We’ve discussed scheduling problems in the past, pointing you to a few resources here and there, but we’ve never really provided a comprehensive approach for those scheduled appointments that go off the rails due to patients canceling, rescheduling, or simply not showing up at all.

Here are the exact strategies we’ve put in place over the last few years. If you’ve got something that works in your practice, leave a comment and share it with us.

Make Reminder Calls
We all forget things, and appointments (particularly those with a long lead time) are among the easiest things to lose track of. Appointment cards are helpful, but in the end, a phone call is your best bet. Email, text message and other automated solutions are starting to make some headway, but a good old-fashioned telephone call is still the most effective tool to combat schedule disintegration.

  • Provide some lead time. Don’t make your calls the night before. Give patients at least 2-3 days notice.
  • Don’t leave wiggle room. Saying, “Call us if you can’t make it,” is an invitation for people to reschedule.

I don’t think we started making these calls as early as we should have. When you’re not busy, it can feel like it doesn’t matter as much, but the truth is that it does matter. In fact, you could argue that it matters more – those cancellations are pretty painful in the early days.

Some practitioners argue that reminder calls encourage people to reschedule. I don’t buy it. Better to know, and take steps to deal with it, then have a sudden hole in your day.

Stay on Time
If you want patients to respect your time, then you need to start that process by respecting theirs. Make sure you stay on time. Don’t reschedule patients. Keep regular office hours.

Yes, emergencies crop up, but your clients will accept that if you explain it to them, apologize, and don’t let it happen regularly.

Book Tightly
What we’re really after here is teaching your patients to value their appointment. A large part of that is demonstrating that you’re busy and run a tight ship. Many practitioners tend to spread patients out over the course of a day, but for us the looser the schedule gets, the more reschedules we seem to encounter – patients figure they can get an appointment on just about any day, so what’s the big deal? It is a big deal, and it starts with effective scheduling.

Don’t Overbook
However, if you’re tempted to treat your appointment book like a discount charter flight and book it 120% full, you’re going to have problems. Overbooking to deal with last-minute scheduling changes is like treating symptoms instead of causes – it’s not getting to the root of the problem. In fact, just like running late, it’s probably creating more of them.

Book Acute Care Visits ASAP
Acute care visits are fertile ground for scheduling glitches. When patients call with an acute care issue, it’s because they want to be seen now. If you can’t see them soon, recognize the fact that they might get better or find someone else in the meantime. That increases the likelihood of a no-show or cancellation.

Follow the 1-2 Month Rule
When a patient wants to reschedule or cancel, remind them that they may not be able to get another visit for 1-2 months. Patients often reschedule simply for convenience, and this technique can often resurrect the appointment. You can read more on this approach here.

Deal With Repeat Offenders
You may discover that a large proportion of your problem appointments are with the same small group of patients.

We do have a no-show fee, but we use it with discretion. And while we don’t often charge people for missed appointments – unless they have some hard cost like custom formulated IV treatments – we do try to educate these people over time by explaining that someone else could have used their time slot.

Failing that, we follow a three-strike rule. After they bail a third time, we usually don’t hurry to call them back. If they call, we try to fit them in that day, or tell them to call back again another day when we might be able to provide same-day service.

Track Your Results
Although you may have a general sense of how well your appointment book holds together over the course of a month, nothing beats having some hard data. The easiest way is simply to have your staff track the numbers. This also lets you identify patterns that might crop up based on the time of day, week or year.

If your software doesn’t do this for you, it’s still easy to implement using pen and paper. Head to CalendarsThatWork.com, and print a lined version of their monthly calendar. Use the first line for reschedules, the second for cancellations (with no reschedule) and the third line for no-shows. Have your staff just put a tick on the appropriate line each time, then add them up at the end of the week/month. You can even enter your email address, and the site will send you the same calendar just before the start of each month.

Everyone has a role to play in keeping the schedule healthy -you, your staff, and your patients – and much of this is about teaching everyone involved about the value of a scheduled appointment. Consider yourself the Dean of the School of Appointment Value, and train your students accordingly. :)

We’ve noticed some dramatic improvements over time using these strategies – if you’ve got any other tips, we’d love to hear them!

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15 Responses to “How to Reduce Cancellations, Reschedules and No-Shows: Our Strategy”

  1. Ingrid says:

    Great post! You have outlined some terrific strategies that apply to anyone whose business runs on appointments.

  2. […] How to reduce cancellations- this is the short version of the long subject line of a post over at Alternative Health Practice, a blog with lots of ideas about running a clinic for alternative health, which applies to CM. Note it. […]

  3. Julie says:

    The hardest yet most important part is enforcing the cancellation policy. I think that giving people warnings and three strikes is way too lenient and it further teaching people how to treat you (and your business).

    How you treat your clients affects other therapists too so be aware that what you do is also affecting the next client. I have a very strict policy being a massage therapist. My schedule is full, I can only do so many sessions a week so each appointment matters to me. I recently had a few people cancel at the last minute who knew that I would charge but thought that they would get away with the first one as long as they rebooked right away. I said it wasn’t so they left angry never to come back which is OK with me but it is a reflection of the whole profession.

    It is all about getting people to respect us. When they don’t they are more likely to cancel at the last minute or just no show.

    Julie

  4. Dan says:

    Hi Julie,

    Thanks for the comment! We’re a little more lenient. Maybe it’s the Canadian in me… :)

    Mostly, though, I screw up the odd appointment myself in my personal life, so I know it’s not always malicious disrespect when a client makes an honest mistake.

    Our three-strike rule usually applies to existing clients. They spend a decent amount at the clinic, and we’re flexible – if they miss a couple of appointments over a couple of years of spending thousands of dollars with us, it’s hard for me to gripe. New clients who just don’t bother to show or call don’t get the same level of flexibility, though.

  5. Acupuncture says:

    Thank you for this post, as well as the comments! I just began a business and do find that while I had set a cancellation policy, I haven’t stuck to it as I should. I think reminder calls for people who prove unreliable can be helpful, but then, should I really take my time to remind them? It seems to be a fine line between knowing life happens and wanting to be forgiving & flexible, but then sending the wrong message and not respecting our own time. With recent cancellations and finding your post, I certainly have to figure out what will work for me! Again, thanks for your tips :)

  6. Dan says:

    @Acupuncture:

    Thanks for the comment!

    I can’t imagine not doing our reminder calls. It takes about an hour to call everyone for an upcoming busy day, but for us, if we can save just one missed appointment, it covers the cost of about two weeks of paying someone to make those calls.

    Even if you don’t have staff, I think you can pay a person for 30 minutes a day to just make your reminder calls, and come out money ahead.

  7. Acupuncture says:

    Thanks, Dan. As my acupuncture practice grows, I have found myself doing reminder calls for the habitual cancellers/postponers. I haven’t put it into practice for everyone, but it seems to be working out better. Cheers!

  8. […] why I loved this blog post by Alternative Health Practice.com – it outlines some great strategies to help all businesses manage their appointments. Some of the […]

  9. Clairee says:

    I’m in two year old optometry practice, thus 90% of our appointments are for new patients and most appointments are made less than a week ahead of time. There are at least 10 similar practices within 2 miles of my location where patients can receive same day appointments. We call our patients the day before their appointments, we stress that we need notice if they need to reschedule or cancel their appointment. However, I still have many no shows. I feel like charging the patients for not showing up is an unrealistic option, as most will just ignore the charge and go to see the competition instead. I dont know what I can do differently to reduce the quantity of no shows. Help!

  10. Dan says:

    Hi Clairee,

    It sounds like your biggest challenge might not really be scheduling, but in finding a way to differentiate yourself. If your clients see so little difference between you and other optometry practices that they’d switch on a moment’s notice, then it may be time to start thinking about how to improve.

    For us, that means service, but it may mean something different in your practice. But you might start be gathering some of your best clients and asking them why they stick with you, what they like, and what could make the experience even better.

    We did something similar for the women’s health services at our clinic. It’s an insightful process – you can see the results here:

    http://stonetreeclinic.com/2011/02/09/patient-centered-care-how-our-well-woman-visit-was-born/

  11. Helen says:

    You might want to have a look at Text Back Appointments . They’ve been really successful with reducing no-shows and are a lot faster to set up than reminder calls. SMS reminders seem to be the modern and popular method of gently reminding clients of when their appointment is and gives the business plenty of time to rebook should they decide to cancel when receiving the text.

  12. This is one of most comprehensive list of ways to avoid appointment cancellations I have seen. In case you still have an issue with cancellations, please check out our solution at SchedFull.com.

    I also noticed a lot of comments about how time consuimg it is to do appointment reminders. We also offer an easy SMS way to make appointment reminders. All you have to do is export your schedule from whatever you use with their contact info and we take care of the rest whether it is via email or SMS.

    Thanks.

  13. kris says:

    Hi Clairee,

    When you call your clients try not mentioning rescheduling in any way, as this gives the client the idea that it is an option, however small (the article above refers to this). Maybe say something like, I have blocked out/reserved some time for you from ____am/pm so I look forward to seeing you then.

  14. Coordinato says:

    People these days do not check their voicemails. And, anyone who is avoiding the doctor will not likely answer their phone; that is either out of fear or embarrassment. Sending a letter takes too long. We have made an appointment reminder software, Coordinato.com, which only sends text messages. A text message is guaranteed to reach its destination and the person will see the message intended for them. Whether they choose to come is another thing.
    It is important for healthcare professionals to build rapport with their clients so that their clients want to come and understand the importance of situation for their own health.

  15. Jure says:

    Hey people, check our new service at http://www.viaemail.me
    It might help you with no-shows!

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