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DENTAL TRIBUNE Middle East & Africa Edition | January-February 2015 41practice management ments, personally I agree with this procedure, but there are gentler cures that go to the heart of the problem. Diagnose the problem: Who are your no-shows? One traditional way of counter- ing broken appointments is by overbooking patients. However, this does nothing to curb the problem, and it creates others instead. As on days with fewer no shows than expected, the doctor will fall behind. What’s worse, longer wait times in the office due to the unpre- dictable or faulty overbooking tend to encourage no-shows. Research suggests that patients who don’t feel respected by their doctor feel a greater temptation to skip. To get serious about fixing the no-show problem, first diag- nose the causes. For example, the longer out the appointment time, the greater the chance of a patient missing it. Forgetfulness, too, is a leading cause. No-show patients tend to be younger and male. Elderly health affected patients also are more likely to skip, partly due to transportation problems and partly due to health problems. To get a picture of what’s hap- pening in your practice, check all no-shows over the past three months. Produce a table with columns for patient gender, age, insurance status (if applicable), day of the week the appoint- ment was made for, morning or afternoon appointment, new or established patient, area of residence, and physician—any variable you’d like to explore. You may discover that most no- shows are new visits in the af- ternoon, or occur with a cold, uncommunicative doctor in the group, or on Thursdays. Export your table to a spread- sheet and graph the results— you’ll spot trends more easily that way. Remove access barriers that encourage skipping Patients are more likely to keep their appointments if you be- come more accessible. If you’re experiencing an inordinate number of no-shows for ap- pointments scheduled months in advance, consider adding an extra dentist, hygienist, or as- sistant so patients can get in sooner. Acute care patients are another group to look at. By booking someone with an acute or emer- gency three days out, you risk creating a no-show. Either the problem resolves itself before the appointment, or the patient looks for another doctor who can treat him earlier. Some doctors have avoided these scenarios and lowered their no-show rate by as much as one-half by converting to open-access scheduling. One dentist has a hybrid system that keeps 50 % of slots open for people who call that day. Such systems can even accommodate patients whose case requires regular follow-up visits. Simply remind them with a phone call or email or sms to ask for an ap- pointment at the set time. Implement a reminder system that works for you If you schedule any appoint- ments in advance, your no-show strategy should include patient reminders. Some practices fa- vor the personal touch of old- fashioned telephone calls, but some others note that reminder calls can drop to the bottom of the list on a hectic day. Another problem is that employees often must leave messages on an- swering machines since most patients work from 9 to 5, pre- venting them from confirming the appointment. The rise of cell phones, however, is increasing the likelihood of a live connec- tion (if call is answered). Many practices use the SMS which ensures that the patient receives the message even if busy or at work. Then they gen- erate a report for the practice. When you shop for new practice management software, you’re better off buying a system that already interfaces with your billing and scheduling software rather than having someone write a new interface. Your cur- rent system may even have a phone reminder tool built in. Good practice management pro- grams also can generate written reminders that you mail. These may be better for elderly pa- tients who might forget a phone call. For your computer-savvy patients, consider e-mail re- minders. Ideally, every scheduled patient should receive a reminder. Short of that, however, you should at least target the kind of visits that your analysis reveals are most likely to be skipped. And use re- minders for your most important appointments—follow-up visits for the seriously ill, new patients, and procedures. The latter two are typically higher paying, and the sort you can’t afford to lose. Whatever system you deploy, is- sue reminders at least two days in advance. Two days gives you enough time to plug in a new pa- tient. Your ability to improvise, though, depends on maintain- ing a list of scheduled patients who’d like to be seen sooner. Address the emotional and mental components A high-tech reminder system alone won’t prevent no-shows. You also need good communica- tion skills. After all, research has uncov- ered emotional barriers to keep- ing appointments. Patients may worry that a treatment or pro- cedure will be uncomfortable, or that they’ll hear bad news. By taking time to learn about your patient’s fears, you can help them over the hump. Likewise, patients with chronic cases often underestimate the importance of follow-up visits because their doctor merely told them, “I’ll see you in three months,” That’s not enough. You need to explain the consequenc- es of their case and the require- ments of follow up. Patients may mistakenly assume that their absence doesn’t hurt your practice—and may even give you a welcome breather on a busy day. The message that you should deliver through your brochure, your Web site, and your employees is this: No- shows disrupt the practice, and that an unfilled slot is a lost chance to help another patient. Should you charge for no- shows? Some practices try to deter no- shows by attaching a financial penalty to them. To avoid a $X or $Y missed-appointment charge, patients typically must cancel the appointment at least 24 hours in advance. It’s a get- tough approach that receives mixed reviews. But doesn’t ho- tels do so? Why do patients ac- cept it from hotels and airliners and not from us? The policy will get patients’ attention, but when you actu- ally charge someone, it’s bad for public relations. This policy sets a sour tone. It’s like announcing, ‘Welcome to our practice—here are the things that will get you in trouble.’ “ Consultants also say that many patients balk (consider it an ob- stacle and don’t show forever) at no-show fees; as a result, they often go uncollected. Further- more, some private insurers prohibit these fees. That said, some practices re- port that charging for no-shows has been a success. Ever since Family Medical Associates of Raleigh (NC, USA) implemented this policy in January 2004, the no-show rate has dropped from 12-15 percent to roughly 6 per- cent. Charges range from $25 for routine follow-up visits to $75 for new-patient visits. They collect about 90 percent of their no-show fees. Patients have ac- cepted this incredibly well. They recall only three conversations with people who have chal- lenged the policy. Some other practices in the States collect only 41 percent of its no-show fees. Some patients complain that they’re not reim- bursed for lost time in the wait- ing room. However, after two years of applying this policy, they achieved their primary goal, re- ducing the no-show rate from roughly 35 percent to 15 percent. Practices are serious about no-shows, although they give people the benefit of the doubt about their first miss if they have a reasonable excuse. But the penalty has definitely raised patients’ awareness about their responsibility. Discharging no-show patients Dr. Ehab Heikal BDS.MBA.DBA Practice Management consultant eheikal@eheikal.com Contact Information While no-show charges remain controversial, virtually everyone agrees that practices are entitled to drop patients who repeatedly blow off appointments. One sound approach is to dis- miss a patient after three no- shows within a given period, say, six months. Record the first no-show in the chart and send a letter or email asking him to reschedule. A second violation triggers a second, stronger let- ter. After the third skip, the de- cision to terminate should fall to you, the doctor—not to the office manager. You may want to con- tact the patient to ferret out any extenuating circumstances that would warrant leniency. The best policy, however, is pre- venting no-shows in the first place. Face it—nobody really likesgoingtothedoctor.Byhelp- ing patients overcome barriers to keeping appointments, you’ll spend less time and energy be- ing a medical truant officer. For more information about the association and its members please visit the ASDI welcome desk on Booth 8C12. www.swissdentalindustry.ch The Swiss Pavilion is organized by the Swiss Dental Industry Association (ASDI) with the support of Switzerland Global Enterprise (S-GE). Intensiv www.intensiv.ch Booth N° 8C13 Deppeler www.deppeler.ch Booth N° 8C15 FKG Dentaire www.fkg.ch Booth N° 8C17 Produits Dentaires www.pdsa.ch Booth N° 8C10 BPR Swiss www.bpr-swiss.com Booth N° 8D10 Jota www.jota.ch Booth N° 8D13 Helvemed www.helvemed.com Booth N° 8D14 Saremco www.saremco.ch Booth N° 8D15 Trisa www.trisa.ch Booth N° 8D17 Unident www.unident.ch Booth N° 8C14 Visit the brand new Swiss Pavilion at AEEDC 2015 in Dubai 17-19 February Dubai International Convention & Exhibition Center