Patient Engagement

Patient Handshake

4 measures you should track to improve the patient relationship.

By Ryan Klepps, PT, DPT*
March 2019

The term engagement has seemingly become the buzzword du jour in almost every industry.

But it’s for good reason. In health care, patient engagement can mean the difference between successful outcomes and incomplete care plans; happy, loyal patients and those who are disengaged; and a thriving clinic and one that’s losing patients (and profits).

And while most care providers agree that patient engagement is worth the investment, many aren’t sure how to measure it or what to do with the data they collect. Furthermore, in many cases, the data providers do collect is not actionable or they’re not using it to its full potential. In rehab therapy, in particular, knowing how to leverage patient engagement data can have a direct—and significant—impact on a practice’s bottom line.

Let’s take a look at four impactful metrics every clinic owner or physical therapist should be measuring to improve patient loyalty, retention, and reactivation.

1 Patient Satisfaction and Loyalty

Many clinics use patient satisfaction surveys, but unless the measurements are actionable from a business perspective, they have very limited value. Organizations that measure satisfaction often experience a significant ceiling effect. In other words, they have relatively high scores that don’t necessarily reflect their customers’ true experience. That’s because traditional satisfaction surveys are conducted in-clinic and at discharge, which can lead to sampling and environmental biases. Furthermore, most satisfaction surveys aren’t sensitive enough to capture meaningful differences between patient scores.

By contrast, the Net Promoter Score (NPS) survey enables you to understand the patient experience on a different level. It is specifically designed to measure patient loyalty—an inherently more impactful metric—without risking the previously mentioned biases. Ultimately, it provides powerful, actionable insights to not only drive business decisions but also shape care delivery models. And it does it all by asking one simple question: “How likely are you to recommend us to your friends or family?”

For example, let’s say you operate a multisite physical therapy practice that consistently sends out NPS surveys to patients across all locations. There are lots of ways you can zoom into the data to gain a better understanding of the patient experience. For instance, you can segment by location, staff member, or even injury type to see what you’re doing well—and where there are opportunities for improvement.

By consistently and frequently tracking this data, you can quickly course correct rather than letting problems escalate or go completely unnoticed. For example, MTI Physical Therapy, based in Seattle, enhances their one-on-one care model with surveys and a patient relationship management (PRM) system. “We follow up with patients asking them to fill out satisfaction surveys and also ask them to suggest ways of improving our processes at all levels,” says Scott Olson, cofounder of MTI Physical Therapy. “With a PRM, we are all able to keep track of our patients and see who might be at risk of slipping through the cracks. Our physical therapists can then reach out to those folks personally to find out how they’re doing, to let them know they haven’t been forgotten and to ascertain if there is anything else we can do to facilitate their care.”

Across the entire health care space, a shared goal is improved patient outcomes, and in rehab therapy in particular, that requires keeping patients engaged for several visits (and potentially several weeks or months). By catching problems early and implementing the necessary changes based on what you learn from NPS, you can drastically improve patient retention.

2 Qualitative Feedback and Dropout

According to the 2018 State of Rehab Therapy Report, only 1 in 10 rehab therapy patients complete the full course of care. To many physical therapists, this may not come as a surprise, but hopefully it motivates you to turn these figures around.1

Patient dropout is one of the most pervasive issues plaguing the industry. It impacts outcomes, reimbursement rates, and bottom lines. Most importantly, it leaves a lot of patients living with unnecessary pain.

By leveraging the qualitative data NPS yields, you can preemptively intervene to prevent a potential dropout from discontinuing treatment. For instance, if a patient is only a few visits into his or her care plan, and he or she scores low, you can dig into the reasons behind that score and hopefully turn things around before the patient drops out for good. You can also choose to supplement your NPS data with an optional follow-up question: “What’s the most important reason for your score?” Then you can organize comments into categories such as “front desk,” “billing,” or “parking.” This allows you to track trends and act on this qualitative data.

You can also pair this data with insights collected from other technology sources, like interactive home exercise programs delivered through a mobile app. This will give you visibility into what exercises patients are completing (if they are at all) and how often they’re logging in, all of which you can then communicate back to their primary care providers. This will also help you pinpoint potential dropouts, such as disengaged patients, before they leave and proactively work to get them back on track.

3 Reactivation

When a patient successfully completes a treatment plan, most therapists hope that patient won’t need to come back for more treatment in the future. But in some cases, the problem may return or the patient may develop a new issue. And we already know that the sooner a patient with a muscle, bone, or joint issue accesses physical therapy care, the lower the treatment costs and the better the outcomes are. In fact, according to a study published in the journal Health Services Research, using physical therapy as a first management strategy resulted in 72 percent fewer costs within the first year.2 So, when a past patient needs to return to physical therapy, how can you ensure you’re the first one he or she contacts?

By monitoring your reactivation metrics, you can identify opportunities to reach out to past patients. Again, NPS is a great tool to pair with reactivation figures, as it will help you identify how likely a patient is to choose you as a provider again. If your reactivation rates are low, ask yourself whether there’s more you could be doing to keep past patients engaged. Do you periodically check in with them to ask how they’re doing or to simply offer birthday wishes or tips for maintaining overall health and strength?

4 Reputation

When it comes to building a positive reputation, nothing speaks louder than referrals and positive reviews. If a patient has a great experience with you and achieves great outcomes, he or she will naturally become a raving fan of your clinic and will want to spread the word. So, one very effective way to assess patient engagement is by looking at what kind of reputation you have online.

What types of reviews are you getting? Do you have enough of them? Do current and past patients send referrals your way or promote your practice on social media? You should be tracking all of this.

Referrals and positive ratings will also help improve your search engine rankings by getting your clinic in front of more potential patients who may be searching for a physical therapist in your area. But reviews—especially positive reviews—often won’t happen on their own; you have to ask for them.

Most patient relationship management (PRM) platforms can not only help automate this process but can also synthesize all of the data to help you manage your online reputation as well as the patient experience you’re providing in your clinic. And that is the key. It’s not just about tracking the right metrics; it’s about leveraging them in the right way to ensure that you actually improve engagement and grow your practice. And to do that, the data has to be actionable.


1 Accessed December 2018.

2 Accessed December 2018.

Ryan Klepps, PT, DPT, is the director of onboarding and member education, WebPT. He 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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