From Review of Optometric Business

Using our electronic records system, we ran a report to see how many current patients we have not seen back in the last three years. The numbers are too embarrassing to reveal here! But it was an eye-opening exercise, and we wanted to do something about it.

The advent of electronic charts makes this kind of exercise easier than it has ever been. It can be done during normal business hours by any staff member who has some available time. Set a reasonable target date for the completion of this project, certainly within two weeks.

On a spreadsheet, we created seven columns of information from the audit: name, telephone number, date of last comprehensive eye exam, call date #1, comments, call date #2, comments. You can probably get 12-20 names horizontally on an 8 x 11 sheet of paper. Next, staff used two color pens. If the call resulted in an appointment, we noted that in blue. Anything else was put in red.

Once we begin the calls, it is not done alphabetically, but it is based on when someone was last seen. We started with the ones that were furthest back. The calls to these patients can be made during normal business hours. Here is the script:

"Hi, Mrs. Jones, this is Jen from Dr. Wonderful's office. Hope all is well. I know that you were seen for your last eye exam XXX ago, but for whatever reason, your continuing care appointment was not made. Normally we would call you or send you a card to alert you about that appointment as it got closer. But a crazy thing is happening around here—we are getting so busy that I am afraid we may have missed the recall. So, I'd love it if we could get that appointment in our schedule now. I know you like Thursday afternoons, late in the day, and I want to be able to have a time slot available for you."

If the patient says they are not sure of their availability and don't want to schedule, the comeback is: "Not to worry—let's go ahead and get that appointment scheduled anyway. We will still send you a notification by e-mail or text before just to be sure that appointment still works for you." Never say: "Let's make the appointment because you can always change it." That gives patients permission to do what you don't want them to do. The language is subtle, but the results are very different.

If someone is not seen in your office for over two years and you have reached a voice mail during your initial attempt, I try to have staff reach them after hours. These reactivation calls are made in the evening between 6-8 pm. I recommend we pay staff at a rate of time and half their normal salary, plus you give them a four-dollar bonus as an incentive for every patient they schedule. Here is the script for these calls:

"Hi, Mrs. Jones, I hope I am not disturbing your dinner, and I hope that the family is well. Dr. Wonderful routinely and continuously reviews the treatment records of every patient in our practice, and he is concerned because it has been [number of months] since you were in for your continuing care visit. So you are obviously overdue, and I would love to be able to get that appointment scheduled for you."

If you do not reach the patient by voice, this message is delivered the same way on a message machine, and you ask the patient to return your call. Note that you left a message with the date of the call on the form.

Wait four to six weeks before a final attempt. Anything sooner would be considered harassment. Repeat the process again, starting with the patients who were most recently seen to the patients most seriously overdue. Once you have left two messages, it is time to mail what I call the "Kill with courtesy letter." This letter comes from the office manager, and it goes something like this:

"Dear Mrs. Jones: We have tried on a number of occasions to reach you by telephone to inform you that you are overdue for your continuing care appointment with our optometrist, but we have not been successful. I can only assume that you are seeking your eyecare elsewhere, and I want to wish you the very best. I also want you to know that if that doesn't work out for you, you will always be welcome back to our practice with open arms. But in the meantime, please let me know where I should send your records so your care may continue uninterrupted. Sincerely...."

Obviously, this is a very tongue-in-cheek letter. These people may not have gone anywhere else; they just have their priorities a little messed up. For some reason, patients think that their eyes are "just fine." It has been my experience that this letter following the two documented attempts to reach a patient by telephone message stimulates a lot of patients to call the office and schedule an appointment.

This is a lot of work, a significant project, but after these calls are made, I often see 30-40 percent of patients who did not previously have an appointment. If you are successful in reactivation, it is very probable that you will need to add additional hours or days. So, get to work--the potential rewards are enormous.

How do you recall patients? Do you have staff call patients overdue for an appointment? What recall strategies have worked best for you?

Keshav Bhat, OD, is the owner of Austin Village Eyecare in Austin, Texas. To contact him: [email protected]