What is the best approach to handling patient cancellations?

What is the best approach to handling patient cancellations? When patients spend hours in waiting rooms, is it fair for providers to charge late fees? Should there be consequences for no-shows? Is anxiety a reasonable excuse to skip surgery? Whether it’s the patient or the provider who cancels an appointment, one thing is clear: no one wins. 

No-shows and late cancellations contribute to practice inefficiencies, and can cause delays in patients getting the medical care they need. Plus, they’re expensive for everyone. Tebra recently found that patient cancellations and no-shows cost practices as much as $7,500 per month. And while not all providers charge cancellation and no-show fees, data shows that patients are paying with longer wait times and worse health outcomes.

Managing cancellations and no-shows is critical for both patient health and practice performance. This article will help you understand why cancellations happen for both patients and providers and outline some meaningful changes you can make to avoid them. 

Tebra recently conducted an online survey of patients and healthcare providers to understand why patients cancel or simply don’t show up to their appointments. Of the patients who responded: 

The remaining patients surveyed missed appointments due to family/personal emergencies, weather, anxiety, and social engagements.

The survey also revealed that it’s not just a scheduling issue. Employment status, finances, and accessibility all play a role in whether or not patients keep their appointments.

Tebra found that patients who are unemployed and looking for work cancel appointments or don’t show up more frequently than other groups, at 70%. By contrast, 45% of patients who are employed full-time cancel or no-show.

This might be due to a few reasons. Patients who are actively searching for employment may have changing or unpredictable schedules, which can make it difficult to show up for their appointments. They may have lost their insurance or face financial challenges that don’t allow for out-of-pocket expenses like medical costs, childcare, transit fare, or parking fees. If they’re also dealing with housing insecurity, medical appointments may not be a high priority. 

An influential study shows that financial stress can also reduce cognitive capacity, making it more difficult to remember and plan. This increases the likelihood that unemployed patients will miss or forget their appointments. All the more reason to consider a compassionate cancellation policy.

Urban patients may not drive, and rural patients might find the distance to their provider daunting. If your practice location isn’t easily accessible by public transportation and doesn’t offer telehealth appointments, you may experience more cancellations or no-shows. 

Many factors influence patient behaviors, so there’s no single fix for missed appointments. Let’s explore tactics to improve patient attendance rates at your practice.

Of the providers Tebra surveyed, 79% relied solely on automated appointment reminders to reduce cancellations and no-shows. However, these providers are still struggling with up to 10 patient cancellations or no-shows every month. While appointment reminders are an effective tool they appear to be insufficient. A multi-pronged approach can be more effective in stopping patients from canceling or not showing up.

Explain that late cancellations and no-shows take time away from other patients and negatively impact you and your staff. Clearly outline your expectations for rescheduling appointments:

Some providers charge for late cancellations or no-shows, but punitive cancellation policies may work against you. Regardless of income levels, nearly 77% of patients surveyed said they would switch providers for a more flexible cancellation policy.

A clear policy won’t help unless your patients know about it. Here are some simple ways to communicate your no-show policies and scheduling expectations:

Today’s patients want convenience in all areas of their lives, including their medical care. Every patient we surveyed reported being more likely to show up to their appointments if they could book or reschedule online without having to pick up the phone. And this is regardless of age: 78% of Gen Z, 81% of Millenials, 77% of Gen X, and 64% of Boomers would prefer an online experience.  

Patients are more likely than ever to leave a provider that doesn’t offer online communication, so it’s worth investing in digital tools or a patient portal that gives patients more control over their experience.

Not only does online scheduling help with patient retention, it optimizes your practices’ resources. Staff can spend less time on the phone or answering emails, and focus on other efforts that keep your practice thriving.

A large percentage of patients cited work conflicts as the main reason for missing appointments, so  flexible scheduling may help combat cancellations. In fact, 71% of the patients Tebra surveyed said offering same-day or next-day appointments would stop them from canceling or not showing up. Providers can also offer evening and weekend appointments to accommodate work schedules.

Patients are more likely to show up for an appointment in which they’re financially invested. Of patients surveyed, 64% said they were more likely to show up if they prepaid for their appointment — 78% if they receive a discount for prepaying. 

An important note: while a discount may seem like a surefire tactic to reduce no-shows, it’s important to understand the legal considerations. Many insurance company contracts and state laws prohibit discounts.

While a short wait can be expected, patients become frustrated when they feel like providers have no regard for their time. When we asked patients what they want most from their healthcare providers, a short wait (52%) was second only to good listening skills (67%).

Since wait times are often out of you and your staff’s control, clear communication and an exceptional patient experience can help make a long wait more tolerable.  

Providers lose almost $6,000 each time a patient cancels surgery. These cancellations also exacerbate already long wait times and represent a time slot that could have gone to a patient with more urgent concerns. 

Anxiety is the main reason patients cancel their surgeries. 70% of patients reported significant preoperative anxiety and either canceled at the last minute or skipped their procedure without notice, according to one study. Anxiety can also make it difficult to remember or adhere to preoperative instructions. This may result in last-minute cancellations because patients are ineligible for their procedures. 

Just like with appointment cancellations, digital tools can also go a long way in preventing canceled surgeries.

Frequent communication leading up to surgery can help reduce patient anxiety. Provide a mix of education and actions patients can take to calm themselves. You can also do a quick check in prior to surgery to monitor a patient’s anxiety levels and offer help if needed. 

Regular check-in emails, texts, or messages through a patient portal can guide patients in the days and hours before their procedure, making sure they adhere to their pre-op instructions — even when they’re stressed out about their upcoming procedure. This is especially helpful when surgeries are scheduled months in advance.

Providers get sick and have conflicts just like patients do. The providers we surveyed said they need to cancel and reschedule a patient anywhere between 1 and 10 times a month for family/personal emergencies or contagious sickness. The good news is that patients consider these excuses for rescheduling to be reasonable. 

Of course, providers don’t always cancel for personal reasons. Occasionally they need to attend to a patient with more urgent concerns or get pulled away for emergencies. While this might be unavoidable, patients are less understanding when it comes to seeing other patients during their scheduled appointment time — 30% less understanding, to be exact.  

Just like with cancellations by patients, interlinked factors are in play. Poor scheduling and appointments running over increase the likelihood that a provider will have to cancel an appointment at the last minute.

A positive relationship with patients is critical to patient retention. So critical that providers who aren’t handling cancellations and rescheduling well face losing patients. 42% of patients Tebra surveyed said they would switch providers after being rescheduled just twice. 

Here are the best ways to cancel an appointment while keeping your patients.

Have your staff contact the patient as soon as you know they need to reschedule. If a patient needs to arrange time off work or childcare, they’ll appreciate as much time as possible to make adjustments.

Patients want to know, unprompted, why the change in schedule occurred and what steps the practice will take to ensure their timely care. But they also want to be respected as individuals. Honest, compassionate apologies go a long way in maintaining strong relationships with patients. 

Patients are already frustrated at a lack of same-day or next-day appointment options. When providers reschedule an appointment, it should be as close to the original timeframe as possible. Providers should also offer multiple dates and times so the patient can choose the most convenient option without having to go back and forth. 

It’s a small gesture, but follow-ups show patients that their health is still a priority. It also gives them confidence that they won’t be rescheduled a second time. 

A good fully customizable online scheduling tool, like Tebra’s, will help you optimize your hours for booking and even schedule buffers between visits. This will help to reduce cancellations and no-shows and ensure your appointments aren’t constantly running overtime. 

The most typical strategies for combating cancellations and no-shows, like appointment reminders and billing patients for missed appointments, aren’t cutting it anymore. By looking at the underlying causes for patient and provider cancellations, we can explore the improvement digital tools can make on practice efficiency and patient retention.