When patients cancel appointments, you're on the line

Key Points

Your patient, a diabetic, calls to cancel an appointment for a checkup. He'll reschedule after he returns from vacation, he says. Several months later, you still haven't heard from the patient. But you have heard from his attorney, who's filed a lawsuit against you for failing to diagnose retinopathy. Among the allegations: The patient was never told that the consequences of forgoing regular checkups could be dire.

"In accepting a patient, we enter into a type of contract to provide advice and care," says Frank J. Weinstock, an ophthalmologist and risk management expert in Canton, OH. "As such, a patient who cancels an appointment, or simply doesn't show, requires the same prudence and good judgment from us and our staff as one getting an exam."

That means checking to see whether patients who miss appointments are awaiting test results, require follow-up care, or haven't completed a course of therapy. It might also mean getting on the phone yourself to impress recalcitrant patients with the need to pursue treatment.

Follow up on no-shows

Appointment reminder calls, often done via computer, are among the most useful tools in physicians' scheduling arsenal. Patients who can't make it can be rescheduled right away, and the calls often compensate for the fallibility of memory-especially if the appointment was scheduled several months back. As Jerrie K. Weith, director of healthcare services for the St. Louis-based accounting and consulting firm Anders, Minkler & Diehl, notes, "In every practice I've worked with, the further out an appointment is scheduled, the greater the likelihood that it will be missed. Either the reason for the appointment resolves, the patient forgets, or the patient finds another physician who can see him sooner."

When scheduled patients don't make it to your office, it's prudent from both a risk management and a business perspective to determine why and to gauge the urgency that the patient be seen. In addition to being proactive, following up on missed appointments shows patients that you care about them and that your time is valuable. And it can improve revenue by seeing that the appointment is rescheduled, Weith says.

In Weinstock's practice every missed appointment is documented, then the chart goes to him for review. "The receptionist might not realize how important it is for a patient to be seen," he says. "An asymptomatic 35-year-old missing a routine checkup doesn't worry me. What I'm really concerned about are patients with disease who miss appointments. In some cases a personal phone call from me will end with the patient saying he now understands why he has to reschedule an appointment." If the patient is unreachable by phone and Weinstock feels he needs to be seen, he'll tell his assistant to send the patient a notarized letter, return receipt requested.

If a patient who's invited to reschedule declines, "the balancing act here is to determine if there's a complaint without prying," says Jeffrey J. Denning, a consultant with Practice Performance Group in La Jolla, CA. Denning's suggested script: "I hope it's because you no longer need to see the doctor. If not, is there anything we could have done to prevent your canceling?" If there is a complaint, the staff member should listen politely, then say, "I'll pass your concerns along to the doctor. Would it be okay for her to call about this? We're always trying to improve and your feedback will help us."