More Practice Management

As any busy dermatologist will tell you, good medical assistants (MAs) are worth their weight in gold. Wait, make that platinum - good medical assistants are really valuable. Who else has the power to make your day run flawlessly, calm restless patients when you're an hour behind schedule, and take care of the myriad details that would bog you down in a hurry if you had to tend to them all?

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Some employees think of the drug sample closet as being free. Fortunately, a written policy can help staff avoid this misconception altogether, as long as it is obeyed.

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Using the Fourth Exam Room (Part 5 of 12)

Thursday, December 15, 2005

Many physicians bog down their workflow by batching a lot of work for the end of the day. When it's finally time to go home, there are charts to dictate, calls to make, and so on. Why not dictate, instead, while you are with the patient?

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Patients choose a dermatologist based on factors such as referral from another provider, subspecialty, and reputation. But experts say patients evaluate based on an entirely different set of standards once they reach the front desk. 

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Practice Management

Reducing No-Shows (Part 3 of 12)

Thursday, September 30, 2004

Many dermatologists get an unwelcome break in the day thanks to patient no-shows. No-show ratios - the percent of patients with appointments who do not show up - hovered around 10% in many practices we interviewed. That is high relative to other specialties, and there are some good reasons that dermatology practices suffer from an inordinate amount of no-shows.

Most practices interviewed by The Patient-Centered Dermatology Practice had a 10% appointment no-show rate.

One is complicated patient insurance coverage. No-shows are highest for patients paying for at least some of the visit out-of-pocket and for patients visiting only for aesthetic (ie, not covered by insurance) treatments.

Long wait times in some practices also exacerbate the problem. Patients may need to wait as long as 2 months to get an appointment as a new patient in some dermatology practices. By the time the appointment arrives, the patient's problem might have resolved or she might have found another, more accessible practice to treat her.

Weak physician-patient relationships also make no-shows more likely. If a patient sees the same physician each time, appointments are more likely to be kept. If a patient is forced to see a new locum at every visit, expect high absenteeism.

Most no-shows can be attributed to:

  • Patients with higher out-of-pocket costs
  • Weak physician-patient relationships
  • Patients who don't realize they'll be missed

Probably the biggest reason patients don't show up is because they don't realize that they will be missed. They don't realize the impact on the practice, their physician, or their health when they skip an appointment. It's up to you to teach them.

While patients are in the office, physicians should communicate to them how important it is to keep upcoming or future appointments, particularly for the sake of the patient's health. Make new patients familiar with cancellation and no-show policies. Before the patient leaves or while scheduling a next visit, office staff should clearly communicate the date and time of the next appointment and provide an appointment card or other printed reminder.

Practices should place reminder calls to patients, preferably 24 to 48 hours before the appointment. Automated systems can handle the calls for you. It's even a good idea to ask patients to call back and confirm that they will keep the appointment, particularly for new patients and procedures.

Although more costly and time-consuming than phone or e-mail reminders, many practices find that sending postcards or letters reminding patients of upcoming appointments is the best way to keep no-shows at a minimum.

Other tactics are to institute repeat-offender policies that give less favorable times to patients who fail to show up for two or three appointments without calling. Some practices will even dismiss these patients after three or four no-shows. At the very least, try putting a note in your scheduling template either always to schedule them at the end of the day or to double-book these patients when their potential not to appear will have less impact.

Some sites we spoke with were considering fining patients who missed an appointment - charging, say, $20, for a missed appointment in order to reinforce the need for patient compliance. This tactic feels good at first but doesn't always work in the long run. You may find your staff spending an exorbitant amount of time tracking down the offender just to collect the fine itself. If you decide to implement a charge anyway, make sure to let patients know about it in advance; they need to know the consequences in order to change the course of their actions.

To avoid misunderstandings, establish clear-cut policies and consequences for no-shows, and stick to them. No-show and cancellation policies should be detailed and specific. For example, how far in advance do you expect appointment cancellations to be made? How late can a patient be before they are considered a no-show - 15 minutes? 30 minutes? What are the consequences of missing an appointment without notice - a penalty fee, reduced access to the practice, or termination?

Include a detailed outline of your cancellation and no-show policy in your patient handbook (if you provide one), or give a printed version of the policy to every new and existing patient. An abbreviated version of the policy can also be posted in a visible area of the waiting room or near the front desk.

If, despite all efforts, no-shows remain a problem in your practice, keep clear, consistent records of missed appointments and follow up on no-shows. If a very ill patient misses an appointment, make every effort to find out why as soon as possible. While follow-up calls can be time-consuming, they can be well worth it if they prevent problems. No-shows may pose a significant liability risk. A patient who misses appointments and suffers injury as a result may have a viable lawsuit if he or she has evidence that the physician did not give clear directions or make reasonable efforts to make sure the patient complied with advice, including follow-up appointments.

Our essay next month will be "Preparing for the Visit."

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Disclaimer: The material above has been prepared by Physicians Practice. It has not been reviewed by the DermQuest Editorial Board for its accuracy or reliability. Reference to any products, service, or other information does not constitute or imply endorsement, sponsorship, or recommendation by members of the Editorial Board.