Reactivating patients

July 1, 2002
I just read the article in the June 2000 issue of RDH about holes in the hygiene schedule. You offered many tips, and we have implemented many of your suggestions.

Dear Dianne,

I just read the article in the June 2000 issue of RDH about holes in the hygiene schedule. You offered many tips, and we have implemented many of your suggestions.

My practice is interested in conducting a mass mailing to all patients who have not been in for their preventive care for an extended time. We are planning to go back five years. I am wondering if you have suggestions on how to word such a letter. We want to motivate the patients to come in for many reasons: preventive dentistry costs less, is less painful, tissue stays healthier and looks better, and so on.

Thanks for your help and for listing your email in RDH magazine for follow-up questions.


Dear Donna,

Many practices lack an efficient system for identifying and tracking patients who have become lost in the recare system. I have seen practices with as many as 5,000 patient charts, yet it is a struggle to keep one full-time hygienist busy. Actually, it only takes 800 to 1,000 active patients to keep a full-time hygienist busy if there is an efficient recall system. Once a patient becomes inactive, it is often harder to reactivate him than to keep him active in the system.

Here's an example for one full-time hygienist, four days per week.

Appointments available in a week 40

Multiplied by 49 weeks/year=1,960

Divided by two (two visits/year)

Patients needed=980

This does not include any periodontal maintenance, active therapy periodontal patients, or sealants.
However, before I answer your question, I would like to address the reasons why patients become inactive and how to remedy that situation.

The patient breaks an appointment.

Every patient who breaks a scheduled appointment should be inform. For the first offense, offer a mild warning: "This letter (or card) is to inform you of your broken appointment on xx/xx/2002. This time could have been used for another patient awaiting an appointment. We understand that circumstances may occur to cause these broken appointments. Many dental offices charge a fee for broken appointments. However, we have opted to send you this letter with the hope this will not happen again."

For the second offense, write a stronger letter: "There seems to be a problem coordinating your busy schedule and ours. Unfortunately, it has been recorded that you missed your scheduled appointments on xx/xx/2002 and xx/xx/2002. A broken appointment affects three people: (1) another patient who is awaiting time to receive needed dentistry; (2) the doctor or hygienist who was prepared for your visit; and (3) you, because your dental needs haven't been met. If you wish to remain a patient in this practice, your full cooperation is needed to see that this does not happen again."

For the third offense, consider a dismissal letter: "There is no easy way to say this, but I must. On xx/xx/2002, you missed yet another appointment with me. No notice was given to this office. There are other broken appointments as well (list the dates of the other broken appointments.)

"A broken appointment affects three people: (1) you, because you missed your needed dental treatment; (2) another patient who could have used the reserved time; and (3) me or my hygienist who was prepared for your visit. I value my time as much as you, no doubt, value yours. I feel it would be in our mutual interests to terminate our professional relationship.

"I will continue to offer you emergency treatment only until (30 days from date of receipt of letter.) Please let my office know where you would like your office records transferred."

The first two letters are signed by the administrative assistant, but the dismissal letter is written and signed by the doctor.

The point is that no broken appointment goes unnoticed. Bad behavior that is not punished is apt to be repeated. In addition, your employer many want to forego the first warning and give the patient only two strikes before sending him packing. Depending upon the situation, this may be entirely appropriate. However, before any patient is dismissed from the practice, the doctor should give the final approval for such an action.

Many practices charge a fee for broken appointments. One doctor told me that part of the reason behind charging a broken appointment fee is to anger the patient so he/she will leave the practice. My personal feeling is that this action creates ill will. Any patient who leaves the practice angry will become a negative missionary, even if he tells something untrue. The fee is rarely recoverable and is never enough to justify the time wasted. If a patient develops a history of late cancellation or broken appointments, it is better in the end to terminate the relationship.The patient lost his dental benefits due to layoff, termination, or benefit reductions in the company where he was employed. When I worked in a dental hygiene school clinic as an instructor, we treated many indigent people who had pressing dental needs. I heard this lament repeatedly: "I haven't been to the dentist in a long time because I lost my job and dental benefits ..."

Indeed, many people have abdicated their financial responsibility for dentistry with the advent of third party or company-sponsored dental benefits. They think that they cannot go to the dentist if they have to pay for the treatment themselves, no matter how cost-efficient preventive care is. It is a sad commentary that third party payment has become a "thorn in the flesh" to many dental practices.

While it is true that many people struggle to cover the costs of necessities such as food, clothing, shelter, transportation and medical care, it is also true that many people waste spendable income on nonessentials. Dentistry appears far down the list of priorities for many people. Our challenge is to help each patient we treat understand and value good oral health that is attainable through our professional care.

The appointment was cancelled by the practice because of hygienist or dentist absence.

I offer three suggestions:

  • Secure the services of a temporary hygienist and pay his/her rate, even if it is beyond the rate of the regular hygienist, since you are paying for their availability.
  • Schedule a make-up day if possible.
  • Leave one day per month unscheduled on the hygiene schedule when prescheduling hygiene appointments to allow for extra time in the event of illness.

No day scheduled six months out should be completely filled, but scattered openings should be left to accommodate patients who telephone for a preventive appointment. Additionally, no patient who has a history of broken appointments should be scheduled six months out. These patients should be contacted by card and invited to call for an appointment.

If your practice has a habit of canceling scheduled appointments, you can expect patients to disrespect your time by canceling their appointment. You know the saying, "What's good for the goose is good for the gander..." The patient will think that, if the practice cancels his appointment, it must be OK for the patient to cancel too.

The patient switched dental practices or moved and did not inform your office.

While it is true that it is impossible to please everyone, it can be helpful when the reasons for a patient leaving are discovered. How can we change something that needs changing or improve our services if we never discover what makes people unhappy?

A reactivation letter.

Now I'll address the crux of your inquiry. Here is a sample letter (may be used on a postal card) to use when attempting to reactivate patients.

"Recently, we have been in the process of auditing our patient records, and we see that you haven't been in to see us since xx/xx/1995.

"If you wish to remain in our active patient files, please call us to schedule a continuing care appointment.

"Remember, maintaining good dental health is a team effort, and we feel honored to be a part of your team! Our goal is to help you keep your teeth for a lifetime.

"However, if we do not hear from you by (10 working days), we will assume you are seeking dental care elsewhere.

"We sincerely hope to hear from you soon!"

Sign off with "warmest regards."

This letter is short and to the point, and it gives the patient a "deadline" to act if she doesn't desire to be banished to the realms of the inactive patients. It does not terminate the patient relationship but merely seeks to reactivate it. Sending this mailing in card form will save your practice postage, especially if you have large numbers to send.

Keeping patients active in the practice requires diligence. When patients fall through the cracks of an inefficient recare system, the result is a hygiene schedule with too many openings. Good computer software will allow the practice to identify and track patients. However, that is just the beginning. Patients have to be contacted in some fashion, whether by telephone or mailing. This is one job that often slides to the back burner because busy administrative assistants are struggling to keep up with the demands of a hectic front desk. In many practices, the best solution has been to hire someone whose sole responsibility is hygiene department scheduling.

Best wishes on your reactivation efforts!

Dianne D. Glasscoe, RDH, BS, is a professional speaker, writer, and consultant to dental practices across the United States. She is CEO of Professional Dental Management, based in Lexington, N.C. To contact Glasscoe for speaking or consulting, call (336) 472-3515, fax (336) 472-5567, or email [email protected]. Visit her Web site at www.profession