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Physician Practices – Appointment "no-shows" and how to stop them

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If physicians could overbook patients as airlines do, “no-shows” (patients who don’t keep their appointments) might not be as big a problem as they are for most practices. Unfortunately, physicians aren’t airlines, and patients aren’t travelers heading to an important business trip or fun-filled vacation.

Appointment “no-shows” are a growing problem

In many respects, the source of the worsening no-show problem can be traced to changes in the health care system. These include develop­ments such as the following:

  • Physicians are seeing more patients in a day and therefore must decrease the time spent with patients to squeeze in one or two extra patients every hour.
  • Appointments are often scheduled months in advance.
  • Changes in many practices’ payor mix have occurred.

From the patient’s perspective, times have changed, too. More and more patients are being forced to cover an increasing percentage of their own health care costs. Patients are also living more complicated lives with multiple appointments competing for their time. And, quite frankly, many patients just don’t understand the impact of missed appointments on the practice.

What is this impact? No-shows cost the practice badly needed revenue and cause wasted time, decreasing physician and staff productivity. For example, if a physician sees 40 patients a day for 48 weeks a year, with average revenue of $30 per visit, a 10% no-show rate would cost him or her almost $30,000 in lost revenue. In a group practice, the numbers are staggering.

Best practices for physician-patient relationships

The reality is that patients will miss appointments for many reasons — anxiety over the appointment, heavy traffic, forgetfulness, lack of transportation, child care issues, or an inability to leave their jobs to make the appointment. The goal for your practice should be to minimize the no-show rate so that it’s no more than 1% to 2% of appointments scheduled. Some best practices for achieving this rate include:

Establish strong physician-patient relationships.

Patients that hold their physicians in high regard and feel as though they have a personal relationship with the physician will make the appointment a priority in their busy schedules.

Thus, it’s important to recognize that keeping appointments is a two-way street — both parties must hold up their end of the bargain. Focus (or refocus) your staff on keeping the practice running on time and avoiding situations that force patients to wait for unreasonably long periods of time.

Educate your patients.

Another important trait of practices that have low no-show rates is that patients have been trained by the office staff on the importance of keeping the appointment. Explain to new patients the practice’s policies for canceling an appointment and the consequences of being a no-show, and don’t hesitate to politely remind ongoing patients.

Staff members should explicate the policies verbally, but your practice can also devote a section of its brochure to the topic or devise a special handout to give to new patients. Also consider hanging a summarized version of your cancellation and no-show policy in the waiting room.

Send appointment reminders.

Have a system in place to make reminder calls, send emails and/or text messages to all patients 24 to 48 hours before an appointment to confirm the time. Also, offer options in the reminder to reschedule if they can’t make the appointment.

Set an appropriate no-show appointment fee.

Physicians struggle with the issue of charging patients for missed appointments. Nonetheless, many practices are charging patients $10 to $30 for missed appointments. If you choose to institute a no-show fee, be thorough when developing this policy.

Consider questions such as:

  • When does a late appointment constitute a missed appointment? 15 minutes? 30 minutes? 60 minutes?
  • Will you charge unconditionally for each missed appointment or make exceptions?
  • Will you charge a patient for his or her first missed appointment or begin with the second one?
  • Does your practice have a good way to track missed appointments?

Above all, before implementing a no-show policy, clearly inform patients of the policy. In addition, once the policy is in place, double your efforts to not keep patients waiting long for their appointments or you’ll risk alienating them.

Last, bear in mind that charging for missed appointments will require training the billing department on how to handle patient inquiries regarding the policy. (You also may need to teach your doctors, nurses and office staff how to calmly and professionally deal with patients who have violated the policy.)

Your time is the most valuable asset

A physician’s time is perhaps his or her most valuable asset, and practices with skyrocketing no-show rates probably aren’t managing this asset particularly well. This failure can, in turn, trigger business problems. After all, the reimbursement for each patient appointment is set by managed care companies and Medicare, and the practice’s ability to increase the payment for an appointment is limited. Manage your time well.

LBMC Physician Business Solutions offers pain-free solutions for doctors. Our experts save you energy, expense and aggravation by handling esoteric business processes that take precious time away from medicine. As a partner Medical Services Organization or a resource for billing, we offer comprehensive services run by award-winning professionals who support your practice in the most efficient and cost-effective way. You get seamlessly integrated support – all conveniently outsourced. Plus, extra time to focus on patients and other medical matters. 

Learn more about our physician business services.

Tagged with: Healthcare Consulting