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Reimbursement and Practice Management

Appointment Reminders

A patient who makes an appointment, but fails to show – wastes one of the group's greatest assets – its time.

In this Pulse article we examine the value of appointment reminders.

  • Techniques to effectively reduce cancellations
  • Timing and content of appointment confirmation calls
  • Texting, email, and other alternatives to traditional appointment reminders
  • Creating priority wait lists

View related pearls

Appointment no-shows are frustrating to physicians, but they are far more than a nuisance. They can put the brakes on your medical practice's efforts to improve its bottom line. A patient who reserves an appointment slot, but fails to use it, effectively wastes one of your greatest assets – your time – and you do not receive any remuneration for it.

A magical patient transporter a la the Star Trek 'transporter' to assure patients show up is only a pipedream. Appointment confirmations won't eliminate the problem either, but they will help with planning. And planning is the ticket to reducing the impact of no-shows and last-minute cancellations, which are nearly the same thing.

Here's how to make the most of your efforts to confirm appointments.

The Best Time

Historically, physicians call patients the night before their appointments. While these contacts might be useful reminders to patients, they won't help your practice when a patient responds by asking to cancel the appointment. Indeed, you'll have little opportunity to convert that now-cancelled appointment into a filled appointment, especially if it was early in the day. Instead of calling the night before, confirm all appointments 36 to 48 hours in advance. This gives your practice's staff at least one full business day to refill the cancelled slot. If you schedule months out, expect forgetfulness and apathy to kick in, as well as the propensity for some patients to seek care from your competitors or just make other plans for that date. Consider confirming long-range appointments, such as quarterly, semi-annual and annual follow-ups, from 20 to 30 days in advance. This will give your staff plenty of time to field any cancellations and refill those slots.

Warm Confirmations

Many physicians contract with an automated service to confirm appointments. While it may be cost-effective, some patients tune out these computer-generated calls. At minimum, perform "warm" calls (that is, calls made by your staff) for all new patients and for patients scheduled for procedures. If you discover a high level of no-shows among certain populations of patients – uninsured, for example – consider adding them to your "warm" confirmation list, too. Take advantage of these "warm" confirmations: gather part of the patient's medical history during the call. Not only will this improve the efficiency of the visit, but it will also engage the patient. Patients who invest some of their time into preparing for an appointment are more likely to show up.

Auto-Reminder Reports

If you automate the appointment confirmation process, your vendor delivers reports to you displaying the patients it could not reach. Don't just toss this report in the trash; research those patients' accounts to find alternate communication points, such as different phone numbers, email address, text numbers, or, if time, surface mail.

Text Confirmations

A growing trend is to supplement or replace voice-based confirmations with texting. Confer with your vendor about its ability to deliver text-based confirmations. If you decide to text confirmations, collect cell phone numbers from patients as well as written permission to text them. Most practices using text confirmations send them 36 hours in advance, just as you would with phone-based confirmation calls. Consider also sending a text reminder two hours before the patient's appointment; it's an effective last-minute way of saying you expect the patient to come in.

Review the Message

There may be a lot of information that you want to communicate with the patient during the confirmation call, but be cautious about trying to cram too much into this brief contact. Be especially aware of the need to be concise if the confirmation is left on voice mail (with the patient's advance permission, of course), sent via an automated call, and especially if transmitted by text message. In addition to the necessary information – date and time of the appointment – consider describing the location of your practice, information you expect the patient to bring, and any special instructions, such as fasting. While there is myriad information to communicate, a lengthy message won't get you anywhere. Indeed, a protracted message might actually do harm as inpatient listeners may just delete the dispatch before getting its full essence.

Encourage Cancellations

Making it easy for patients to cancel their appointments might not be your primary goal for the confirmation process, but it's a worthy secondary one. Converting a potential no-show into a cancelled appointment gives you the opportunity to schedule another patient into that empty slot. When you confirm appointments – whether over the phone, through electronic communications or by letter – be sure to include instructions for cancelling the appointment. Create a cancellation telephone line, or even a separate telephone number, so patients who want to cancel can call and leave a voicemail message 24 hours a day, seven days a week. In sum, providing an easy means for patients to cancel makes it more likely that those who plan to skip the appointment will grab that option instead of just not showing up. The result will be more opportunities to convert a vacant slot in the schedule into a reimbursable visit by another patient.

Establish Priority Lists

Formulate a wait list of patients who are willing and have enough flexibility to be seen earlier than their scheduled appointments. You'll find many patients appreciate the opportunity for earlier accommodation. Call this a "priority list" or "VIP list" to emphasize the good service you try to make possible. When adding patients to a list maintained on Excel or paper, be sure your staff consistently records the patient's name, medical record number (or other identifier), cell phone number, and the time and date of the originally scheduled appointment. (Of course, you'll have all of the details in the practice management system under the patient's record.) Note any weekdays on which the patient is not available for call-in. When patients cancel appointments, start calling names on your priority/VIP list. Don't leave messages in those patients' voice mail boxes; instead, keep calling numbers from the list until you get a patient on the phone who confirms his or her willingness to come in on short notice. Maintaining and using a priority/VIP list requires more staff time, so be sure employees know that you're monitoring the schedule closely. Indeed, filling a schedule may add more work for schedulers and other office staff but it also creates more opportunities for reimbursable encounters.

Physician Attitude

Recognize how your attitude toward a full schedule affects your employees. If you praise staff for giving you a "light" day, that's exactly what they'll try to deliver every day to ensure your continued admiration. In contrast, thanking employees for a full and productive day shows you value filling all available slots – the value will rub off on your staff.

You may experience higher cancellation rates if your practice has lengthy waits for appointments, so put a priority on reducing the time to next available appointment by reviewing how physician scheduling templates are set up. And, be sure to monitor the performance of your schedulers. Use thoughtfully designed and well-timed confirmation techniques to prevent no-shows and convert cancellations into appointments. The result will be a busy day, a more efficient office and an improved bottom line.

Pearl 08/22/12

No-Show – Will Owe
Consider charging patients for missing appointments. Establishing a fine for patients who fail to show for their appointments doesn’t always change patients’ behavior, but it may prompt them to give you a courtesy call if they plan to miss their appointment. Consider a threat of the charge on the first offense and follow through with an invoice on the second instance. Although the invoice will probably go unpaid, your actions might just get the attention of patients who don’t bother to call when they can’t make their appointment. Before implementing, check with your participating agreements, as some insurers won’t allow it for their covered beneficiaries. Regardless of your payers’ stance, be sure to inform your patients in writing about this extra charge, in order to comply with Truth in Lending laws.

Pearl 08/15/12

Selective Overbooking
Experiment with intentional overbooking. If your no-show rate starts creeping higher – and especially if it tops 10 percent – try double-booking certain patients, such as the patient who missed two previously scheduled appointments. Alternately, you could double-book two types of patients – one, a quick visit and the other, a new patient. This form of strategic overbooking accounts for the fact that the intake process of the new patient will consume at least 10 minutes. While your nurse is performing the intake and readying the patient for you, you can see the patient scheduled for the quick visit.

Pearl 08/08/12

Huddle Up
To vet out predictable no-shows, establish brief morning meetings – sometimes called “huddles” – for you and your clinical support staff. A quick assessment of the day’s appointment schedule can uncover potential opportunities that can create openings, such as the patient who was admitted to the hospital the previous day, or the patient on the schedule who was, in fact, just seen yesterday on a same-day, work-in basis. Invite your appointment scheduler to the huddle so that he or she can determine these predictable no-shows – and get your feedback about the times in which patients can be accommodated on an acute basis. Investing five or 10 minutes each morning into these brief meetings can pay off significantly.

Pearl 08/01/12

Cancel Your No-Shows
It's one thing to identify the financial and logistical problems that missed appointments cause; finding solutions can take even more time but will be well worth the effort. Target the causes and reduce the impacts of patient cancellations and no-shows by reminding your medical staff to educate patients with chronic illnesses about the importance of regular follow-up. A few words of encouragement from you and your nurse help chronically ill patients to understand the need to keep routine, follow-up appointments. When scheduling the follow-up visit, be sure to ask the patient what date and time work best for them, instead of simply giving them an appointment. If you give patients' appointment cards, review them for legibility – or consider printing a confirmation page from your practice management system.

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