Top 5 Fridays! 5 Ways to Reduce Your Patient Visit Average

I frequently get asked, "how do I lower my visit average?" This depends on a lot of factors, but in general, if you treat the average patient who should be a Rapid Responder, the visit average should be somewhere around 6-8 visits.

There are some out there on social media who have visit average claims that are lower and higher. However, if in general, most of your patients are in therapy for 2 months or more, you're probably stringing them along and perhaps not even know it.

1) Have a plan

the plan and progression/regression of the patient's program should be based on your experience for how the patient presents and what they are having PT for
perhaps you're McKenzie trained and spine patients are mostly getting better in 4-6 visits
you should be able to take those same principles of repeated motions to the extremities and TMJ and loading strategies to empower patients to self treat
make sure the patient is involved in this plan with a clear prognosis

I often tell patients, "Based on my findings and how you are responding to different positions/movements/treatments, I think this will take about 4-6 visits."
it may be more or less depending on how rapidly you respond, compliance, and other factors

bottom line: if you don't have a clear plan/progression in your head on where you want the patient in 3-4 weeks, how can you tell them a prognosis?

2) Frame your treatments as transient and ensure dosing is understood

one of the first things I tell patients is, "No matter what intervention I choose today, scraping, wrapping, movement, exercise - the effects of that treatment will not last unless you reinforce them
another thing I say, "If you walk out of here feeling and moving better, and I give you homework to reinforce it, you should come back next visit keeping at least some of the improvements."
this is repeated over and over throughout the session
after showing them their own self resets or correctives (and of course spending time making sure they know how to perform them correctly), I ask them, "Whose fault is it if you only feel good when you leave, but not when you come back?"
check out this video on how I explain Resetting the Pain Threshold
bottom line: if the patient understands the HEP, you chose the right self treatment strategy and they dose appropriately, the patient will get better, faster, and without 2-3 visits/weekly

3) Understand your limitations

realize that with Rapid Responders, it normally will not take 5-6 visits for any one treatment to start having major effects
pain and mobility can often be rapidly improvement through exercise/movement/manual means
the technique and exercise most likely does not matter - choose a combination of what you're smoothest at explaining and delivering plus what the patient may prefer and had good experience with in the past
if you think some breakthrough in pain reduction is going to happen after a month of little to no changes, it's probably not going to happen and it's time to refer out
bottom line: it's unlikely you're going to stumble upon some amazing treatment after 1 month or greater than 6 visits of little to no effect

4) Make the patient's home program simple

even if someone has a lot of deficits to work on, choose one that is both easy to work on and the one your gut tells you will give the patient the most functional gains
a home program of even 4 or more exercises is likely not to be performed in the dosages that are enough to maintain improvements between visits
keeping the home program to 1-2 things at a time that are novel and get rapid gains are also a sure fire way to keep the improvement going between visits, and also cut down on visits overall
bottom line: if the average person cannot understand your HEP, or it takes longer than 5 minutes to explain it, it's probably too complex

5) Choose your patients wisely

another way I keep my visit average down - I discharge mostly without exception after

2 no-shows or 2 cancellations

in general, some patients have a good excuse, but those who cancel regularly, are more than 15 minutes late regularly, I count them as a cancellation
they don't value your time, or for whatever reason going on in their lives, they cannot commit themselves enough time to help themselves
if you keep on seeing patients and/or letting them reschedule, chances are, your visit rate is going to be higher than it should be
bottom line: non compliant patients are wasting your valuable time

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Interested in live cases where I apply this approach and integrate it with pain science, manual therapy, repeated motions, IASTM, with emphasis on patient education? Check out Modern Manual Therapy!

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