Six Step Method to Reducing Your No-Shows
Teri Gatchel, MBA, CPC
Karen Zupko & Associates
No show rates are on the rise again and several factors contribute to this.
First, specialty saturation in large metropolitan areas forces doctors to now compete for fewer patients.
Next, consider economic factors such as increases in the unemployment rate that have forced patients to ride out their illness or take over-the-counter remedies. This is compounded by the increase in the patient’s out of pocket expense for physician office visits.
For example, a patient with a chief complaint of wrist pain, spends approximately two hours not working to visit the hand specialist’s office. This represents approximately 5% of their weekly take home or approximately $36.00 ($18/hr not including federal/state withholdings).
Add to this the money they spend for their deductible and/or copayments, and parking which could be in excess of $200 for the office services only. These economic challenges your patient’s face could lead to an alarming increase in the number of no shows.
Considering the financial burden no shows can have on your practice, what can YOU do to stop the red ink effect from killing your productivity?
- Examine your wait times. If you have a reputation for being chronically late patients might decide they cannot afford to spend the time waiting for you. Determine the top three reasons why you are running behind and fix them.
- Evaluate no-show trends. Is there a specific time of day or weekday, an appointment type, (e.g. new vs. established), a demographic group, or ancillary provider appointment that results in more no-shows? Is there a trend between working and unemployed patients?
- Develop internal policies for return visits based on current standards of care. Avoid filling your schedule with patients who are outside of their global period and remain symptom free.
- Resist the urge to “add” ghost patients to your schedule to keep the doctor on time and staff overtime to a minimum. I know no one will admit to doing this but the reality is that most of you know someone who has! As mentioned in the first step, find out WHY the doctor is running behind and fix it!
- Create an internal policy for no-shows. Once you have analyzed trends affecting no-shows, you are ready to provide a solution. For over two years, CMS has allowed practices to charge Medicare patients directly for missed appointments. For more information go to http://www.cms.hhs.gov/transmittals/Downloads/R1279CP.pdf
The fee charges for the Medicare patient is for the business missed rather than the service that might have been rendered. If you decide to implement this into your practice a written policy is needed for use with all patients regardless of insurance type. Keep in mind, this is NOT a new concept! Dentist and veterinarians have being doing this for years; not to mention, charges for missed appointments in other industries such as hair salons and spa facilities, etc.
A word of caution, this can represent a PR nightmare for some offices. We recommend carefully performing the analysis first to help you identify the no-show problem. If you incorporate a charge for no-shows this does not automatically resolve your no-shows. In our experience, most practices use it as a way to discourage patients from no-showing, often forgiving one or two misses before an actual charge is issued.
Once you have developed a policy and begin to enforce it, you will spend more money trying to collect on the back-end. If the charge runs through your normal statement cycles, you could potentially send three statements to a patient and even then there is no guarantee the patient will pay. Further collection action may be necessary including referral to a collection agency. Be sure to monitor your collections efforts monthly. If most of your no-show charges sit on your accounts receivable, you may need to re-evaluate your decision.
6. Analyze the success of your appointment reminder system.
If you automated your appointment reminder process only to discover no-shows are still occurring or perhaps now they are worse then ever, it may be time to ask yourself:
What time of day are reminder calls made? If most of your patients are working and your system places phones calls to the home during work hours, how many replies will you get?
Instead, consider updating registration materials to obtain email addresses and cell numbers. Appointment reminders can be sent via an email or a text directly to the patient’s computer or cell phone. The response time is greatly improved providing you the opportunity to fill vacant slots. There are several vendors who can help you manage this task. To find out more, we have listed a few below:
www.smilereminder.com
www.drdial.com
www.medvoice.com
www.televox.com
Teri Gatchel is a consultant with KarenZupko & Associates, Inc., a Chicago-based practice management consulting and training firm working with hand surgeons.