Turn Your No-Shows into Yes-Shows

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.

Much of the research, including this journal article that investigates missed appointments from the patient’s perspective, concludes that long wait times can also lead to an increase in missed appointments. Thus, it’s important to find a happy medium between overbooking—which patients often perceive as disrespectful to their time—and underbooking, which isn’t good for your bottom line.

4. Send Reminders

 As WebPT writer Charlotte Bohnett explains in this article, there are plenty of reasons why you should implement appointment reminders, especially via phone. “In a Practitioner's Journey article entitled ‘How to Reduce Cancellations, Reschedules, and No-Shows: Our Strategy,’ the first suggestion they offer is to make a reminder call: ‘Appointment cards are helpful, but in the end, a phone call is your best bet.’ How much of a best bet? An article on American Medical News explains that patients are significantly more likely to keep an appointment when they receive a phone call reminder, according to a study from the June American Journal of Medicine.” Bohnett also cites several case studies “from companies like Walgreens, Hilton, McDonalds, and even Guinness on how phone and text message reminders save thousands of labor hours, increase revenue drastically, and decrease patient no-shows.”

But unless you—or your front office staff—have plenty of extra time on your hands (which is unlikely), calling each patient about an upcoming appointment may not be a realistic or cost-effective solution. That’s where automatic appointment reminders come in. These easy-to-set reminders allow you to customize delivery method (phone, text, or email) and time to suit your patients’ preferences—and you can be sure the reminders always will go out, no matter how busy you or your front office staff get.

5. Cut Repeat Offenders Loose

There comes a time in every service provider’s career when you have to make a difficult decision: continue working with a challenging client or part ways. In the case of repeat missed-appointment offenders, keeping patients who are repeatedly disrespectful of your—and your staff’s— time is bad for both your morale and your bottom line, and that’s a dangerous combination. According to Dawson, “It is advisable to warn the clients in advance that if they miss another appointment, you won't be able to work with them again. You then need to stick to your word and explain politely that their constant canceling/non-attendance is costing you time and money, reducing appointment availability for other clients and that for this reason you can no longer see them.” And if you’re not up for a face-to-face confrontation, Dawson says a phone call or email are both acceptable methods of communication.

Looking for more ways to turn your no-shows into yes-shows? Check out this HCPro article, where, among other things, PT compliance expert Rick Gawenda recommends talking with patients about why their appointments are necessary and what benefits they will receive as a result of showing up.

How do you tackle no-shows in your practice? Share your experiences and advice in the comments below.