Your Reactivation Playbook Is Ready
Watch Chad's training, run your numbers through the one-more-patient calculator, then work the Master Checklist below. Prefer to read it? Download the written guide to save and reference. It's all on this page.
The Story of Karen
I treated a woman for back pain years ago. I'll call her Karen. She did really well in treatment. The last time I saw her she told me she was back to walking, back to doing everything she wanted to do. I discharged her and felt good about it.
About a year later I saw her again, in a wheelchair. Her pain had come back a couple months after we finished. She'd slipped, got an MRI that showed stenosis and disc degeneration, and was told she needed a fusion. During the fusion, the way she described it to me, they "nicked her spinal cord." She hadn't walked since, months later.
Karen had taken care of my own grandparents. I'd known her for years. And I could not stop thinking one thing: she never heard from us again. Not a call. Not a text. Not an email. She got worse, she got scared, and she took the next available exit in the healthcare system, with us nowhere in the conversation. That was my failure, and my responsibility.
I can't control what other providers do. But I can control whether a past patient hears from my practice at the moment their pain comes back. That's what this playbook is about. The script in Gear 1 below is addressed to Karen, on purpose.
If you search your own memory for a few seconds, you have a Karen too. Everything in this playbook makes you money. That's nice. But that's not why I run it.
Every new patient in your practice comes from one of five channels, listed in order of ease, not in order of how much attention they get:
- Reactivations — people who already know, like, and trust you
- Word-of-mouth referrals from past and current patients
- Physician referrals — MDs, DOs, NPs, PAs, dentists, podiatrists
- Partnership referrals — employers, gyms, yoga studios, run shops
- Cold traffic advertising — people who have never heard of you
Most owners spend 90% of their marketing energy on channel five and almost none on channel one. That's backwards. Channel one is the lowest cost and highest ROI new patient source you will ever have, and you already paid for it, with clinical hours.
Here in Harrisburg we see 100 to 120 new patients a month, which means we also graduate 100 to 120 patients a month. Run that out over ten years and the list gets very large. Then ask the honest question: what percentage of the people on that list have heard from your practice in the last 90 days? For most practices, the answer is zero.
The Reactivation Training
Chad walks through the 3 Gears that run across all six of his clinics: the automated 90-day check-in, the 24/12 campaign calendar, and the Conversion Catch that stopped 82 patients a quarter from slipping away.
Prefer to read it? Download the written playbook.
The full 3-Gear system, scripts, and checklist as a clean, print-ready document you can save and reference.
What Is Your Unfilled Capacity Actually Costing You?
Pick last month. Every expense you had, rent, payroll, software, was already paid. Could you have seen one more new patient? Could you have seen ten more? Run your own numbers.
The One-More-Patient Calculator
Revenue you didn't realize because of unfilled capacity, not $1,000 after costs. The full $1,000, because the costs were already covered.
The 3 Gears of Reactivation
Three moving parts. When all three turn together, reactivation stops being a campaign you run when you're scared and becomes a system that runs whether you show up or not. Build them in this order.
The Set-It-and-Forget-It Loop
Ten years ago, reactivation meant a giant promotion twice a year: big push, big spike, then six months of silence. Now every patient who graduates gets one thing: an automated check-in 90 days later. Built once. Runs forever.
Patient status changes to discharged or graduated → wait 90 days → send one message.
"Hey Karen — it's been 90 days since we last saw you in PT. This is Chad at Madden & Gilbert. How are you doing?"
No offer. No discount. No emoji. One human question, sent at the moment people are most likely to be sliding backwards and looking for answers somewhere else. Replies get handled inside 120 seconds by Emily, our AI conversion agent, 24/7, carrying the conversation to the point where the patient is ready to reactivate.
Why 90 days? At 30 days most people are still riding the win. At 180 days they've usually already made a decision: injection, imaging, surgery, or resignation. Ninety days is the fork in the road.
The instinct is to add "20% off recheck visits this month." Resist it. The moment there's an offer, it becomes an ad and the reply rate drops. This is a check-in from a clinician who remembers them. Keep it that way.
Build one 90-day post-discharge check-in this week. One message, one trigger, built once. For owners using Breakthrough, this is automated.
The 24/12 Calendar
Gear 1 catches people on the way out. Gear 2 stays in front of everybody else. Across our six clinics we send 24 email campaigns and 12 text campaigns a year, and we only make an offer about twice a year. Everything else is goodwill, roughly an 80/20 mix. Our marketing team schedules the whole year in one sitting.
- Goodwill (the majority): a health tip, seasonal advice, three exercises for shoulder pain, a thank-you note. No ask.
- Direct response: the single-question check-in. "We haven't seen you in a while, how's that knee holding up?" Open-ended, conversational.
- Promotion (about twice a year): a real offer, timed to land right before your slow season.
The test we've run over a thousand times: a beautifully designed newsletter versus plain text that looks like it came from a person. More than 90% of practice owners guess the newsletter wins. It's always the plain one.
The first time Carl Mattiola, our CEO, showed me this, he took my best-performing direct mail piece, converted it to a plain email, and sent it. I walked in Monday morning and Deb and Jill at the front desk told me I "had to shut it off." Over 200 people had responded over the weekend.
A designed newsletter looks like marketing, so it gets read like marketing: skimmed and archived. Plain text looks like a note from their PT, so it gets read like a note from their PT. Match the creative to the media. That's the whole trick.
Text is a different animal than email: keep it short, warm, and open-ended. No emoji walls, no promo blasts. You're texting somebody who spent six weeks in your clinic with one of your clinicians and got better.
Block 60 minutes. Schedule 12 months of campaigns, 24 email + 12 text, in one sitting. Two offers maximum for the year, placed right before your two slowest months.
The Conversion Catch
This is the invisible leak. A few years ago our team was reviewing a strong Q1 in Harrisburg: 340 new patients, high fives all around. Then we asked one question: how many did we miss? We audited every scheduled eval that cancelled or no-showed and never came back.
The cause: the front desk was working out of six different spreadsheets that never talked to each other. Nobody could see the whole picture, so nobody owned it. We put in one very simple change: every lead and every potential patient goes into one place, and everybody, front desk, marketing, the owner, works the same list.
- One list. Every lead from every source, email, text, Google, Meta, phone, lands in a single place the whole team can see. Six spreadsheets is the same as zero spreadsheets.
- Five minutes. The industry average response time is more than 24 hours. Wait a day and conversion drops more than 90% versus responding in five minutes. This is the single most expensive habit in private practice.
- Questions, not scripts. When the practice asks more questions than the patient, the patient comes in. When it flips, they don't. Mirror what they say, then ask a "what" or "how" question. Repeat until they're ready to schedule.
She's checking people in, collecting copays, scheduling out, answering the phone, and working AR. Then you send an email that generates 200 replies and expect five-minute follow-up. That was never going to happen, and it isn't a performance issue. It's a capacity issue. Solve it with a system, not a conversation.
Run the audit this week. Pull every scheduled initial eval from last quarter that cancelled or no-showed and never returned. Count them, multiply by your average plan of care. That number is your Gear 3 budget.
What You Get to Stop Doing
Practice owners hold onto reactivation tactics that were the best available option in 2011 and are now just labor. Here's what this system replaces.
The Designed Newsletter
You're paying for design that actively reduces response. Send the plain one.
Six Spreadsheets
One list. Everybody sees it. This one is free, and it's worth the most.
The Scripted Follow-Up
Get people from your patient list to respond, then ask them questions. Have a conversation.
Writing Another Email
Once an email works, put it on a schedule to repeat. Or pull from Breakthrough's pre-written library and adjust it to your clinic.
The Master Checklist
Everything in this playbook, in the order you should do it. Tick items off as you go; your progress saves on this device.
Build the 90-day check-in. Just that. If you never schedule a single campaign, never clean up your lead tracking, never do anything else on this checklist, the automated check-in on every graduate will still put patients on your schedule every month for as long as your practice exists. Start there and add the rest when you're ready.
The Set-It-and-Forget-It Loop
The 24/12 Calendar
The Conversion Catch
See the 3-Gear System on Autopilot
The 90-day loop, the 24/12 calendar, the one list, the five-minute response, all of it lives in one place in Breakthrough, with the campaigns already written and tested across 1,300+ private practices. You can build it yourself, plenty of owners have, but it takes longer and usually stalls at Gear 3, because that's the part that needs a system instead of a person. On a free 15-minute growth session, the team will show you: