, problems occur like those covered below.
The real measure of success for any recall system is how busy the practice is; the number of patients that are actually seen. Of course, the recall system is only one of many factors at work on that point, but if preappointing is truly great, those practices should be quite busy. My concern is that the practice may look busy when the doctor looks ahead at the appointment schedule, but it may fall apart to some extent as any given day grows closer.
To measure your success, don’t look ahead at how booked you are. Instead, look back at how many patients per day you actually saw in the last six months or year. This will account for one potential problem with preappointing: a large no show and last minute reschedule rate. Generate a report for how many exams you performed in 2015 and convert that into exams per week by dividing by 52 weeks (or used 50 weeks if you took two weeks for vacation). Divide that weekly number by the number of days per week that you see patients (it is OK to have a half day). That provides a rough estimate of how many patients per day you truly see. It is often shockingly low, but you should know it.
The reschedule rate and no show rate can really play havoc on your office efficiency because it is difficult to be staffed properly when you are not sure how many patients will be seen. It is feast or famine.
It is interesting that reschedules and no shows are often a love-hate thing with ODs; we know they hurt revenue and profit, but on any given day when you are busy or tired, you may secretly welcome them. This may prevent you from actually wanting to recognize that they are a big problem for your business.
When preappointing is done properly, it takes a huge amount of staff time to confirm, reconfirm, monitor responses, manage and reschedule appointments. Usually there is a combination of postal, email and telephone communications about the appointment that begins several weeks in advance.
Conversely, with a traditional reminder system, the patient must decide if he wants an appointment and then proactively schedule it, usually within the next few days or a week. The likelihood of a no show is minimal in this case as is the amount of staff time needed.
Practices that use preappointing may have a lower revenue per exam metric. This occurs because preappointing results in more patients being seen with no visual complaints and often seen sooner than when the patient must call for an appointment. Seeing patients with no complaints results in more “exam-only” visits, while visits with complaints often lead to acceptance of new eyewear, contact lens fittings or additional testing.
We intuitively know that there is the possible risk of being perceived as pushy when the office staff tells patients they are scheduling them for their appointment next year. There are some clever ways to spin that, but eventually the patient realizes he has a real appointment and some will feel they wanted more control over that.
Many patients will simply go along with the office procedure, but if they really do not want that next eye exam in that time frame, they will cancel or no show. You could charge a no show fee, but that also creates more bad will.
Another negative for preappointing is less known, but occurs when the practice brings in an associate OD and wants to transfer some of the loyal patients from the senior doctor to the associate. This can be challenging in general, but it is made worse when all the patients have standing appointments with the senior doc. If patients have to call to set up an appointment, the receptionist has an opportunity to offer more convenient appointment times with the new doctor and encourage patients to try him or her.
Optometrists often look to dentists with some level of admiration and we may try to mimic their practice management techniques. It appears that dentists are quite successful with preappointing, but we should realize that teeth require regular professional cleaning and that motivates the patient into more frequent visits than routine vision care.
By that logic, we may see a high degree of success if we preappoint patients who need medical eye care, especially because these patients are usually seen back in less than one year.
It may well be that having multiple recall tools available is the best approach. An ideal recall system for a practice that is strongly service oriented might be to ask the patient how he would like to be notified about his next visit. You could preappoint some, send email reminders to others, and post cards to the rest. I wonder which method most patients would choose.
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.