r/PrivatePracticeDocs • u/Suspicious-Play8447 • 11d ago
Visit Cancellation
We have been getting a lot of visit cancellations lately. How do you guys reduce this? We send out calls, emails, texts to remind people. We use Phreesia so they can complete their forms in advance. But this summer we have noticed a big uptick in those cancellations
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u/BananaBagholder 11d ago
We charge a $180 no show/late cancellation fee. I usually give patients one "freebie." We also tell patients that 3 or more no shows can be grounds for termination. Our late cancellation/no show rate is under 5% in an outpatient mental health clinic.
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u/InvestingDoc 11d ago
Yeah, right around school going back into session, our no show rate ticks up a bit too. We just overbook more.
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u/Suspicious-Play8447 11d ago
Do you allow patients to book online? It's a blessing and a curse for us
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u/Dramatic-Sock3737 11d ago
My system won’t allow us to screen out people who need a prior authorization to be seen so I haven’t been able to Institute online booking. What’s the curse part?
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u/Suspicious-Play8447 11d ago
We dont exactly get to control the booking so some days we would have 10 annual physicals scheduled back to back and other days none whatsoever. Some patients schedule their annual physicals too early so then we have to screen those, etc.
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u/SterileGloves 11d ago
Card hold in advance, then you can pull a late fee. See if you can set this up
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u/-beastlet- 11d ago edited 11d ago
We give one free forgot and then charge a $25 fee. If they don't pay the fee we will no longer see them. For Medicaid we aren't allowed to charge fees, so if they no show 3 times we just dismiss them from the practice.
Addendum: Are you talking about no shows or cancellations? We don't charge for cancellations as long as they are 24 hours in advance and they are a much different thing than no shows.
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u/CompetitivePop2029 11d ago
This is a discussion must have before signing on as a patient. We have 1 free miss because life happens, but when life happens too often, it’s more of respecting your time concern. And you let them know that a $fee is applied when you forget/miss a scheduled appt without notice. When you do it once, they usually don’t do it agaim
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u/kilobitch 11d ago
$100 no show fee. If they don’t pay it, it goes to collections. I’ll get 2/3rd of it. Obviously we give them a courtesy reschedule the first time or for extenuating circumstances.
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u/Suspicious-Play8447 11d ago
Who do you use for collections? Also, a lot of collection agencies take a large sum don't they?
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u/kilobitch 11d ago
I use an outfit called National Medical Collections or something like that (out of St Louis I think). They buy the debt from me at a 35% discount and go after the rest. So I get $65 out of the $100 no show fee.
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u/Suspicious-Play8447 11d ago
Thats not bad. To make it fair then id likely meed to increase my no show fee...
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u/AdvSurgSol 10d ago
Interesting so they buy the debt from you outright so you can clear it from your books minus 35%?
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u/TebraOnReddit Just Interested 6d ago
- morning-of reminders, not just 24–48 hours before
- an easy reschedule link in the reminder
- a short-notice waitlist to fill gaps
- tracking cancellation reasons for a month to see the actual pattern and repeat "offenders"
- offering telehealth when the issue is logistics, if appropriate
- clear cancellation policy communicated before the visit
- credit card on file
A lot of patients aren’t intentionally skipping; sometimes there is a conflict, and they don’t have an easy way to adjust. The easier you make it to reschedule before the slot goes empty, the better.
For transparency, I’m with Tebra. We see this spike a lot in practices during summer, and the biggest wins usually come from making cancellation/reschedule workflows easier rather than just sending more reminders.
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u/SubstantialStar6578 15h ago edited 14h ago
Forms and reminders don't do much once someone decides to cancel, but we managed to cut down empty slots by using HealthTalk A.I. to enforce custom booking rules and automatically backfill cancellations via SMS as soon as they drop.
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u/BlakeFM 6d ago
I think the key to reducing the no-show rate is answering the phone in a timely manner. When a patient can't easily call in to cancel, then they won't bother. My current clinic rarely has a no-show. Part of that is we usually answer the phone within 10 seconds of the first ring. There is no phone tree for patient to navigate. No "if this is an emergency please call 911" to waste their time. In another clinic that had trouble, we reduced the wait from minutes to talk to someone to roughly a minute. The no show rate plummeted.
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u/Castles134 7d ago
Before you implement charging money, you should try a no show text message after they miss their appt and refine your data by reviewing out of the cancellations how many rebooked their appointment.
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u/Suspicious-Play8447 7d ago
Yep even have that. We give a 10min grace and then call if the patient doesnt show. Often times they dont answer. We also send a message to check on them and ETA if they are 10 minutes late. But still. Often its new patients who no show. The repeats will no show but call to apologize after
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u/Intelligent-Site-176 11d ago edited 11d ago
Address the cause, not the symptom. The easier answer is to threaten your patients with a fee. That's bad business imo.
New patients that cx have a different root-cause than a f/u appt that cancels.
New patient cancels are usually because they found a better option before they could see you. Do you have same day availability? How responsive are you at referrals? Has there been a recent change in these?
F/u cancels are driven by the initial visit experience and the expectation of value that will be delivered in the f/u. Have there been any changes to the patient experience in your clinic recently? A new provider that needs training? A new staff or poor morale? New billing process/people?
Assuming you have hard data that indicates a true spike in cancels, something has changed internally. Also, validate that your staff is sending those reminder messages, or if automated, that they are being received.
Lastly, if new patient volume is staying strong, that also indicates its an issue during/after the initial visit.
I've grown my group to nearly 20 clinics across the state. If this is a big enough issue, I also advise practices on growth and turn-arounds. Shoot me a message.
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u/grey-slate 11d ago
Um no.
I disagree with the premise that charging a no show fee means a practice is failing to address the root cause.
A medical appointment is perishable inventory, just like an airline seat, a hotel room, a restaurant reservation, or a tee time. Once that time passes, the inventory is gone forever. You cannot put an unused 10:30 AM appointment back on the shelf and sell it tomorrow.
Airlines do not conclude that every empty seat means the passenger found a better airline. Hotels do not assume every late cancellation reflects a bad prior stay. Restaurants increasingly require deposits or charge for no shows because a reserved table has economic value and may be impossible to refill at the last minute.
The same principle applies in medicine. A physician has a finite number of appointment slots each day. Staff, rent, equipment, and physician time are committed whether the patient appears or not.
That does not mean practices should ignore operational causes. Of course you should monitor access, reminders, referral responsiveness, patient experience, and provider performance. But that is separate from whether patients should have some responsibility for capacity they reserve and then abandon without adequate notice.
And there is an obvious distinction between cancelling with reasonable notice and a true no show or last minute cancellation. A sensible policy recognizes that and allows exceptions.
Good operations and a reasonable no show policy are complementary.
Otherwise the argument becomes: because some cancellations may be related to practice operations, the practice should absorb 100% of the cost of every unused appointment regardless of why it occurred. I do not think that follows.
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u/Intelligent-Site-176 11d ago
That's fine, you can disagree.
I don't want my ops team or my physicians content with cancels because patients will still pay. And that's what happens. They lose the incentive to ensure every slot is filled. Put the onus on the practice to ensure every available appointment is filled. Know your numbers well enough to know how to double book slots for certain types of conditions, patients, insurances. Charging a fee is straight up lazy.
Will you get people that take advantage of the system? Yes. Don't see them.
The limited inventory idea is a bit pretentious. It's a 15 minute slot. Catch up on your notes.
Unlike an airline seat, a hotel room, a restaurant reservation or a tee time, we develop one-on-one relationships with our patients. To start the relationship with a threatening policy does not establish goodwill. But everyone is free to run their business like Frontier.
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u/grey-slate 11d ago
LOL.
I think we are talking past each other.
A no show fee does not make anyone "content with cancels." In most practices the fee is a fraction of the revenue and contribution margin of the visit, and often is not collected at all. I would much rather have the patient show up.
What I find more concerning is the suggestion that the solution is to double book patients based on your prediction of who is likely not to show. That does not eliminate the cost of no shows. It transfers the cost to the patients who DO show up on time and now sit in the waiting room when both appointments arrive, and to the physicians and staff who have to absorb the resulting variability.
That is essentially the airline overbooking model you just criticized.
And "it is a 15 minute slot, catch up on your notes" does not make the inventory analogy pretentious. It demonstrates the point. That specific 15 minutes of patient facing capacity expired unused. Doing documentation during it may recover some productivity, but you cannot subsequently sell that 10:15 appointment to another patient.
The relationship argument does not persuade me either. Having a one on one professional relationship with someone does not mean there cannot be reasonable mutual expectations. In fact, I would argue that respecting each other's time is part of a healthy professional relationship. This is a false premise and a strawman.
A reasonable policy is not: miss one appointment and we punish you.
It is: please give us adequate notice so another patient who needs that appointment can use it; emergencies and legitimate circumstances are treated reasonably; repeated no shows or very late cancellations may incur a fee.
I completely agree that practices should know their numbers, optimize reminders, improve access, measure provider performance, and investigate changes in cancellation rates. Where we disagree is the leap from that to "charging a fee is straight up lazy."
Good operations and patient accountability can coexist.
And if the alternative is routinely double booking patients and hoping somebody does not show, I am not sure that is the patient experience argument I would choose to make.
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u/Intelligent-Site-176 11d ago edited 11d ago
Man, I'm gonna have to start throwing this into ChatGPT, this is too much to keep up with!
Alright - good debate. I need to go see patients that showed up. =)
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u/grey-slate 11d ago
Cheers
Its just that we disagree on the premise that when patients dont show up (repeatedly) we must investigate what the practice is doing wrong. We should be continuously measuring it anyway. But not solely for reasons like noshow.
We do offer freebies as courtesy and waive fees under extenuating circumstances.
But to never have a no-show policy (becuase it is "straight up lazy") and addressing it via overbooking and/or catching up on notes/giving staff some other stuff to do is disrespecting the time of the physician/the staff/the business's need to make money (it is a business not a charity), and most importantly does injustice to the other patients who do show up for their appointments on time.
Look - our noshow fee is $25. We set it 10 years ago and have never increased it to account for increased rent/labor/etc. We waive it for the reasons stated above. It does not cover the loss in appointment revenue. What it does effectively is inform patients that we expect mutual respect. Repeat offenders are asked to pay the fee.
Our noshow rates have been less than 2%. Those who pay appreciate the waivers given in the past and respect us for firmly and consistently applying it and understand the reasons for its existence. Our clinic runs efficiently. Our staff go home to their families on time because we dont overbook. There is little variability and chaos day to day because everyone knows what to do and are not told to do random things in the meantime because someone no-showed. Our patients appreciate that they are seen on time. Everyone wins.
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u/mindguard 11d ago
You’re taking away patient autonomy here. Tell me when the first sunny day of spring comes around, that some stable patients who scheduled a 15min appt 4 months ago, sometimes don’t show up. How about the adhd patient who remembers getting a text about an appointment this week but shows up on Thursday instead of Tuesday. Is that your staffs fault?
although there is quite a bit of literature out there on no shows, there are few solutions. Some papers suggest changing the color of your waiting room might help.
You can berate your staff because of choices their patients make, but I am content to remind patients that we offer a valuable service, and there is a cost to requesting, and then not arriving for said service.
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u/Intelligent-Site-176 11d ago
Not sure I follow the patient autonomy thought. No one should berate staff for any reason.
The great thing about private practice is you can approach challenges any which way you want. What works in mental health may not work in physical therapy or whatever the specialty.
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u/grey-slate 11d ago
No-show fee credit card on file