Every urology practice is concerned about decreasing reimbursements and increasing overhead costs. This translates to an erosion of the bottom line. There is little we can do to increase reimbursements. However, we can do a lot to improve the efficiency and productivity of our practices. One of the simplest methods is to decrease the no-show rate, a problem that impacts most medical practices. For this article, I will discuss the impact of no-shows on the practice and suggestions for reducing the no-show rate in urologic practices.

Each missed appointment costs the practice approximately $140—and that’s a conservative estimate based only on the office visit. That amount quadruples—or more—if that missed appointment represents surgery. If you have multiple no-shows each day, you don’t need an MBA (master of business administration) degree to calculate the lost income that can impact your practice.

Prevention of No-Shows

You should motivate and even reward the staff for reducing the no-show rate. The doctors need to motivate staff to keep the doctors’ schedules full. The staff must understand that open time slots are a loss of income to the practice. A full schedule improves productivity and profitability. When the latter occurs, the physicians need to compliment the entire team and, at a minimum, say, “Thank you for giving us a full day.”

No-shows can be prevented. Begin by requesting 3 phone numbers for each patient. This includes the home number, work number, and the patient’s cell phone number. If 3 is too many, ask for the “best” number to reach the patient. There are automated systems that can be used to contact patients. Still, these are less effective than a human being contacting a patient. Now, some software programs provide an automatic text message to patients reminding them of their appointments. Increasingly, practices take advantage of reminding patients through an automated, text-based service.

A longer time interval between appointments significantly increases the no-show rate. For example, patients who are given an appointment more than 150 days after their last appointment may have a higher no-show rate—as much as 30%. This is compared to patients who have an appointment within 10 days of their previous office visit and have less than a 5% no-show rate. You can target patients likely to miss their appointments with a “warm” confirmation. Examples of identifying patients who are likely to be a no-show would include patients who have been given an appointment more than 150 days out, patients who previously have canceled appointments, patients who are scheduled for a procedure, new patients, or specific demographics or payer types who have a history of not keeping their appointments.

Another option for reducing the no-show rate is to consider accepting electronic appointment requests. Programs on many practice management systems allow patients to request an appointment, after which you contact them to confirm a date and a time.

Try to make it easy for a patient to cancel their appointments. It is difficult for patients to cancel appointments in most practices. If a patient cancels an appointment, follow up on all cancellations and allow the patient to reschedule an appointment. Also, let the patient know that you appreciate the notification about the cancellation.

Another effective method of reducing the no-show rate and keeping the schedule full is maintaining a list of patients who would like an earlier appointment. Consequently, when openings occur, the scheduler or receptionist can go to the waiting list and contact patients who could fill those open slots.

Of course, it is necessary to carefully document all no-shows in the patient’s chart or electronic medical record. Remember that no-shows are a significant liability for the practice, and consulting with your malpractice carrier about the protocols for managing no-shows is recommended.

To Charge or Not to Charge No-Shows

There are advantages and disadvantages to charging a penalty for no-show patients. Charging the patient provides the patient an opportunity to change their behavior. It is an excellent idea to inform the patients that the doctor was expecting them and held a time slot. Their cancellation or not keeping their appointment resulted in a lost opportunity to fill that slot with another patient who needed your urological services. Experts on this topic recommend charging patients who are second-time offenders. Patients should receive a warning for a first-time offense.

Not charging patients includes difficulty collecting the no-show fee and losing the patient. Another option for the repeat offender is to require prepayment to “hold” the slot. The receptionist informs the patient that the appointment will be held for them; however, they need a credit card number to keep it. If the patient cancels the appointment, you submit a fee using their credit card.

Guidelines for Charging Medicare Patients

As of 2007, Centers for Medicare and Medicaid Services policy allows physicians to charge Medicare patients for missed appointments if the practice does not discriminate against charging only Medicare patients. The practice must be consistent and charge for non-Medicare patients who miss appointments. The guidelines also state that the charges for missed appointments for Medicare and non-Medicare patients are the same. Please note that Medicare does not pay for missed appointments, and charges should not be billed to Medicare. For more information, go to www.cms.hhs.gov/MLNMattersArticles/downloads/MM5613.pdf

On occasion, I have had patients who are chronic no-showers, but you don’t want to remove them from your practice. For example, suppose a relative or friend brings a patient, and their ability to be on time is out of their control. In that case, give them the last appointment of the day to avoid causing havoc with your schedule.

Bottom line: It does not require rocket science to reduce the no-show rate. Attention to detail, looking at no-show patterns, and motivating staff to keep the schedule full are simple solutions to solving the no-show problem.