Thanks, but No Thanks for the Referrals

Reviewing practice metrics isn’t just about looking at per visit values, aging reports and comparing charges and collections. It is about using those numbers to uncover inconsistencies and issues as they arise (rather than when they are out of control).

One of the reports that I suggest my practices look at monthly is titled “No Shows and Cancelations.” As long as staff members are accurately accounting for each patient on the schedule (marking them as checked in, checked out, missed, rescheduled, canceled, etc.) this report should be easily produced.

With cancelations there should be a reason recorded within the electronic scheduler or chart (“Patient has been exposed to COVID-19 and is awaiting test results. Will call in 2 weeks to reschedule- CP 9/8/20”). This way, we could also run a cancelation report and easily look at each patient’s appointment history and follow-up after a period of time. Reschedules should be noted as well in the case that a patient continually reschedules and does not follow up as dictated by their treatment plan (especially for post-op patients).

Missed appointments or “No Shows” are an entirely other can of worms and one that can be disrupting your schedule and losing your practice a substantial amount of money.

Consider that your per visit value is $100. You schedule 30 patients per day and on average 16% (5 per day) miss their appointment. If we calculate that you take 3 weeks of vacation per year, those 5 no shows per day have cost your practice $122,500 (Keep in mind that this % is low for many practices. . .).

So what do you do? Keep adding more patients to the schedule, additional eligibility and benefits checks for staff and prep time for clinical staff and doctors while the no show rate continues to increase?

Or. . .Do you use the information provided within your E H R to uncover patterns/commonalities amongst your no shows and then take action? 

When a new patient is scheduled, we record reason for visit, primary care/referring provider as well as insurance and demographic information. What if we used that information to determine if patients referred from specific providers miss their appointments more than others or if patients with certain insurances no show more than 50% of the time? One of my practices recently discovered that the reception staff at a local PCP practice was scheduling appointments for patients and not communicating the appointment information. Another was e-faxing referral information to multiple podiatry practices and telling the patient they would be contacted with an appointment (resulting in the patient being called from multiple podiatry offices, causing confusion for all).

Your situation might be different, and it is possible that having a stricter cancelation/no-show policy in place and actually enforcing it (for your existing patients) would improve the situation. In other cases, having a “2 or 3 strikes you’re out” (no further scheduling of appointments with communication to the referring provider) policy for delinquent new patients would help. The takeaway here is that no matter how it is done, you need to take action to resolve these issues. Here is an example of a letter I composed for one of my practices who recently determined the cause of their high no-show rate. It is also available in the PEP Resource Library.

<< Click here to download the Referral Scheduling Update Letter >>

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