Late Cancellations & Missed Appointments
Ways to Reduce and Discourage Them
By Shannon Peyton May 10, 2019
Late arrivals, late cancellations, and missed appointments are the bane of every medical practice. They reduce your revenue, leave you with pockets of unusable space in your day, and may deprive other patients of the care they need. If you think about it, the true cost of a missed appoint isn't just the appointment that the patient missed because he/she will want to reschedule, taking up yet another appointment slot. This means the true cost of a missed appointment is two appointments, not one. In this article, we will look at ways to discourage and prevent missed appointments.
Having a written policy, will help you, and any employees, react to late cancellations and missed appointments consistently. Inconsistent adherence to the policy will leave your patients unpleasantly surprised in the event you do charge a missed appointment fee. Some patients may even argue with you when you charge for one missed appointment if you routinely wave or neglect to charge the fee without rhyme or reason. No one likes trying to collect money from angry patients. Having a policy doesn't mean that you won't take true emergency situations into account, just that there are guidelines in place to help the office cope with the impact of missed appointments and to allow your patients know what to expect.
Give your patients notice of any changes to the policy and have them sign the updated policy at their next appointment. Providers who see the same patients every week or two, will find it easier to give advanced notice of a policy change than those who only see patients every few months.
2. Have a missed appointment fee. Do you remember the first time you noted that a doctor's office had a late cancellation or no-show fee? Knowing that there is a missed appointment fee will motivate patients to keep track of their appointments.
The fee will also help you. While you are providing a much-needed health care service, this is also your livelihood. A last-minute cancellation or no-show means you lose out on revenue for that lost appointment. Imagine that you have 7 late cancellations and 3 no-shows in a week and you average 24 appointments a week, earning an average of $70/hour in insurance payments. This means you earned $700 less this week. $700 in lost revenue could mean that you can't pay all your bills this month or that you can pay the bills but that you won't be able to take your salary, forcing you to dip into your emergency fund. With a $50 missed appointment fee, you could recoup up to $500 of your lost revenue.
“We understand that there are times when you must miss an appointment due to emergencies or obligations for work or family. However, when you do not call to cancel an appointment, you may be preventing another patient from getting much needed treatment. Conversely, the situation may arise where another patient fails to cancel and we are unable to schedule you for a visit, due to a seemingly “full” appointment book.”
This paragraph emphasizes the impact of late cancellations and missed appointments on the treatment of patients, encourages patients be courteous and conscientious of other patients' need for treatment. This is a kind way to explain to any patient why it is important to give proper notice and helps them to think not only about their own life issues but also to try to be cognizant of the impact their actions can have on other patients who also have their own life issues.
II. Definitions and consequences . The cancellation policy should include the definitions of late cancellations, late arrivals, and no-shows as well as their consequences.
Each specialization has its own requirements for patient scheduling: counselors can often fill cancellations within a day or two while surgeons need one to two weeks to obtain authorizations for surgical procedures. If you aren't sure what the minimum cancellation time should be, consider how long it usually takes to fill an open appointment (or the average time it takes to obtain an authorization) and let that help you determine the minimum cancellation time. Check the cancellation policies of the peers in your area to see what their cancellation policy looks like.
B) A graduated fee schedule:
C) A three-strike policy: all patients who have three late cancellations or missed appointments in a year are discharged. You set the maximum number of occurrences and the time frame to fit your practice.
D) Charge a deposit to reschedule. The deposit can either be a missed appointment fee that must be paid before the patient is permitted to reschedule or it can be a deposit that is paid when the patient reschedules which you apply towards a missed appointment fee; apply, in part or in full, to the patient's copay, deductible, or co-insurance for his/her next appointment; or refund back to the patient at his/her next appointment.
1. Appointment reminders. Appointment reminder can come in many forms from phone calls and text messages to email reminders and will help prevent late cancellations and missed appointments. The downside to appointment reminders is that either you (or your staff) need to spend time making calls or sending text messages or email reminders, and phone call reminder can be especially time consuming.
Instead of doing the reminders yourself, you can hire a company to send reminders by text or email for you. You will have to format your information so that the company can import it into its system. You can get around the fee by doing those yourself, but again, they will take time.
Another option is to convert a cellphone number into an email address, so that reminder texts can be sent as if they were email reminders and replies come back to your email account, not a cellphone. Text reminders are also more effective than voice mails since text messages have higher rate of being read than voice mails (do you know anyone who simply returns your phone calls without bothering to listen to the voice mail you left?).
You have an appointment with Dr. Smith on Tuesday, March 1 st at 4pm at the Glendale office (Optional) . Please reply to this email to confirm your appointment.
Dr. P.R. Smith
Hi John (name optional) , this is George calling to confirm your appointment on Tuesday, March 1 st at 4pm. Please call the office at 623-555-5555 if you have any questions.
3. Limit the repeat offenders. Patients who routinely late cancel or no-show appointments have the greatest impact. Don't allow repeat offenders to abuse your time. Determine what is a reasonable number of missed appointments and then discharge anyone who exceeds this limit.
If discharging patients seems too extreme, take other steps to limit the impact of repeat offenders. Limit the number of appointments that a patient can schedule in a set time, whether they make it to the appointment or not.
4. Make appointments appear scarce. This is another way to limit the effects of repeat offenders but could be applied to all patients who cancel late or miss appointments. Dan Clements explains that by “[t]elling a patient that [he/she] can't get another appointment for two months delivers the message that a) you're in demand (always good for business) and b) they need to respect the appointments they've made.” (Clements 2006) When the patient calls to reschedule, not having another available appointment for weeks or months may motivate the patient to keep the appointment they currently have.
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