Avoiding a loss

One of the main strategies a lot of physicians use to reduce no-shows is charging patients a fee for a missed appointment. Although this can work in some cases, Elizabeth Woodcock, of Woodcock & Associates in Atlanta, said charging needs to be combined with prevention.

“You need to make sure you’re doing a good job internally before starting to charge,” she said. “We want to see patients … the intention isn’t to charge, but to make sure they show up.”

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One of the main things physicians can do is have a phone reminder system. Woodcock said it’s a good idea to call people at least two days before the visit. This might also be combined with a text reminder three to four hours prior to the appointment.

An option to use with this kind of system is creating a response so patients can push a certain number if they are going to miss the appointment. This can be a good way to catch people who might not call into the office. Office staff should be cautious of telling patients to be prepared to pay their co-pay during the message. It may keep people who are having financial difficulty from making their appointments.

Another way to reduce no-shows is by paying special attention to new referrals. If  patients have never been to the practice before, make sure they knows how to get there and why they were referred. Hertz said it is common to have a primary care provider call an office, say they need an appointment for a patient, and the patient doesn’t know the doctor actually scheduled an appointment. Woodcock said it is always wise to call new patients, particularly if there was a long wait time, because they might have gone somewhere else.

Calling well in advance when there is a long time between appointments is good practice even for established patients. If a patient is going to be seen once every few months, twice a year or annually, it is a good idea to make sure you sent them ample reminders.

“If a patient has prostate cancer and is seen by the urologist once a year, you can’t schedule a year in advance and give them a small card and call the night before,” Woodcock said.

She recommends creating a list by month. If a patient needs to be seen in February of next year, for instance, indicate on the calendar to call in January to set up an appointment. Hertz recommends creating a tickler file that triggers office staff to send out reminder cards a month in advance of appointments that are set a long way out. The cards can ask patients to call to confirm or reschedule prior to the appointment.

“This way, you are actively managing care, and not just with appointments a year out,” Woodcock said. “Patients are really asking for it, and we have not as an industry done it. It’s like filling out the card that sends you a reminder at your dentist appointment.”

Many of these changes will be made at the administrative level, but there is also one thing that doctors themselves can do to reduce no-shows, Hertz said. That’s to effectively communicate why patients are coming to see you in the first place. Doctors should let patients know that the appointments are set for a reason and that it affects their care when they miss one. If you tell a diabetic you need to see him every three months to check A1C levels, let him know what A1C levels are and why that is important for his or her health.