Last Updated Jun 2013
One thing that is definitely not good for our business and therapy practice are appointment no-shows. A missed appointment means missed revenue. This article was inspired by a frustrated reader's Q&A. How do I deal with cancellations/no-shows?
1. Implement a policy
My cancellation/no-show policy states that three cancellations, two no-shows, or a combination of one cancellation and no-show is subject to automatic and unquestionable discharge. The doctor, if referred, is notified of noncompliance with prescribed physical therapy frequency.
In my experience, unless someone has a great excuse (school holiday, kids sick, they are actually sick), the regular cancellation and no show patients have absolutely no intention of taking physical therapy seriously or are unable to come regularly. For whatever reason it is, if they cannot come regularly, especially enough to learn their home exercise program, they are not going to do well.
I once had an intern who refused to implement this with his patients. He had a patient who probably cancelled or didn’t show up at least four to five times before he discharged her. She wrote him a letter, apologized, begged to be taken back. I said, "Don't do it." He did it anyway out of the kindness of his heart. He told her she had to come three times/week for two weeks straight. She came once.
2. Make the visit worth their time
I once heard a stat that stated for every verbal complaint you get about your therapy practice, there are at least five non-verbal complaints about it. We try to bend over backward to make people happy. Little things like 1:1 attention, asking them about themselves and their family (not just about their symptoms), offering to make them coffee, not overbooking, taking them within five minutes of their visit, and getting them out in a reasonable time all make a difference.
The 1:1, whether it's manual therapy, pain science education, or actually watching someone perform their exercises for the first several sessions also make the value of your services be more than something they can just do at home.
3. Make patients responsible for adhering to the schedule
Part of the Cx/NS policy reads that since your appointment is 1:1, if you are later than ten minutes, the therapist has the right to cancel the appointment. Here is one thing fourteen years of practice has taught me: when someone calls saying they'll be late, here's the equation
- 5 minutes = 10 minutes
- 10 minutes = 15 minutes - your therapist may not be able to see you
- 15 minutes = please reschedule
While I try to accommodate patients who are late, I always let them know politely that the visit may be shorter if the next appointment is on time. Most reasonable individuals understand this. If they do not, they do not value the therapy services you provide or your time which equals not my patient. Stanley Paris always told us that if a patient told him there was too much traffic, he would say something like, "You did not leave early enough then." Make them responsible.
4. Give them a clear prognosis on visits/time to meet their goals
Patients are more likely to stick to your plan if, from day one, you are able to tell them approximately how many visits or weeks it will take to meet their goals. This is what separates us from other "straight" practitioners that may tell their patients.
Another important aspect of this is not going over your prognostic number of visits without explanation. Seeing someone twice a week for 20 weeks when you told them it would take 3-4 weeks equals a lost patient. Make sure you change the program, or tell them how they are doing regularly. Every visit is a reassessment.
5. Office staff calls each patient if they are ten minutes late
Whether it ends up being a reminder that ends up rescheduling, or a polite warning about our cancellation policy, you may recoup a lost visit/revenue from someone who genuinely forgot. We don't count the cancellation if someone reschedules for another time that week. The original Q&A clinician who prompted this article eventually wrote a rule that said two consecutive ten minute late visits counts as one cancellation. I like that. It makes people more responsible for their therapy treatments.
What are some of the strategies you employ to deal with appointment cancellations in your therapy practice? Leave a comment below, I’d love to hear from you!
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