Forward Booking for the Win

Forward booking simply means a patient already has or gets booked for a future appointment when checking out at the end of a visit. Example appointments include:

• A recheck in a couple of weeks for the concern seen that day
• A follow-up in two months for pets requiring regular lab work due to a condition or medication
• A next visit scheduled in six months or a year when due for another wellness exam

The type of appointment doesn’t matter. It only matters that an appointment exists or gets made at the time the patient leaves the practice.

In a presentation entitled 20/20 Vision — The Clearest Way to Grow Your Practice in 2020, Jason Wernli, founder of ALLYDVM, explains that forward booking can:

• Build a more consistent schedule with fewer hot or cold days, which helps practices schedule a right-sized staff
• Improve client retention and customer service
• Increase compliance
• Improve profitability and lead to overall practice growth

Some in the veterinary profession resist making forward booking a priority because they worry clients won’t like it. However, in a survey with 500 participants, Wernli found that 80 percent of people prefer to forward book because they worry about missing the next needed appointment.

Forward booking rates

Forward booking rates get calculated as a percentage on a transactional basis, not on the number of total appointments on the books. For example, if a larger practice sees 100 patients in a single day, and 21 of them have future appointments scheduled, then the forward booking rate for that day is 21 percent.

The veterinary world only started tracking forward booking rates relatively recently, and according to Britni Prusa with VetSuccess, the average forward booking rate finally climbed into double digits in the last six to 12 months for the 2,500 or so practices for whom the company pulls metrics such as its Practice Overview Reports or Daily Dashboard Reports. The dashboard even allows practice leadership to look at forward booking rates by practitioner.

VetSuccess sees monthly averages for practices that work to improve forward booking in the 18–21 percent range.

Brandon Hess, CVPM, CCFP, veterinary business consultant with VetSupport, explains that a few shifts in mindset and reminder strategies make forward booking rates as high as 40–50 percent possible.

Forward booking strategies

Hess points to forward-booking in dental practices for a success model.

1. Make the next appointment before leaving the norm, not an option.
   Implement a process where practitioners specifically note the next time a patient needs to be seen so that the front-desk team, or whoever handles checkout, can see and support those recommendations before clients leave.
   
   Sample conversation: “Dr. Bailey wants to see Tiger again in two months. I’ll schedule your next visit for Saturday, August 15, at 5:30 pm. We’ll remind you a month or so in advance, and if we need to pick a different date or time, we can adjust our plan then. Does that work for you?”
   
   
2. Trust that appointments can be scheduled even if you don’t know which practitioners will be working which days in the future.
   Even if you have no clue which practitioners will be working which days six months from now, make the appointment anyway and include any important notes about clients’ preferences, such as wanting to see a specific provider at the forward-booked appointment. If the preferred doctor ends up not working that day, your team can catch that when the reminder process kicks off and then can help the client choose another date and time.
   
   Tip: “If you stifle the success of this by saying, ‘I don’t know what doctor is going to be available,’ then it’s not going to work,” Hess says.
   
   
3. Use a layered and multi-method reminder process (postcards, phone calls, emails, text messages) starting a month out from the next appointment to lower the risk of no-shows.
   “What I will sometimes recommend, depending on the practice,” Hess says, “is to make forward-booked appointments a different color on your appointment screen, like bright red, if you don’t already use red. Then, once a month, your staff can look at the next few weeks for bright red appointments, and they can call and confirm or reschedule as needed.”
   
   This may add a step or another layer to typical outsourced reminder systems, but Hess says it’s incredibly important to improve client service, prevent no-shows, and increase patient care compliance.

Forward booking results

Over time, forward booking can result in positive changes for both general and specialty companion animal practices.

Decrease incoming calls for appointments. As more routine visits get forward booked, the number of calls should go down. “I acknowledge the fact that forward booking is not going to decrease those urgent or emergency phone calls,” Hess says. “The goal is to decrease those phone calls that you’re getting from clients that want vaccines the same day.”

Prevent lapsed patients. In many cases, lapsed patients and clients result from busy lives, not any issues with your services or care. Rather than expecting clients to call for an appointment when they remember or have time a year from now, which easily can become 14 months or more, put something on the schedule for when practitioners want to see pets.

In a late 2019 study, ALLYDVM found that the average animal hospital has more than 1,000 cases with missing reminders. That’s a data/technology glitch, not a sign of uncommitted veterinary clients.

Missing reminders represent a gap in the normal patient appointment cadence, and they can happen when:

• A new patient of an existing client gets entered into practice management software
• A new patient and a new client move to the area or switch practices where prior veterinary records may not be received, fully imported, or fully integrated with practice systems
• Recommended follow-up care—preventive or active-condition specific—doesn’t get documented in the patient profile or client record

Without those software flags, the next appointment reminder will fall through the cracks of any reminder protocols. Missing reminders result in lost revenue as well as weakened patient care.

Increase compliance. By structuring appointments to support pet-care protocols and recommendations, practices can lead clients into better compliance for everything from preventive care products and services to more complicated case needs.

We often talk about and track compliance primarily in terms of things like vaccinations and parasite protection. Compliance matters in sick-pet cases as well, including patients with internal medicine, neurology, cardiology, orthopedic, and dermatology issues. Rather than cycling between sick and better, flare-up and improvement, setback and progress, follow-up appointments can set the course for steady, consistent improvement and case maintenance.

“Let’s say an animal comes in with really bad hair loss,” Hess says, “and then it gets better, so that client doesn’t come back in for the next appointment. The point of the recheck is to continue managing that and keep on improving it.”

Compliance in those kinds of cases matter as well, so forward booking isn’t simply a topic for general practices. It’s important for specialty hospitals as well.

“I used to manage a really large emergency, specialty practice before I started consulting,” Hess says. “They were really pretty good about forward booking because they for sure wanted to see those cases for follow up.”

Increase revenue. Currently, Hess explains, there is no direct correlation data that says a certain percentage of forward booked appointments links to a specific annual increase in revenue. We can, however, project that better client service, better compliance, and more regular visits will increase revenue.

“What I have seen is for practices to start seeing a significant increase in revenue [double digits] once they hit about a 30–35 percent forward booking rate,” Hess says.

Forward booking during the pandemic

As states move toward loosening business restrictions due to the COVID-19 pandemic, veterinary practices hope to resume more routine care and more normal operation. We don’t know yet how restrictions may come and go as COVID-19 cases rise and fall, so it’s good to have a plan for when you can and cannot see certain types of appointments.

Hess suggests that practices go ahead and forward book requests clients make during pandemic restrictions based on the projected dates governors or the state’s veterinary licensing boards announce for the resumption of routine care.

Now part owner of a large practice in northern Kentucky, Hess’s team booked some appointments forward during restrictions.

“We might not be seeing certain types of appointments, but as clients call us and want their pets to be seen for routine stuff, we’re putting them on the schedule for a month from now,” Hess says. “Rather than saying no now and having them call us back when things resume, let’s go ahead and quote, unquote, forward book that appointment, even though we cannot see it right now.”

He adds, “There is a chance that we may have to call and reschedule those appointments, but I’d also rather my staff do that, than put it in the clients’ hands. I never know when I’m going to hear from them."