How Practices Should Deal With Late Patients

Even if practices have clear-cut policies on handling no-show patients, dealing with late patients - especially those who are chronically late to appointments - is another issue altogether.

Late patients can throw off a practice's schedule and affect the amount of time physicians can spend with patients, especially in a small practice. Therefore, dealing with them raises questions: Should you accommodate late patients right away? Can you show them the door?

Declining to see a patient isn't usually an option, as it can be downright unethical and could actually cause a legal problem.

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"Turning patients away if they're arriving late - you must talk to your malpractice carrier about that," says Elizabeth Woodcock, an Atlanta-based healthcare consultant, trainer, and author of "Mastering Patient Flow to Improve Efficiency and Earnings." "And you need to understand any malpractice risks you're taking by implementing such a policy. Unfortunately, if they have a heart attack on your doorstep as they're walking away, it's going to be your problem."

It's important to try and get the patient in to see someone if possible, such as a nurse or another doctor, says Ericka L. Adler, a partner at the firm of Kamensky Rubinstein Hochman & Delott, LLP, and contributor to Practice Notes, PhysiciansPractice.com's blog. If a patient does not get required care that can come back to hurt the physician if something happens to the patient, she adds.

Practices do have some options, however.

The first thing a practice can do to diminish late patients is make sure it is generally running on time.

"Please, please make sure that your practice is running on time," says Woodcock. "The practices that yell the loudest about chronically late arrivers are the ones who run late themselves. If the doctor is always running an hour behind, I'm going to run an hour behind [as a patient]."

Only the doctor or another healthcare provider can determine how important it is to see a given patient quickly.

Woodcock suggests that if a patient is more than 20 minutes late, front-desk staff should contact the clinical team and see how soon a patient should be seen.

But for future appointments, chronic lateness may qualify as a valid reason to dismiss a patient entirely if they don't change their behavior.

At Performance Pediatrics in Plymouth, Mass., late patients - those who are more than five minutes late - are treated the same as no-show patients. On the first and second offenses, they're sent a warning letter. On the third offense, they're told they will be dismissed if the problem continues. And on the fourth offense, they are asked to find another provider.

"If you're five minutes late, everyone is five minutes late," says administrator Leann DiDomenico McAllister, adding that sometimes traffic can be bad on a particular day. "But we're talking about people who are a half-hour late. Or people who call an hour before their appointment because they forgot their kid had a baseball game."