Easy tips to reduce your cancellations and no-show rates, increase productivity

Rehab Regs, March 11, 2004

If your facility has been experiencing a decrease in productivity due to patients who don't keep their treatment appointments, you're not alone. Although expert opinions vary on what successful cancel and no-show rates are, there are steps you can take to improve your scheduling process, encourage patients to keep their appointments and avoid vacant appointment slots for your therapists, regardless of your current rate.

The cancel and no-show rates at your facility are an indicator of how productive your facility is and how productive it could be in the future. Some administrators choose to bundle the two categories together, while others calculate different rates for appointments that were canceled in advance and those that were never canceled but were not kept by a patient. Additionally, facilities may choose to include in the rate an appointment that was canceled but rescheduled as it still signifies an empty slot in the therapist's schedule.

"The cancel and no-show rates are just like any other measuring stick to calculate the success of your operations," says Angie Phillips, president and chief executive officer of Images and Associates, a consulting firm in Amarillo, TX. "There's no aggregate number that's acceptable or not acceptable [in the industry]."

What you can do

If you've decided that your rate could use some improvement, take a critical look at your scheduling book and try to determine when and for what type of appointment your patients are canceling.

For example, appointments scheduled for weekday mornings and afternoons around 3 p.m. are high no-show and cancel times for the pediatric population because they are difficult for parents to keep, Phillips says. If your patients depend largely on public transportation, any days or times with limited routes may affect your rate.

Determine whether your cancels and no-shows are largely for initial evaluations or ongoing patient appointments. A missed initial evaluation can have more of a negative impact on your productivity and revenue, Phillips says.

"This patient is likely to receive a course of care consisting of six to twelve visits. If they don't reschedule, you've lost all of those appointments," she says. Experts suggest you ask the following questions if your rates seem too high:

 Is there adequate communication? Be sure your facility explains why the appointment is necessary and how the patient will benefit, suggests Rick Gawenda, PT, director of rehabilitation for Detroit Receiving Hospital.

 Was there a long wait? Patients may be frustrated if they have to spend too much time in the waiting room before their scheduled appointment. It is impossible to eliminate all wait times, but clinics that keep patients informed have higher satisfaction rates, says Phillips. Consider posting signs instructing patients to check with a receptionist if they wait more than 15 minutes past their appointment time.

 Are we accessible? Do your location, available transportation, and hours of operation meet the needs of your patients? Is there reasonable parking near your entrance?

 Did we provide an appointment reminder? For Phillips, giving patients a business card-sized appointment reminder is more effective than an 8.5 x 11 in sheet of paper. Confirmation phone calls may also shrink your cancellation rate.

Create an incentive

The importance of therapy treatments may be lost on some patients, which is why therapists must stress the need for therapy to both current patients and those scheduled for initial evaluations. "Try to explain the importance and benefits of therapy," says Gawenda. Include him or her in the goal setting as well as in the development and progression of the treatment plan.

Progress the treatment plan as appropriate so patients can see why he or she requires skilled therapy and why he or she should continue to attend therapy sessions. Patients who are maintained on the same repetitive program may feel they can do it independently at home, so you must reinforce the importance of therapy.

Patients also expect their therapists to spend quality time with them during their treatment sessions. To a patient, 15-30 minutes of direct, one-on-one time working with a therapist may be more valuable than intermittent instruction from a therapist over a 60-minute period. Show the patient you value his or her time.

If you suspect issues such as transportation and child care cause your patients to miss appointments, consider providing in-home therapy under Medicare Part B.

Although additional planning may be required, if you can reduce your cancel rate by going to your patients, you may be able to better serve them while increasing your own productivity and revenue.


A case study in cancellation containment

If you're a speech-language pathologist (SLP) at Cincinnati Children's Hospital Medical Center, you don't need to worry about no-shows or last-minute cancellations in your evaluation schedule. No, you haven't discovered the secret to convincing all of your patients to show up as scheduled. But you and your facility have figured out a way to keep your evaluation schedule full, despite the inevitable cancellations and no-shows.

About a year ago, the department scheduled all initial evaluations in two-hour time slots. With an approximate cancel and no-show rate of 28%, it was not uncommon for an SLP to have two hours of unproductive time due to a missed appointment. This had a significant effect on the SLPs' productivity and the potential revenue for the department. To counteract this problem, the department formed an action team to look at the entire scheduling process. Led by Diane Geiger, PhD, CCC-SLP, the team created a procedure of overbooking initial evaluation appointments based on the average cancellation/no-show rate per site.

For example, at one site, 21 general speech-language evaluation appointments are scheduled each morning for five SLPs. The appointments are staggered in 90-minute increments, and the families are told that they might have to wait up to 20 minutes.

Because these are general evaluations, any SLP can see any of the patients. Knowing that four to seven patients won't show up, this schedule results in about three evaluations per SLP. Ann W. Kummer, PhD, CCC-SLP, director of the speech-pathology department at the medical center, says there has never been a time when every patient has shown up for his or her appointment, and patients usually have only a short wait. Kummer says the facility and its patients benefit from this system in a number of ways:

Increased productivity/revenue. By strategically scheduling more initial evaluations based on your no-show rate, you can avoid the empty appointment slots caused by patients who miss their appointments. "We are guaranteeing that the speech pathologist will have patients to see," Kummer says. "There is the possibility that they will be very busy if more patients than expected come, but there will also be greater productivity and greater revenue."

Reduced waiting time for appointments. By booking more appointments each week, patients get appointments sooner.

Team approach. Because several SLPs perform evaluations simultaneously, there is an opportunity to collaborate and help each other.

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