You're ready for the exam, but where's the patient?

Some doctors bill patients who don't keep scheduled appointments. But others say that approach only alienates patients.

By Julie A. Jacob, amednews staff. Oct. 21, 2002.

If there's anything more aggravating than the patient who doesn't follow directions, it's one who doesn't even show up for the appointment.

Patients who fail to show up for their appointments -- whether because they forget, have car trouble or can't get off from work -- cost a practice time and money, say physicians.

Missing patients
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Marcy Zwelling, MD, an internist in solo practice in Los Alamitos, Calif., said that patient no-shows have become more of a problem in the past few years. It's become so much of a problem, in fact, that she now charges patients who fail to show up for their appointments without calling to cancel ahead of time.

Tim Gorski, MD, an ob-gyn in Arlington, Texas, estimates that about one out of three of his new patients misses appointments without bothering to call and cancel.

"If patients don't have a relationship with physicians, they don't mind not showing up," Dr. Gorski observed. "People hardly ever miss their haircuts ... they take that more seriously than seeing a doctor."

But there are ways to cut down on patient no-shows.

Patient no-shows have been increasing.

One effective way to get more of your patients to show up for their appointments is to have the office receptionist call the day before with a reminder, suggested Crystal Reeves, a principal with The Coker Group, a health care consulting firm based in Roswell, Ga.

"Some people simply forget about their appointments," said Reeves.

Michael Fleming, MD, who practices in a 10-physician primary care group in Shreveport, La., said his practice routinely calls patients to remind them of their appointments.

"We go to great lengths ... to remind them," said Dr. Fleming.

Another way to cut down on patient no-shows is to have someone call and find out why the patient couldn't make the appointment. That accomplishes two things, said Reeves.

First, it reminds the patient that the practice takes missed appointments seriously, said Reeves.

Some physicians bill patients who don't keep their appointments.

In addition, the calls provide useful information, which is helpful in letting the staff know how they can serve patients better. Did the patient simply forget? Did he or she have problems getting time off from work? Was it a transportation problem?

It's important for the staff to be friendly and not accusatory during those phone calls, Reeves said.

"You'll get more cooperation from patients if you frame it as doing a favor for them by wanting to see why they couldn't make the appointment," she said.

It's a good idea to make a note in the patient's chart that he or she missed the appointment, she added.

It's also a good idea to track patient no-shows in the computerized appointment scheduling system and to warn patients who miss more than one appointment without canceling in advance that they may be dropped from the practice, said Dr. Fleming.

"If any patient has several no-shows, it shows up in our computer management system," Dr. Fleming said.

"If it continues, these patients can only get "work-in" appointments, and if it still continues, we dismiss them from our practice."

Opinion is mixed on the effectiveness of charging patients for missed appointments to lessen no-shows.

Dr. Zwelling said that charging for no-shows has reduced the number of patients who skip appointments without calling in advance.

Although a few patients get angry when they are charged for a no-show, most are understanding and then try harder to make their appointments, she said.

However Dr. Gorski thinks that charging patients for skipped appointments "either can't be done or is counterproductive since patients will simply go elsewhere."

Consultant Keith Borglum does not recommend charging patients for missed appointments.

"It focuses on money, not patient care," said Borglum. "It also might have been the office's fault."

For example, he said, the office might have failed to call to confirm an appointment or entered the wrong appointment date into the computer.

Reeves agreed that charging patients for missed appointments can be tricky.

"It makes patients mad and they are unlikely to return, and it's very hard to collect money for no-show patients."