Rehab

Cancel out patient no-shows

Rehab Regs, January 24, 2006

Patients missing appointments is a fact of life in the healthcare industry. Some patients will call to let you know, while others simply don't show up. Although no facility can eliminate cancellations, it can make an effort to reduce that rate.

The gold standard for a cancellation rate in the industry is 5%. However, that number can vary significantly depending on what you consider a cancellation. Some facilities count cancellations strictly as situations in which people fail to show up without a warning. Others only count those times in which someone cancels and no other patient fills the slot. There are also those that take into account any patient who doesn't come in for the appointment time he or she originally scheduled.

"No matter how you come up with the number, the important thing to remember is you need to look at all facets of a cancellation," says Ken Mailly, PT, of Mailly & Inglett Consulting, LLC, in Wayne, NJ. "You need to know how many no-shows, call-ahead cancellations, and reschedulings you have going on at your facility."

Examine your situation

The simple fact is that cancellations cause you to lose money. Because you can't charge for services not rendered, every open appointment caused by a cancellation is lost revenue, and every patient who calls to cancel forces your staff to spend more time trying to find another patient to fill that open slot.

However, threatening patients with no-show fees and telling them how cancellations cost you money won't necessarily make them realize why showing up is important.

To help your patients realize why keeping appointments is necessary and to keep your cancellation rate as low as possible, examine the following at your facility:

  • Patient/therapist relationships
  • Scheduling
  • Cancellation penalties
  • Patient satisfaction

Develop a rapport

The number one cause of high cancellation rates is poor patient-therapist relationships, according to Mailly.

"Clinics with high rates generally don't have a strong connection between their therapists and their patients," he says. "Patients are seen by whomever is available that day so the patients don't feel they have a therapist and the therapists don't really feel that their patient has cancelled."

Ensuring that each therapist is responsible for specific patients can help remedy this problem. This might mean assigning one OT, one PT, and one speech pathologist to specific patients depending on each patient's needs. This practice will only help if therapists develop personal relationships with clients and stress that attending therapy is part of their recovery.

"It's a safe assumption that the patient doesn't care how much money you're making, but most patients do want to get better," says Mailly. "If you lay out the consequences in terms of a longer recovery and not in terms of dollars, patients will better understand the need to show up more."

Strong patient-therapist relationships may also help the patient feel as though he or she is canceling on a person and not just a company. Sitting down with patients during their initial evaluation and talking about your expectations for them and their expectations for you can help sort out the problems.

"On a patient's first visit, we have our therapists sit down and go over our therapy agreement," says Shawneen Buckley, MS, CCC-SLP, director of the Center for Communication Disorders and Special Needs Preschool Program at Saint Francis Hospital in Poughkeepsie, NY.

"We basically [package] it for our therapists so they can explain that attendance is an integral part of the patient's commitment to and success with the therapeutic process. We also clearly request that if they must cancel, [they should] do it at least 24 hours in advance."

Conflicting schedules

Certain cancellations are inevitable because a patient will realize he or she has a conflict after making the appointment. Part of reducing cancellation rates, however, is trusting your staff to schedule appointments that fit a patient's need.

"Just filling in open slots on your schedule like a puzzle is not the best way to look at it," says Mailly. Set up a schedule that works best for your patient. If you immediately start seeing [that] a patient is reluctant to come at a certain time, you're setting yourself up for a cancellation and lost revenue."

Maintain flexible hours and match up each patient with the therapist whose schedule best matches that of the patient.

Filling in the blanks

Set up a system for filling in your schedule when patients cancel or need to reschedule. "We've been able to drastically reduce our cancellation rate because we can almost always fill in a slot as long as the patient gives us some notice," says Buckley. "We have designated schedulers who know what they're doing and know which patients want to move up if there's a cancellation."

Keeping a waiting list can save you time. Instead of calling every patient scheduled to come in that day, you'll know which patients have already requested to be on the list. Have your therapists or schedulers ask patients whether they want to be on the list each time they schedule a new appointment.

Another key component is reminder calls. Call your patients at least 24 hours before the appointment to remind them of it and give them an opportunity to let you know if they can't make it. It's also a good idea to call any patient who is more than 15 minutes late. For this situation, a cell phone number is useful.

Laying down the law

Though it's against the law to charge patients for services not rendered, the question remains whether you want to try to recuperate some of that money through no-show penalties.

Some facilities believe that monetary punishment is the only threat that will make patients understand that they need to show up. Others believe it is a deterrent to patients buying into the program. If you feel your facility needs to implement monetary punishment for no-shows, the standard fee is $25. Keep in mind that insurance companies do not reimburse for this fee, so it will have to come from your patients' pockets.

"I find that you shouldn't have to resort to monetary punishments, but if you're going to, make sure you're up-front about it and lay it out clearly in the patient's first visit," says Mailly. "You need to have a written policy, and you need to be consistent with it, or what's the point?"

The other option to consider is whether to stop treating a patient after a certain number of missed appointments.

"Ask yourself whether the patient really values your service if [he or she is] continually missing appointments," says Buckley. "We have a 'three strikes and you're out' policy if the person is a straight no-show, but even for patients who call ahead, we'll counsel them if it becomes a pattern."

Keep in mind that if you stop treating a patient, it's a discontinuation of services not a discharge. Questions may arise about whether you abandoned a patient, but if you are reasonable in your documentation, you should be safe.

Quality of care

No matter how good your scheduling is or what your penalty policies entail, your patients will stop showing up if you're not treating them well.

"It goes back to having a good relationship with your patients," Mailly says. "Therapists should want to know why their patients are canceling. Find out if it has anything to do with their condition."

Cancellations aren't always due to a patient's inability to make it. Find out whether there is something you can do to make patients feel better about spending time at your facility.

Putting lost time to good use

When all else fails and your patient still doesn't show, don't sit around and wait for your next appointment. You can take your next patient if he or she has arrived early, but since there's always a chance the patient might show, put that time into tasks you usually postpone until the end of the day or don't do at all.

Consider spending lost time by

  • calling a patient who recently visited to follow up with how he or she is doing after a treatment
  • calling a physician or insurance company to clarify any questions
  • catching up on a note you were going to write later
  • working on marketing or recruiting of patients or physician referrals

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