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Clinical Solutions Blog

How to Quickly Build a Caseload

Posted by Rick Lau on Sep 26, 2017 2:00:00 PM

build a physiotherapy caseload.jpg

I talk to a lot of clinic owners including people who are just starting out or have been in a business a long time. And when I ask them what their biggest challenge is, a lot say: building a caseload.

After building and selling over 100 rehab clinics, I understand the challenge.

When you’re starting out as a clinician or clinic owner, it’s obvious that you need to get patients to get your business off the ground, and to pay your bills!

And if you’ve owned a clinic for sometime, it may be that you just hired that new physiotherapist or chiropractor and you need to get their books full.

Clearly, building, maintaining and sustaining a consistent caseload is critical to the survival of any clinic!

When I mentor clinic owners, we always aim to have around a 80% utilization. This means 80% of your schedule is full.  

We don't want it to be empty or it won't pay for the rent. But, we don't want it to be too full or we can’t fit in existing patients who call to book or we can't fit in new patients.

So if you're struggling with building your caseload, listen up...

Today I want to share a few ways you can build up your caseload fairly quickly.

Let’s dive in…

1) Get More New Patients

The first challenge we face in these situations is getting more new patients. In fact, getting more new patients is often at the top of our agenda all the time.

But when there are so many clinics competing for the same space. When there are new clinics opening on the next corner or street. And when there are so many service confusions — ie: when physio, chiro, massage, acupuncture, and naturopathy — all claim to fix lower back pain, how on earth can you stand out of the crowd and attract those new patients to your clinic?

How does the patient really know where to go?  

Will they choose the clinic that has the better brand, or the clinic that has better marketing?

The answer to that question is both.

A great brand can help you stand out above a competitor who doesn't have one. 

But in truth, if you have this wonderful looking brand but do no marketing, you’re not going to get your brand recognized. Quite simply, you’ll have no eyeballs (aka traffic) coming your way.

So when it comes to getting more new patients, you absolutely have to use a range of marketing tactics.

It's often best to have a marketing mix made up of the following: (aim to have an equal split so you are NOT dependent on too much of one marketing source) 

  • SEO
  • Adwords
  • Yellow pages
  • Email marketing
  • Direct mail
  • Facebook marketing
  • Community marketing   
  • Doctor marketing

Marketing is a lot of work and takes a lot of time. But it’s the essential external stuff you have to do to get in front of more eyeballs so the phones keep ringing!

Over 427 clinic owners just downloaded this! 
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2) Get Your Patients to Stop Self Discharging  

Here is a crazy stat: Accordingly to Strive Labs, who analyzed 1 million patients,

20% of patients drop out in 3 visits and never come back!  

So here you are spending all of that time and money on marketing only to realize your patients are more loyal to their hairdresser than your plan of care (assuming you even have one)!

So the easier solution and something you can control at your clinic is to focus on the internal stuff - stopping your patient discharges.

If you can fix self discharges by improving your patient experience, you will significantly build your caseload.

By how much, you ask?  

By at least 30%!  

So if you have a $500,000 business, you can fill up your caseload by 30% and generate an extra $150,000.

The key is, first you have to set some benchmarks for the clinicians working in your clinic.

Let me share an example from one of the clinic owners I work with. We onboarded a bunch of physiotherapists and chiropractors to his clinic. And we figured out that if we gave each clinician about 25 new patients a month, they should be able to build a caseload that bills about $20,000 per month or $240,000 per year.  

He now uses this is as a benchmark for clinicians at his practice.

Once you have a benchmark, you need to measure the clinicians. And you do this through a Net Promoter Score (NPS) and Patient Visit Average (PVA).

NPS = (% of Promoters) - (% of Detractors)

Developed by Fred Reichheld, NPS measures the loyalty that exists between your patients and your clinic.

NPS asks your patients the direct question: "How likely is it that you would recommend [your clinic] to a friend, family or colleague?"

Patients then respond to this question on a 0-to-10 point rating scale. The NPS divides your patients into three categories:

  • Promoters (score 9 - 10): Loyal enthusiasts who will keep coming to your clinic and refer others.
  • Passives (score 7 - 8): Satisfied but not enthusiastic patients who are susceptible to competitive offers. Passives only count towards the total number of respondents and does not directly affect the score.
  • Detractors (score 0 - 6): Unhappy patients who can damage your brand through negative word of mouth.

PVA = Total Visits / Total New Patients

When calculating PVA, take the total number of patient visits (including new patient visits) and divide it by the number of new patients that have visited you. Both numbers must be from the same time frame (ie weeks, months, etc.).

Most people think of PVA as just a number. I would like you to think of PVA as a relationship indicator. The higher the PVA, the better the relationship.

When you measure this metric in weeks or months, it gives you a pretty good average.

So the key here is, if you fix your patient experience, you should see your NPS increase to 90% and see your PVA increase up to 10. 

So for example:

  1. 25 new patient x PVA 7 = 150 visits per month per clinician
  2. 25 new patient x PVA 9 = 225 visits per month per clinician

So that's an extra 75 visits per month and an extra 50% increase in your caseload. And that really just means the patient is coming an extra 2 visits, which really helps your business on every single level.

To fix patient engagement you can do several things:

  • Create a culture of patient experience with your staff and measure it
  • Train your clinicians how to do the perfect assessment
  • Call patients the next day after assessment
  • Call your patients BEFORE the assessment
  • Call patients who self discharge

The idea is that you put patients front and centre and really go out of your way to make them feel important and special. Make their experience one they’ll remember and one they’ll enjoy!

Most importantly, until you fix your leaky patient funnel, I’d highly recommend you stop doing any form of marketing!


Because all you’re doing is telling more people in your community how crappy your business is!

You need to fix your funnel first, period.

What is the patient experience funnel?

It’s the lifecycle of a patient from the time the patient finds you online, to you answering phones, doing an assessment, providing treatment, graduating them from their treatment plan, giving you a google review or referral - rinse and repeat.

Patient Funnel.png

You need to fix your patient experience funnel first!

Evaluate each step of the patient journey, what you’re currently doing and what you could do to make it better. How could you systemize the process to get better outcomes each step of the way?

I can tell you this: fix the funnel and your caseload will consistently look much healthier, guaranteed!


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Why do Patients Self Discharge and What to do About it

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Patient Engagement: 8 Steps to a Kick Ass Assessment

Topics: Patient Engagement

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