Cancellation/No show policy (Full Version)

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JSPT -> Cancellation/No show policy (June 17, 2008 5:32:22 PM)

Has anyone had success implementing a cancellation/no show policy at their clinics?

I know of policies out there which charge $x if an appointment is not cancelled at least 24 hours in advance, but I think such a policy would be hard to enforce.

How about using a carrot instead of a stick?  If a patient has 0 cancellations/no-shows during their course of PT, they get a $25 gift certificate, or something like that.



TexasOrtho -> RE: Cancellation/No show policy (June 17, 2008 6:26:30 PM)

Nope...$25 dollars for non-emergency cancellation within 24 hours. Period. For better or worse it's had a significant impact on our cx rate.  We verbally discuss the policy during the initial intake (verbally is important).  It's highlighted on the intake forms.  Lastly we bring it up when the patient tries to cancel.

It may sound heavy handed but it has helped us tremendously.



SJBird55 -> RE: Cancellation/No show policy (June 17, 2008 11:10:09 PM)

I don't have a cancellation/no show charge as a policy.  I'm of the opinion that the services I provide are valuable and that the patient and I are a team.  I attempt to go the extra mile for each of them and I actually expect them to contact me if something arises in their schedules as soon as they know it.  Life happens; I expect life to happen. 

I also encourage a cancellation IF the patient is doing well and doesn't believe services are needed.  Of course, I already have an inkling that the person is going to be doing great and actually think services won't be necessary, but I have that conversation with patients too.  Prior to scheduling, I generally have a conversation about the frequency of scheduling and what the patient can commit to and a bit of the game plan that will help achieve the desired outcomes within the patient's time commitment.

When someone calls to cancel, our policy is to see if there is a more convenient time that might work better.  Sometimes I get on the line to do a quick phone conversation to offer recommendations for activities or whatever for the patient to accomplish before the next scheduled appointment.

If I had a high amount of cancels or no shows, I don't think I'd first look to some financial policy for that problem.  I am more of the type of person that would ask why.  What am I not doing that patients don't value or respect me and my time?  I don't want to micromanage behaviors and I don't want to determine if the person has a legit reason for a cancel or no show... For some reason, a financial "punishment" just doesn't seem tasteful to me. 



bonez -> RE: Cancellation/No show policy (June 18, 2008 1:42:47 AM)

quote:

ORIGINAL: SJBird55

I don't have a cancellation/no show charge as a policy.  I'm of the opinion that the services I provide are valuable and that the patient and I are a team.  I attempt to go the extra mile for each of them and I actually expect them to contact me if something arises in their schedules as soon as they know it.  Life happens; I expect life to happen. 

I also encourage a cancellation IF the patient is doing well and doesn't believe services are needed.  Of course, I already have an inkling that the person is going to be doing great and actually think services won't be necessary, but I have that conversation with patients too.  Prior to scheduling, I generally have a conversation about the frequency of scheduling and what the patient can commit to and a bit of the game plan that will help achieve the desired outcomes within the patient's time commitment.

When someone calls to cancel, our policy is to see if there is a more convenient time that might work better.  Sometimes I get on the line to do a quick phone conversation to offer recommendations for activities or whatever for the patient to accomplish before the next scheduled appointment.

If I had a high amount of cancels or no shows, I don't think I'd first look to some financial policy for that problem.  I am more of the type of person that would ask why.  What am I not doing that patients don't value or respect me and my time?  I don't want to micromanage behaviors and I don't want to determine if the person has a legit reason for a cancel or no show... For some reason, a financial "punishment" just doesn't seem tasteful to me. 



Collecting it can be a bit of an embarassment too for the client. This is different than a no show however and to inquire as to what their care plan is supposed to be will often ferret out the reasoning behind why the cancelation occured and if the client was fully listening to your discussion regarding their treatment.



goodlooks58 -> RE: Cancellation/No show policy (June 18, 2008 3:29:23 AM)

I started out at $25.00 for non-emergency cancellations and now I have increased to $45.00---this has helped tremendously as pts. try their hardest to keep the apptment. It is not heartless as I try to explain to the pt that the spot they miised could have been filled by another pt



ianwvu -> RE: Cancellation/No show policy (June 18, 2008 3:29:57 AM)

We have a $40 NS/24 Cancellation policy.  I say it works well, even if we don't collect.  We are pretty lax about actually collecting it, and it is very case sensitive, but the fact that it is there convinces some people to make their appointment when they would otherwise cancel.  I treat my patients like adults, and don't feel I have to spoon feed them the responsibility of showing up for their appointment.  Life gets in the way, but I'm sure all of us agree, that some people in life have trouble owning up to their commitments.  When it involves my practice i take things like this seriously,  I.e....where they cancel 30 minutes before their appointment, because they forgot it was today (for the 3rd time a week and a half), or they decided to stay out of town for an extra day because the weather was nice, or they ate too much food during thanksgiving dinner to where they don't feel that good, I don't really tolerate that stuff very well.  Notice I stated this is when I get this kind of info 30 mins prior to an appointment.  Now if that was a prime appointment that is very sought after, with proper notice and I could have put 1 of several different patients in that time slot that actually needed the treatment, but now I can't because I was only given 30 minutes notice, It kind of gets to me.  With these certain types of cases, we do (for the most part) charge.



Sebastian Asselbergs -> RE: Cancellation/No show policy (June 18, 2008 6:38:05 AM)

Exactly as Ianwvu said. Very few collections needed (about three times last year(. And occasionally, I am happy if a certain patient no-shows - catch up time for paper.



JSPT -> RE: Cancellation/No show policy (June 18, 2008 6:53:10 AM)

Thanks for everyone's feedback. 

Let's say we decided not to charge for a non-emergency cancellation, but instead offered some kind of reward at the end of a patient's therapy if they have no cancellations or no-shows. 

Do you think such a policy would be effective?



SJBird55 -> RE: Cancellation/No show policy (June 18, 2008 8:12:48 AM)

See, most of you have the "you" reason for a cancel/no show financial policy.  You want to "fill a slot."  Now, how much value is that kind of attitude?  Does that type of attitude show that we care about the patient and that missing an appointment equals missing out on a progression of our services opportunity?  Does that attitude convey that missing appointments sometimes = backsliding?  Our services are and should be about the patient and NOT about losing a slot.  Of course, this is just my opinion.

ian, you know what we do when someone forgets an appointment?  1) try to reschedule 2) that person is jokingly harrassed by me - with a smile of course 3) the person will begin receiving a reminder phone call from my office manager prior to each scheduled appointment.

JSPT... again, I don't micromanage patients.  (edit:  okay... I DO micromanage to a degree since my office manger will do phone reminders, but the patient does need help in remembering and there is no way I can assist them to meet their goals if they forget their appointments.)  I have enough more clinically relevant stuff I track and use to improve my services that tracking individual patients on their attendance, is in my opinion, a costly, timely, unvalued by me decision.  If I have to "bribe" a person to attend, what does that in a backwards way suggest?

For the older patients that live alone... no lie... if the patient no shows... we're on the phone within 20-30 minutes.  My biggest fear is that someone might fall at home and be lying on the floor somewhere injured.  If that person doesn't answer the phone, our policy is to contact the emergency contact and if no response to activate EMS.  One time a patient was having a heart attack and an ambulance was on the way... another time, a patient was having severe shortness of breath and I had to convince the spouse to activate EMS... most of the time, the patient forgets.  They never do again because they get my speal about how I worried about them and how my heart was racing because more than anything, I wanted to hear their voice on the phone. 



TexasOrtho -> RE: Cancellation/No show policy (June 18, 2008 8:20:38 AM)

One thing to consider.  In a busy clinic like ours where one PT sees quite a few patients, we have people struggling to get scheduled at times that are convenient for them.  When a patient is very late, no-shows, or just doesn't feel like coming in that day, it often indirectly affects another's episode of care.

The patients must understand how scheduling affects them and other patients as well and we tactfully discuss this aspect of their care at our clinic from intake through discharge.  We also make sure they understand that the clinical care does not exist in a vacuum and that the administrative details are a component of patient satisfaction.  Our goal is to excel on every level.  This includes transparency and accountability on the part of everyone involved, IMO.



Sebastian Asselbergs -> RE: Cancellation/No show policy (June 18, 2008 8:50:14 AM)

Our services also deserve a level of respect from those who hire us to do that service.  We have to earn that by doing it well - they have to honour the arrangement-contract. Simple. Your examples are very appropriate and I think I  do no different - but the general issue is : here a contract and here are the terms. Flexible, but clear to make sure people know their responsibility.



ianwvu -> RE: Cancellation/No show policy (June 18, 2008 5:08:02 PM)

SJ,

You may have not seen the point I was trying to make.  When someone "forgets" their appointment 3 times in a week in a half, I am past the point of giving them a little harassment and laughing it off.  I joke, kid, and screw with my patients more than most therapists, because I will bore myself to death if I can't laugh at people, and be laughed at.  With that in mind I am no ones baby sitter.  Is it just me, or does it seem like in this society no one feels they need to be held accountable or take responsibility for their own actions(or lack thereof).  Fool me once, shame on you, fool me twice, shame on me, fool me three times and you’re getting charged!  These could have been 3 appointment times that a post op patient, MVA patient, or severe LBP patient would have been happy take if we were given proper notice.

With being said, as I stated before I rarely actually go through with the charge, but sometimes, its warranted.



TexasOrtho -> RE: Cancellation/No show policy (June 18, 2008 6:36:47 PM)

That's exactly how I see it.  I'm all for consumerism, but I'm not a freaking Applebee's.  For better or worse, the fee (or threat of the fee) has cut our cancellation rate from ~13% to 6-8%.  I understand objections to such a policy, so to each their own.



SJBird55 -> RE: Cancellation/No show policy (June 18, 2008 7:24:04 PM)

Ian, I understood the point you made.  If you haven't self-reflected on why cancels happen, my impression is that the patient doesn't value your services. 

In all honesty, in my experience, the patients that tend to forget are the ones that have issues of dementia, history of abuse, depression issues.  Some of them also are dependent on others for transportation.  Some have insomnia.  My heart goes out to them.  (There happen to be a few patients that have unforeseen circumstances occur at work - and here in MI, we are all lucky to have a position that pulls a paycheck.  I don't ever hassle those patients either because life happens - we just figure out what will work in light of new circumstances.)  The majority of the folks that cancel on my schedule didn't cancel because they don't care about PT... they need help in the area of remembering because they have more issues than I ever have to deal with.  Yes, my office manager will micromanage and provide reminder phone calls to them. 

And I definitely use humor, there is no reason to embarrass them or badger them or make them feel guilty.  My favorite 2 H's are implemented... express humor and help them.  I don't get bitter about it because I know their behavior isn't being intentionally directed at inconveniencing me.



ianwvu -> RE: Cancellation/No show policy (June 19, 2008 2:13:29 AM)

SJ, Obviously you are taking what I’m saying as this is how we treat the MAJORITY of our patients, I'm assuming that is what is bringing the "love thy neighbor" philosophical stuff.  Let me repeat that this is RARELY a charge a patient ever sees.  I probably impose this charge on about 1-2% of our cancellations/no shows.  Bottom line for our clinic,  the fact of the policy just being there reduces cancellations.

To the original poster, IMO I don't know if giving a prize for perfect attendance would work.  How would you get this point across, would it be in the initial paper work or something?  What would the guidelines be?  What if someone was only coming in 2-3 times for a HEP, would they still get a gift card compared to someone who is coming for 20 visits and only missed 1 appointment?  Just curious.



SJBird55 -> RE: Cancellation/No show policy (June 19, 2008 6:59:34 AM)

Ian, I'm not being philosophical.  Each and every time a patient cancels or no shows... my little brain thinks of that patient, what I know of that patient, where I'm at in the care being provided, what has been provided and I do my own little self-assessment, mental critiquing to see if there is a value issue and that I'm missing the boat and having a disconnect with them OR if life happened OR if it is a patient issue based on history and what I know and does my role now extend to helping them remember appointments.  That is my behavior that I have had for years.

When I was practicing a 1/2 mile up the road, the cancel/no show rate was much higher.  There was a difference in the ambiance, for lack of a better term.  For number 1, I wasn't in control of hiring... and most folks were just doing a job.  Second of all, I couldn't help all employees realize that a "you matter" attitude toward patients is how customers like to feel.  Thirdly, and this may have been the greatest variable, management from top down seemed to want to micromanage, didn't expect autonomy AND didn't value employees for their strengths or weaknesses which then of course created the feeling that the efforts of employees weren't appreciated.  If you want philosophical, I think the third factor created something like a trickle down effect such that the patients/customers knew that bottom line no one really cared if they attended or didn't attend.  Oh, management definitely cared if patients no showed or canceled, but the reason that they cared was because money was lost.

I don't believe there is anything necessarily wrong with having a policy in place that financially impacts those that cancel or no show.  What I think is that having that type of policy is the lazy/easy way to attempt to solve the issue.  The $40 you collect doesn't garner you the money you could have captured - it's more of a "better than nothing" kind of thing.  If you are only imposing the charge for 1-2%, then you aren't really enforcing the policy.  In my opinion, it is sad to think that threatening patients with a non-enforced cost for missing an appointment is what motivates patients to attend.  (There's some philosophical for you.)  Mentally, I honestly have a difficult time with that.  For me, I would rather know that patients were attending their appointments because they saw value in what was being provided versus wondering... am I meeting needs/expectations OR are they just trying to avoid a $40 charge?



ianwvu -> RE: Cancellation/No show policy (June 19, 2008 5:43:00 PM)

Responses below in BOLD

quote:

ORIGINAL: SJBird55

Ian, I'm not being philosophical.  Each and every time a patient cancels or no shows... my little brain thinks of that patient, what I know of that patient, where I'm at in the care being provided, what has been provided and I do my own little self-assessment, mental critiquing to see if there is a value issue and that I'm missing the boat and having a disconnect with them OR if life happened OR if it is a patient issue based on history and what I know and does my role now extend to helping them remember appointments.  That is my behavior that I have had for years.

I agree,  as Do I. 

When I was practicing a 1/2 mile up the road, the cancel/no show rate was much higher.  There was a difference in the ambiance, for lack of a better term.  For number 1, I wasn't in control of hiring... and most folks were just doing a job.  Second of all, I couldn't help all employees realize that a "you matter" attitude toward patients is how customers like to feel.  Thirdly, and this may have been the greatest variable, management from top down seemed to want to micromanage, didn't expect autonomy AND didn't value employees for their strengths or weaknesses which then of course created the feeling that the efforts of employees weren't appreciated.  If you want philosophical, I think the third factor created something like a trickle down effect such that the patients/customers knew that bottom line no one really cared if they attended or didn't attend.  Oh, management definitely cared if patients no showed or canceled, but the reason that they cared was because money was lost.

Good points, and I think they are all valid, make sense, and I would agree.   So what happens when all those negatives you speak of do not exist?  Are there still cancels?  I would guarantee your answer is YES.  Now out of those cancels, are there some that actually have no reason to miss, except the fact that they are unreliable?   If you say NO, I would like some of whatever your smoking, or the address to the fantasy land you live in, I'd like to visit sometime.  Again, this is a very small portion, but I do believe it affects cx/ns rate.

I don't believe there is anything necessarily wrong with having a policy in place that financially impacts those that cancel or no show.  What I think is that having that type of policy is the lazy/easy way to attempt to solve the issue.  The $40 you collect doesn't garner you the money you could have captured - it's more of a "better than nothing" kind of thing.  If you are only imposing the charge for 1-2%, then you aren't really enforcing the policy. Exactly, that’s my point. This is not a way to supplement our clinic income, it is a motivating factor for those select few, who feel they can blow of their appointments at any whim, for them to reconsider that decision because is may affect their wallet.   In my opinion, it is sad to think that threatening patients with a non-enforced cost for missing an appointment is what motivates patients to attend.  YEP, you hit the nail on the head.  It is sad isn't it?  Its sad that it actually works too.  But that’s the society we (or at least I) live in.  (There's some philosophical for you.)  Mentally, I honestly have a difficult time with that.  For me, I would rather know that patients were attending their appointments because they saw value in what was being provided Yes again, I like knowing that, and I do know that 100% for the majority of our patients.  We receive praise from every aspect of the referral process- docs, MA's, Nurses,  Patients, family members about our quality treatment and staff.  We receive just as many referrals from former patients as we do doctors, so we must be doing something right.  But there are always exceptions to the rule.  versus wondering... am I meeting needs/expectations OR are they just trying to avoid a $40 charge?   There are always exceptions



SJBird55 -> RE: Cancellation/No show policy (June 19, 2008 8:02:30 PM)

I never said clinics would be cancel free, even with the best care.  Cancels will happen.  What is a reasonable cancellation rate?  I have no idea.

I honestly have no idea if my patients value my services.  How could I know that?  How can "value" be measured?  You are providing examples of what I would term, loyalty. 

I chose to not have a financial threat or any type of reward for patients.  I believe that choosing either of those options creates a false security/assumption that services are valued.  I believe it also skews my ability to self-reflect and may reduce my ability to change to meet the needs of the customers.



ianwvu -> RE: Cancellation/No show policy (June 20, 2008 12:55:11 AM)

How can "loyalty" be measured? Is there a standard measurement for that?  We can make that argument for just about anything when it comes to peoples feelings.  Do the majority of my patients value my treatment?  My interpretation? Yes.  Do I care if someone else interprets its differently? No. 



Sebastian Asselbergs -> RE: Cancellation/No show policy (June 20, 2008 6:29:04 AM)

I maintain that my services ARE valuable. I have NO doubt about that. When the patients book an appointment, they KNOW that they just can't walk in - my secretary works hard to find them a spot as soon as possible. They already know from that it is BUSY at the place.
They have already encountered a high level of cooperation and kindness to get them in at a good time.
I maintain that VERY few ever get charged, but the cancellation policy posted, does make it out in the open: patients get a small reminder the first time they look at their appointment cards. An that is usually all that is needed.

Many people who do not show, have slept in, forgotten, got busy, or had an emergency. Most all of them are mortified, and many will say: "Charge me for that". THEN we don't - they appeciate us MORE.

If I can get a call from the emergency dept from a 78 year old husband, telling me his wife can not make the appointment because she is having a heart procedure....OR if a 14 year old can have is principal call from school to say he has to finish a project, then most people CAN call when they can't make it. I appreciate your population, SJ, mostly geriatric, with a higher incidence of possible forgetfulness, Alzheimer's etc, but that is not the case here.

MY time IS valuable - and I am worth it LOL



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