In this episode of Chiropractic Deep Dive, we explore one of the biggest challenges every chiropractor faces: keeping patients consistent with their care plans. Drawing from an insightful Zoom call led by Dr. Noel Lloyd, we break down the core problems behind missed appointments, the costly ripple effects, and most importantly—practical, proven strategies to build a strong Kept Appointment Percentage (KAP). From using powerful scripts to creating an engaging office culture, you’ll learn exactly how to inspire patient commitment, boost outcomes, and stabilize your practice. Whether you’re struggling with “Swiss cheese schedules” or just want to sharpen your systems, this deep dive gives you actionable tools to transform patient consistency. (Note: This podcast was created using AI-generated voices for narration.)
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Welcome to the Chiropractic Deep Dive. We're brought to you by Five Star Management, your dedicated partner in, uh, chiropractic consulting. Today we're diving into something pretty much every practice faces, right? It's that challenge of keeping patients actually sticking to their care plans. Oh, yeah, that's a big one.
We've all been there, felt that frustration. You know, a patient commits, they're on board for wellness. Then poof, appointments start falling off. It hurts their results. It hurts your practices. Momentum definitely undermines everything you're trying to do. So our mission for this deep dive is to pull out the real gems, the critical actionable stuff.
From this fantastic zoom call, it was led by the esteemed Dr. Noel Lloyd, focusing on building a killer KAP, kept appointment schedule killer, KAP. Love that. We wanna arm you with insights, um, things you can use right away to tackle this head on. Help your patients get those optimal results and, you know, make sure your practice thrives.
Yeah, it's really foundational. I mean, patient consistency. It's not just like ticking boxes, it's the bedrock of good chiropractic care. If they're not showing up, they're not healing. Simple as that. Exactly. Okay, so let's unpack this. Dr. Lloyd really zeroed in on this core problem right at the start.
What's the central issue? He and the participants flagged. Well, Dr. Lloyd, he just laid it out plain and simple. Patients sign up often for really great care plans. Mm-hmm. Plans that can genuinely help them, but then they just don't keep the appointments right. And this isn't just, you know, an annoyance. It directly tanks their clinical results.
If they're not getting consistent care, they don't get better. And what happens then eventually they just drift away. Disappear from the practice. Yeah. And we've all seen that schedule, haven't we? The one that looks like Swiss cheese, all those holes. Mm-hmm. That feeling of Where's Gloria? Mm-hmm. Or where's Johnny gone?
It just sucks the energy outta the day doesn't, it's more than just an empty time slot. Absolutely. It's a disrupted healing process for that patient. And yeah, it's visible day to day. Like maybe you've got 60 appointments on the books for Tuesday. Sounds good. Yeah. Yeah. It looks great on paper, but then end of the day you look back.
Only 40 actually came in. Dr. Lloyd nailed it with that Swiss cheese analogy. Those holes, they're lost chances for care and let's be honest, lost income too. Definitely lost income. So, okay, that's the problem. Clear enough. Dr. Lloyd didn't just leave it there though, right? He proposed a target, something measurable.
Yeah, he did. He gave a really clear benchmark. Practices should be aiming for, uh, patients keeping 85% to 90% of their appointments. Or even better, 85 to 90%, right? 85% is good, solid, but if you're hitting 90% or more, that's stellar. That's something to be really proud of. Shows real commitment to patient outcomes. And how do you figure that out?
The calculation? Super simple. Honestly, you just take the number of appointments that were actually kept and divide it by the total number that were scheduled. That's your KAP percentage. Okay. Simple. Yeah. Can you give us a couple of quick examples? Just make it concrete. Let's say you scheduled a hundred appointments in a week and 85 people showed.
Boom, 85% KAP or maybe, uh, you had 64 scheduled, but only 52 made it in. Do the math. That's about 81% still. Okay, but room for improvement right now. Imagine a really great week, maybe 48 scheduled and 46 kept their appointments. You run those numbers. That's a fantastic 96% KAP. That one number tells you a whole story.
It really does. And it's clear going beyond just the math, why this KAP score is so incredibly important. It's way more than just a number on a report, isn't it? Oh, absolutely. What really came through on the call, and uh, one participant really hammered this home is that KAP isn't just a metric, it's a direct indicator of whether patients are sticking to the plan.
It shows adherence. Exactly. If that number's low, it's a huge red flag. It tells you patients aren't really on track and honestly they're probably not getting the results they should be. Dr. Lloyd used this great analogy, oh yeah, he said it's like putting new tires on a car, but forgetting the lug nuts.
Oof. The car might look okay, but it's not safe. It's not gonna perform. Same thing here. If patients miss those crucial, consistent adjustments, they're just not getting the full benefit, the results will be poor. That leg nut analogy. Yeah. Yeah, that really hits home. Every appointment matters, and there's a ripple effect too, right.
When patients do get better, huge ripple effect. When patients stick with it, finish their care and genuinely feel better, guess what? They become your best referral sources. Your walking billboards, totally. It creates this positive, uh, waterfall effect. Dr. Lloyd called it driven by real success stories. And it also circles back to patient education, something a participant really stressed.
How so? Patients have to understand that just because the pain eases up, that doesn't mean the underlying problem is fixed. Correction takes time. Consistency. If they don't get that they bail too early. Yeah, they slide right back to day one, like the participant said. And the whole effort is wasted. Right.
Because the root cause, the subluxation or whatever it is, it's still there. Yeah. Okay. This obviously impacts the finances too. Oh, massively. Every missed appointment is revenue. Straight out the window gone. Yep. And uh, someone on the call made this really sharp point. It's actually a double whammy because your staff, they're still there.
They're on the clock getting paid even if the patient doesn't show right. Wasted labor costs. Ugh. Exactly. It hits the bottom line hard, and I bet that hits morale too. I mean, nobody enjoys having to call staff off or send people home early because the schedule just evaporated. No, it's no fun. As one person put, it really SAPs the energy and the team spirit.
When the schedule sparse like that creates uncertainty. So. Okay. A strong KAP. It's also like a sign that you're doing a good job with patient education and expectation setting from the start. For sure. If those expectations are, um, fractured, as Dr. Lloyd described it, like Right. If the patient thinks they should be totally fine after three visits or they don't get why they need to keep coming, once the sharp pain is gone, they're much more likely to drop off.
Yeah, way more likely. So educating them clearly about the difference between feeling better symptom relief, which often happens first and getting better. True correction. Which takes time. That's vital. Explaining why each visit builds on the last makes total sense. We've talked about the why. Let's shift now to the what not to do those big avoidable mistakes.
Dr. Lloyd and the folks on the call pointed out things that practices do that just kill their KAP. Okay. Yeah. One of the absolute biggest, and a participant was really emphatic about this is not making a big deal out of the first missed visit. The very first one. Yes. That first miss is a critical moment.
It's an early warning sign. I think someone used the term woodshed them. That sounds a bit harsh maybe. Ah-huh. Yeah, it sounds intense, but the idea is to address it directly, but you know, gently pull them aside privately, maybe show them their x-ray again. Remind them why they started. Exactly. Remind them of their goals, why they came in.
Mm-hmm. Emphasize that missing visits kills momentum. It sets them back and then ask the crucial question, is the schedule still working for you? Do we need to find a better time? So it's about concern, not accusation precisely. Dr. Lloyd stressed that if you just ignore that first, miss, you basically give them permission.
You set the stage for, oh, I guess I'll just miss whenever. It totally waters down the importance of their care. The second you see a patient working against their own best interest, the doc, the team, you have to step in. That's a really powerful insight. Don't let that first one slide. What else? What other common pitfalls?
Rushing the report of findings, the ROF, or uh, skipping the care plan agreements, the CPAs, a participant flagged this as a major error source. Why is that so bad? Because patients need to really get it. They need to understand their diagnosis, why it matters, what the plan involves step-by-step. Dr. Lloyd even suggested asking them to like.
Teach back a piece of the information. Oh, interesting. To check comprehension. Yeah. If they can explain it back to you, you know, they've actually understood it. Smart. Yeah. Okay. What about cancellations? Someone calls to cancel. Uh, yes. The common mistake there is just saying, okay, thanks for letting us know and leaving it at that.
Instead of, instead of immediately offering specific alternatives, a participant shared this brilliant script, really practical patient calls to cancel. You say something like, Hey, totally understand. Life gets crazy sometimes. Look, we're here today from 8:00 AM to 6:00 PM I can squeeze you in at 2:30 or 4:30
Which one of those works better for you? I love that it's proactive. Totally. Dr. Lloyd calls it standing between the patient and the mistake of just letting the appointment go entirely, you're guiding them back. Nice. Any other big dumps? Yeah. Letting patients just kind of drift in and out without any real structure.
If you don't set clear guidelines and emphasize the schedule's importance right from day one, they'll feel like they can just make up their own schedule. Oh, which leads to inconsistency. Bingo. And finally, Dr. Lloyd hit this one hard. Not using written care plans. If the plan is just sort of talked about vaguely.
In theory, patients will mentally adjust it, forget parts of it. A written plan is tangible. It's a commitment device, something they can see and refer back to. Okay. Loads of things to avoid there. Very helpful. Now let's flip it. Let's talk solutions. Those killer KAP ideas, the tips, the hacks for success, right?
So the number one strategy, and this came from someone with a crazy high, KAP, like 95, 98%. Wow, okay. What's their secret? It sounds simple, but it's profound. Cultivate a great office culture and environment. Your office has to be a place people actually look forward to coming to the whole vibe matters. Everything.
The look at the walls, the music you play, how it smells, and most importantly, the people. The energy your team brings, it all adds up to an experience that makes sense. People wanna be in positive environments and I guess wait times fit in here too long. Waits probably don't help the vibe. Definitely not.
Dr. Lloyd made a sharp observation. If patients always have long waits, they'll start helping you out. His words by missing appointments. Ah, they'll fix your scheduling problem for you pretty much. They just won't come back if you don't respect their time. Okay, so great environment, respect, patient time.
What's another killer idea? Deliver a really strong day 2. That report of findings has to land powerfully. Patients need to deeply understand their problem. That gives them the why, the strong incentive to show up consistently and remember not to downplay it. Crucial point Dr. Lloyd made. Do not minimize their problem.
Resist saying things like, oh yeah, no sweat. We see this all the time. Easy fix. That makes it sound trivial. It undermines the value of your expertise and the need for ongoing care. Make sure they grasp that this issue probably took years to develop. Good reminder. Okay. What about those written plans again.
How do they become a strategy? Okay, so this high KAP participant detailed this really smart process. A third visit, or maybe call it a break in visit. Third visit, okay. Yeah. And crucially, it's often a dedicated team member, not the doctor who handles this. They sit down with the patient privately, maybe in a consult room, and go over all the office policies, the agreements, the expectations, setting the ground rules.
Exactly. Patients initial and sign these things, and they're framed positively as guardrails designed to help them get the best results as quickly as possible. This covers stuff like what to do if you absolutely have to miss an appointment, make it up that same day or the next day. It clarifies the difference between a quick adjustment visit and needing a longer consult.
Dr. Lloyd said this process effectively trains them to be a good patient. I really like that framing, training them to succeed in your office. But you know, life happens. People will still miss sometimes. What's the best way to handle that moment? You handle it with empathy, but also provide a solution.
Gently pull them aside, like we said, maybe show the x-ray again. Remind them about their condition, why they're there, and clearly state how missing visits slows down their progress. Dr. Lloyd offered this fantastic script, the You're Scaring me One, that's the one. You're scaring me, patient name! I've been a chiropractor for a long time and honestly, the thing I've seen hurt more good chiropractic patients and great care plans than anything else is missed appointments.
I simply can't give you my best work if you're not here consistently. Is there maybe a better day or time that works reliably for you? Wow. That focus is entirely on their wellbeing, not your scheduling convenience. Exactly. It shows genuine concern for their outcome. It resonates way more than just saying, Hey, you missed your appointment.
That script feels like something the whole team needs to be comfortable with though. How do you get everyone on board? Uh, that leads right into another killer strategy. Develop written scripts for calm and patient objections and then practice them. Role plays. There's like role-playing. Yes. One participant described a really rigorous system.
Staff and doctors have these written scripts for things. Patients say, I feel fine now. It's too expensive. I don't have time. They actually role play these scenarios in staff meetings. Yeah. And get this, new hires have to memorize these scripts and get certified on them before they're even allowed to answer the phones certified to answer the phone.
Wow. That's commitment to consistency, isn't it? It means the whole team is prepared. Confident and delivering the same message when faced with those common hurdles. Very systematic. Yeah. Any other scheduling hacks that came up? Yep. Advanced multiple scheduling. The idea is ideally on that third visit, you lay out the entire care plan schedule, all the appointments clearly mapped out so they see the whole journey.
Exactly. It lets them put everything into their personal calendar right then and there. They can immediately see any potential conflicts way down the road and address them upfront. Proactive and don't forget the follow up, consistent follow up. Have a system maybe weekly to review everyone who canceled, missed, or rescheduled the CMR list.
Actively reach out and get those people back on track. It's essential hygiene. That's a lot of good stuff. Yeah. What about empowering the team like the cas, the chiropractic assistants? Huge one here. Dr. Lloyd calls it the transfer of authority. Transfer of authority. Tell me more. Okay, so after the doctor discusses the care plan with the patient, right there in front of the patient, the doctor explicitly says something like, okay, Jill, we're gonna be seeing you regularly for this.
Now Mandy here gesturing to the Ca, Mandy's job is absolutely crucial. She's the one who helps us all stay on track with the schedule. Ah, so the doctor is formally handing off the scheduling responsibility precisely. It empowers the ca. It tells the patient clearly, Mandy is your go-to person for appointments.
Then if the patient later tries to negotiate the schedule with the doctor or mentions a conflict, the doctor redirects them. Yep, the Doctor reinforces. Remember, it's Mandy's job to help us stay on track. She's fantastic at working things out. She'll help you with your appointments and you should reinforce this again at re-exams too.
That creates such clear roles. Makes sense. Should the cas also understand the phases of care? Oh, definitely. Train your CAS on the different phases, you know, relief care, corrective care strengthening, or wellness care. Why is that important for them? Because it equips them to handle objections better. If a patient says, Hey, I'm feeling way better, do I still need to come three times a week?
The ca knows they're still in the correction phase. They can explain why exactly. They can explain. That's great. You're feeling better, but we're still working on correcting the underlying issue. As Dr. Lloyd might say, you still have this vertebra that knows how to find the nerve, so we need to keep up the consistency to make lasting changes.
It's a great line. Knows how to find the nerve. Very clear. Okay, one last point someone raised was about the plan itself fitting the patient's life. Yes, absolutely critical. Congruency. If you, the doctor prescribed three visits a week, but you know, realistically, this patient's work schedule or commute means they can only truly make two.
Don't set them up to fail. Right. Adjust the plan upfront. Maybe it means two visits a week, but for a longer duration, say eight weeks instead of six, it's far better to create a plan they can actually keep, even if it looks slightly different than to stick rigidly to a protocol that guarantees missed appointments right out of the gate.
Set realistic. Achievable expectations build success in from the start. Okay, so wrapping up the core content from the call. Yeah. What were Dr. Noel Lloyd's final big takeaways? The things he really wanted everyone to walk away with? He really doubled down on visual education. You have to explain the x-rays, the scans, don't skip it.
If patients only go by how they feel, they leave When the pain does exactly, they won't understand the need for true correction. He's also a big proponent of using a three phases of care chart. It's a visual map helps patients and the team see the whole journey from that first adjustment all the way to maintenance.
Makes the process tangible. Yeah. And he hammered home that transfer of authority. Again, Mandy's job is to help us stay on track. Make sure I have room for you, make sure you have room for us. He kept stressing that care isn't just, you know, casual playtime, appointments matter. And he shared a couple more power scripts too, right?
He did. For the ROF, he suggested asking the patient, okay, look, there will be days you're driving here feeling pretty good, thinking of five things you'd rather be doing than seeing me. Looking at this chart, can you tell me why people keep getting adjusted even after the pain is gone? Forces them to articulate the why, right?
Gets them thinking beyond just symptoms. And then that missed appointment script we mentioned. You're scaring me, Jill. I've seen missed appointments hurt more good chiropractic patients. I'm gonna ask you to recommit to our schedule. Powerful stuff. Definitely. And how did the participants react? What were their final takeaways?
It seemed like things really clicked. People were buzzing about the transfer of authority, especially using it at re-exams that woodshed moment, but delivered with genuine care. The idea of scripting objections before hiring someone. Proactive training. Yeah. And just the relentless consistency needed in reinforcing why keeping the schedule is key for patient results.
And that whole concept of the third day visit. Specifically educating patients on how to be good compliant partners in their own care, often using those written guidelines. Wow. Okay. What an incredibly practical, deep dive into building that killer KAP. It's so clear, isn't it? Yeah. It's a strong kept appointment schedule.
It's not just a number, it's fundamental patient care. It's practice stability. It's creating that healing environment. Cool. We've gone through the core problem. The downstream effects, the common mistakes to avoid, and crucially, those powerful, actionable strategies from office culture, right down to that transfer of authority.
So as we wrap up, here's a thought to leave you with something to chew on. What's the one single chain you can realistically implement in your practice this week? Starting now, to build a culture where every single patient understands that their consistent care is absolutely non-negotiable for their health.
Now if you want some personalized help figuring out how to implement these strategies or maybe tackling other practice challenges, we strongly encourage you to book a free call with Dr. George Birnbach. He's brilliant. The link is right there on the show notes for this deep dive, super easy to find.
It's a great opportunity for tailored advice. Absolutely. And hey, if you're feeling fired up and ready to really accelerate things, consider joining us live in Orlando, Florida. We've got two fantastic transformative two day events happening. Big weekend. Huge one is focused on win-win associates finding and building great associate relationships.
The other is our new patient edge event, packed with strategies to help you get a flood of new patients fast, both incredibly valuable for sure. All the details, the registration links, everything you need is in the show notes for this episode as well. Check it out. And finally, don't miss out on future deep dives like this one.
We're always unpacking essential tips, actionable strategies from leaders in the field. Make sure you subscribe now so you get more insights directly from us here at Five Star Management. Thank you so much for joining us for this really crucial chiropractic deep dive. We look forward to helping you crush your practice goals.