The Fastest Cure for Cancellations and No Shows
By Jon Rutty, Practice Transition Specialist
This has got to be one of my favorite topics. While I also love goal setting and making a good plan, I love to see major problems turn around with a good strategy. Many times, Cancellations and No Shows seem to be some sort of blue whale that is swallowing you up, but it doesn’t have to be that way, and following this simple plan will help you to regain control of your schedule and accommodate the people who actually show up to their appointments.
If you are like most offices, you have a 20% or higher Cancellation and No Show rate. That means in an office that sees 40 patients a day, on average 8 people are moving their appointments or abandoning them for one reason or another. Sound shocking? What’s worse is that what many offices are doing is not only failing to keep people on the schedule, it is frustrating some of their best patients so much that they want to leave.
Blink if you do one of these things.
1) When someone cancels or no-shows you charge a small fee to their account. You tell patients about this hoping this will deter them from being absent, but you likely hear something like, “Well if that’s what you have to do, I guess you have to do it,” as they roll their eyes on the other side of the phone. Fast forward 6 months to a year, and they have the same balance on their account and you are thinking to yourself, “They are never going to pay this.” Then at some point when you are cleaning up your AR you decide, “let’s just write off all of the no-show balances and put a note in their account that they have to pay it to reschedule,” or worse, you decide to send them the dreaded dismissal letter. How’s that working for you?
2) You schedule patients three columns across because you have such a bad problem in your office, you just don’t know when someone is going to show up. So by having three people scheduled you hedge your bets and salvage the day. That is until all three decide to show up at the same time and someone has to wait because there is not enough space to see them all, or if there is, a 30- minute appointment now takes an hour because you can’t be in three places at once, therefore putting the rest of your patients behind. How am I doing?
The reality is that I’ve seen no shortage of ways that aren’t working for practices. Would you like to know how to fix this problem for good? Good! I’m going to give you some specific action steps that, when used will work to keep good people in your schedule and weed out those who are just not able to show up to their appointments.
Step 1 – You Don’t Have “Cancellations”
We don’t say the “C” word, especially in the company of patients. I can’t tell you how many times I have heard a professional tell a patient, “Oh we have cancellations all the time. If we can move you up we will.” THUD! That’s the sound of me falling over and dying in the background. Why don’t you just tell them that they are free to cancel anytime because we always have a backup plan. Stop it! What you say to patients will forge the type of relationship you want to have with them. They don’t need to know we have cancellations all the time. Just tell them, “If we can make time for you sooner, we will.” So what do we do instead? It’s not uncommon that offices tell patients that they need to call 24 hours ahead of time if they can’t make the appointment. However, the reason why patients aren’t good at this is because you are telling them, and they often forget what you say, don’t they? Instead, ask them, “Ms. Jones, will you please call me 24 hours ahead of time if you can’t make this appointment?” And then wait for a response. By doing this, you engage their brain. They have to say “yes” and people don’t like to be liars. They will remember, “Shoot, I told the office manager that if I couldn’t make it to the appointment I would call 24 hours ahead of time.” And then they will call. If they call with notice, then reschedule them like normal.
Step 2 – How to Respond to Someone Wanting to Cancel Same-Day
There is only so much we can do in the way of giving someone a consequence for not showing up to their appointment, but can we agree that what we do needs to accomplish two things: 1) the patient either stays on the schedule or never cancels again, and 2) make sure we don’t create more unnecessary work for us on the backend (i.e. culling through AR reports for small balances that need to be written off, or collected). What I am about to show you has helped hundreds of offices all over the nation for the past 30 years to reduce their cancellations and no-shows to an average of 10% or less.
When a person calls to cancel, ask them this question. “Ms. Jones, I’m sorry to hear you’re having trouble today, what can I do to help you keep this appointment?” And then stop talking. Don’t talk. They are thinking. What you have told them without telling them is, “Ms. Jones this isn’t okay. How can we fix this?” You will be surprised how many people come up with a creative solution to their own problem. You might be asking, “What in the world can we do to help them keep their appointment?” That’s a great question. They may ask you the same thing. If you have time to move them up or down on the schedule for that day, then do that. Ultimately, you want to discover what is going on. Can they come late? Can they come for some of it, but not all of it? What can they do? As much as you can, use the time that you already have scheduled to do something productive with them. If they have multiple quads of work, perhaps just do one quad. If they have a cleaning and an exam, maybe do one or the other. Holes in your schedule are never a good option, especially last minute, so work with them as much as you can to keep them on the schedule without running anyone else behind.
Step 3 – What If They Say They Can’t Make It After All?
Great question. Tell the patient, “I’m sorry you can’t make it to your reserved appointment time today. I don’t have another appointment time for three weeks. I know the doctor would hate for you to wait that long for your appointment. Are you sure there is nothing you we can do to keep this appointment?” This is crucial. Telling a patient they have to wait three weeks could be the reason they cancel their other plans instead. You want to make it inconvenient for a patient to call without notice and get right back onto the schedule. “But what if I have an open day tomorrow,” you ask. Move them out three weeks. At the very least, this amount of inconvenience could be the reason they never do it again. But if it isn’t, the next step is sure to be.
Step 4 – When They Definitely Can’t Show Up
If you have exhausted steps 1, 2, and 3 and they are still going MIA, then tell them this. “Ms. Jones, I’m sorry you can’t make it today. I have rescheduled you for (three weeks out). I know this will never happen, but in the unlikely event that it does, I just need to let you know that you will have to prepay for all of your future appointments.” This is GOLD! What are we doing here? We are telling the patient that this is not okay, but we are not slapping them in the face with a no-show fee. We are setting boundaries for our office, but we are not insulting the character of our patients, nor are we excusing it like it’s okay. If it happens again, collect the patients fee upfront before scheduling. In our offices, anyone who prepays, and I mean anyone, gets a 5% discount and I would extend it to them as well. If you do this, you will see your Cancellations and No Shows drop dramatically, because people who pay upfront, show up.
As with anything, fixing your schedule is a process. It takes time and practice. When using this strategy, you want to use your brain too. You’re a smart person. If someone is calling late notice because of a death in the family, it is obviously not the time to go down this road, but that is the exception, not the rule. I promise if you begin to use this strategy today, you will begin to see more patients showing up to appointments and experience less disturbance in your production in the weeks and months to come.
