Where have all my patients gone?

Getting a handle on patient attrition

In an earlier time, a child had a single pediatrician and at age 18 graduated to a general practitioner that he or she kept until death. And in that time, no one ever moved, medicine ran on a fee-for-service basis, and employers that offered health insurance rarely, if ever, changed plans. None of that holds true any more, and most practices are seeing an ever-changing patient panel.

With no such thing as patient loyalty, what can you do to make sure you don’t lose too many patients, too many employers, or too many payers from your practice?

"The question these days is ‘who does the patient belong to?’" says Donald Lloyd, FACMPE, chief executive officer of the Murfreesboro (TN) Medical Clinic. "Is it the employer, the managed care organization (MCO), or the physician? On a trust level, the strongest relationship is with the physician, and we have to be willing to play off that strength."

Employers, however, are concerned about health care costs, and they are more likely to strike an alliance with the MCO. The push and pull often leaves the patient and provider in the lurch, says Lloyd. "You have to be able to prove to the patient — and thus to the employer — that you are not only a good financial deal, but you provide the best care for the health care dollar they spend."

That means seeing patients on time, treating them like family, and meeting their health care needs. It also means that office systems have to be efficient and billing processes and documentation completed accurately and in a timely and efficient manner.

"You have to survey patients about what you do," Lloyd advises. "If they don’t like something, be prepared to make a change. If you do all that, then patients will let their employers know that they want to keep you on the panel."

But Lloyd is in an enviable market. Although his 37 physicians have some 240,000 patient visits per year, he is in a small market that encourages loyalty. "We have a sense of community because our doctors are in church with their patients; their kids are in school together. They are in service organizations together."

In other markets, keeping attrition low takes more than seeing patients on time, says Bob Goldstein, FACMPE, chief administrative officer at the Browne-McHardy Clinic in Metairie, LA, a suburb of New Orleans. "Our patient/physician relationships are directly affected by payers," Goldstein says. "If a company switches plans, then the patient switches. You have to strike a balance of participating in an optimal number of plans so that you are available to as many patients as possible"

But you still have to maintain good business practices and provide quality care. "You aren’t going to be able to keep every patient for ever," he says. For example, if you have one plan that has 50,000 potential patients — of which you have 10 — and you are dropped from that plan, then there is little reason to fight that deselection, Goldstein says. If you have 1,000 patients, you will want to take action. (See related story on what to do when you are deselected, at right.)

In a market with large managed care penetration, the answer to patient attrition is to have a continuing flow of new patients making up for whatever is lost, Goldstein says. "You have to maintain your contracts and be more than Marcus Welby. You can’t wait for patients and payers to come to you, or you won’t stay very busy. What you have to do is actively maintain your relationships with payers and make sure they know you provide high quality efficient care."

According to Andrea Eliscu, president of Medical Marketing in Winter Park, FL, you can keep deselection levels to a minimum if you have the data that shows you are a good doctor. "Managed care is here to stay," she says. "You can’t just take your toys and go home. You have to be board certified, you have to have quality outcomes that you track, you have to practice effectively but not overuse resources, and you have to provide good quality service and have the survey data that shows your patients are satisfied."

With such hard facts in evidence, Eliscu says you are more likely to be recommended to a managed care panel. If you continue to prove your value in the same ways you won the contract, then you are much less likely to be deselected.

[Editor’s note: We’d like to hear about patient attrition rates in your practice. If we receive a sufficient response, we’ll release average statistics in a follow-up story. No names of individuals or practices responding will be released. Please respond to Francine Wilson by e-mail (dhubbell@ix.netcom.com) or by phone at (800) 446-1139.]