A Bad Sign: Watching Revenue Walk Out the Door

While making a professional call on a doctor’s office the other day, a colleague of ours watched $5,000 walk out the door.

The small-but-painful drama that unfolded in the reception area is worth retelling if our experience can save other medical practices from losing patients and revenue. It was a real-world lesson in physician and medical practice marketing. Here’s the sad tale…

No sooner had I taken a seat, when the individual next to me declared, “I’m tired of waiting and I’m leaving. And do you want to know why?”

Before I could respond, the woman continued to vent.

“I’ll tell you why. This place makes me feel like I’m an interruption. Hell! I’m the paying customer.”

‘This doctor’s a good guy, maybe the best in town,” the soon-to-be-ex-patient said. “But I’ll bet you a buck he never walks in this own front door. The opposite of welcome is unwanted.”

Submitted as evidence, she said, “Look at that ‘welcome window,’ over there. First, it’s locked open to just a narrow slit. And if that isn’t an unfriendly barrier, the window is plastered with ‘bad behavior’ signs.” (The signs were tattered, curling faded paper, and an unprofessional contrast to the modern reception area that even included a children’s play room.)

“Good luck,” she said and with that, the patient ‘fired’ the practice and the doctor and left.

 The “bad signs” posted at the front desk were, in fact, unfriendly. They read:

 “If you are more than 15 minutes late for your scheduled appointment, you will have to reschedule.”

• “If you miss or cancel a scheduled appointment the same day, you will not be able to be seen for 4-6 weeks. If this occurs more than once, a $25 fee will be added to your account.”

• “It is the patient’s responsibility to obtain their own referrals. We do not call for referrals.”

• “There is a $5 charge for any forms that need filled out by the physician. Prepayment is required.”

Later we found that although patients have been threatened not to be late, the doctor is habitually late. And speaking of additional fees, there is a hefty (unreasonably high) surcharge for making any photocopies and for sending/receiving email documents.

Regrettably, it is not unusual for us to find “riot act” signs in the office, in practice brochures and on the provider’s website. It happens all the time. (It shouldn’t, but it does.) What is unusual in this story is that the loss of a patient is usually a completely silent event. The patient may have their reasons for going elsewhere, and they simply never return to your office.

Because this individual verbalized some of the issues, this practice (and many others) can do something about the “bad signs” and punitive warnings—and likely other issues—that drive patients out the door.

Some practical observations and actions…

• There’s no up side in this. The patient behavior modification (if any) that results from a four-cent sign is not worth a $25 surcharge or the loss of $5,000 in patient revenue.

• Every business manager knows the average case value of patients in their practice. Depending on the practice, specialty and case mix, the “patient value” can range from a few hundred dollars to many thousands of dollars.

• The lost revenue from one patient (in case size) does not include sunk costs for advertising and acquisition. In addition, a single lost patient can include family, friends and the subsequent negative word-of-mouth.

• Advice to doctors: Walk in your own front door from time to time. See what greets patients and new patients. Consider how you would react to “bad signs” or other unfriendly messages if they greeted you in a retail or service business where you are the customer.

The patient is not an interruption…they are the purpose of the practice. It’s reasonable to have policies and procedures for a smooth operation, but posting negative directives (in multiple signs) can do more harm than good.

A bad sign—even one—sets the stage for a bad patient experience or worse, lost revenue. And no gain in “patient behavior modification” (for the benefit of the staff or office process) will ever amount to the loss of a single patient.

Stewart Gandolf, MBA