One of the biggest drains on your practice revenue is the problem of cancellations and no-shows. In some practice environments, it’s not uncommon for as many as 10-15% of all appointments to go unfulfilled. Fortunately, this is one area with many potential solutions. By establishing a few simple procedures throughout your organization, you can greatly reduce your cancellations and no-shows. At SpectraSoft, we typically find that many practices cut their cancellations in half implementing just one or two of these suggestions!

1. Communicate the importance of the appointment.

Most practices give each patient a small card on their way out the door with the date and time of the next appointment. This approach has two main drawbacks. First, the card is easily lost. Second, a small handwritten card fails to convey the importance of the appointment, both to the patient’s health and to the people whose livelihood depends on the success of the practice.

A better approach is to print a confirmation letter for the patient on a full-size, 8½” x 11” sheet of your office stationery.Create a separate version of the letter for each common appointment type or condition your practice handles. The outline of the letter should be:

I. Thank you for choosing our practice.
Let the patient know you appreciate their business. This should be included in the first paragraph of the automated reminder letter.

II. Here is a list of your appointments along with special instructions.
All of the patient's appointments (if there is more than one) should be listed in the letter, as well as any special instructions related to that appointment. This gives the patient one easy reference she can keep and refer to.

III. It’s important that we see you on this date.
Stress the importance of this to the health of the patient. For example: “It is very important that the doctor can make sure your prescribed [therapy/ medication] is achieving the expected result, and that you are not experiencing any negative side effects.”

IV. We understand that your time is valuable. Our time is valuable too.
Explain that your practice has set aside the time of practitioners, staff and equipment for this appointment, all at a considerable cost. If your practice has a policy of billing no-shows, you should include it here. If your policy is to bill “repeat offenders,” you may want to create a separate template for these patients.

V. Please call to reschedule if you can’t make your appointment time.
This is the trickiest part of the letter. If you make it sound too easy for patients to cancel, many will; however a cancellation that can be filled by a patient on your waiting list is preferable to a no-show. Try tracking your no-shows and cancellations by appointment type for a month (see Tip #5 below). If a certain appointment type is generating many no-shows, remind the patient to cancel if they can’t come. If no-shows are low relative to cancellations, you may not want to mention the option of rescheduling in your letter.

VI. We look forward to seeing you.
Finish the letter by thanking the patient again. Remind them to call if they have any questions or problems. Let the patient know that your practice truly cares about their well-being.

2. Reconfirm the appointment verbally, eye-to-eye.

Studies indicate that the average person will make an error entering basic customer information roughly 5% of the time. Other misunderstandings between the front desk and the patient can occur many ways. Perhaps you write down the correct date on the book and confirmation, but then verbally state a different date by mistake. Other times you will say one thing and a distracted patient will hear something else.

Do not rely solely on the appointment letter to make sure the appointment is scheduled correctly. Take the letter and verbally review it point by point with patients before they leave, looking the patient in they eye to make sure he/she is paying attention.

3. Remind the patient about the appointment.

If you pay a staff member to call and confirm the appointments of all the patients scheduled for the next day, you will almost certainly boost your revenue. However this is a tedious task which often gets put on the back burner and forgotten. Besides, it’s often difficult to successfully contact a number of patients who aren’t home during the day and/or don’t have an answering machine.

Fortunately, you can automate this task several ways. The first is to use an automated phone service, such as CallPointe. Not only do these companies make the calls for less than you would pay your staff, but they also achieve higher contact rates by calling in the evening and redialing numbers that did not answer the first time. For larger practices, it is even more economical to install an in-house reminder system like JulySoft's ReminderPRO.

Second, try e-mailing appointment reminders. E-mail is ideal not only for appointment reminders, but also for compliance programs, practice marketing and more, so make it a habit to ask for an e-mail address when your patient signs in.

4. Encourage compliance with the prescribed medicine or therapy.

One reason that many patients don’t show up for appointments is out of embarrassment, because they have not kept up with the regimen they were prescribed. To help your patients improve both their appointment attendance and their clinical outcomes, you may want to put together a basic compliance reminder program using the tools already discussed. Restate the prescribed regimen on the appointment confirmation, send a reminder e-mail a few days after the appointment, and possibly consider placing an encouraging reminder call, recorded by the practitioner and delivered by an automated phone service bureau. Saving even a few appointments a week will usually pay for this impressive level of care.

5. Track the reasons for no-shows and cancellations.

If you carefully chart the numbers of no-shows and cancellations along with the reasons given by patients for each occurence, solutions will often become apparent. Perhaps patients fear a particular procedure. Or a certain practitioner may be rubbing patients the wrong way. Once you identify the problem, you can often come up with communication stategies or changes to your practice that can reduce the problem. The trick is to track each no-show and cancellation along with the stated reason on a consistent basis.

6. Follow the “80/20” rule.

A famous rule in sales is that 20% of your customers will generate 80% of your sales. The same will likely hold true when it come to cancellations and no-shows at your practice: roughly 20% of your patients will account for 80% of your cancellations and no-shows. For this reason, it’s a good idea to track patients who have failed to show for an appointment or who repeatedly cancel and establish a special set of policies for this group. Some of these policies may include: billing for a no-show, requiring 24-hour notice for cancellations, making an extra reminder call or sending a reminder e-mail, or having the front desk give the patient extra attention as they are leaving.

7. Book appointments when it is convenient for the patient.

This advice sounds simple enough, but if you are running a busy practice, it’s often difficult enough just to find any available time for a patient, much less one that is at the most convenient point in the day for the patient. This is especially true if you are running a physical therapy practice, where patients must often see two or three practitioners during the same visit. In these cases, automated solutions like AppointmentsPRO can play a big role in reducing no-shows and cancellations.

The built-in logic in AppointmentsPRO analyzes all of the variables for an appointment, including the patient’s preferred date and time, and instantly evaluates dozens or hundreds of options to come up with a set of choices that meet all of the criteria. In many cases, it would be difficult or impossible for you to do the same simply by eying an appointment book. When an appointment must be scheduled at a less than ideal time for the patient, you can store the patient’s name in the “Waiting List” feature, so that when other cancellations come in, you have the opportunity to move that patient to his/her preferred time. This added level of service not only reduces no-shows, it will also greatly enhance your reputation and overall patient retention rate.