No-Shows Cost Plenty
Missed Appointments Mean Decreased Income and Efficiency By Judy Capko
Judy Capko is a writer for Physicians Practice
 The demands of patient care require physicians and office administrators to work long and exhaustive hours. They rarely leave the office on time, and the day’s work is never finished. Despite this frenzy, physicians often end up with gaps in their schedules due to last-minute patient cancellations and no-shows. Practice management consultants around the country agree that missed appointments are a major problem. No-shows not only mean a loss of charges, but office staff members can lose hours scheduling the no-show appointment, pulling and reviewing the chart, calling afterward to find out why the patient did not show up and rescheduling the appointment.
Beyond the lost charges and time, no-shows also represent a lost opportunity to better serve patients who are in need of treatment.
“If you are not serving your patients, your relationship with them will suffer, and they may go elsewhere for their care,” said Rebecca Anwar, a consultant with The Sage Group, a medical marketing firm in Philadelphia.
Why do patients miss appointments and what can be done to encourage no-shows to keep future appointments?
There are a number of reasons practices experience high no-show and late-cancellation rates. It can be caused by a poorly managed scheduling system that does not match patient needs with available physician time, or a practice that does not place enough importance on staying on schedule and resolving scheduling problems that arise. In addition, changes in society influence certain behaviors in patients, leading to no-shows and last-minute cancellations. For example, some patients have hectic lifestyles that contribute to their diminishing value for keeping appointments, and some think they’ll never be missed.
“There are days when people can’t juggle it all, and something has to give,” said Tessie Quattlebaum, a practice management consultant with Quantrex in Liburn, Ga. “That’s no excuse, but physicians need to recognize this shifting cultural dynamic.”
Other patients may miss appointments due to a lack of physician loyalty, personal moves and changes in their insurance plans. An appointment missed here and there just doesn’t seem to matter.
Honor and manage your schedule
Physicians and their staff members must value their patients’ time by honoring their schedules and keeping patients well informed once they arrive in the office. If there is a delay, let them know.
“If you don’t regard their time, they won’t regard yours,” said Anwar. “Everyone in the office needs to contribute to maintaining a consistent schedule that allows enough flexibility to meet patient demands, but does not compromise production or efficiency.”
Scheduling patients too far into the future can also lead to a high rate of no-shows. “If a patient calls with a chronic condition that is not urgent and you book the patient out three weeks, that patient is likely to feel better before the visit or may even forget the appointment. Worse yet, the patient may decide to go elsewhere,” said Jack Valancy, a practice management consultant in Cleveland Heights, Ohio.
Staff members who do not take the appointment schedule seriously can also encourage no-shows, albeit unintentionally. For instance, some busy practices are relieved when patients do not show up because they get a chance to catch up, even though that opening could have been filled with a patient who needed to see a doctor.
To that end, practice staff members may also send verbal messages giving patients permission to discount their appointments. For example, a scheduler who says, “Let me know if you cannot make it,” sends a message that the practice expects that patients may not honor their appointments, and that’s OK. Similarly, “We’re squeezing you in,” gives patients the impression they will not be missed if they do not show up. These subtleties can have a dramatic effect on how much patients value their appointments.
In addition, there are practices that simply have a reputation for canceling appointments at the last minute or chronically running late. In these situations, patients quickly learn to disregard the importance of prescheduled appointments.
“If you are the victim of daily missed appointments, your scheduling system may be the culprit,” advises Anwar of The Sage Group, who suggests that practices follow these six “critical” rules to effectively manage their schedules: - Allow enough time for each patient, based
on appointment type.
- Stay on schedule and communicate delays.
- Ensure patient access is sufficient to
meet patient demands.
- Train staff to provide feedback to
no-show patients and reinforce the importance of keeping a
scheduled appointment.
- Establish a method of confirming patient
appointments.
- Hold staff and physicians accountable for honoring the schedule.
To make sure everyone on staff honors the appointment schedule, conduct formal training sessions for new employees and annual staff updates.
Decrease the rate of no-shows
To control no-shows, start by arming your practice staff with processes that work. Provide receptionists and schedulers with scripts for scheduling and confirming appointments. Use terms like “we’re expecting you” or “we’ve dedicated our 3 o’clock appointment slot to you.” Strong words reinforce the patient’s obligation. Technology, such as an automated telephone reminder system, can save staff time, and most practices see immediate drops in their no-show rates.
Brent Greenberg, M.D., of Penn Elm Medical Group, a 12-physician family practice in Escondido, Calif., said his practice’s no-show rate began to improve when it started confirming the next day’s appointments for all patients. “Patients who have been scheduled for several weeks or more really appreciate the call, as they tend to forget,” Greenberg said. “It seems everyone’s life is more hectic.”
If patients are reminded but still miss their appointments, follow-up calls should also be placed to make them aware that they were missed, to request advance notification in the future so that other patients can be seen and to reschedule their appointments. “Also, during the next visit, the physician needs to mention the failed appointment and remind the patient that it’s important for his/her care to keep appointments,” added Valancy from Cleveland Heights.
Interestingly, experts say that physicians have the best opportunities to turn around no-show patients.
 “A simple, polite comment from the physician does more to discourage a missed appointment than any phone call from staff,” Greenberg said.
Fed up with absorbing the costs of no-shows, some practices charge fees to control no-shows. However, many experts consider this the least effective method to control no-shows.
“It alienates patients, who rarely agree that they did not have a legitimate reason for the missed appointment, and punitive methods can be damaging to the patient relationship,” said Georgia-based practice management consultant Quattlebaum.
Valancy agrees: “I’m not a big fan of this. It antagonizes patients and may send the message that the practice is only interested in the money.”
At the end of the day, missed appointments equal lost time and money, but practices can decrease the rate of no-shows by implementing some or all of the procedures above. Over time, the physician, staff and patients should see an increase in efficiency.
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