No-shows can cost a practice a considerable amount of revenue over the course of a year. No-shows are frustrating to staff, providers, and other patients who would have gladly moved into an earlier appointment date if prior notice had been received. The dilemma ensues...should a practice charge their no-show patients?
Physicians never have the same day twice, but if there's one constant they can count on, it's that some patients miss appointments. Sometimes that can seem like a blessing, especially during a busy day where you're already half an hour behind by 11 a.m. But whether you're happy or not, an empty slot on the schedule still means missed revenue that can never be captured.
But in today's tight healthcare environment, physicians are trying hard to keep that revenue from floating out the door. Missed appointments cost a practice in three different ways. First, you take the lost revenue from the missed appointment itself, then you add the cost of employees who spend time scheduling the appointment and making follow-up calls with the patient, and then there's the empty time that otherwise could have been filled with other patients. If you allow 45 to 60 minutes for a new patient, you could see anywhere from three to 10 people for follow-ups during that time.
With lost revenue adding up, more practices are beginning to charge for missed appointments. If the patient indeed pays the bill, it can help a practice recoup some of its lost revenue. Many practices hang the threat of a charge out there simply to get the patients through the door.
Charging patients adds paperwork and costs for the office, and even if the practice is vigilant in sending out its bills, many of the charges go unpaid. Instead, there are proactive alternatives to addressing the no-shows. An alternative would be tracking them to learn who the chronic offenders are and then scheduling them near the lunch hour or the end of the day.
Although it's tedious work, many practices use some form of a telephone reminder system to confirm upcoming appointments with patients. It may seem like the simplest idea, but it is the most effective way to keep no-shows to a minimum. It is also the only way to deal with new patients, who typically require longer blocks of time. New patients also are the hardest ones to gauge, since the office does not have a history with that person.
By calling patients to remind them of their appointments, it cuts the no-shows in half. The problem with some call systems, though, is that employees spend valuable time making calls during business hours, only to get answering machines and voice mail, where the messages that are left might never reach the intended person. It's not until the time of the appointment, when the patient either shows up or not that the practice knows if the staff member's time was spent wisely or wasted. To get around this problem, some practices request a confirmation call from the patient, with enough lead time to fill the slot with someone else if the person doesn't respond or cancels the appointment.
Some offices keep waiting lists of patients who have an appointment several weeks out but would like to get in to see the doctor sooner. Waiting lists can help fill more slots at the last minute, especially if a practice takes careful notes and knows what patients are willing to do anything to get an earlier appointment.
To avoid the staff hours involved in making calls, practices have started to invest in automated calling systems, which also can interface with practice management software to conduct the entire appointment confirmation process with very little, if any, human input. Automated systems also can make calls later in the evenings, when the chances of reaching a live voice are better, and they allow for an immediate confirmation.
What to do about no shows
In an effort to improve, or maintain, provider-patient relationships, many practices typically do not charge for no-shows. Examining why patients feel they do not need to cancel appointments may reveal some "permissive" actions by your office:
- Long and unexplained wait times demonstrate that the provider does not respect the patient's time (and the patient, therefore, doesn't respect the provider's time);
- A schedule where patients must set an appointment so far in advance lends to patients finding help elsewhere or simply getting better on their own;
- Office staff does not follow up on missed appointments (leaving the patient wondering if anyone noticed, or cared);
- The provider has a reputation for canceling appointments at the last minute.
Controlling the number of no-shows requires developing and consistently working a realistic strategy. Tracking no-shows by physician, payor, day of the week and month, and by practice site will help provide an understanding of the situation. These numbers can also be used to chart progress and evaluate your strategy. Some possible strategies include:
- Send appointment reminders;
- Make reminder calls 48-72 hours before the appointment;
- Adjust hours to best accommodate your patient population;
- Study your walk-in and same-day appointments and try to balance with anticipated no-show visits;
- Establish a policy for repeat no-shows-restrict their appointments to walk-in only, or dismiss them from the practice altogether.
Although some practices have success with charging a missed-visit fee to patients, most practices find charging for no-shows generally creates more ill will than it is worth. The best bet is to determine what is causing your no-shows and try to fix that problem.
Marge McQuade, CMSCS, CMCS, CHCI, CPOM