This post was inspired by a frustrated reader's Q&A. How do I deal with cancellations/no-shows?
1) Implement a policy
My cancellation/no-show policy states that 3 cancellations, 2 no-shows, or a combination of 1 cancellation and no-show is subject to automatic and unquestionable discharge. The doctor, if referred, is notified of non-compliance with prescribed PT frequency.
In my experience, unless someone has a great excuse (school holiday, kids sick, they are actually sick), the regular Cx and NS patients have absolutely no intention of taking PT seriously or are unable to come regularly. For whatever reason it is, if they cannot come regularly, especially enough to learn their HEP, they are not going to do well.
I once had an intern who refused to implement this with his patients, he had a patient who probably Cx or NS on him at least 4-5 times before he discharged her. She wrote him a letter, apologized, begged to be taken back. I said, "Don't do it." He did it anyway out of the kindness of his heart. He told her she had to come 3 times/week for 2 weeks straight. She came once.
2) Make the visit worth their time
I once heard a stat that stated for every verbal complaint you get about your business, there are at least 5 non-verbal complaints about it. We try to bend over backward to make people happy. Little things like 1:1 attention, asking them about themselves and their family (not just about their symptoms), offering to make them coffee, not overbooking, taking them within 5 minutes of their visit, and getting them out in a reasonable time all make a difference.
The 1:1, whether it's manual therapy, pain science education, or actually watching someone perform their ther ex for the first several sessions also make the value of your services be more than something they can just do at home.
3) Make patients responsible for adhering to the schedule
Part of the Cx/NS policy reads that since your appointment is 1:1, if you are later than 10 minutes, the therapist has the right to cancel the appointment. Here is one thing 14 years of practice has taught me, when someone calls saying they'll be late, here's the equation
- 5 minutes = 10 minutes
- 10 minutes = 15 minutes - your therapist may not be able to see you
- 15 minutes = please reschedule
While I try to accommodate patients who are late, I always let them know politely that the visit may be shorter if the next appointment is on time. Most reasonable individuals understand this, if they do not, they do not value your services or your time = not my patient. Stanley Paris always told us that if a patient told him there was too much traffic, he would say something like "You did not leave early enough then." Make them responsible.
4) Give them a clear prognosis on visits/time to meet their goals
Patients are more likely to stick to your plan if from day 1 you are able to tell them approximately how many visits or weeks it will take to meet their goals. This is what separates us from other "straight" practitioners that may tell their patients.
Another important aspect of this is not going over your prognostic # of visits without explanation. Seeing someone twice a week for 20 weeks when you told them it would take 3-4 weeks = lost patient. Make sure you change the program, or tell them how they are doing regularly. Every visit is a reassessment!
5) Office staff calls each patient if they are 10 minutes late
Whether it ends up being a reminder, that ends up rescheduling or a polite warning about our cancellation policy, you may recoup a lost visit/revenue from someone who genuinely forgot. We don't count the cancellation if someone reschedules for another time that week. The original Q&A clinician who prompted this post eventually wrote a rule that said 2 consecutive 10 minute late visits counts as 1 cancellation. I like that, it makes people more responsible for their treatments.
There are certainly more ways out there, and these were 5 off of the top of my head. What strategies do you use in your practices?
5) Office staff calls each patient if they are 10 minutes late
Whether it ends up being a reminder, that ends up rescheduling or a polite warning about our cancellation policy, you may recoup a lost visit/revenue from someone who genuinely forgot. We don't count the cancellation if someone reschedules for another time that week. The original Q&A clinician who prompted this post eventually wrote a rule that said 2 consecutive 10 minute late visits counts as 1 cancellation. I like that, it makes people more responsible for their treatments.
There are certainly more ways out there, and these were 5 off of the top of my head. What strategies do you use in your practices?
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