Patient attrition

Patient attrition is the flip side of new patient growth: the rate at which existing patients stop coming back, whether because they moved, changed insurance, or simply drifted out of the recall system without any single dramatic event. It is one of the quietest numbers in a practice, because unlike a bad review or a lost case, attrition rarely announces itself: a practice can lose several percent of its active base a year and not notice until new patient growth stops covering for it.

Attrition is also the number most feared and most overestimated around a decision like dropping a PPO. The honest data, and Ryan's own experience dropping plans across multiple practices, consistently shows real attrition landing well below what a nervous team predicts beforehand, especially with ninety days of clear communication and a membership plan offered as an alternative. Fear of attrition, not the actual number, is usually what keeps a practice trapped in an underpaying contract.

Measure it by comparing the active patient count period over period, adjusted for new patients added, and treat a rising number as a signal to look at reappointment rate and hygiene scheduling before assuming it is about insurance or price at all.