Become a Data-Driven Practice; Start by Tackling Self-Discharge

laptop displaying data

Strong practices benchmark their self-discharge rate.

By Heather Chavin, MA*

How many times have you heard, “Keeping a customer is more cost effective than getting a new one”?1

How about, “You can only manage what you measure”?

I spend a lot of time in diverse types of clinics around the country. Almost all have self-discharge issues. Those are the customers you’re not keeping, resulting in money and patient satisfaction walking right out your door.

You’re already looking at the metrics to keep your doors open. I would argue that you need to include your self-discharge rate among them. Your clinic’s data, particularly patient satisfaction and outcomes data, aren’t meaningful unless you are collecting it from the majority of your patients. Any business would look fantastic with feedback from only the most satisfied customers.

How to tackle the self-discharge problem one experiment at a time

The first step is to measure your baseline self-discharge rate using a commercial outcomes products, your EMR program, or a simple spreadsheet. Collect the number of self-discharged patients monthly or quarterly to create a baseline. Once you have a benchmark, bring it to your staff—front office and clinicians. You might think you have the answer, but what great leader wouldn’t leverage the collective intelligence of their staff? Additionally, your staff will be more engaged in implementing the solution if they help to create it.2

Brainstorm ways to improve your patient retention together.

  • Jerry Durham, a private practice owner for 19 years, says, “Make the front desk the leader of the patient experience. They know more about the practice, i.e. the patients and the daily goings-on than anyone else . . . guaranteed.”
  • When booking an evaluation, Durham adds, “Get the patient’s story, of which their expectations will be a part. The ultimate goal is to build as much trust as possible before arrival.” Have a basic script to explain what physical therapy is and what the patient can expect.
  • Use the patient’s name. I’m surprised at how few clinic reception staff actually use the patient’s name. It’s the quickest, easiest way to connect.3
  • If you have commercial outcomes software, use your risk-adjusted projections to get an average number of visits for that patient. Clinicians can use that number to set expectations with the patient, so they don’t drift off after visit three thinking physical therapy doesn’t work.
  • Tori Carlson with Therapeutic Associates shares that one of the most effective strategies is having the clinician walk the patient up to the front after an evaluation to schedule future visits as per the plan of care. Provide the patient with a printout of all upcoming appointments.
  • Get clinicians in the habit of asking each patient before they leave whether they have their next appointment scheduled. Jennifer Allender, also with Therapeutic Associates, says, “If a physical therapist can walk the patient to the front desk at regular appointments, it helps with dropouts in the long run.”
  • Carlson also recommends personal reminder calls. When you personally call to remind patients of their appointments, they are less likely to no-show and you can immediately reschedule them if they have a conflict.
  • When a patient no-shows, call as soon as it’s clear they are not coming with an invitation to reschedule. Call again within 24 hours expressing your concern and the treating physical therapist’s concern. Have the physical therapist call within 48 hours if there is still no response. Time is your enemy, so it is advantageous to front-load your efforts.
  • Utilize email and text formats.

Tactics aren’t everything. Blake Hardy with Core Physical Therapy in Iowa has had enormous success reducing self-discharges.

“To get a good result like this takes several steps, some easier than others. First, solid organizational values that reflect integrity, honesty, and no fear of being vulnerable. Change can only occur with honest looks at what is happening; when you find an answer you don’t like, you can’t just pull the covers over your eyes.

“Next comes hiring people who believe in the organization and want to do what is best for it. From there, we found our baseline, set the goal, and communicated that to staff. With such a strong foundation in place, things come together quickly and easily.”

Engage your staff along the way to get feedback and make course corrections. Pay special attention to anyone who brings negativity or who is silent. They have a valuable message. Don’t be afraid to face it.

Take one or two quarters to gather some data. Did you succeed? Celebrate and repeat. Did you fail? Celebrate (yes, celebrate the effort!) and spend some time identifying the lessons learned. Refine again or pick another strategy.

Don’t quit until you’re at least at 80 percent completed plans of care and only 20 percent self-discharge.

Knowledge is not power. Everyone has knowledge. Informed action is power.

With the frantic pace of change in health care and the many facets of running a business, few practices have dedicated the time and resources to effectively use data to change the way they do business or the way they practice.

Change requires planning, tracking, accountability, and lots of communication and feedback. That list of skills is undoubtedly on the résumés of your office staff. The practices that have the most success with data-driven initiatives are the ones that engage the leadership skills of their administrative staff.

If you haven’t already started cultivating the leadership skills of your staff, now is the time. You can start by handing this article to one of your staff members and scheduling a time to sit down and talk.


1 Reichheld F, Sasser Jr W. Zero defections: quality comes to services. Harvard Business Review. Published 1990. Accessed September 26, 2018.

2 Yoerger M, Crowe J, Allen JA. Participate or else!: the effect of participation in decision-making in meetings on employee engagement. Consulting Psychology Journal: Practice and Research. 2015;67(1):65-80.

3 Carmody DP, Lewis M. Brain activation when hearing one’s own and others’ names. Brain Res. 2006;1116(1):153-158.

Heather Chavin

Heather Chavin, MA, is a member of the Private Practice Section (PPS) Administrator’s Alliance and the business partnerships manager at CareConnections Outcomes Platform. She can be reached at

*The author has a vested interest in this subject.

Copyright © 2018, Private Practice Section of the American Physical Therapy Association. All Rights Reserved.

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