I often receive emails from dentists and office managers asking me about practice management issues. Here is a question about a common office dilemma—cancellations and broken appointments.
Dear Belle, I'm hoping to pick your brain on a new policy that we might implement regarding late cancellations and no shows in the hygiene department. We currently do not have any late cancellation fees in place, but this issue is becoming a greater issue than it has been in the past. We're considering charging our full fee if there are two broken appointments without approval from the office manager or doctor. If a patient refuses to pay, he or she will be dismissed from the practice. I know late cancellations and no shows are a big issue for everyone, and usually our appointment reminder postcards, emails, texts, and phone calls do the job of reminding people of their appointments well in advance. Our patients seldom cancel their appointments for treatment. It happens more in hygiene. How would you suggest I inform our patients of the new policy? I don’t want to simply send a mass mailing or mass email. Please let me know your suggestions to address this issue.Sincerely, Rob, Office Manager
Dear Rob,
Communication in the beginning is key. If the problem is in the hygiene or recall department and not with the doctor's treatment schedule, your have to look at the message patients take away from the six-month recall and the periodontal maintenance. Determining per day the number of cancellations and no shows that are six-month recall versus periodontal maintenance will give you a clue as to the value perception patients have for their appointments.
If patients are being dismissed from their hygiene appointment with, “You're doing great with your oral hygiene so we'll see you in six months,” you're opening the door to patients' control over when they decide to see the hygienist again. When I hear that from my hygienist I know I can slide another three to six months without much change since I am “doing great.”
If your goal is to have patients return exactly at their preappointed six-month visit, the message should include a call to action. “Your oral hygiene is good. I would concentrate the electric brush more on the lower anteriors because there was calculous buildup along the gum line that is irritating the gum. You also have some fracture lines on teeth numbers eight and nine and appear to be bruxing with the lower anteriors because they have small chips. I do not want you to go longer than six months because I'm monitoring these areas. You can schedule your appointment now or if you want or we can remind you by email, text, or phone a month before you're due to schedule an appointment. Would you like to reserve time now or have us contact you?”
The reason that it is not prudent to preschedule all patients is that some will do so to make you happy but will have no intention of keeping their appointment. Their schedules change frequently or they're self-employed and don’t know when their next work project will start. These patients like to keep their options open and should seldom be scheduled too far in advance. They're often available to take last minute cancellation appointments because of their flexible working hours. Other broken appointments occur when patients who have dental insurance lose their job and insurance benefits, or their insurance changes to out of network between appointments.
My experience with developing recall strategies is to look at the system and analyze it for its failures. If you're pre-scheduling, don’t offer someone the same time on the same day of the week every time. This teaches them that this is “their time” and they'll become hostile if you cannot always accommodate their "time." People’s situations change, and when someone retires it's inefficient to continue to book the exact time on the exact day even though a patient could very well come in another time.
Hold some prime time appointments open each week to accommodate new patients. Studies show that hygiene visits are valued by patients and are a main motivator for calling the dental office other than emergencies. If you postpone seeing new patients longer than two weeks, you might lose them to the dentist down the street. If you see a number of cancellations or no shows for new patients, this is a sign that they didn’t wait for you to make the time for them.
Whether you can legally charge for a broken appointment depends on if you have a written appointment policy that a patient has agreed to abide by. The policy should be visible on your website and in any written financial or treatment plan agreements. If you turn an account over to a professional collection agency, they may or may not be able to collect for broken appointment fees. This depends on the signed financial agreement and would be subject to federal and state laws.
Communication with patients is critical to reducing cancellations. When patients understand how appointments work in your practice, they will respect your time. You must respect patients' time also. Running late without an explanation is poor customer service. If a patient cancels an appointment the day of the appointment, every effort should be made to save that appointment.
If you are in network with insurance companies that have policy provisions that allow you to charge for excessive broken appointments, check to see what their requirements are to bill for those broken appointments. The ADA Current Dental Terminology has two active codes: D9986–missed appointment, and D9987–cancelled appointment. You can bill for these but it doesn’t mean they're covered benefits under a policy.
Communicate the value of regular care, offer convenient scheduling with a variety of times, and remind patients about their appointments. In the office, make sure all team members understand, communicate, and follow cancellation policies consistently. Include cancellations as a regular topic on your daily huddle agenda.
So, Rob, before you decide to charge the full fee for two broken appointments, I would make sure the policy is in writing and has been explained to patients when they make their appointments. Some practices report that charging a broken appointment fee is a deterrent to last minute cancellations, and others report that patients consider the charge bad customer/patient service. Whatever you decide to do, make sure it is legal and ethical to do so.
