It's noon on a Wednesday when your phone rings – your 2 o'clock can't make it. The same thing happens the next month, when this same patients calls in to cancel last minute. You are frustrated and the lost revenue is starting to pile up; after all, you've pushed other more reliable patients to later time slots / dates because this patient had already filled these spots. What to do? Before you "fire" the patient, consider all of the following steps to reduce your last-minute cancellations and no-shows.
Step #1: Develop a Cancellation Policy
The first step toward reducing those last-minute cancellations and missed appointments is to develop a cancellation policy. A fairly common practice is a 24-hour cancellation policy. This gives you an adequate amount of time to try and fill that now-empty time slot, while ensuring some compensation if you are not given fair warning.
Some clinics will charge the full amount of the visit (minus whatever insurance would have covered), others 50 percent of the amount, or even a flat rate fee for a cancelled or missed appointment. Choose the option that will make you feel fairly compensated for the lost time.
When developing your cancellation policy, keep a friendly tone and remind the patient why the policy is in place. Here is an example of well-written cancellation policy: Please be aware of my 24-hour cancellation policy. Because it is very difficult to fill a cancelled appointment without sufficient warning, appointments cancelled without 24 hours notice and missed appointments will be charged a fee of $50.
Step #2: Make Your Policy Well-Known
Now that you've developed your cancellation policy, you have to make sure your patients are aware of it. This is crucial if you are going to enforce the cancellation policy, because you'll have a hard time getting the patient to pay the fee if they weren't made aware of it.
Make sure to include an explanation of your cancellation policy when a patient first books an appointment with you. It's a good idea to mention it on the phone when they book their appointment and include a signed agreement on your intake form – it's hard to dispute the fee when you are able to show the patient their signed agreement.
Additionally, include a note in your appointment reminder emails and on a sign in your waiting-room area as gentle reminders for existing patients.
Step #3: Keep a Cancellation List
While a solid cancellation policy is a good defense against cancellations, your best defense is to keep a list of patients you can contact last minute when an appointment opens up.
Find out which patients are interested in being on your cancellation list and be ready to call or email them when you have a last-minute cancellation. You may be surprised by how many people are willing to be contacted, especially people who have unpredictable work schedules that make it difficult to book an appointment in advance.
Step #4: Enforce the Policy, But Be Flexible
Cancellation fees are a tough pill for patients to swallow. It will likely cross their mind that an alternative to paying the cancellation fee is to find a new practitioner. So, while you want to enforce your policy so people respect your time, you don't want to lose a loyal patient over it.
It's important to be flexible here. For example, you may not want to charge the cancellation fee on the first offense. In this case, you can remind the patient of your policy, let them know you'll waive the fee this time, but make it clear that next time, you'll have to charge them. Also remind them it's because a last-minute cancellation directly affects your business. Once a patient has had two or three offenses, you can start to enforce the cancellation fee.
Additionally, if there are extenuating circumstances, such as a death in the family, it's in your best interest to show some compassion and not charge the cancellation fee.
Step #5: Set Up Prepayment
Because cancellation fees are such a touchy subject, it may be in your best interest to not actually charge the cancellation fee at all if the patient is giving you some pushback. After all, you really don't want to lose them as a patient, and you want to keep positive word-of-mouth in your community.
However, if no-shows and cancellations are becoming a regular occurrence, you may want to consider an alternative to charging a cancellation fee and have the patient prepay for future appointments instead. This is a good way to keep your relationship in good standing – you are showing your commitment to the patient by waiving the cancellation fee in exchange for them showing a commitment to you. Many reasonable patients will have no issue with this compromise and will appreciate it.
Step #6: The Last Resort
Your very last resort in this situation is to "fire" your patient. If they are constantly cancelling or not showing up for their appointments, let them know you appreciate their business, but their cancellations and no-shows are too problematic.
Also keep in mind that patients who have cancelled / no-showed several times and don't agree to prepaying or paying the cancellation fees are patients you don't want. Yes, you are a doctor providing care, but you also operate a business, and it deserves to uphold certain standards of business practices.
Remember, there are several steps you can take before getting to the point that it's necessary to "fire" a patient, and it all starts with developing and enforcing a cancellation / no-show policy. But once a patient's lack of respect for your time becomes an issue, it's in your best interest (and theirs) to part ways and focus your attention on the patients who respect and appreciate the services you provide and the policies you have in place.
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