Broken and cancelled appointments must be handled immediately and efficiently.
Do not repeatedly schedule patients who are prone to cancel or miss appointments. With experience, a front desk employee will be able to determine who these patients are. Rather than allowing them to repeatedly affect our schedule we must think of ways to schedule these patients with a better chance for success. Consistency in the way we communicate with these patients will help them quickly learn that our time is as valuable as their own.
First of all, each patient must sign our financial policy at their first visit. According to this document, any appointment that results in a no-show or is not canceled with at least 48 hours notice is considered a broken appointment. The financial agreement states a $50 fee will be charged for any broken appointment.
When a patient does not abide by this agreement, we have a system with a series of phone calls to be made and letters to be sent to help us document efforts in case we need to eventually dismiss this patient …… but we rarely do this. It is more typical that we identify these patients and then use a different approach to scheduling them so that they have the chance to change their habits.
FIRST MISSED APPOINTMENT:
When a patient misses an appointment, attempt to contact them within 5-10 minutes. They may just be running late. Or they might be close enough to still make it to their appointment. Note this call as a contact note in the patient’s chart.
Our current approach is to waive the first $50 fee. If you are able to get a hold of the patient, try to find out why – is it money, time, fear, etc? We will obviously not enforce the policy in an extreme situation such as the death of a loved one, family emergency, etc. Even if the patient did not have a good reason for missing their appointment we will still waive the first fee and use verbiage similar to the following:
| Receptionist: “Hello Mrs. Johnson. This is Angela at (insert practice name here) . You had an appointment with us at 10 am and its now 10:15! Is everything OK?” Patient: “Oh no, I completely forgot!” ….. or ….. “Oh shoot, I thought that was tomorrow!” ….. or ….. “Oh yeah, I can’t make it today. I’m really busy at work.” ….. or ….. “I didn’t know I had an appointment. Are you sure I scheduled something?” |
Depending on what the patient says, you need to decide how to proceed with scheduling this patient. Does it seem like this patient will be committed to keeping future appointments? Here are some options:
- If it seemed to be an honest mistake by a very motivated patient, find a new time that is convenient for everyone and schedule it.
- Give them some time slots that have been difficult for you to fill and see how they respond. It could be that they are going to be a very difficult person to schedule no matter how committed they are to fixing their teeth.
- Schedule them at the end of the day or before lunch so that if they miss, at least everyone gets to go to lunch or head home a little early!
- If you have to schedule them out more than a few weeks, let them know you’ll put them on the “ASAP” list and contact them if something opens up earlier.
| Receptionist: “It looks like I can’t get you in for several weeks. Would 2pm on the 7th work for you?” Patient: “That will work.” Receptionist: “Great! Make sure you make it to this appointment so we won’t have to push it out again!” |
There should never be any guilting or shaming, but we do want to convey the message that keeping their appointments is absolutely expected in our office.
If you are unable to reach the patient, try a couple more times throughout the day. If you are still unable to contact the patient, make a note to call again the following day. These attempts will also be noted in the patient’s chart. Remove the patient from the schedule and transfer them to the Unscheduled list if appropriate. If you still cannot contact them the following day, send them a 1st Broken Appointment Letter.
2ND MISSED APPOINTMENT:
If a patient breaks a second appointment, but is very remorseful, you may feel inclined to give them one more chance:
| Receptionist: “Hi, Mrs. Johnson, you missed your appointment again! I hope everything is OK.” Patient: “Oh darn, I did it again. I’m so sorry. Can I move it to another day?” Receptionist: “I understand life is unpredictable and this kind of thing happens. We really need you to keep these appointments though since we have other patients that really would have loved to take that spot. If you remember, I did waive the missed appointment fee last time, but I’m not able to do it a second time. And we really need you to make this next one because we’ll usually dismiss a patient after three missed appointments. So let’s make sure we get this scheduled on a day you can definitely make it!” |
At this point we still want to be kind and understanding, but we don’t want the patient to believe routinely missing appointments is a normal thing and remind them that there are consequences unfortunately.
If you are unable to reach the patient, do the same as above – try a couple more times throughout the day, call them the next day, and if no answer send their 2nd Broken Appointment Letter.
3RD MISSED APPOINTMENT:
If a patient misses a third time, office policy is to dismiss them from the practice. Of course, use your best judgment here. Some patients need to be dismissed and the formal process is to send them a final letter stating so. See our 3rd Broken Appointment Letter.
If you decide against dismissing a patient, an individualized approach around scheduling the patient must be followed. Here are some ideas:
- Request that the patient prepay before an appointment is scheduled.
- Offer them “day of” appointments only. Meaning we will contact them any day that we have a hole in our schedule.
- Give them short appointments at specific times. Nothing more than an hour in time slots most convenient to our schedule in case they miss again.
| Receptionist: “Mrs. Johnson, you missed your appointment again! As you know, we need that 48 hour notice to avoid the cancellation fee. Also, this is your 3rd missed appointment so I can’t schedule another appointment for you. There are a couple things I might be able to do though….” |
As always, keep the conversation as light as possible while conveying the importance of your message. There is no reason to be rude to a patient even if they have made your job more difficult. Some patients will eventually come around and create new habits around the way we schedule. Some never do and a decision on how to handle them will have to be made by our team.