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Reducing No-Shows & Cancellations
One of the biggest drains on your practice revenue is the patient no-show. Fortunately, this
problem has many potential solutions. Here is an eight-step approach that can cut your
no-show rate dramatically.
STEP 1: CALCULATE THE COST OF
NO-SHOWS AND CANCELLATIONS
Before you invest your time, eff ort and resources
into reducing your no-shows, you need to know what it’s worth to you. So consider this: A typical PT practice loses 10-15% of all their scheduled ap-pointments due to no-shows and cancellations. Yet the actual revenue lost is actually far worse. No-shows simply create “dead time” that you
cannot bill for, while your employees and resources sit idle. Assuming you dedicate just $50 in payroll, equipment, rent and utilities for
each scheduled patient, fi ve no-shows a week
add up to $12,500 a year!
It gets worse if the appointment is never made up and that potential revenue is lost forever. One such case a week billable at $100 is $5,000 a year!
In the worst case, a patient referred to you never makes it to the fi rst appointment.
As-sume the typical case involves 10 visits at $100 per visit, and you lose one such patient a month, that’s $12,000 in revenue down the drain! Your losses due to no-shows may be higher or lower, but if you add up the extra money you could take home if you cut your no-show rate by a half or two-thirds, you will
fi nd it’s worth it to keep reading…
STEP 2: CREATE A MULTI-CHANNEL
REMINDER PROGRAM
If you want patients to show up for their appoint-ments, REMIND THEM! It sounds obvious enough,
yet many PT practices suff ering through high
no-show rates simply don’t focus on their reminder
program. Remember that everyone organizes their personal calendar in their own way: some patients
cling to reminder letters…others respond best to
phone messages...many others prefer an elec-tronic reminder via email. When you implement a multi-channel reminder program, you give each patient the tool that works best for them. And the more often you remind patients about their next appointment, the more likely they will remember. Your reminder program should consist of three channels:
1. Send text messages.
With so many people using smart phones, text messaging has become the best way to reach many of your patients. Fortunately, there are automated systems that make this a hands-free,
eff ortless process. We’ll discuss that technology in
Step 3.
2. Instead of handing the patient a small re-minder card, use a full-page letter.
Tiny reminder cards have three drawbacks: (1) the card is easily lost; (2) the card is handwritten, increasing the chance of human error; (3) a small card can’t hold all the information you need to reduce no-shows. A better approach is to print
a full-size, 8.5” x 11” confi rmation letter. (It’s less
likely to be lost!) All future appointments should be listed, as well as any special instructions related to those appointments.
3. Call every patient the day before their appointment.
In a recent Mediware customer survey, one in six respondents said they don’t make reminder calls. (Odds are the actual number is even higher!) The
because it is interruptive. People have to stop what they are doing to answer the phone. Even if you have to leave a message, you will make your way into the routine of nearly every patient you contact. The telephone is also the most personal reminder channel. When you call a patient, you show you care. The problem with a telephone
calling program is the drain it puts on your staff . In
Step 3, you will read about ways to automate this tedious process.
4. Send email appointment reminders.
Email is often the most eff ective way to get on your
patient’s schedule. Of course before you can email patients, you will need their email address. Make this a standard part of your patient intake process. Your email reminder message should contain all pertinent information such as the date/time of the appointment and any special instructions for the session.
STEP 3: AUTOMATE THE REMINDER
PROCESS
After reading the suggestions in Step 2, you
probably realize that your staff cannot conduct a
multi-channel reminder program by hand. If you rely on your people to personally call or manually email each patient reminder, there will be many hectic days when the job doesn’t get done. With a
fully automated reminder system, every reminder is sent every day.
You’re going to need four tools to completely auto-mate the process:
A) Scheduling software that contains all the patient and appointment data.
This is the hub of your automated reminder pro-gram. Your scheduling software can instantly print a personalized reminder letter for each patient as they leave, complete with their future appoint-ments and session instructions. The data in your software will also be used to generate reminder texts, calls and emails.
B) An automated telephone system. A phone system scans the next day’s schedule and auto-matically pulls each patient’s phone number and information to make the day’s reminder calls — no
one in your offi ce has to lift a fi nger!
When you automate your reminder phone calls, you know that the job is completed every day without fail. You also achieve higher contact rates because the phone system can call in the eve-ning when more people are home. It also redials
numbers that did not answer the fi rst time. You
can automate phone calls two ways: with a calling
Work with Referring Physicians to Prevent that First No-Show
If a patient misses that fi rst appointment, the odds increase dramatically that you will never see that patient. So do everything you can to prevent that fi rst no-show. Send brochures to your referring physician so that
your new patient knows something about you and feels comfortable working with you.
Then ask if you can work with the physician's front desk to schedule the patient at your clinic while the patient
is still in their offi ce. That way they already have an appointment — and they are a part of your reminder
sys-tem. You can sell the doctor on the idea by explaining that this approach will increase patient compliance and
service or an in-house system. Either solution can integrate with scheduling software. And here’s the
best part…YOU SAVE MONEY!
For example, fi guring in wages and benefi ts, you
can easily pay $1 for each reminder call made by
a staff member. Service bureaus and automated
systems can make those same calls for 25¢ or less. Here is a sample breakdown of costs...
No matter which solution you choose, the revenue you gain by saving just two or three patient visits with a reminder call almost certainly pays for itself. C) Automated email system. Like the telephone, the best way to send email reminders is with an automated system that pulls data from your scheduling software – that way no one has to do a thing.
D) Automated text messaging system. Just like email and telephone reminders, you can send text messages automatically from your scheduling
sys-tem. A text message system has the added benefi t
of alerting your practitioners when patients arrive or cancel – so you reduce patient wait times and
speed workfl ow. When automating text/phone/
email reminders, you must make sure that your system has an opt-in feature. Then during your initial patient intake, you can mark which types of reminders should be sent to each patient.
STEP 4 – CONSTANTLY ENCOURAGE
PATIENT COMPLIANCE
A study of patient no-shows published in The An-nals of Family Medicine (AFM) found that two-thirds of participants mentioned that negative emotions about going to the clinic were greater than the
per-ceived benefi t of keeping the appointment.
Like-wise, self-resolving symptoms resulted in missed appointments. One patient explained, “When my feet were swollen it was on my mind, but as soon as the swelling went down, then I forgot about it.” Forty-one percent of the participants did not know what happens in a clinic if there is a failed appoint-ment. Many thought that cancelled appointments allow the practitioners to catch up or take a break. The AFM study demonstrates that you must clearly communicate how important it is to keep each ap-pointment. For example:
The treatment may hurt for a while, but the benefi ts will last for a lifetime;
Even if the symptoms go away for a while, the underlying problem must still be treated; We can’t stay in business if you don’t show up!
Start with text of your reminder letters and emails, and the scripts of your reminder calls. Create a separate letter or script for each common appointment type or condition your practice handles. The outline of the communi-cation should be:
SAMPLE AUTOMATED CALLING COSTS
Based on 200 Work Days (Roughly One Year)
Calls Per Day $1 per callManual $2495 initial cost; no cost for local callsAutomated System $250 set-up fee; 25¢ per callService Bureau
Cost Cost You Save Cost You Save
20 Calls Per Day $4,000 $2,495 $1,505 $1,250 $2,750
30 Calls Per Day $6,000 $2,495 $3,505 $1,750 $4,250
50 Calls Per Day $10,000 $2,495 $7,505 $2,750 $7,250
I. Thank you for choosing our practice. Let the pa-tient know you appreciate their business.
II. Here are your upcoming appointments. List the appointments.
III. It’s important that we see you on this (these) dates. Stress the health of the patient: “It is very important that we make sure your prescribed home exercises are achieving the expected result, and that you are not experiencing any negative
side eff ects.”
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
equip-ment for this appointequip-ment, all at a considerable cost. If your practice has a policy of billing no-shows, you should include it here.
V. Please call if you can’t make your appointment.
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 fi lled by a
pa-tient on your waiting list is preferable to a no-show. Try tracking your no-shows and cancellations for a month (see Step #6 below). If a certain appoint-ment type is generating many no-shows, remind the patient to cancel if they can’t come. If cancella-tions become a problem, don’t mention reschedul-ing in your letter.
VI. We look forward to seeing you. Thank the
pa-tient again and remind them to call if they have any questions or problems. Let the patient know that your practice truly cares about their well-being.
STEP 5: COMMUNICATE AND RELATE
It’s not enough simply to create reminder letters and calls. The most important factor in patient re-tention is the relationship you build with the patient.
The patient relationship starts with the clini-cian. Care, enthusiasm and attention are inherent skills of a good practitioner, so we won’t go into that here. However, make sure every therapist is aware of the talking points outlined in Step 4. Pa-tients naturally respect their physician or therapist, so it makes sense that all reminder letters and calls should come from this provider. Have your practi-tioners record the reminder calls and digitally sign the reminder letters.
Your front desk also plays a key role. Their
fi rst responsibility is to make sure all patient data
is compete and up-to-date. (You can’t send an email reminder if you don’t have an email
ad-dress!) Confi rm the patient’s address and phone
number on a regular basis. Next, the front desk
must accurately schedule and confi rm the next
appointment. Studies indicate that the average person will make a data entry error 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 confi rmation, but then verbally state a diff erent date by mistake. Other times you will say
one thing and a distracted patient will hear some-thing 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 each patient before they leave, looking the patient in they eye to make sure he/ she is paying attention.
Customize patient care offi ce-wide. If your patient has a unique worry or need, address it personally. For instance if the patient has a histo-ry of no-shows due to fear of pain, the front desk should remind the therapist to address these fears during the visit. Or if the patient can’t drive, the therapist can tell the front desk to check when a driver I the family is available. Your sched-uling software should let you insert pop-up notes to remind colleagues of these items.
STEP 6: IMPLEMENT SCHEDULING
PROCEDURES THAT REDUCE
NO-SHOWS
Hold time slots for new patients. Your no-show rate will increase as you allow more time to pass between the scheduling date and the actual
ap-pointment. It’s always diffi cult to leave open slots in your schedule that may never be fi lled, but if new
patients cannot get in to see you for several days, consider the negative impact this will have not only on your no-show rate, but also on your ability to get and keep new patients. Determine the needs of the patient. Logistical issues such as trouble
get-ting off work, child care, transportation and cost all
led to no-shows in the AFM study. To reduce these types of cancellations, use open- ended questions when scheduling patients. Many people are simply too forgetful or distracted to think through their personal schedule. Instead of giving them a time, involve them in the scheduling process with open-ended question:
Wrong: “How is Monday morning at 10?” Right: “What day is good for you?
Other questions might include: “Are there any issues we should be aware of that may keep you from your scheduled sessions?” or “Do you have any special needs we should know about?” Limit
wait times. Issues of respect were a factor in no-shows among 44% of the AFM study participants. Waiting was one way disrespect was communi-cated: not only the time in the waiting room, but also in the exam room. Wait times have a great impact on patient satisfaction, and in turn on physician or outpatient hospitals referrals and
other sources of new business. Use scheduling
software. Many smaller PT practices laugh at the notion of software when they can easily schedule all their patients with a book. What they overlook is all the other advantages of scheduling software, including:
Detailed, standardized patient intake stored in a database.
Faster scheduling and superior customer ser-vice — you can schedule complex, recurring, multi-resource appointments in seconds using computer logic.
Exhaustive practice management data – your scheduling software can generate reports on resource usage, referral patterns and outcomes.
STEP 7: MEASURE, ANALYZE AND ACT
It is essential that you track key practice measures to see how you are doing at managing no-shows,
5 Ways To Improve Patient Compliance
One reason that many patients don’t show up for appointments is out of embarrassment, because they have not kept up with their home exercise regimen. To help your patients improve both their appointment attendance and their clinical outcomes, you may want to put together a basic compliance program:
1. Use your automated phone and email systems to generate reminders – not about the appointment – but about
keeping up with the prescribed home exercise regimen.
2. Have your therapist check on the patient occasionally — over the phone or by email.
3. Motivate — pass along informational magazine articles or share uplifting books with your patient.
4. Always focus on the benefi ts of therapy — regaining strength, improving quality of life, etc.
cancellations and the factors that lead to poor patient retention. Again, you will need scheduling software to track these numbers accurately.
Average patient wait time. Work with your
staff to limit the average wait to no more than fi ve
minutes.
Percent of scheduled appointments that are (1) seen, (2) no-shows or (3) cancellations.
Keep in mind that there is a big diff erence between
a no-show and a cancellation. A cancellation can
often be fi lled with someone on your waiting list. A
cancellation also indicates that the patient appreci-ates the importance of the appointment and had the courtesy to cancel. A no-show indicates there may be a problem with your reminder system or your no-show policies.
Cancellations & no-shows by therapist. You
may fi nd that you have a therapist whose approach leads to more no-shows than the offi ce average.
You may want to sit down with this therapist and go over possible solutions to correct the problem.
Cancellations by patient. If a patient has missed more than one appointment, you may want to institute a policy where that patient is billed for any future missed appointments that are not cancelled in a timely fashion.
Reasons for cancellations, no-shows. If you track the reasons given by patients for each oc-currence, solutions will often become apparent. Perhaps patients fear a particular procedure. Or
rush hour traffi c may be particularly bad in your
area. Once you identify the problem, you can often come up with communication strategies or chang-es to your practice that can reduce the problem. Make sure to track each no-show and cancellation along with the stated reason on a constant basis. Call your no-show patients immediately to follow up with them and make sure everything is OK. Some patients don’t show up for an appointment because they are embarrassed. Maybe they didn’t do the home exercises they were supposed to do, or they didn’t show for their last appointment. Someone from the practice (either at the front desk, or when possible, the practitioner) should follow up over the phone with each patient who
misses an appointment, to fi nd out the reason
and to encourage that patient to attend the next appointment.
STEP 8: CREATE A POSITIVE
ATTRACTION
When patients fail to show, it’s often because that have chosen not to keep the appointment. Here are three ways to make patients want to keep their appointments.
3 Ways To "Market" Your Appointment
A reminder campaign is really a marketing campaign persuading your patients to show up for their appointment. A successful marketing campaign focuses on three things –reach, frequency and impact – and so should your reminder campaign:
Reach. What percentage of your scheduled patients are you able to reach? Update your database every time a patient checks in and confi rm the home phone, work phone, address and email address.
Frequency. People need to see an ad several times before it sinks in. The same is true with appointment reminders. Give your patients multiple reminders via email, telephone and mail.
Impact. It's not just how often you remind your patients that counts. Your message also needs to have impact – why should a patient show up at your offi ce? Stress the benefi ts in your reminders.
Increase the energy level. When a patient is involved in a recurring form of treatment, whether it’s physical therapy, counseling or anything else,
they are often dejected about the eff ects of their
condition. Depressing surroundings become all the more intolerable — while a break in the day that
is fi lled with optimism and energy is all the more
welcome.
Take a look around your practice from a “patient’s eye” view: do they feel excited about what they are
scheduled to experience…or is it a bit of a downer
to check in? You can start with the basic surround-ings. Maybe your site needs a paint job, or artwork on the walls. If you are treating patients in a com-mon treatment area, consider whether portable partitions might increase the privacy and improve the atmosphere of your practice.
Then work with your staff to review the entire
patient experience. When a patient checks in, are they greeted with a smiling, personable welcome, or a casual glance from an overworked or disinter-ested receptionist? The therapist should be able to
greet each patient by name and ask specifi c
ques-tions about the patient’s current state, based on notes in the patient documentation. At the end of the appointment, let the patient know it was great to have them and that you truly look forward to seeing them again.
Sell the sizzle, not the steak. An old marketing rule states that you should sell the benefits of your product, not the features. The same is true in your practice. Remember that no one comes to your office to get treatment — they come to get better. If you are a physical therapist, don’t talk to the patient about doing bends, stretches and lifts; talk about increasing strength, flexibil-ity and coordination. Constantly repeat the ben-efits of what you are doing with the patient and help them see that what they are accomplishing is worth the pain and frustration.
Fear and urgency are two more powerful tools you should use in moderation. Don’t be afraid to point out the negative consequences of abandoning treatment. Many people drop out of program thinking in the back of their mind that some day they will go back. This almost never happens. Create a “now or never” sense of urgency about the importance of maintaining their course of treatment.
Make your patients feel at home. If you have patients that will be coming in on a regular basis, give them a brief office orientation. Show them where the coffee pot and the bathrooms are. Introduce them to the staff. In short: make them feel at home. Encourage the office staff and practitioners to display photos and memo-rabilia in their work areas, to create opportuni-ties to share a little about themselves. Anything you can do to strengthen relationships with your patients is sure to improve not only reten-tion, but the results you achieve.
CONCLUSION
By reducing no-shows and cancellations, you improve both your income and your outcomes. Hopefully, these simple steps will help you along the way. Let us know how you’re doing and if this article was helpful by emailing us at info@mediware.com.
If you would like to know more about scheduling software, telephone & email reminder systems, pa-tient documentation and other technologies that can help your practice, call your Mediware consul-tant at 1-800-279-8456 or visit Mediware.com.
About Mediware
MediLinks® is the premier documentation and scheduling solution for Outpatient Rehab Services,
Acute Care Rehab, Post-Acute Care (IRF/SNF) and Respiratory Services. Through experienced
workfl ow and content, MediLinks manages compliance, improves outcomes, protects revenue, and optimizes effi ciency. Our integrated tools and workfl ows enhance clinical decision making and
allows for clinical and business management. Mediware understands the challenges of providing
solutions in the Rehab space. Our technology solutions solve the workfl ow challenges and regulatory changes facing Rehab providers. Visit Mediware.com/rehabilitation, call 1-800-279-8456
