Practitioners lose thousands of dollars annually from patient ‘no-shows’ and untimely cancellations. A single practitioner with an average of 10 no-shows per week can lose $40,000 or more a year.
Reducing these by even half can result in $20,000 more on the bottom line since there are virtually no incremental costs involved. It is a matter of utilizing your clinical and support staff more efficiently.
The following are some strategies that have worked with other practices to bring no-shows under control to a tolerable level. No single step will work. The solution involves a comprehensive approach that is tailored to your practice’s unique circumstances and patient demographics.
Team Approach. To be successful, the strategy should involve input, buy-in, and a coordinated effort among practitioners, clinical staff, and support staff. Everyone needs to focus on the objectives of keeping each practitioner’s schedule full and maximizing patient access.
Make an Assessment. Determine the extent of the problem. Begin with a spreadsheet, for each provider and in total, of historical data (one to three months) to include:
• Available patient blocks;
• Patient no-shows or same-day cancellations;
• Patient emergency and walk-in visits;
• Regularly scheduled recurring-patient visits and regularly scheduled new-patient visits;
• Total visits; and
• Total unfilled blocks.
This information will assist you in determining how many no-shows, cancellations, and unfilled patient blocks you need to reduce. It will also identify whether this is a practice-wide issue or concentrated with one or more practitioners. Equally important, it provides a basis for benchmarking and comparing future results of steps to be taken.
Analyze Current Scheduling Policy. This analysis can identify factors which may be contributing to the no-show problem. It may also identify other factors contributing to unfilled appointment blocks, e.g.:
• Overscheduling that causes long wait times. This can create patient dissatisfaction and resulting loss of patients and no-shows;
• Patient scheduling too far in advance (i.e., six to eight weeks). This can also cause a loss of patients who find access to care somewhere else;
• No follow-up appointment policy; and
• Erratic patient reminder policy.
Diagnose the Problem. With the information provided above, you will be able to identify and focus on the factors contributing to your no-show problem. External factors can include payer-referral and pre-certification constraints, as well as individual non-compliant patients. Internal factors can include ineffective or counterproductive scheduling policies and practices; poorly administered follow-up and patient reminder practices; untrained, inadequate, or incompetent support staff; and practitioner-induced cancellations (i.e., inadequate notice of vacations and other time off, or unpopularity with patients).
Execute the Action Plan. The following steps have been proven to reduce no-shows and have increased patient access to care as well as practitioner productivity. No one single action can be expected to produce desired results.
• In scheduling patients out to six weeks, allow for estimated new-patient visits and emergency visits based on a rolling average of historical information;
• Do not leave excessive blocks of time open which will cause patients to be scheduled too far out; for example, don’t leave half-days open in anticipation of these being filled by later appointments;
• Confirm with the practitioner on each visit whether there will be a follow-up visit, and schedule it before the patient leaves the office. Give the patient a written appointment card;
• When scheduling patients beyond four weeks, ask if they would be able to come in sooner on a 24-hour notice. Place these patients on a chronological walk-in list for unanticipated cancellations;
• Send reminder notices to patients seven to 10 days before the scheduled appointment, requesting them to call and confirm;
• Make reminder phone calls two to three days prior to the scheduled visit. Try to make personal contact to confirm. Note that the patient-reminder function can be outsourced to vendors who specialize in this service. Some online scheduling packages provide for an automated reminder system to assist in this function;
• Require practitioners to notify scheduling personnel of vacations, conferences, and other anticipated leave no later than eight weeks in advance;
• Review each practitioner’s schedule seven days in advance, and overbook for the historical no-show rate after consideration of anticipated walk-in and emergency visits;
• Do not charge patients for no-shows. These have historically created ill will that outweighs any benefits;
• Track repeat no-show patients, and consider a policy of available bookings only for these patients;
• Develop a written manual of scheduling policies and procedures, and train all personnel who have patient contact; and
• Track and monitor results, and re-evaluate the policies and procedures. Communicate with personnel and reward positive results.
A well-thought-out scheduling plan will reduce no-shows and increase revenue, patient access, and efficiency of personnel resources. It may also provide data to determine the feasibility of extended hours or additional providers.
James B. Calnan, CPA, is partner-in-charge of the Health Care Services Division of Meyers Brothers, P.C. in Longmeadow; (413) 567-6101.