Reducing no-shows

Starting Oct. 1, 2007, the Centers for Medicare and Medicaid Services (CMS) officially endorsed the practice of physicians charging a fee to Medicare beneficiaries who fail to show up for appointments. If you charge Medicare patients a fee for missing appointments, however, you must charge the same fee to all who skip appointments, regardless of the payer.

The immediate impact of the CMS official endorsement of no-show charges has been a wave of medical practices charging patients for missing appointments. That's a good first step. But charging a fee and collecting it from a patient are two different propositions.

The wisest solution to the no-show problem is a two-pronged attack: Try to prevent it from happening, and take steps to keep it from ruining your day when it does occur (as it inevitably will from time to time).

Missed appointments are dreadful for your dermatology practice's bottom line. Under fee-for-service reimbursement, an unfilled appointment means you bear the entire overhead for that time slot, but get no reimbursement for it. Given the high fixed costs of running a medical practice, your profits really suffer with every no-show.

As a physician, you face a double whammy from no-shows, because your time cannot be inventoried. That empty slot cannot be "refilled" after the time goes by.

Take steps to prevent

A nominal charge is one option for trying to reduce no-shows, but it's only one tactic in the larger battle. Let's look at some proven strategies for your dermatology practice to keep your schedule full.

Create timely access

The longer patients wait for appointments, the more likely they are to forget - or find other dermatologists who can get them in sooner. Make yourself available; monitor your appointment waiting period each month.

Follow up with patients who transfer their records to other dermatologists in your community. This is perhaps the most effective and easiest way to monitor patient dissatisfaction. Contact patients who've transferred their dermatologic care elsewhere; their answers will swiftly reveal any access problems.

If you've reached capacity, don't despair. Hire another dermatologist or a physician extender to increase your supply. Alternatively, reduce patient demand by no longer participating with your lowest-paying health plan. Although you'll want to evaluate these options carefully before acting, either strategy - increasing capacity or reducing demand - can improve access to your practice immediately.

Watch your language

Follow-up interviews with patients who fail to show for appointments reveal that many feel they were doing the practice a "favor" by staying away. How? Maybe they sensed your support staff's relief every time a patient didn't show up - after all, it's less work for them!

Recognize that the patients who do keep appointments aren't oblivious to these reactions by staff. Another surprising factor that interviews with no-show patients may reveal is that they don't think the physician will ever know they didn't show up. Why? Consider that patients speak to a receptionist - not you - when making appointments and receiving reminders.

Be sure to showcase your knowledge of the situation. Give staff a script: "Dr. Smith asked me to call and find out when you wanted to reschedule your appointment."

Put aside charts for patients who fail to show up, and review the nature of their appointments. Timely action on your part is a risk management necessity, but it also demonstrates to patients that you are keeping tabs on them.

If you do see the patient again, mention your disappointment. Be polite, but also tell the patient that missing appointments doesn't just inconvenience you; it also takes away appointments that other patients wanted.