Home Forums Practice Management Systems Controlling the Schedule and Decreasing Cancellations

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  • Travis Campbell

    Since this seems to be a popular topic recently, here is our policy on patients and appointments. I have never once had to dismiss a patient for scheduling issues since this policy tends to account for any type of patient. Feel free to use, discuss, critique, or rant  🙂

    1) 48 hour notice
    We used to do 24, but so many patients called the day before, often at like 15 minutes before we closed for a 8am appointment and think that still meant 24 hours….sorry, but 16 hours < 24 hours. Therefore we went to 48 because now you can be “nice” if you want, but you get at least 1 full business day to fill the slot.

    2) $50 per hour fee
    Used to do $25 flat, but $25 is not enough to cover a hygienist, per hour helped for longer appointments, and patients actually seem to respect a higher fee more. We might go to $75 in the future if we continue to have problems.

    3) 1st offense = warning. “I understand life gets in the way. As a courtesy I have permission to waive the $50 short notice cancellation fee for you today only, but I won't be able to again. What is a good day/time to get you back on the schedule so you can get “XYZ” treatment done that is important due to “ABC” reason? (set time) Great, if your plans change will you please let me know at least 48 hours notice so we can help you avoid any cancellation fees?” (wait for the verbal commitment)

    4) 2nd offense = charge, similar wording to the first about rescheduling. (If this is doctor time, you might want to move ahead to the next point. Hygiene time you have your costs covered.)

    5) 3rd offense. VIP patient / Pre-op patient
    “It sounds like you have a busy life. Would it be easier for you to call us the day you have some available time to come in instead of scheduling ahead?
    If Yes – “Great, I will put you on our VIP list for those with busy lifestyles. This should help you avoid any future cancellation fees. Please call us early in the morning when you have a day you are available and I will do my best to get you on the schedule if we have time.”
    If NO – we will reschedule hygiene, since the fee is high enough to cover your costs, but all doctor visits become pre-pay or pre-op first.

    6) Pre-Op visits
    These visits are for the patients that are just unreliable. A vast majority of the reason is either money, or massive lack of time management and we need to help them make us a priority. Ask for payment in full the day of diagnosis, if they pay in full, book them like normal. If they are resistant:
    “Okay, when would you like to come in for your pre-op appointment. We will check and make sure everything is still good to go, answer any questions you might think of, and take care of financing on that day. Would this week or next work better for you?”

    Pre-op appointments are set in the overflow column, so an assistant or FD member sees them. The doctor might pop in if the patient has a question, but otherwise not. Take vitals, review treatment, collect payment in full. Then schedule the actual treatment time. If they no-show a pre-op appointment, we lose nothing at all.

    The vast majority of reasons people cancel is money, so that is no longer an issue with prepay. And since they have already paid in full, we now become a priority (people follow their own money).

    Sandy Pardue

    Stop making patients think cancellations are normal.

    I think we all agree that broken appointments are not good for the practice. Through our investigations into the causes of broken appointments, we’ve discovered many times they could have been avoided if the practice had been more proactive. It's easy to blame broken appointments on the patients and it’s easy to start threatening a broken appointment fee. I believe practices have a lot more control than they may realize.

    The actions and words of the dental team may make patients think cancellations are normal. Using the word “cancellation” when speaking to patients can actually train the patients to think it’s okay to cancel.

    I recommend that you take “cancellation” out of your vocabulary. Inform the entire team that you guys will not be using it in the office. Stop saying things like, “If we get a cancellation we’ll give you a call,” or “we’ll probably get a cancellation this week and we’ll be able to get you in.” You want patients to think that it rarely if ever happens.

    Stop calling patients and saying something like, “Hi Susan, this is Mary from Dr. Green’s office. We had a few cancellations for next week and I was just wondering if you guys could come in.” This verbiage sends a message to the patients that schedule changes are normal and the practice expects them to happen.

    If you call patients that requested an earlier appointment date when scheduling, try saying something like, “I've worked it out so that we can see you sooner.” If you are trying to fill open spots on the schedule you can say something like, “We had a change in the schedule.”

    If you want patients to think canceling an appointment is something that rarely happens in your practice, take the word cancellation out of your vocabulary. You see, if you expect cancellations, chances are you will get cancellations.

    Sandy Pardue

    Know that a large portion of broken appointments begin chairside.

    As we evaluate broken appointments and track exactly what was done prior to the appointment day, what was said and what was left off, we see that many of the broken appointments should have never occurred. Most could have been prevented if the practice had only exercised more internal control.

    When we look at the different procedures that are the most common for broken appointments, we see that prescheduled hygiene, surgeries, root canals and SRP's result in more broken appointments than other procedures.

    When we look further at the actions of individual practices, we see that when clinical teams spend more time educating in the chair, before the appointment is made, the treatment plan acceptance is actually higher and the patients are more apt to schedule and keep their appointment.

    Clinical teams and what they communicate to the patients are very key in this whole cycle of the broken appointments. Getting patients to show up for appointments starts with reinforcing the diagnosis chairside. Educate the patients about their condition. Most of you probably feel like you are already doing this. I am asking you to go one step further. Tell them what will happen if they put it off.

    Don’t assume the patients already know that the problem they are having is going to get worse and that they know it’s going to cost more if they put off the treatment. They must be told that it will get more expensive; tell them they may start having pain. Let them know it will not get any better on its own. This is what they will understand. You need to get their attention. It needs to be documented that they were told.

    Say things like, “It is going to get worse and you will have some pain if we don't get you back soon” or “That cavity is going to get bigger and cost more if you put if off.” Patients have to see the benefits before they will want it bad enough to find the money and keep the appointment; they have to see how it will benefit THEM.

    If your clinical team is not stressing the importance of the next visit to the patient while they are in the chair, you probably have many more broken appointments than you should. This includes hygiene and preappointing six months in advance. The hygienist has to encourage the patient to return and to stay on schedule. She has to stress the importance and she has to add value.

    Every team member is responsible for making sure that patients are educated on their needed treatment and their questions have been answered. Make sure you let them know you are counting on them to be there for their appointment.

    Happy Scheduling!
    Sandy Pardue, Consultant

    Sean Crabtree

    Good stuff.  In working with practices all over North America we've learned that the key to decreasing cancels/no shows in a dramatic way is really 2 fold.

    1-Creating value chairside rather then trying to educate.  Finding out what is most important emotionally for the patient and having them realize how that treatment can get them what they want (hyg needs to be communicated as part of that tx).  Education will not motivate patients or frankly any of us.  If education were the key-no one in healthcare would smoke:)

    2-When value is created then a financial commitment at the time of scheduling is no big deal.  And a financial commitment up front will eliminate the vast majority of cancels/no shows.

    Stuff still happens for the remaining few and for that, the cancel policy mentioned by the original poster can be a big support.  The key there is to communicate it properly on the FRONT end so as not to have it become punitive.

    When really going over board to communicate on the FRONT end then the 3 strike scenario works great.  1st strike let it go, 2nd strike charge, 3rd strike-short call list.

    On another note we have found that many cancels can be prevented by simply addressing the cancel call differently.  Many times the person taking that call simply reschedules the patient instead taking the time to dive in and find out why the patient needs to cancel.  Often times a work around can happen.

    Hope this helps-Good luck!

    Sean Crabtree, The Crabtree Group




    steven mautner

    overbook, don't confirm, take walk-ins in the morning.

    Sandy Pardue

    Most cancellations could have been prevented. It's not always the fault of the patient.

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