Insider knowledge on how to reduce broken appointments & no shows

Dr. Mark Mosier

The trick to increasing collections is reducing broken appointments and no-shows by shifting your patients’ priorities. The stratagem in shifting priorities is more about laying out the truth and importance of care more than anything, but there’s a bit more strategy involved to successfully achieve the goal.

Priorities are where the importance lies—whether the patient says “yes” to treatment or “no” is a level of priorities. You are competing with the priorities of a vacation, a new car, a great sale, a coffee date . . . we could go on and on. Keeping appointments is simply a matter of priorities. I commonly say that most people would show up and not be late for their own wedding. Why? Their wedding is top priority. Though my speciality is dentistry, regardless of your specific health care profession, the following practices (perhaps slightly customized) will help make your appointments top priority. Shifting your patients’ priorities starts chairside with the doctor using scripts to emphasize the importance of the next appointment. From there, the message is then handed off and carried through by the team.

What is measured has the tendency to change. I challenge you to take a percentage measurement of no-shows and late cancellations for the last three months, then make efforts to lower this percentage. It will involve both attitude and communication. Training the staff to not accept a patient’s excuse for changing and breaking appointments is critical. It is also critical to not “encourage” broken appointments. Yes, believe it or not, some offices “encourage” the changed appointments by stating on the appointment card to call if the patient wishes to change the appointment, or allowing cancellations to be left on the answering machine. Stating such on the appointment card makes cancelling seem like an option. The answer machine is a dead no-go. It completely takes away the opportunity to recommit the patient. However, discouraging broken appointments or last minute changes is a skill that can easily be learned and developed.

First, you need to learn to discern between worthwhile reasons for change and those that are “weak excuses,” or in other words, cop-outs. Most worthwhile changes are called in first thing in the morning and start out with a sincere apology such as, “I’m sorry, but I was up all night with the flu.” In the worthwhile situation, you should show empathy. State that you will call them back before 5:00 PM today to reschedule the appointment. This will give you another opportunity to show empathy, which only builds your relationship, and the practice.

With the weak excuse, you need to change strategies. Examples of cop-outs include a shopping opportunity, a hair appointment, or even car problems. If the patient gives these things a higher priority than the appointment, make rescheduling difficult. Never give the weak-excuse-patient the next available time, or prime time options. Instead, give him/her two choices of hard-to-fill times at least eight weeks out. It has amazed me how many patients change their mind when they see how long they have to wait. The appointment all of a sudden becomes priority, as it should. Never accept a broken appointment as a normal part of the day.

There are a couple initial practices that you can implement to help reduce broken appointments and no-shows. For instance, many offices will send out cards, then call, and if the appointment is not confirmed verbally with the responsible party, the appointment time is released 48 hours out. This practice has to be clearly and verbally communicated in advance when initially scheduling (six months for recares), and in writing on the appointment cards. The other option is to require a deposit to hold the appointment time when scheduling. This is a practice that I use. I figured, there must be a reason that it works for hotels, and if the patient was not willing to pay then, why would they be able to pay later. Cancelling because of lack of money is quite common. Using this practice has worked quite well for me.

The most important factor in shifting your patients’ priorities is laying out the truth and importance of the dental care (or chiropractic care, or acupuncture, etc.). The dental appointment isn’t going to take priority, if the patient doesn’t see the need for it now. Give them a reason to keep the appointment, such as the risk of infection, the cavity getting deeper, potential pain, more expensive treatment if they wait, the temporary wearing out, and so forth. Lay out the truth and find a solution to the patient’s problem in a nice manner. In my practice, I’ve offered several times to send a cab for car trouble, but most of the time, my patients figure out a way to get there when they see how important it is.

The takeaway from this post is that people keep appointments they want to keep. The challenge is making patients want to please you and want to keep the appointment they originally committed to. Apply even one of these practices within your office and the priorities will become more favorable.