Retention and Churn Rates

Retention and Churn measure the duration of care clients receive. By default, a client is considered "retained" if they have attended at least 8 sessions, and "churned" if they have fewer than 4 sessions, but you can adjust these thresholds in Settings > Metrics by clicking the Edit button.

While individual clients' needs my vary, the aggregated rate across your entire practice, or for an individual clinician, is an important measure of performance. In general, it costs money to acquire a new client, so higher retention and lower churn correspond to higher profitability.

To calculate retention over a timeframe, we first look at the unique clients whose intake occurred during the timeframe, and then find how many of those clients went on to have at least 8 sessions. Similarly, for churn, we look at how many of those clients had fewer than 4 sessions.

In Q1, 100 clients had intakes.

• 80 went on to have 8 or more sessions

• 8 had 1-3 sessions

• 12 had between 4-7 sessions

In this example, the retention rate is 80%, and the churn rate is 8%.

• Each client/clinician pair is included at most once, even if there are multiple sessions categorized as "intake".

• If a client sees multiple clinicians, they appear in the calculation for each clinician.

• Sessions categorized as "Billable Cancel" count towards the retention threshold. Other cancels do not.

• When calculating retention and churn, each session counts as 1, independent of the Completed Session Counting Rules you've set up.

• Retention and Churn rates include everyone, regardless of whether their status is currently inactive or discharged in your EHR.

The Retention Report allows you to run a retention report for a value other than 8. This allows you to find out, for example, how many clients from a timeframe went on to have 10, or 12, or any other number of sessions. The report also shows more details like the average sessions per client per clinician.

On the Clinician Metrics, Clinician Detail, and Practice Dashboard pages, the Retention Rate shown uses the 8 session threshold, and Churn Rate uses a 4 session threshold by default. You can adjust these in Settings > Metrics and then clicking Edit.

On the Retention Report, you may sometimes see a notice like this:

When your selected timeframe is close to "today", PracticeVital automatically shortens it for accuracy. If a client started 5 days ago and has had 1 session, it's unrealistic to expect them to already have 8 sessions. It's also unrealistic to consider them "churned", because they very well might go on to have 8 sessions -- time will tell. Therefore, we exclude those clients from the calculation entirely so they don't skew the metrics in either direction.

When shortening the timeframe, we assume 1 session per week by default, but you can change the average expected time between sessions in Settings > Metrics by clicking the Edit button. When calculating 8 session retention, clients with intake dates in the most recent 8 weeks are excluded. Likewise, when calculating 5 session retention, clients with intake dates in the most recent 5 weeks are excluded.

Yes. PracticeVital allows you to exclude clients from retention and churn calculations based on the services of the appointments they attend.

For example, psychological testing clients are typically only seen 2–3 times, so including them in retention metrics doesn’t provide useful insight. To handle this, we can configure any psychological testing services in your Service Mappings settings to exclude clients from retention and churn.

Here’s how it works:

• When PracticeVital detects an appointment with a service that has been configured for exclusion, the associated client is excluded from all retention and churn calculations for that clinician, across both past and future appointments.

• The same client will still be included in retention and churn metrics for other clinicians in the practice, unless one of their appointments with those clinicians also matches an excluded service.

Sometimes you may want to exclude a client from a clinician’s retention for reasons that aren’t reflected in the services they attend (e.g., brief consults, unusual treatment arrangements). In these cases, the practice can:

1. Create a dedicated service/billing code with a $0 fee (e.g., “Retention Exclude”).

2. Schedule a short (e.g., 15-minute) appointment for the clinician and client using this service.

3. Contact us to configure that service in Service Mappings to exclude clients from retention and churn.

Once this is done, PracticeVital will exclude the client from the clinician’s retention and churn metrics just as if they were linked to a testing service.

• Use exclusions sparingly. Overuse can distort your retention data and hide valuable insights.

• Ask why you’re excluding. If the reason is systemic (e.g., billing issues, scheduling bottlenecks, frequent no-shows), excluding those clients may mask an underlying problem that deserves attention.

• Example: It may be tempting to exclude clients who churn because of billing issues. But those billing problems are having a real impact—and addressing them with a better payment process or policy could directly improve retention.

Exclusions are best reserved for situations where the client’s treatment pattern truly falls outside of normal therapy expectations (like psychological testing).