Column: Cancellations, Broken Appointments

Jan. 1, 2006
Dear Dianne,

Dear Dianne,

My productivity is suffering because of problems keeping the schedule filled. Mondays seem especially bad! When we come in on Monday morning, there are often numerous messages on our machine from patients canceling appointments.

My lone business assistant works hard to keep the schedule full, but filling last-minute openings is a huge problem, especially in the hygiene schedule. Can you give us any advice on how to solve our problem of excess cancellations and broken appointments?

Downtime Dana in Detroit

Dear Downtime,

This may be of little consolation to you, but many offices are experiencing problems just like your practice. Obviously, there are many reasons why patients do not keep their appointments, such as illness, last-minute problems leaving work, or out and out fear. However, it seems to me that we have a huge problem these days with basic honesty and dependability. Additionally, our economy continues to be sluggish, leading to many people losing jobs and third-party dental benefits. When people are struggling financially, dentistry comes further down the list of priorities after housing, food, medicine, transportation, etc. Some areas of the country have been especially hard hit with layoffs and business closings, which ultimately affects service industries in those areas. I wish it were not so, but it is.

Downtime is the great “gobbler” of profit. While I do not know of a way to completely eliminate disappointments other than to stop making appointments and have patients take a number (welcome to 1950!), I do feel that there are some strategies we can employ to keep downtime to a minimum.

Monday patients

You mentioned that Mondays are especially prone to cancellations. I recommend that the message on your machine be changed so that the patient is not permitted to leave a message over the weekend. Instead, the patient should be instructed to call the doctor’s personal voicemail. Some patients will reconsider disappointing when given this option. Additionally, your scheduling coordinator should be aware of patients who have a negative history of late cancellations/no-shows and choose a day other than Monday for those appointments.

Be proactive

One of the keys to excellent schedule management is to be proactive in identifying those patients who are chronic offenders. These are patients who have proven by their past behavior that they will disappoint. They are the 2 to 4 percent of your patient base that drive you crazy, because they are so unreliable. If you have paper charts, any and all disappointments (both late cancellations and broken appointments) should be documented either in a different color of ink and/or highlighted so the entry stands out. Your scheduling coordinator must pull charts three to four working days before the actual appointment date so she can check for past problems with disappointment. If your practice uses computerized charts, disappointments must be documented and should be easy to access. Again, chronic offenders have to be identified.

There are two subsets of patients in which an answering machine message is not an acceptable method of confirming the appointment. One is the new patient (you have no history with them), and the other is the chronic offender. Speak directly with the aforementioned patients to confirm, which may necessitate someone taking the telephone number home to contact the patient after regular business hours. This may not be a popular option, but it is so much better to find out ahead of time that the patient is not planning to come and have an opportunity to fill that time, rather than facing an irate and frustrated doctor or hygienist pacing the hallway. In most cases, only a small number of patients require this option anyway.

In hygiene, another proactive strategy is for hygienists to be discriminating in whom they allow to preschedule a six-month continuing-care appointment. If a patient has proven to be unreliable in the past, it is unwise to allow that patient to schedule an appointment six months away. Instead, those patients should be told they will receive a card informing them that it is time for their continuing care and to please call the office to schedule an appointment. Let those patients take the “leftover” appointments. Never give them a prime-time appointment. Those “unappointed” patients form the call list used to fill openings.

All clinical personnel should stress the importance of the next hygiene visit. The doctor should say, “I want to see you in ___ months for your preventive care appointment. That is your most important appointment, Mrs. Smith.” Hygienists should state the specific reasons that the next visit is important. “On your next visit, I’ll be checking those pockets for any signs of progression,” or “Your next visit will be important in determining if your gum recession is getting worse or stabilizing.” Please insist that all personnel refrain from using the word “cleaning,” as this trivializes the appointment. Also, every time a patient is seen by the doctor, the assistant should verify that the patient has his next hygiene appointment.

Confirming appointments

Did you know that confirming appointments can actually be counterproductive in some situations? It is true that some patients are annoyed by those calls. In many cases, dependable people do not need to be reminded and can be insulted by the call. Confirmation calls can interrupt something the patient was doing or wake a sleeping child. Sometimes patients will use the opportunity to cancel because we made it easy by calling them.

Actually, I do not know of another profession on earth that goes to the lengths we do to ensure people will come to their appointments! Some offices beg and cajole, almost to the point of harassment. The whole idea of confirmation says, “We’re not sure you are coming, so that’s why we’re bugging you.” I think it is entirely possible that patients live DOWN to our expectations!

As an alternative, I suggest that we start asking patients this question: “Mrs. Johnson, do you require a courtesy confirmation call?” If the patient says no, the scheduling coordinator should say, “Great! I’m going to mark you ‘confirmed’ right now in my schedule. Thank you for being dependable!” If the patient says yes, inform the patient approximately when he or she will be called. (I recommend placing the call two working days before the scheduled visit.) Here’s a good script for a confirmation call:

“Hi, Mrs. Jones. This is Mary at Dr. Smith’s office. Our schedule indicates you have reserved time with our hygienist (or doctor) on Wednesday, May 10, at 9 a.m. We’re looking forward to seeing you then!”

Generally, I do not recommend leaving messages asking patients to “call and let us know you got this message,” except in the case of a chronic offender, as it is punitive to your good patients and ties up business assistants with extraneous telephone calls.

As previously mentioned, it is very important that chronic disappointers be spoken with personally, rather than leaving a message on a machine. However, this may necessitate having the patient call the office. Here is a script that can be used in this instance:

“Hi, Mrs. Jones. This is Mary at Dr. Smith’s office. I’m calling regarding your appointment on Wednesday, May 5, at 10 a.m. Could you please return this call by tomorrow, Tuesday, May 4, at 10 a.m.? The number is ____________. Thank you for your consideration.”

Another strategy for chronic offenders that you do not wish to dismiss from the practice is to have the patient prepay a sum of money or furnish a credit card number in order to hold the time in the schedule. The scheduling coordinator would take the patient into a private area and say something like this:

“Mrs. Jones, according to your record, there was a disappointment on March 5. There was another one on July 10, and unfortunately there was yet another on Sept. 14. Now, we know you are a very busy person, but so are we. In order for us to hold this time for you in the doctor’s schedule, we will require a $200 nonrefundable deposit (or credit card number). This payment will be applied to your dentistry, of course.”

No doubt, you have some spoiled patients who are accustomed to being coddled. Maybe they have been unreliable for their appointments and no real consequences have surfaced. Further, if there were no consequences for bad behavior, it is guaranteed to happen again.

It’s time to start holding patients responsible for their appointments by setting forth some consequence for disappointment. Consequences can include a broken appointment fee and/or a letter of warning. A broken appointment fee can create ill will and cause the patient to angrily leave the practice and bad-mouth the doctor. I prefer that patients who disappoint without sufficient notice be dealt with one on one with the business assistant.

However, ridding the practice of “dead wood” patients who disrespect you by not keeping their appointments is one option that should be exercised in some cases. Every case should be dealt with in the appropriate manner, because there ARE some legitimate reasons people miss dental appointments.

To summarize:

Your business staff members should be pro-active in identifying chronic offenders.

Do not allow patients to leave messages of cancellation on the office answering machine over the weekend.

Make sure all clinical personnel use communication that stresses the importance of the hygiene appointment. Do not trivialize that appointment by calling it a “cleaning.”

Be discriminating with hygiene patients on who is allowed to preschedule.

Never leave messages of confirmation for chronic offenders or new patients.

Make sure you and your hygienist(s) do not hurt people, especially on their first dental visit.

Ask patients if they need a courtesy confirmation call, and start retraining patients not to cancel appointments by administering appropriate consequences for disappointments.

Best wishes, Dianne

Dianne Glasscoe
Ms. Glasscoe is a speaker, consultant, and writer for the dental industry with more than 30 years� experience. She is CEO of Professional Dental Management, Inc., in Frederick, Md. You may contact her at (301) 874-5240, [email protected], or visit www.professional