Managing Cancellations and No-Shows

For a healthcare practice that runs on appointments, cancellations and no-shows can be the bane of a practice manager's existence. An optometry practice's revenue only depends partially on consultation fees, but patients who aren't turning up for their appointments are also not purchasing new glasses. Even if your practice has made attempts to reduce the number of no-shows or cancellations, you may still find it can be a significant problem, particularly at certain times of the year (think the week leading up to Christmas or the day before a long weekend). These are some strategies to consider that may help to minimise the impact of patients failing to turn up for their appointments.

Reminders and Confirmations

This is the most commonly used method of ensuring a patient attends their scheduled appointment. However, as many optometry practices will know, this isn't foolproof. Consider when is the most effective scheduling of your reminders. Some practices like sending a reminder a week ahead, a day ahead, and even the morning of, while others will just send a reminder the day before the appointment. Three reminders leading up to the appointment may be seen as excessive (and annoy your patients), so it may be wiser to do this only for certain patients you know have difficulties keeping their appointments.

Think about your method of communication. In our digital age, many patients anticipate electronic communications via email or text message. However, this may not be the most effective method for certain patients, particularly those in older age groups who are less technologically savvy. In these cases, call the patient instead of texting them.

Consider a system where the patient is required to confirm their appointment rather than receive a passive reminder. Your system may allow a reply message with a simple Y, and if the patient fails to confirm their appointment the day prior, call them. Encourage the reception staff to be attentive with appointment confirmations. On the morning (or any time) of a day of the week, check that all tomorrow’s appointments have been confirmed and if they haven’t, proactively chase up the patient.

The wording of your reminder or confirmation message can also influence a patient's perspective on their appointment's importance. Consider saying something like, “We look forward to seeing you at this time on this day. Please reply Y to confirm your attendance." This can make the patient feel like the unwavering expectation is that they will be there as scheduled, rather than the appointment being something they can just choose to turn up to.

What should you do about repeat offenders?

Many practices will have at least one patient, that patient, where you’re 90% sure they’re not going to show up. It’s up to each practice manager and perhaps even the optometrist to decide how the patient relationship should be, moving forward.

Some practices may double book appointment times when they know one of the patients is not likely to show. You just need to make sure that you are able to manage the situation well if both patients do happen to turn up.

Some healthcare practices charge a cancellation or no-show fee, though this is not typically found in optometry. Should we be charging such penalties? While some may argue that this emphasises to the patient the inconvenience of their last-minute cancellation or failure to attend, it also creates bad will, especially if the patient had a legitimate reason for their behaviour. The general recommendation is to avoid charging cancellation and no-show fees in optometry practice.

Build a Waitlist

While this doesn't help you avoid cancellations or no-shows, it does avoid lost revenue from a patient who's failed to show up and, simultaneously, makes another patient very happy that they could be seen earlier.

When adding patients to the waitlist, it's helpful to ensure you know what they're attending for and how urgent the appointment is. Are they a -6.00 myope who has broken their glasses and is scraping by with an old pair from two scripts ago? Or is it simply someone who has no particular concerns but just wants to get their annual eye check out of the way?

Encourage the reception staff to be proactive about the waitlist. In addition to this, remember to remove patients from the list once they've been seen.

Consider whether you still have a duty of care

Even though it was the patient’s fault that they didn’t turn up for their dilated retinal exam as scheduled, and then when they do come in 12 months later, it turns out they have sight-threatening diabetic retinopathy, it could be argued that you failed to follow up on your duty of care.

If you’re expecting to see a patient for a clinically important review appointment and they cancel or fail to show, don’t just let it pass. A patient who cancels their appointment should immediately be offered a rescheduled time slot. If they say they’ll call back later to book, write yourself a note to chase them up if they don’t get back in touch within a reasonable timeframe.

When it comes to a patient who has failed to attend their appointment altogether, the optometrist’s legal duty of care requires them to “ensure that they have exhausted all opportunities to contact the patient.” This duty of care could be seen as satisfied by three separate phone calls at different times of the day or a letter explaining the attempts at contacting them.¹

Remember to document every attempt at following up with a patient who has cancelled a clinically important appointment or failed to show.

Summary

Building a good rapport and relationship with your patients is another strategy for minimising no-shows. A patient who feels a connection to the practice staff, whether the dispensers or the optometrist, is more likely to honour your time by attending for the appointment or at least have the courtesy to cancel with adequate notice. In addition to this, taking proactive steps to remind patients of their appointment and confirm that they will be attending can help to keep your appointment books full.