Article Submission Guidelines for Practice Management, EHR, Glaucoma, and Managed Care

Exclusive Date: June 19, 2013

Appointment Confirmations: A Good Job Will Increase Your Income

 Sponsor: AIR OPTIX<sup>&reg;</sup> for Astigmatism
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Most optometric offices confirm appointments; at least that was the plan originally. It's a good idea to be a stickler on this task because it is very common for the confirmation effort to decline as staff members get busy. If confirmations are done effectively, they can result in producing $30,000 additional revenue per year for the average practice (5% of $600,000). An appointment slot that passes with no patient is production that is lost forever.

Let's review an effective plan for appointment confirmation.

Phone, text or email
I think it is smart to use all three methods of communication. Email is the primary method for confirming appointments in my practice, but a smaller group of patients love text messages and don't use email as much. Electronic messages have a few strong advantages over telephone:

  • We have a better chance of reaching the patient because email and text usually goes to the individual and not the household like the telephone. Also, the message remains as a visible reminder in the inbox, unlike voice mail which is usually gone after it is listened to.
  • The email or text asks the recipient to click on a button within the message to confirm the appointment. This action shows up on your office software dashboard as confirmed and no further effort is needed by your staff. We know these patients received our message and they are planning to show up.
  • Links are provided within the message to the practice website and a button takes patients to history forms to complete before the appointment. Additional information about the upcoming visit can be customized and provided, including a map.
  • Email and text messages from a doctor's office are impressive and can get patients talking to others about your practice.
The easiest way to use email and text to confirm appointments is to subscribe to one of the software programs that specialize in electronic communication. Some of the best known companies are Websystem3, Solutionreach, Demandforce and 4PatientCare. You need a large number of email addresses for your patients to make this work, but your staff should be gathering that information on nearly every patient seen.

Of course, email and text is still not perfectly reliable for everyone, so our staff uses the telephone to contact any patient who is not confirmed by email. Using the appointment scheduling module in our practice management software, we click next to each appointment to indicate contacted, no answer or left message.

Automated voice phone calls are also quite effective in the confirmation process and they can be surprisingly pleasant. My staff has plenty of downtime during the day when we are not seeing patients and I like to have side jobs for them, so we have no problem making these calls personally.

No shows
An excellent confirmation system will drastically reduce no shows. If you have more than 5% of appointments ending up as a very last minute cancellation or no show, you should carefully review your confirmation procedure and consider modifying it. Confirmation efforts are extremely important for practices that use pre-appointing for routine exams.

If no shows are excessive, consider asking for patients to confirm your confirmation. This happens automatically with email, but most phone confirmations are simply left as voice mail with no response. You could ask the patient to call your office back and confirm the appointment, but many people just ignore this request. On some days with very high demand, like Saturdays, you may want to require that the patient call you back to confirm, or the appointment will be cancelled.

I don't care for threats to charge a fee for no shows in most cases, but every practice is different and some with unusually high patient demand may have to go to extreme measures. In the vast majority of cases, practices need more patients and they need very patient-friendly policies to increase demand through referrals. In addition to a stronger confirmation effort, another way to decrease the impact of no shows is to speed up the doctor's portion of the exam and schedule more patients per day. Double-booking appointments that are not actively confirmed or are suspect for some other reason is also a good strategy.

Start early enough
Many offices make their confirmation calls the day before the appointment, but that does not really allow enough time to fill any appointments that are vacated. It is best to send the email or text message about 3 days in advance. If the appointment is not confirmed by the patient, I would make the phone calls two days before the appointment.

Supervise and personalize the effort
It's important that an office manager or the doctor spot check that confirmations are really getting done. Staff members may drop the procedure or simply forget to do it. In some cases, employees may actually like to see more no shows because it makes their work day easier.

If more than one staff member works on confirmation phone calls, be sure to have them initial the schedule or call list so there is no confusion where each one thinks the other is doing the job.

Best wishes for continued success,

Neil B. Gailmard, OD, MBA, FAAO
Editor, Optometric Management Tip of the Week