Optometric Management Tip # 99   -   Wednesday, December 10, 2003
Are no-shows a problem?

In this tip, I'm going to review the usual steps that many offices already take to reduce no-show appointments. But this tip is not just about how to prevent no-shows; it's also about how to think about them, and what to do when they happen. I think patients not showing up (and not calling to cancel) are a fact of professional life.

Calling all patients one day in advance to confirm appointments has proven to be an effective deterrent to no-shows and I recommend it. Like many office procedures, however, this one is an easy one to drop as soon as the office staff gets busier than usual. And once it's dropped, it's easy to just let it go and not re-instate the confirmations. This may even happen without the doctor/owner being aware of it. Our office places a C next to each appointment when it's confirmed, to let everyone know that it was done. It's true that many people are not home during the day, but answering machines and voice mail are commonly available and they work well. Contrary to popular belief, HIPAA regulations do not prohibit phone call confirmations. Just leave the message very general... such as name of patient, name of doctor and time of appointment.

The next office procedure that should be in place, and should occur automatically, is that a receptionist calls each patient who does not show up in order to reschedule. This is another procedure that may have once been in place but has been mysteriously dropped. It's a good idea to review these activities at a staff meeting to see if they still occur as designed. We place that rescheduling call about 1 hour after the appointed time, and we'll try again if we don't make contact. This is important because all practices need patients, and the sooner they are seen, the better. It also demonstrates that the office is very aware of its schedule and no-shows don't go unnoticed. Our office takes a very patient friendly approach - even for an inconvenient breach such as a no-show - and we are very understanding when a person misses one appointment. We give them the benefit of the doubt, especially the first time.

Along these lines, I know that some doctors occasionally consider implementing an office policy that charges a fee to patients who don't show and don't call to cancel in advance. A variation on this strategy is to place a warning about such a policy on appointment cards as a deterrent, without ever actually sending a bill for the violation. This concept is popular in some dental practices. I don't recommend this policy. Even if the bill is never sent, all patients read the warning and will perceive the practice as difficult to deal with. A negative perception is created among the 95% of patients who are not even no-show offenders.

We must remember that patients who don't show will generally think that the reason they missed an appointment was not their fault. It was due to something beyond their control, and any penalty that may be levied would be completely unfair. Even hostility by office staff will be viewed as a poor attitude and a lack of compassion for the hectic life they lead. I know we could debate all that... but it does not matter if the no-show reason was truly reasonable or not, what matters is that patient will think it was reasonable. To think otherwise would be to indict oneself. Further, we must realize that the patient is an individual and a consumer, and as such, they take the view that any business is a bigger entity and has more resources and advantages. The view is that they patient is small and the practice is big and they pay fees to the practice, therefore the practice should provide them with a few perks. If you want to increase productivity and income, it is all about the patient - not the practice!

Finally, if you adjust your schedule and your clinical routine to be more efficient, an occasional no show will not ruin your day. In fact, the extra time created by a no-show may allow you catch up, see an emergency patient, return some phone calls, meet with a staff member, do some maintenance on some equipment, or monitor a long list of practice statistics that need attention. In short, just use the time productively and move on.


Best wishes for continued success,

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