No Shows? Not If We Can Help It!

“It is in the ordinary events of every day that we develop the proactive capacity to handle the extraordinary pressures of life. It’s how we make and keep commitments, how we handle a traffic jam, how we respond to an irate customer or disobedient child. It’s how we view our problems and where we focus our energies." - Stephen Covey, The Seven Habits of Highly Effective People, 1989

Many of the programs we visit complain about their rates of no shows and cancellations and ask us how to reduce or eliminate them. Most programs eventually just imagine no shows are a part of doing business. Not True! We don’t agree! Here are some strategies that work.

If you use a traditional scheduling system, there is no magic way to fill those time slots where patients have not shown up, or to completely eliminate no shows, but there are ways to reduce their number.

Become aware of patterns of behavior in your patients. Train staff members to recognize these patterns, such as showing up or paying late, or canceling at the last minute. We encourage our organizational clients to have their office managers or clinicians speak to patients confidentially when an unacceptable behavior begins to emerge as routine, such as canceling appointments on short notice. This is a recovery support as well, helping patients learn that such behavior can and does have negative impact on their own health as well as on other patients receiving treatment.

Accurate scheduling is another important element in reducing no-shows. The more precisely your staff schedules appointments, the less likely there will be long waits in the reception area or long gaps between patient visits for clinical staff. For example, don't squeeze a 120-minute new patient assessment visit into a 50-minute follow-up slot, and don't allow 50 minutes for a visit that will most likely only take 30. To create the most accurate schedule, thoughtfully discuss and designate various appointment time limits with clinical staff members.

Many offices set up telephone reminder systems to alert patients of appointments, typically within the next 24 to 48 hours. Although this takes staff time, it is generally the best way to assure patients remember their appointments - especially routine visits that may have been scheduled months in advance. Be sure to get permission to make reminder calls and if possible, get cell phone numbers to help with access and confidentiality. The reminder call is also a good opportunity to prompt patients on the costs of the visit and any paperwork they may need to bring or drug screens that may need to be performed.

If you haven’t already done so, consider implementing a charge for patients who miss appointments without canceling them. The extra fees may recoup some of the lost revenue and may also encourage patients to keep the appointment they would have otherwise canceled at the last minute. Whether or not you actually impose or waive the charge is up to you. You should, of course, accommodate any specific situations that may have caused the patient to cancel the appointment. By notifying patients of your no-show charge at admission, you are within your rights to charge them if they miss.

If you’re ready for a radical change, you can completely eliminate no-shows by doing away with appointments altogether by using a system called open-access scheduling.

Open-access scheduling appears to be the wave of the future, and is intended to improve your patient flow and reduce stress on your staff. Medical practices that have switched to open-access scheduling have reported that their scheduling problems have been significantly reduced, and, in some cases, virtually eliminated. Patients are thrilled to have fast access whenever they call for an appointment, and this fosters a better patient-program relationship. A concept created in the late 1980s, open-access scheduling essentially means that today's work is done today. Patients are seen the same day they call for an appointment, whether it's a new patient, an emergency or a routine visit. Open access encourages existing patients to continue in a program that can see them the day they call or soon afterwards rather than being told the next available opening is in the distant future. Patients become more comfortable asking for needed services as well as more accepting of recommendations for additional services.

Open-access scheduling encourages new patients, too, since they will be seen the day they call or at a convenient date in the not-too-distant future rather than up to weeks ahead so they can be served in a new-patient slot. This, in turn, eliminates no shows and rescheduling for new patients who have simply forgotten about an appointment made so far in the future or who have found another program that will see them sooner.

With few exceptions, no appointments are scheduled far in advance under an open-access system. Exceptions to this might include: patients who prefer to schedule their visit in the near future, follow-up visits and regular maintenance visits. Some programs have implemented partial open-access scheduling by "reserving" a number of daily appointments for new patients or emergency visits.

To fully implement open-access scheduling, your organization will need to overhaul its scheduling system. This includes decreasing appointment types, simplifying operational processes, using past appointment requests to predict future demand, and developing contingency plans for times when demand exceeds prediction. When first implementing this new approach, be prepared to create an upheaval in your program.

Initially, the program must work to eliminate the backlog of appointments or those booked into the future in the traditional manner. To do this, refrain from booking advance appointments and working extra hours for the "same-day" appointments until the backlog is eliminated. Your program will also need to develop a plan for handling times of extreme demand or a clinician's absence. Efficient clinicians must also be “protected” from taking over their colleagues’ overflow.

Once implemented, an open access system has been shown to increase both patient satisfaction and revenue while decreasing no shows, cancellations and stress on staff members.

Interested in learning more? The American Academy of Family Physicians has an online module available which provides step-by-step plans for converting to an open-access scheduling system. We found it a bit complicated, and perhaps more than the average program would want/need to do, but the principles are clearly stated.

As always, if we can help you in any area of program development or operations, please call us. After interacting with hundreds of programs, we have the experience to help you solve problems. Contact us at info@lanstat.com