As sports rehabilitator Heidi Dawson writes in this article: “No-shows [are] the bane of a therapist’s existence.” We’re inclined to agree. You’ve got your schedule precisely booked—often down to the minute—and a no-show or late cancellation can turn your well-balanced plan for the day into a disheveled mess of frantic “are-you-still-coming?” phone calls followed by thumb-twiddling boredom. Oh, and then there’s the lost time and revenue to consider. Despite how frustrating no-shows can be, though, all hope is not lost. There are several things you can do to tackle the no-show problem and increase the odds that your patients will show for their appointments. Here are five:
1. Set a Policy
Dawson writes that “time is money,” and that’s especially accurate for therapists because you don’t make money without treating patients. To take that several steps further, if you don’t make enough money, you won’t stay in business, which means you won’t be able to continue serving your community. And that’s a huge piece of the puzzle patients often overlook when choosing not to make their appointments a priority. So create a policy that outlines specific rules for scheduling and canceling and present it as part of your initial consultation forms along with a sentence or two about the impact of missed appointments. It’s not enough to just set rules. Instead, make sure your patients understand the reasoning behind your policy and you’ll immediately increase their compliance. (Hint: avoid language that is critical, dramatic, or punitive. Rather, be polite and appeal to your patients’ empathetic sides. Most will understand and respect you more for your honesty.)
So what kind of rules should you set? That’s totally up to you. Some therapists opt for a 24-hour cancellation notice requirement; otherwise, they charge for the full appointment amount. However, most also understand that there might be mitigating circumstances that warrant a penalty waiver. Other therapists request a pre-payment or deposit from patients as soon as they book appointments, but as Dawson point out, this might make your patients feel like you don’t trust them, which could potentially drive away business. Still other therapists keep patient credit card details on file, although you can only do this if you have record of a pre-authorization agreement with the bank or patient demographic query (PDQ) supplier (a similar arrangement to that of a hotel that places a hold on a consumer’s funds until the stay is complete, at which time they charge the card.) Otherwise, keeping card details on file is a bad—and possibly illegal—idea.
Regardless of what policy you choose, just make sure you clearly communicate to patients what you expect of them before they begin therapy. That way, there are no surprises when you go to enforce your policy.
2. Identify Trends
If you’re not already tracking your no-shows and cancellations, start doing so now. You may come across some interesting demographic and logistical trends that can help you predict the likelihood of patient attendance at a given appointment time.University of Missouri faculty Howard Houghton, MD, and Patricia Alafaireet used electronic medical record and billing system data to identify missed medical visit characteristics. They found:
- Medicaid recipients had a higher rate of no-shows than any other insurance beneficiary type. Additionally, Medicaid patients who had appointment times outside of the public transportation schedule never showed.
- Patients who lived five to 10 miles away from the practice were most likely to make their appointments, whereas patients who lived 19 to 60 miles away were more likely not to show. Patients who lived more than 60 miles away almost always made their appointments.
- Young, single men had the highest no-show rates. However, attendance was better for mid-morning appointments on Tuesday, Wednesday, or Thursday.
While quite interesting, Alafaireet says, “We really do think [the findings are] probably practice-specific.” She recommends starting a simple Excel spreadsheet. “You want to look for the factors that can be controlled,” Dr. Houghton advises. Then, once you’ve identified some common missed appointment trends, start implementing ways to change them.
3. Schedule Better
The University of Missouri study found something else interesting: Patients were more likely to show up for an appointment at a time of their choosing. According to the article, many traditional schedulers “followed practice protocol” by “scheduling the first caller for Monday at 8:00 AM, the second for Monday at 8:30,” and so on. Dr. Houghton and Alafaireet found that the most successful schedulers asked patients on what date and at what time they wanted to come in—an easy change that could significantly increase your yes-shows.