Ep. 22: When Should You Actually Deactivate a Patient
So a patient of yours hasn’t been in for a few years and isn’t answering your front desk’s calls—what should you do? Should you “deactivate” or “purge” their chart? And for that matter, what should you do about the thousands of inactive charts you may have sitting in your practice? Most dentists approach this wrong and it costs them a ton of potential production. So in this episode, Jeff discusses the right way to do it!
Topics:
1:17 – How do you define an “active” patient?
6:55 – The four reasons why you would deactivate a chart
15:04 – How to reactivate all your “inactive” patients that should come back in
Links:
Download the MGE Reactivation Program - https://www.mgeonline.com/mge-reactivation-program
Train your team to reactivate patients - https://ddssuccess.com
The New Patient Workshop - https://www.newpatients.net
The MGE Communication & Sales Seminars - https://www.mgeonline.com/abc
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Questions From This Episode
What are the four legitimate reasons to actually deactivate a patient chart?
The patient has passed away, the doctor genuinely doesn't want them in the practice anymore, the patient has made clear they don't want to come back and nothing reasonable can change that, or the patient has moved somewhere the practice can no longer realistically serve them. Notably absent from that list is simply not having heard from someone in two or three years.
Why is not having been in for two or three years not a valid reason to deactivate a patient?
Because the two-year active patient definition is a largely arbitrary number that seems to have originated from practice sale conventions, not from any real evidence about patient behavior. Most patients who've drifted away still consider the practice their dentist the entire time, and if something serious came up, they'd likely call that same office first, they simply need a bit more consistent outreach, not a permanent write-off.
What should you do with a patient who can no longer afford your fees after switching to an HMO plan?
Take them off the active recall schedule if they've said they won't be returning, but keep them on the newsletter and general mailing list rather than cutting off contact entirely. Patients who leave because of a plan change often come back once they realize they'd rather pay a bit more and stay with a practice they actually like, so it's worth staying in their minds rather than assuming that relationship is permanently over.
Why does Jeff recommend a homemade-looking newsletter over a polished, canned one?
Because a newsletter that looks like it was actually put together by the practice itself, rather than an obviously templated one with a photo simply dropped in, tends to read as more genuine and gets actually read. It doesn't need to be elaborate, a short educational article, some office news, and a current offer are enough, consistency and authenticity matter more than production value.
Why should reactivation calls not just be handed to whoever has some spare time?
Because reaching a genuinely large number of inactive patients takes real, dedicated hours, and treating it as a side task squeezed into someone's existing workload rarely produces meaningful results. It's a good starter role for a new, upbeat hire since scheduling a routine recall visit is straightforward to teach, but that person still needs to be prepared for the small percentage of people who won't be pleasant on the phone, and not let that color how they treat everyone else.
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Picture a chart for one of your patients, we'll call him Mr. Smith. He hasn't been in the practice for three years. He was a nice person, never a problem, paid his bills and showed up on time. But two and a half years ago he missed his last cleaning appointment, and you haven't seen him since. Your office may have called him once or twice, but he's never called back. So with it being three years now, do you purge or deactivate this chart, decide he's no longer active, and call it a day?
Back in episode 11, I talked about how much it actually costs to acquire a new patient, and how most offices have retention issues that cost them 50 percent or more of their patient base, a lot of Mr. Smith's, essentially. So for this week's episode, I want to drill down on this specific subject, when should you actually deactivate a chart, how to keep your patient base active, and what to do about the patients who've already become inactive. My name is Jeff Blumberg, and I'm your host.
I want to start by addressing something I've said before, what I consider the two biggest managerial problems in the dental industry. The first is case acceptance, which we covered back in episode one. The other is the hygiene department. Hygiene should be growing continuously, it's a genuine recurring income source, and it's also how you keep patients coming back so you can continue maintaining their health. Yet it's not uncommon to see a dentist who's been practicing for ten years still struggling to fill three days of hygiene when they should realistically have eight to ten.
A lot of that problem is born from poor follow-up, combined with this whole concept of what makes a patient inactive. We generally consider an active patient someone who's been in the practice within the last two years. There's no actual study behind that number that I'm aware of, no white paper showing patients within two years are meaningfully more likely to schedule than patients at three years. It's essentially an arbitrary figure. I've heard this two-year standard since I entered the industry in the early 1990s, and my suspicion is it originated from practice sales and brokerages, the idea being that if you're buying a practice, patients seen within the last two years are a better bet to return than patients seen three or four years ago.
But look at any practice that's been around a while, they'll have their active patients, maybe 1,500, 2,000, 3,000, and then double or triple that number sitting as inactive, patients who simply haven't been in within that two-year window. Inactive almost always outnumbers active by a wide margin unless it's a brand new office.
So how does this actually happen? Think about the concept of a chart audit. You've probably done these, or had an office manager do them. You pull up a report of anyone who hasn't been in for two years and purge their chart, some offices call the patient first, some don't. You look at Mr. Smith, you've called him three times, he hasn't called back, it's been two and a half years, and you decide he's not coming back. We assume the worst in these cases, even though we genuinely have no idea what's actually going on, since we haven't actually spoken with him. So we purge the chart, mark it inactive, no more calls, no more postcards, no more mail.
That's the office's perspective. Now look at it from Mr. Smith's side. Nine times out of ten, if he gets a toothache a year from now, who's he going to call? You. He walks back into your practice after three and a half years, and when you mention it's been that long, the response is almost always, really, has it been that long? I've been meaning to call you guys. In his mind, you were always his dentist, that never changed for him. But on your end, your staff looked at this and assumed he didn't want to come back, maybe he'd gone somewhere else, all decisions made about someone you never actually spoke to.
Doesn't that suggest maybe we shouldn't have made Mr. Smith inactive in the first place, maybe we just needed to try a bit harder to get him back? And say he's not the most reliably compliant patient, he tends to miss appointments here and there, but he's not a bad person, he's not blowing off multiple appointments in a row deliberately. That's exactly what patient education is for, gently reinforcing why keeping regular cleaning appointments matters, that keeping his teeth for life contributes to better overall systemic health and quality of life. That's an educational opportunity to make Mr. Smith a better patient, not a reason to decide he's simply a bad one we don't want back.
This is really the core problem. We spend real money getting someone into the practice, as I covered in episode 11, and then spend almost no time or follow-up actually keeping them there, which is what I want to get into more this week. Let's start with when you should actually deactivate a chart.
Quick disclaimer here: you have to decide what's right for your own practice, this is my advice and opinion, what we teach our own clients, but you're ultimately responsible for the decision and its consequences. And obviously, there are legal requirements around how long you must retain patient records regardless of activation status, that's on you to follow properly.
What we teach clients here at MGE is that there are four legitimate reasons to deactivate a chart. Reason one is straightforward: the patient is deceased. Not much more to say there.
Reason two: the doctor doesn't want to see this patient again. That might be a surprising thing to hear from me, but it's a genuine, valid reason. In our Communication and Sales Seminars, we actually spend time on what we call the problem patient, someone whose presence in the practice is genuinely more costly than it's worth. If tomorrow's schedule has a name on it that makes you not want to go to work, or makes your staff visibly stressed the moment they see it, either that relationship needs a direct conversation to reset expectations, or that patient needs to go elsewhere. That's entirely your right.
There are real rules around dismissing a patient, especially mid-treatment, and you'll find the specifics in your state's Dental Practice Act, always follow that to the letter. But if someone in your practice is creating a genuinely toxic environment, despite real efforts to smooth things over, it's worth asking honestly how much that person is actually costing you, not just directly, but in team morale and how it colors your interactions with every other patient that day. My advice if you're ever unsure how to handle a dismissal: call your malpractice carrier first, they genuinely want to help you avoid a lawsuit and will point you in the right direction.
Reason three: the patient genuinely doesn't want to come back. I'd actually split this into two versions. First, a patient who's upset, you do everything reasonable to resolve it, and it still doesn't smooth out, they simply don't want to return. Fine, that's their call, mark them inactive.
One important note here regardless of the reason: there should always be a real approval process before a chart gets marked inactive. You don't want a new receptionist making reactivation calls able to unilaterally deactivate someone the moment a patient says they're not interested. I've seen staff who are genuinely poor communicators upset patients unintentionally, get told the patient doesn't want to come back, and simply mark them inactive without anyone else ever reviewing it, quietly losing patients without anyone realizing it's happening. Whoever manages this should see and approve every deactivation.
The second version of reason three is trickier: a patient whose employer switched them to an HMO plan, and they genuinely can't afford your fees anymore. In that case, you can take them off the active recall schedule, but make sure they know they're still welcome as a patient, you simply don't participate in that specific plan. If they have an HMO, they won't have benefits at your office, if a PPO, they'll pay somewhat more out of pocket, but the plan itself doesn't prevent them from coming to you. I'd still keep them on your newsletter and general mailing list rather than cutting contact entirely.
I say this because if you've ever dropped an insurance plan and seen patients leave as a result, you've probably also seen some of them come back eventually. It happens often, someone switches to an HMO-only office, realizes they'd rather pay a bit more and stay where they were genuinely comfortable, and returns. So stay in their minds, don't write them off completely. As it happens, one of our clients in central Florida gets her single biggest source of new patients from the corporate office across the street, patients unhappy with how they're treated there simply walk into her practice instead. Don't assume that door is permanently closed.
Reason four: the patient has moved. Again, this is exactly why an approval process matters, I've seen plenty of cases where someone moves but still flies back into the area a few times a year and fully intends to keep the same dentist. When someone tells you they're moving, ask directly whether they'll be finding a new dentist there or staying with you. If they're relocating somewhere you genuinely can't serve them, help them find a referral in that area, that's a nice gesture, and handle the records transfer with proper patient consent. But moving alone doesn't automatically mean the relationship has to end, don't get robotic about it.
So those are the four legitimate reasons: deceased, the doctor doesn't want them back, the patient genuinely doesn't want to return, with that caveat around HMO and plan changes, or the patient has moved somewhere you can't serve them. Notice what's missing from that list: simply not having heard from someone in two or three years. That is not, on its own, a valid reason to deactivate a chart.
So think about the average practice: 2,000 to 2,500 active patients and maybe 5,000 inactive ones, deactivated purely due to time passing, not because they're deceased, moved, or genuinely don't want to return. What do you actually do about that group? Most practice software, Eaglesoft, Dentrix, and others, can run a report showing exactly who in your full patient base currently has a next appointment scheduled versus who doesn't. I'd genuinely recommend running that report, it tends to be a shock, a small number with something scheduled, and a large number without.
So how do you prevent building up a large inactive base in the first place, and what do you do to bring back the ones who already have? First, you need someone genuinely responsible for this. If you're sitting on five or six thousand inactive charts, do the math: if hiring someone at 40,000 dollars a year to run reactivation gets you even a hundred reactivated patients a month, and getting a hundred new patients through marketing alone would typically run you 25,000 to 30,000 dollars, that's a strong investment. This doesn't have to be a dedicated new hire either, it could be an office manager, a dental assistant, or a scheduler, but someone specific needs to own keeping the patient base active.
Next, you need regular, ongoing communication with your patient base. At minimum, a genuine practice newsletter, quarterly at least, ideally monthly. I do both mail and email personally, and marketing tends to move in cycles, lean too hard into digital and mail becomes more novel and effective again, lean too hard into mail and the reverse happens. The point is consistent, regular outreach either way.
As for the newsletter itself, I have a personal preference here: I'd rather it look genuinely homemade than professionally templated with your photo just dropped in. When I get something from a local business that clearly looks like they put it together themselves, not a slick, obviously purchased template, I find it more genuine, and I actually read it. It doesn't need to be fancy: a short educational piece, maybe how brushing technique matters or the link between gum health and heart disease, some office news, a new hire, a birth announcement, and a current offer, a referral special, something on Invisalign, whatever fits.
This accomplishes two things. First, it keeps you in your patients' minds. We've talked about this before in marketing episodes, you want multiple points of contact, a mailer, something online, a billboard, a commercial, so you're genuinely everywhere as far as the patient is concerned, which makes them more likely to actually respond. If someone's getting your mail and also getting a call from your office, you have a much better shot at getting them back, and often they'll simply pick up the phone and call you first once they've had consistent contact for a while.
It also helps retain the patients you already have, not entirely on its own, but it genuinely helps. And there's a practical side benefit too: USPS mail forwarding only lasts six months. If you go quiet on a patient for over six months and they move, you lose their updated address entirely. Yes, you could dig up a new address through other means, but why spend staff time on that for a large patient base when regular mail simply keeps your database accurate on its own.
Beyond the newsletter, you can layer in postcards, text campaigns, and phone calls, along with the occasional special offer for patients who haven't been in for a while, something like a discount on their next visit to nudge them back. The goal is steady, non-annoying, consistent contact that keeps you active in their minds and gives you a real shot at reactivating them.
Which brings us to phone calls specifically. We have a Reactivation Program available as a download on the episode page, a structured sequence of letters and calls designed to bring inactive patients back. Depending on how many inactive patients you have, this might be a part-time task or, if you're sitting on five to ten thousand inactive charts, genuinely a full-time role.
One important warning: don't just tell an existing team member to squeeze this in for an hour a week. Reaching several thousand inactive patients takes real, dedicated hours, think through how many actual man-hours it would take to properly work through five thousand names, you may need a dedicated hire depending on your specific situation.
This is actually a genuinely good starter role for a new, upbeat hire, someone naturally social who enjoys talking to people. As we've discussed before, I wouldn't put a brand new hire straight onto new patient phone calls, since you're spending real marketing money to generate those and can't afford early mistakes there. But reactivation calls are simpler to teach, scheduling a routine cleaning and exam for someone like Mr. Smith doesn't require the same complexity as scheduling six crowns and an implant.
One thing to prepare that person for: they will occasionally run into someone who isn't pleasant on the phone. It happens in every business, a small percentage of any patient base simply isn't going to be nice. What you don't want is for one bad call, why are you people calling me, I got your letter and it was awful, to color how they perceive everyone else they call that day. We're naturally wired to focus on the negative, twenty patients could come through in a day, nineteen perfectly pleasant and one genuinely rude, and that one interaction is what gets talked about at the end of the day.
So prepare whoever's making these calls to log the occasional unpleasant interaction and hand it off to the office manager to decide how to handle that specific patient, rather than letting it shape their attitude toward the rest of the list. The overwhelming majority of people will be perfectly fine, it's just worth setting that expectation upfront, especially for someone making these calls at real volume.
That covers the core of it: the actual reasons to deactivate, and how to keep your base active and bring back the patients who've drifted. One quick preview for a future episode on building the hygiene department specifically: you need to make regular cleanings feel like a genuinely big deal. Walk into most dental offices and you'll see signage for Invisalign or teeth whitening, but rarely anything promoting the importance of a routine six-month checkup. If you make it feel important in your own messaging, it becomes more important to the patient too. We'll get into that in more depth in a future episode, but it's genuinely critical, and these inactive patients are considerably easier to bring back than acquiring a brand new patient, which you should still be doing anyway. Getting them back helps their overall health too, which is really the whole point.
That's everything for this week. I hope this helps. Links to everything mentioned, the New Patient Workshop, the Communication and Sales Seminars, and the Reactivation Program, are in the episode description. We also cover real examples of reactivating patients on our online training platform, DDS Success, ddssuccess.com, link included, with a free demo available. Thank you so much, I hope you all do well, and I'll see you next week.