How to Reduce No-Show Patients at Your Medical Practice

When a physician hears "What is your hourly rate?" she most likely assumes the question is directed to an accountant or an attorney. Unfortunately, physicians rarely think they possess an hourly rate like other professionals.

While it's true that payment systems do not lend themselves to billing an hourly rate, every doctor has one. Not realizing the importance of hourly compensation causes many practices to fail to appreciate the enormous value of strategic scheduling, and most importantly, the need to keep their schedules full. You should think of your "no show" patients as time-pickpockets. They steal your opportunity to completely schedule your day with revenue-producing visits.

In our increasingly casual society, it can be difficult to know how to end the no-show trend. Some doctors think overbooking is the answer; but that only reflects poorly on their practice. They're bound to find that if every patient shows up, they'll leave with a low opinion of the practice as a result of long waits and disorganized scheduling. Practice reputations can be tarnished not only by word of mouth, but also word of mouse. Disappointed patients can also broadcast their dissatisfaction online using ratings websites such as Yelp.com.

So what can you do to help your patients arrive at your practice every time they are scheduled for a visit? Here's a step-by-step method to recalibrate your thinking about no-show prevention:

1. Assign a responsible staff member to be the scheduling czarina and to champion "Operation No Show." Appoint only one person to guard your valuable time. If everyone is in charge of your schedule, then no one person really "owns" the results.

2. Track every no-show patient in your computer system. For a variety of reasons, including medico-legal issues, you should not delete failed appointments. Instead, track them in your computer system by creating a no-show tracking code (i.e., DNKA - Did Not Keep Appointment).

3. If you are a specialist, inform referring doctors if their referred patients don't show up for scheduled appointments. It is easier for the referring docs to track the status of patients using their EHR if they hear directly from you; and you don't want them wondering why you haven't sent them a report.

4. Follow up with missing patients. If you are a specialist or surgeon, and the patient is in a global period, you probably want to know that the healing and recovery process is moving along as planned - even though you are not paid for the visit. It's a good idea for staff to call and check up with patients or their caregivers (especially if the patient is a child), and note the conversation in the chart. Sometimes patients just feel better, and assume they don't need to come to their appointment.

5. Analyze the data like the airlines do. Look for patterns in no-show appointments, analyze both the day of the week, and the time of day. Certain days typically yield more no shows; usually Monday and Friday are the worst days. Also look for differences among physicians over a period of time.

6. Rethink your appointment reminder protocols. Some offices are sporadic and inconsistent in sending patient reminders. These are a few examples of how you can to improve your reminder process:

• Send a reminder using a self-addressed envelope. Patients can address the envelope at check-out. One OB/GYN office uses this technique to remind patients to schedule their annual Pap smear. A radiology practice successfully uses the same method to send mammogram scheduling reminders. It's harder to ignore a piece of mail in your own handwriting.

• Implement new technology. Technology solutions can help you automate patient reminder e-mails and/or text messages, using the parameters that you set up. Thus, it doesn't matter if your staff isn't in the office to make a call. This method also allows your practice to receive a text or e-mail response back from the patient, to confirm that they are coming to their appointment. Using technology makes sending reminders easy and seamless, and also cuts down on your telephone volume.

• Allow patients to pre-register for appointments online. Pre-registration is a signal that the patient intends to show up. Through implementation of patient portals, many offices have found a correlation between patients who complete their demographic and health histories online, and low no-show rates.

• Ask for a deposit. Some out-of-network physicians and aesthetic-oriented practices also ask patients to make a deposit toward their appointments - just like high end hair salons and restaurants. Your practice, like other service businesses, suffers economic losses if customers don't show up, so this deposit acts as a sort of insurance.

In the end, value your patients' time, as well as your own. Make a concerted effort to see people within 15 minutes of their appointment and you'll see their willingness to return the respect by coming to their appointments.

Karen Zupko is a seasoned healthcare adviser who has more than 25 years of consulting, coaching, and training experience with physicians and practice managers. You can contact her at kzupko@karenzupko.com. Arielle Nelson, MFA, is a research associate with Karen Zupko & Associates.