Best Ways to Deal With No-Shows

Elizabeth Woodcock, MBA

Disclosures

July 14, 2009

Introduction

A patient's failure to show up for an appointment can be devastating to your bottom line. You receive no revenue for the scheduled time slot, but you still have all of the related overhead.

The tough economy is affecting patient volume, and most practices are experiencing volume decreases of 5%, some as high as 20%. More patients are deciding against preventive care, delaying elective procedures, or failing to keep appointments for follow-up care. Although many patients are polite enough to cancel or reschedule their appointments, others just don't show up.

Although you may have been lenient about your no-show management strategy up to now, it's probably wise to become more proactive. Try these tactics.

Let the Patient Suggest the Appointment Time

According to a recent University of Missouri survey that looked at 11,000 scheduled patient visits, patients who suggested the most convenient time for an appointment were more likely to show up than when the scheduler suggested the appointment time. Usually the scheduler was trying to book patients in the way that was most organized for the practice. For example, they'd schedule the first patient who called at 8:30 am Monday; the next one at 9:00 am Monday, etc.

When patients suggested their own appointment time, they took into account transportation schedule, family commitments, and other factors. When they tried to adapt their circumstances to the scheduler's appointment, they were more likely to miss the appointment.

Call to Confirm Upcoming Appointments

For new patient visits, procedures, and other lengthy appointments, ask the patient to call back to confirm.

Start by asking the patient's permission to place reminder calls or send e-mails 2 days in advance of the appointment. This allows patients 1 full day to plan for the appointment or contact you to cancel, and helps assure the slot is filled.

While a majority of doctors' offices already place a reminder phone call, asking for a call back to confirm is novel, and can be very helpful.

Establish a Priority List of Patients Who Will Come in if a Last-Minute Opening Occurs

Dust off the 'waitlist' but update it by calling it a 'priority list.' Manage the list on a computer instead of paper. You can do this easily by creating a simple Excel® list.

When patients call to cancel, having a ready list of other patients willing to come earlier than their scheduled time can save the day.

Track Offenders

Past actions can often predict future behavior, so track patients' missed appointments in your scheduling system. Dismiss frequent offenders from your practice after a predetermined number of no-shows (for example, 3).

Alternately, establish a separate scheduling template for these patients. Give chronic offenders appointments on a 'Dr. No-show' template, with each physician sharing equal responsibility for seeing any patients who do show up. Or, tell chronic no-show patients that they will be seen on a walk-in basis only. This approach means that precious slots won't be taken from the patients who do keep their appointments.

Overbook

Use yield management techniques, which are popular in the airline industry, and known as 'strategic overbooking.' Consider overscheduling some appointment slots. For example, if 2:00 pm to 4:00 pm is traditionally slow, that might be a time to overbook.

Instead of adding slots sporadically through the day, be strategic. Evaluate your historical no-shows to determine patterns -- appointment types, payer types, days of the week, time of day -- and overbook accordingly.

Charge Patients Who Don't Call to Cancel

In concert with proactive steps to manage no-shows, your practice can charge patients who don't show up. Even Medicare allows physicians to charge their beneficiaries, with certain restrictions. (See http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5613.pdf)

Unless your payer contracts prohibit it, take a credit card number from the patient to 'reserve' the slot and charge them a no-show fee if they don't show up. After the no-show occurs, send the patient a bill.

Medicare's policy is to allow physicians to bill patients for missed appointments; however, Medicare itself does not pay for missed appointments. Additionally, Medicare requires that if you will need to bill all patients for missed appointments, not just Medicare patients.

This tactic may cause ill will with some patients. You might avoid using it for a patient's first no-show, or waive it if a no-show patient becomes upset and promises to do better next time.

Let Patients Know How Much You Appreciate Their Calling in Advance to Cancel

Sometimes patients fear calling to cancel because they're afraid the front desk staff might 'yell' at them, or be angry. Put up signs in your office that ask patients to call if they can't make it, assure them that no one will be angry -- and in fact, you will be grateful if they do so.

You could also explain to patients that calling to cancel is helpful to other patients, and improves the good neighbor/community member spirit.

Look Within for the Cause

Is your practice doing something to cause more no-shows? Do you know what your average no-show percentage is, compared to most physician practices? Some estimates indicate that physician practices may average from 5% to 10% no-shows. Do you or other physicians in your practice frequently cancel patients' visits, thus bumping patients' appointments? Is your time-to-next appointment more than 3 weeks? If so, patients may get impatient waiting for the appointment and find another doctor in the interim. Do you run several hours behind? These factors contribute to no-shows.

Although there are many strategies to manage successfully through these turbulent economic times, don't forget the basics -- reducing missed appointments improves your practice's bottom line, and takes the heat off you.

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