• Lower revenue per exam. When your schedule has a higher concentration of patients with no complaints, your average gross per patient drops. I like some self-selection of patients so the people in the exam chair actually want to be there or need to be there. I like to see an average gross per exam of $450 to $500.
• No shows. Even with multiple confirmations, preappointing leads to greater no shows and last minute cancellations. Some people will go along with the program each step of the way, but if they really don’t want to come in (often a money issue), something will come up at the last minute that conveniently makes them miss the visit.
• Awkwardness at checkout. Setting an appointment for three to six months for needed eye health care is readily accepted by patients. We do this in my practice all the time for glaucoma patients and other follow-up visits. This is also why preappointing works so well in dentistry. But when your office tries to set an appointment for a routine eye exam one year in the future, the perception changes. Even with good education, patients want to think of routine eye care as something under their control. They generally agree that regular exams are important, but they want to decide exactly when to come in. Part of the reason is financial, although no one wants to bring that up. Most people need to plan for any purchase that runs hundreds of dollars.
• Is it an appointment or not? The more specific your staff is with the future appointment (March 30 at 2pm), the more resistance they will feel from patients. The trend is to keep it very general (we’ll just reserve some space for you next year); but that technique leads to some surprised patients next year when they learn they have an actual appointment they never agreed to. The very fact that most offices use the general approach is evidence that their patients don’t accept preappointing all that well.
• We need to save some space for you in our busy schedule. This is the clever line that many offices like to use as justification for why they need to set the appointment one year in advance. Otherwise they would just send a postcard and leave it up to the patient to call. The problem is that it lacks credibility. Patients know from other sources and from experience that they could call up almost any eye care office and get an appointment within a few days. It reminds me of those often-used ads by health professionals with the line that reads “Now accepting new patients”. I think almost everyone knows that very few practices don’t accept new patients and it seems kind of silly.
• It smells like a business strategy. Patients really are smarter than we think and they can easily spot an effort to make them return for profit reasons. We can see it in other businesses and they can see it in ours. Be careful of overly aggressive pressure to return in the name of “patient education”. That can alter the image of the practice as money-hungry rather than one with a primary concern for eye health and good vision.
• Resentment and patient loss. Realize that all practices have patients who quietly leave them for other eye care providers. It’s hard to track this group, but the effect is extremely important to practice revenue. Some practices have a high dropout rate and some have a small one. Of course, when preappointing is done well, it does not actually annoy anyone, but many systems go awry over time. Many staff members simply can’t implement a system with subtle nuances flawlessly. A simple, honest procedure designed to remind people when they are due for their next exam really can’t be messed up.
• Staff hours. A well-managed preappoint system requires a lot of staff hours. There are multiple phone calls and mailings needed to confirm, reschedule and chase down the people who are hard to reach.

A mail/phone recall procedure

My preferred recall method is a letter or post card mailed one month prior to the recall date, with a follow up post card one month later to those who do not schedule. This approach is easily processed with every major office management software program on the market.

To improve the recall success rate, a follow-up phone call to patients who do not respond to either mailing can be added if the practice has a very friendly and caring staff member. The phone call must be very non-confrontational and not pushy. It is made to check that everything was OK with the previous service and to ask when the patient would like to be recalled in the future. Many of these will simply schedule on the spot.

The recall system should be set up to occur each year for at least five years, unless the patient instructs your office to stop.

The key to a busy practice

So what is the key to a busy practice if it’s not preappointing? It’s customer service. It’s creating an environment where the patient knows their needs come first and where eye care is different and exciting. A successful business is one where customers want to return.


Best wishes for continued success,

Neil B. Gailmard, OD, MBA, FAAO
Chief Optometric Editor, Optometric Management