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04/17/2017    Paul Kesselman, DPM

Missed First Appointments (Frank J. DiPalma, DPM)

Missed First Appointments (Frank J. DiPalma, DPM)

There is no simple solution to this and there are
multiple factors here. On one hand, asking for a
credit card deposit on the phone does set a bad
tone, but with high deductibles and co-payments
and tight schedules, last minute cancellations
are also unfair to other patients who would
otherwise been able to obtain care sooner.

I agree that calling the patient the day
before to confirm is far better than
collecting a credit card "deposit" on the
potential new patient. However the reality is
that tight schedules and last minute (24 hours is
last minute) cancellations are unfair to other
patients who also have tight schedules and may
need to be put off. Patients need to understand
that their appointment is secured by the "hold"
placed on their credit card.

And this does not only apply to new patients as
some established patients are also chronic no
shows despite using the day or two before
reminder services which allow patients to confirm
or cancel their appointments.

Another issue is that collecting cancellation
fees prior to the appointment may be contrary to
your contract with the carrier. Thus it is
important to be sure that no charges go the
carrier prior to the appointment and that
patients sign an agreement that they understand
this payment is based on an agreement between the
two parties and will somehow either be totally
refunded or credited to outstanding balances when
the patient is seen.

Perhaps a better idea would be to email, fax or
have the patient go to your website and have them
complete all the new patient documents and
sending them back to you sometime prior to their
appointment (more than 24 hours). Having them
complete these forms will save your staff time at
the first office visit.
On one of your forms you can also include a
payment sheet which provides a credit card to
facilitate collection of co payments and/or
charges subject to any deductibles or
cancellation fees. Some patients may prefer to
pay with other means (your demographics will
easily predict this), some preferring debit cards
others EFT transfer from their bank, etc.

It's also important to make patients understand
that your office policy is not to see patients
unless their obligations (co pays, deductibles,
etc.) are paid prior to their visit. To suggest
that this sets a bad tone is not reality. New
(and even established) patients often ask how
their co-payments can be made. With co payments
sometimes more than the actual allowance for the
service (I've seen some for $75) and patients
whose insurance doesn't kick in until their $12K
deductible has kicked in, it's more important
than ever that patients are properly educated.

By putting the cancellation fees last, you
minimize the feelings of payment prior to the
visit.

Again this is a complex subject and I don't
really believe there is a right or wrong
previously presented. There should be a gentle
way to communicate these issues to your patients.
Your practice demographics should enable you to
find that comfortable approach.

Paul Kesselman, DPM, Woodside NY

Other messages in this thread:


04/19/2017    Keith Gurnick, DPM

Missed First Appointments (Frank J. DiPalma, DPM)

No matter how efficiently you try to run your
office scheduling, and no matter how well
trained, courteous and professional your office
staff is on the scheduling phone calls, and no
matter if you e-mail, text, or make reminder
phones call one or even two days in advance of
the appointment, there will always be a some no
shows (some without even the courtesy of a
cancellation phone call), or same day or last
minute cancellations , some with a request to be
rescheduled for that same initial visit during
that same phone call.

New patients, just like existing patient
Cancellations and no-shows happen for a variety
of reasons, some of which have already been
listed in other posts. The reasons are not
relevant anyway.

Here is my office policy:

1) We do not require a credit card up front to
schedule a NP appointment, unless it is a cash
patient with no health insurance and then we do.
A cash patient who will not give us the credit
card info on the phone is simply not scheduled,
simple as that.

2) Every new patient, even if scheduled for the
same day receives an e-mail from my office which
includes the office policy and a bunch
of other things we want the patient to have
access to on their cell phone (such as location,
parking, insurance, office policy, etc.)

3) We allow one no show or one new patient
cancellation with no repercussions or financial
punishments.

4) The 2nd time there is a no show or
cancellation the patient is required to give us
their credit card, in order to reschedule again,
and the card is charged $150 which is non-
refundable for any reason. That is $75 to pay for
both (two) of the prior no-shows, or previous
last minute cancellations. A last minute
cancellation is any appointment that is cancelled
within 24 hours, but also only if we were not
able to reallocate to another new patient who
wants to get in asap.

Here are my results: 1/2 the time we get the
credit card, we charge the $150 and when we
reschedule the patient they finally show up the
next time (usually on time also.) Often, these
patients continue to be "scheduling flakes" for
follow up appointments.

The other 1/2, do not want to pay or give the
credit card over the phone, thus they also do not
want to commit to their next appointment and we
never see them or hear from them again. I assume
they go somewhere else and become someone else's
issue.

However, rather than my office staff telling a
potential new patient who either no showed or
cancelled twice, that we won't see them, or that
we will not reschedule them, it is better to let
the patient make their own decision: if they want
to become a patient in my office or not.

Keith Gurnick, DPM, Los Angeles, CA

04/18/2017    Lynn Homisak

Missed First Appointments (Frank J. DiPalma, DPM)

I believe you are asking ‘should you bill a new
patient you haven’t even seen yet?’ and ‘should
you collect their credit card information prior
to their appointment? Instead of applying a Band-
aid on an obvious problem and sending a negative
message to patients before you even meet them,
why not try to determine the reason WHY new
patient cancellations are such an issue for you?

Yes, new patients must occasionally cancel an
appointment. It happens. It is not typical,
however, to have a new patient cancellation
"problem". Unless of course, new patients are
scheduled so far out that their ailment went away
or they decided to go see `Doctor Downthestreet’
and get that plantar fascia fixed sooner. Maybe
they had a poor phone experience or your office
location/appearance didn’t appeal to them? Just
as you would do clinically…address the symptoms,
diagnose, and then treat the problem.

Ideally, new patients should be scheduled within
one to three days of calling your office, unless
they specifically request a later time. Courtesy
reminder calls are beneficial as is keeping a
"Wait List", allowing your staff to reschedule
any empty blocks of time as they occur. You can
certainly create a more mindful behavior by
explaining the practice's “no-show” fee policy at
their first visit, but do you really want to
penalize new patients before you have a chance to
prove that you are exactly what they are
searching for in a podiatrist? Show them you're
glad they called you by getting them in – sooner,
rather than later. If that is indeed the problem,
it’s likely that your no-show rate will improve
and everyone wins.

Lynn Homisak, Federal Way, WA
Rockwood Programs