The attendance problem
Today’s veterinary practices face mounting financial pressure as a result of clients either postponing routine appointments or stopping patronage altogether.
Although it has been 10 years since the global financial crisis, the scars remain. Despite steady gains in international markets in recent years, the world is still experiencing subpar economic growth, with resulting high levels of public, corporate and consumer debt.
This global financial squeeze has placed ongoing financial pressure on households and widened the gap between wealthy and financially challenged pet owners, and this pressure is having a direct impact on standards of care in the veterinary industry. Corporatization and the growth of online retailing are also squeezing veterinary practices’ margins.
All these factors mean that client retention and recall effectiveness remain essential to practice success. Nevertheless, the industry’s understanding of the impact of reminder and recall success on overall practice performance remains poor. Covetrus regularly and systematically collects and analyzes industry data and gathers anecdotal feedback from front office staff, practice managers, and practice owners. This helps us not only to identify which aspects of practice operations have the greatest effect on efficiency and profitability, but it also offers insight into why and how the most successful practices outperform the rest.
Encompassing 407 practices, the 2017 Covetrus North American Veterinary Industry Marketing Research Survey3 was designed to provide insight into practice operations. Questions were designed to gauge the level of marketing used in practices, how practices handled recalls and reminders, and how their efforts impacted client retention. Data gathered from this survey was supplemented by data from the Covetrus Global Veterinary Research Annual Survey, which included 336 practices in 2016 and 254 practices in 2017.
Setting the stage
Reminders and recalls play a pivotal role in veterinary practice success. The relevance of reminders and recalls to clinical, operational and financial outcomes makes them a key performance indicator (KPI), with consequences for several aspects of practice performance. In particular, they assist with client retention and returning patients to the practice for additional appointments.
Successful patient outcomes remain a cornerstone of the veterinary industry, with routine attendance, health monitoring and disease prevention being critical to the delivery of excellent care. However, increasing pressure on household finances in recent years has created a gap between optimal and essential care, which in turn has resulted in longer intervals between visits.
Significant numbers of clients continue to avoid routine examinations or postpone treatments for their pets, increasing pressure on beleaguered practices. More vexing is that practices report difficulties in re-engaging with clients who have missed several routine appointments. Statistics underscore the importance of reminders and recalls as a mechanism for ensuring that clients return for scheduled appointments and as the first line of defense against becoming ‘lapsed’ in the first place.
What are reminders and recalls?
A reminder is a message sent to clients who have currently scheduled appointments to reiterate the appointment details. Ideally, all customers should be booked for their next appointment at the conclusion of their previous one, as reminders are more successful than recalls in ensuring that patients return for their next appointment.
A recall is a message sent to clients who do not have a currently scheduled appointment but are due for a visit. These customers should be sent a series of communications to prompt them to return to the practice. Recalls can be more successful if they are targeted around a meaningful date, such as 12 months after a previous visit or when the pet is due for an annual checkup.
Current state of the veterinary industry
Experts agree that the veterinary market is becoming increasingly competitive, particularly with regard to pricing challenges from online channels. Additionally, veterinarians tell us they are increasingly encountering pet owners who seek treatment advice from pet stores or the internet.
For privately owned practices, corporatization is a further worry, with estimates suggesting that 15% to 20% of America’s 26,000 veterinary clinics are now owned by a corporation.
Notwithstanding corporatization, the 2017 Well Managed Practice Study reported that the top five concerns and challenges for today’s veterinary practices are staffing, growth, facility location, finding and retaining veterinarians, and political and economic uncertainty.
To counteract these challenges,practice owners expressed their need to introduce expanded hours and services, find qualified support staff, improve client communication, expand their facilities and provide targeted training.
A 2017 IBISWorld report highlighted the following observations with respect to local competition: “In the animal hospital and clinic segment the main bases of competition are location, the hours of operation, the range of services offered, the quality of care, fee rates, and programs and systems to promote recommendations or referrals.”
In the face of this highly competitive environment, retaining existing clients and increasing the number of appointments remain high priorities for practice owners, yet our research data and anecdotal evidence show that doing so continues to be a significant concern. In the Covetrus North American Veterinary Industry Marketing Research Survey, 25% of practices reported that they find attracting new clients “challenging.”
More than 30% of practices in an international 2016 Covetrus survey experienced a reminder success rate of less than 70% in the previous 12 months.4 Furthermore, less than 50% of new clients return the following year and 60% of existing clients may not have visited the clinic in 18 months or more.
Further underlining the challenges facing the veterinary industry, a 2018 Veterinary Hospital Managers Association (VHMA) report noted that new client growth across its 600 member practices was 12% lower in October 2018 than it was in October 2017. The report also stated that “this continues to be a discouraging trend, as these numbers have declined almost every month of the last three years.”
With the average transaction value for a typical American practice being approximately $191, losing a single appointment each day can cost over $66,000 in revenue per year.
It is important to note that this calculation does not take into account the time and and money wasted making follow-up calls to schedule and remind clients; nor does it consider money lost through no-shows.
This data make it clear that effective management of recalls and reminders can deliver a very healthy return on investment. This is especially true when an automated reminder/recall system is put in place.
Another concern highlighted in our international survey is that a significant 45% of practices do not measure KPIs at all, including reminder statistics. This means that affected practices do not have real targets against which to measure business performance and success.
Only a small percentage of veterinary practices are diligent in sending out appointment reminders to their clients. In the 2016 Covetrus Global Veterinary Research Survey, 20% of practices reported sending 250 to 500 reminders per month.
Another 19% send 100 to 250 reminders monthly, and the same percentage send less than 50 reminders each month. Unless these practices are seeing fewer than 50 patients per month, this is an abysmal result.
Also of great concern is that 14% of the 336 practices surveyed were unsure of how many reminders they send out monthly. The survey also revealed that 44% of practices send only one appointment reminder regardless of success — mistakenly confident that a single reminder will do the job of encouraging clients to return for a follow-up.
Another alarming statistic: In the 2018 VHMA practice survey, only 26% of practices said that a compliance report was helpful in managing their hospital.
That such a large percentage of practices fail to monitor reminders or recalls, or worry about how their processes are performing, exemplifies how the veterinary industry lags behind other sectors in giving this essential administrative function the attention it deserves. With the best intentions, veterinary professionals are notoriously guilty of not always operating their practice as a business. Greater profitability supports improved patient care, which makes it clear why reminders and recalls should be top of mind for all practices.
Smaller independent practices not adopting this mindset are particularly at risk. Large corporate practices with a business focus are entering the market in more significant numbers. These generally efficient and effective practices are in a prime position to drive local practices that lack business acumen out of the market.
Reporting from the North American Covetrus team indicates that those who send out more than 2,500 combined healthcare and appointment reminders per month are seeing improved patient care and increased compliance.
A full 20% of practices admitted that “we do not worry about performance, so long as the practice is reasonably full.”
Adopting reminder/recall best practices
Our research confirms that the process followed largely determines the impact of a reminder/recall system on the number of practice appointments and client retention. By combining our data with global marketing trends we have identified the processes used by top performing practices. These processes, which form the basis of what we refer to as best practices, include tasks carried out before, during and after the reminder and recall processes.
The ability to capture and efficiently use such client data as mobile phone numbers and email addresses to communicate effectively is a crucial aspect of client retention best practices. It is an ongoing process against which front office staff should be measured and managed. Although collecting this client information often seems to fall into the “too hard” basket, it is the foundation of reminder/recall success and needs to be built into the regular practice workflow and incorporated into the routine of each appointment.
Forward booking the next appointment before clients leave the practice is a crucial procedure of top-performing practices, and it should be a KPI for every front office team member. Some practice management solutions issue automatic prompts for this process, thereby ensuring that all staff remember this important step.
Having the right technology and software in place to implement this process up is essential. A booked appointment is a great start, but allowing customers to schedule online or confirm automated reminders electronically increases appointment attendance rates and frees up staff for other tasks.
By utilizing online booking, existing and potential clients can schedule appointments at a time that suits them, even outside business hours.
Practices should also check that recall dates are set accurately within the practice management system and staggered throughout the month. This will help create an efficient system that does not overwhelm the front office team as appointments are confirmed.
Sending small batches of reminders and recalls each day, rather than doing larger monthly runs, makes the process more manageable and ensures an evenly scheduled appointment book. Our suggested method is to automate this process. This allows practices to increase the effectiveness of their reminder/recall process while freeing up staff to provide excellent customer service to those pet owners who are in the practice.
Scheduling a single appointment over the phone takes about three to five minutes. Multiply this by the number of appointments scheduled each day, and this “quick task” quickly becomes quite time-consuming.
Continuing to attempt to engage with lapsed clients can also have a positive impact on practice revenue. Our research confirms that the best practice is to continue to recall clients at regular intervals — not only after 12 months when their recall is due, but continuing to reach out for 24 and even 36 months. When factoring in the average transaction value versus the cost of sending a recall, the adoption of this process becomes very compelling.
Our industry knowledge allows us also to conclude that when recalling a client, the best practice is to communicate three times using three different methods (SMS, email and postcard) during the months immediately before and after the recall due date.
One of the important factors in recall success — with success measured by the number of clients who book appointments — is the practice’s response mechanisms. In other words, are customers able to respond to reminders and recalls efficiently and conveniently, at a time of their choosing?
Online appointment booking can play a pivotal role in reminder/recall success, as the technology provides a quick and convenient way for clients to respond immediately, no matter when they receive the communication. This technology has been adopted by many service-oriented businesses, from hair salons to doctor’s offices, with veterinary practices lagging behind demand. This channel is expected to grow and become even more effective in the future.
The convenience of online booking for clients is underscored by data showing that practices with an online booking capacity report that 50% of appointments scheduled online are made outside of regular business hours, and 17% are new clients. Not surprisingly, 17% of practices report an increase in revenue after adding an online booking service. These statistics demonstrate the need to find processes that will alleviate the pressures on frontline staff and thereby improve practice efficiency.
The ability to automate both recall and client response mechanisms is a key factor in what we identify as best practice methodology. Automation ensures that the recall process is not reliant on individuals and thus runs seamlessly even in the absence of key personnel. Even the most diligent practice teams are unlikely to find sufficient time to implement an effective manual reminder/recall system, given the complexity of sending multiple messages across multiple media and the need for integration with an online booking engine.
Establishing clear protocols and following a tried and trusted systems approach provide the most efficient way of operating the system. This enables staff to concentrate their efforts on patient care instead of fulfilling tedious administrative duties. It also means that when staff members are absent due to illness or leave the reminder/recall process and optimal booking of appointments will not grind to a halt but instead will continue to run automatically and seamlessly.
It is very straightforward and well documented that if the number of clients recalled increases, an increase in recall effectiveness and compliance can be expected, with a positive flow-on effect for other practice KPIs.