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07/13/2015
RESPONSES/COMMENTS (PRACTICE MANAGEMENT) - PART 1
RE: Problems with No-Show First Appointments (Joshua Kaye, DPM)
From: Hartley Miltchin, DPM
Over the years, we have found a number of new patient no-shows, even though they are telephone verified 48 hours prior to their scheduled appointment. Nothing is as frustrating as booking out an hour for a new patient and they are disrespectful enough to not show up, without even as much as a phone call.
Approximately 3 years ago, our office began asking for credit cards from new patients in order to schedule an appointment. The patient is told that their card will not be billed prior to their appointment and we do not keep credit card information on the computer. They are informed that if they fail to cancel their appointment 48 hours prior, their credit card will be billed 50% of the consultation fee.
Since implementing this system, the number of new patient no-shows has dropped to virtually zero. Most patients are very understanding as to why we collect credit card information and there is very little hesitation. We have only billed 2 new patients in 3 years for a no-show. Neither of them called to dispute the charges.
Hartley Miltchin, DPM, Toronto, Ontario
Other messages in this thread:
07/14/2015
RESPONSES/COMMENTS (PRACTICE MANAGEMENT) - PART 1B
From: George Jacobson, DPM
I was considering requiring a deposit or appointment reservation fee to be refunded or applied to the visit. Dr. Miltchin's method is "cleaner" without having to refund or reverse charges. I guess if the card is no good, we are still back at square one, but maybe it will occur less frequently. I would also have to tell myself that if we didn't write a new name in our appointment book because of this policy, that this was a patient that would not have showed up. Since I keep track of new patients who do not show up, I would be able to compare the effect of the policy on my practice. Practice management seminars should begin advocating this policy and make this the industry standard.
Get patients used to the policy. We had no problem getting patients used to paying their co-pay before treatment. I do not know how to verify that the credit card information is valid prior to entering the charge with our system. We only do this after the card is swiped. Also, can't the "customer" just call the credit card company and claim they didn't agree to the charge, didn't get the service or they didn't authorize the charge? I guess "nothing ventured, nothing gained."
George Jacobson, DPM, Hollywood, FL
07/14/2015
RESPONSES/COMMENTS (PRACTICE MANAGEMENT) - PART 1A
From: Olga Luepschen, DPM
I recently had to take my dog to a veterinarian. Our local veterinarians said my Corgis' allergies required specialized care. When I called to schedule the appointment, I was required to give my credit card number before booking the appoinment slot. I was informed the consultation would be between $400-600. If I was a no-show, the credit card would be charged $75.
The final charge was approximately $500. This included the oral and topical medications for his severe allergies. I paid this and drove the 2 1/2 hr each way. Needless to say, as soon I returned back to my office, I implemented a $25 no-show fee. I am now considering requesting credit cards prior to booking. Our profession is just as valuable as that of other specialists. Patients need to learn to respect us as well.
Olga Luepschen, DPM, Sebring, FL
07/11/2015
RESPONSES/COMMENTS (PRACTICE MANAGEMENT) - PART 1B
From: Keith Gurnick, DPM
With all due respect to Dr. Busman, in a well run, busy, and efficient podiatric medical practice, a missed appointment is not a blessing in disguise. A scheduled appointment should be a commitment by the patient and also by the doctor for an office visit which takes into account the time, treatment room, office staffing, and other resources needed for that patient's care.
I do not believe any doctor expects to make a living on the money collected for a missed appointment or even enjoys...
Editor's note: Dr. Gurnick's extended-length letter can be read here.
07/11/2015
RESPONSES/COMMENTS (PRACTICE MANAGEMENT) - PART 1A
From: Ara Kelekian, DPM
With all do respect, Dr, Busman, he is welcome to implement any policy he finds fit for his practice. As he can read, among other responses, there are other physicians in numerous specialties who have engaged in the same practice policy. He mentions that there is no doctor-patient relationship at the time of the phone call. I wholeheartedly agree, and therefore there is no damage to that relationship. Once the patient shows up to the appointment, this discussion becomes irrelevant.
It is disrespectful to other patients and my practice when individuals take up space that can be devoted to someone who needs to come in and will come in. So while we are all entitled to our opinions, I am simply responding to a colleague who would like a viable solution to a problem that is real and relevant. And it seems that my advice echoes well among our other colleagues who have implemented something similar.
Ara Kelekian, DPM Montebello, CA
07/10/2015
RESPONSES/COMMENTS (PRACTICE MANAGEMENT) - PART 1B
From: John Moglia, DPM
My son missed his initial visit with a specialist and I was billed $30. My address was taken by phone as part of the telephone appointment. I now have my staff get new patient addresses as well. I have heard that some specialists request credit card information at time of the appointment in the event the appointment is not kept.
John Moglia, DPM, Berkeley Hts, NJ
07/10/2015
RESPONSES/COMMENTS (PRACTICE MANAGEMENT) - PART 1B
From: Matthew B. Richins, DPM
Our policy is not perfect, but it is effective. A new patient who is a no call/no show one will never get another appointment and the referring doctor is notified. This speaks to the potential patient's character. I believe they will be non-compliant and/or do the same in the future. Because they have not signed our financial policy, there is no charge.
All established patients are charged $25 for a no show fee if they cancel within 24 hours. They are reminded of this policy when they call to reschedule or cancel their appointment and 90% of the time, they find a way to make the appointment. In Missouri, we cannot bill Medicaid patients a no-show fee, but we remind them of the policy (but do not enforce it for these patients), and they usually show up. Any patient with three no-shows gets dismissed from the practice. It is true that I lose patients, but why would you want to have these types of people haunt your practice?
Matthew B. Richins, DPM, Joplin, MO
07/10/2015
RESPONSES/COMMENTS (PRACTICE MANAGEMENT) - PART 1A
From: Paul Busman, DPM, RN
"We clearly notify them of our policy which states that we need 24 hour notice for cancellation; otherwise we will send them a bill for $100." - Ara Kelekian, DPM
Colleagues with more legal knowledge than me might disagree, but I don't think that potential patients who don't show up for that appointment are in any way obligated to pay that $100 bill. A phone call to make an appointment does not enter them into a doctor/patient relationship which puts financial obligations onto them. Many might see it as a sign that the doctor is more interested in money than patient care. As annoying as those missed appointments are, I don't think that this is the way to handle it.
In another response to this thread, Dr. Udell says something to the effect that it's frustrating to have staff sitting around with "nothing to do." As our OR supervisors are quick to rightly point out, there is ALWAYS something to do. There are tons of little tasks that we're often too busy to get around to. That missed appointment may be a blessing in disguise, giving time to get some of those tasks done.
Paul Busman, DPM, RN, Clifton, Park NY
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