Patients that "No Show" for appointments

Today's Calgary Herald had an nice article in the Editorials section by a staff person that works in a specialist's office (see following).  The article laments that the specialist had 21 patients "no show" for their appointments in one week.  And these were patients that had confirmed their appointments soon before their appointments!

My own experience with "no shows" started approximately 8 years ago when I was just taken over the practice from the Physician who had retired from it.

A "no show" rate of usually 3 to 4 per day was normal.  I almost always see patients on time and I don't double or triple book - so I really noticed a hit in my income when 4 patients per day didn't show up!  In "real dollars" in those days, patient "no shows" cost me approximately $500 per month - which translates roughly to $6000 per year in lost income!

I had no way to make up for that lost income, and this problem became magnified when rent increased by almost 200% over the course of a few years - not to mention the drastically increased costs associated with staff and office supplies, etc.

My answer to this problem ironically was inspired by my wife's hairdresser!

This enterprising and efficient businessman charged $50 for a "no show" for haircuts in his shop.  This practice was tested in court in Calgary within the past 5 years, and the judge found against an Oil Company that booked a whole restaurant for an office party - but did not show up for the party.

So, I started charging patients in my office a $60 no show fee for regular office appointments and a $150 no show fee for consultation or complete medical appointments.

Also, when patients "no show" for Specialist Appointments that my office arranged for them, we charge them a $150 fee for rebooking the appointment and we require that they pay the Specialist's "no show" fee as well.  Patients that don't comply with the above are discharged from the practice.

Our collection rate for no-shows in our office is about 100% for Family Practice patients.  We don't apply the fee for punitive reasons at all - and we respectfully explain to our patients why we need to charge them.  To date, we have had very few, if any problems.

We only collect about 10% of "no shows" that are referred to us from other offices.  It is a rare circumstance that I get to see both sides of the referral process, as I both generate and receive referrals.  

I think that as Family Docs, we really need to support our Specialists in terms of requiring our patients to take ownership of their appointments times.  The result will be a medical system that is improved for everyone!

I now send a little note with my referral letters to Specialists, informing them that if my patient doesn't show up, I will charge them $150 for the inconvenience, plus I will require that the patient pay the Specialist's no show fee.  Patients that refer to me that are no shows end up getting a quick note on the referral letter to inform their referring Doc that they didn't show for the appointment.

Of course, I never charge a no show fee to patients that have legitimate reasons (like an emergency, etc.) for not showing up.  These people are accommodated in a friendly and professional manner - and they seem to really appreciate our efforts to help them out.

Some may argue that wait list times in excess of 2 years just beg for "no show" patients that simply forget about their appointments....this is perfectly reasonable.  But most offices (like mine) call patients before their appointments to confirm them for the patients.  We do this as a courtesy to patients and they really seem to appreciate it.  I believe that most Specialist's offices (except those attached to a Hospital for some reason) usually do this as well......

(Herald Article Following):

Empowering
patients

Dawn Rosine, Calgary

I work in a very busy surgeon/specialist office. Our wait list is well over 50 people. We are booking new patients into February 2009. Some waits to see a specialist are close to a year, considering one must first go to a general practitioner or walk-in clinic for a referral. These specialists change lives and, in many cases, save lives. In our office we work exceptionally hard to accommodate all patients, including phoning to remind them of their appointment if they haven’t confirmed. Last week, we had 21 patients who were confirmed miss their appointments. No phone calls.

They just did not show up. I know we aren’t unique with this frustration. MRIs and CT dates are also missed. I think it’s time for patients to take some ownership in the constant struggle of our health-care system, the system most everyone loves to complain about. If you know you are being referred to a specialist, take ownership and call them and find out the status of your appointment. Make note of your time and date. If you don’t need your appointment, take the time to cancel so someone else may be moved up. Above all, be responsible!