Patients who do not keep their appointments are a financial burden on a practice and can have a major impact on others waiting for treatment. “It is important for a practice to account for the occasional no show,” said Dianne Williams, CEO of ENT Associates of Alabama in Birmingham. “Our average non-surgical patient brings in about $150. If you have 10 no shows a day, that translates into $1,500 a day of lost revenue.”
Explore This IssueAugust 2018
If the rate of missed appointments is high, other patients can be impacted. A study done by an acute care hospital system noted that lowering the number of patients who missed their appointments caused the next available appointment average to drop from 100 to 55 days (Hardwired Results. Published 2014.).
“A slot that is not used means that a person who is a day or more away from being seen could have gotten that slot,” said Jon Chabot, practice administrator for ENT, Ltd., in Norfolk, Va. “Getting patients in quicker can have an impact on their treatment and health going forward.”
Finding the “who” of missed appointments has been made easier by electronic patient scheduling software, which usually have ways of flagging no shows. Most practices call the patient immediately. This is to see if they are lost, delayed in traffic, or have missed the appointment for some other reason. If they can’t get in touch right away, practices try again within 24 hours. This is often the time when a new appointment is made.
Prevention can lower the incidence of missed appointments. Phone calls made a day or two before the appointment lower the rate of no shows. Emailing and text messaging are useful, adding the advantage of a link patients may use to cancel and/or reschedule. Other tips that have proven to be useful include the following:
- Stay on time. If you expect the patient to respect your time, respect the patient’s time.
- Keep a waiting list. This lets you fill in the gaps by calling people who are prescreened for availability.
- Know your patient. Some people are chronically late, and if the pattern can be established, flag them in the scheduling software. When their appointment is at 10:30, tell them it is at 10:00 so they’ll be on time.
Double booking is another way to lessen the impact of no shows. Some practices note certain days or times patients are more likely to miss, and add a second slot in that timeframe to recoup the lost revenue. “We allow for missed appointments in our scheduling and have four additional spots a day,” said Williams. “If everybody shows up, the doctor is a little busier. If they don’t, there is still a normal schedule.”
Being diligent is very important. You have to follow up, be consistent, and send out the reminders. Every step in the process is critical. —Dianne Williams, CEO of ENT Associates of Alabama
One controversial way to lower your rate of no shows is through the use of financial penalties, whereby practices charge patients who miss an office visit $25 to $50. It is legally important to have a written policy and send patients written notification of the fee. In addition, it is against the law to charge such a fee to Medicaid patients. Some insurance companies may prohibit this, so look at all of your agreements. “Although our policy says it can be charged from the first incident, we seldom do it unless they are a repeat offender,” said Williams. Some practices ask for the fee when the patient arrives the next time or use a charge card on file. Others bill it as they would a regular charge.
ENT, Ltd., bills a portion of their fees up front. “We collect a $50 deposit when the appointment is rescheduled,” said Chabot. “If they show, it is applied to their bill or refunded.”
Firing a Patient
Chronically missed appointments may lead to the patient being “fired.” This is addressed in your no-show policy and notice. The methods and notifications for implementing this policy are the same as terminating a patient for other reasons.
“Being diligent is very important,” said Williams. “You have to follow up, be consistent, and send out the reminders. Every step in the process is critical.”
Kurt Ullman is a freelance medical writer based in Indiana.