Practice Management Improvement Strategies

Take a bite out of the no-show rate

More than half of the orthopedic practices that responded to the KarenZupko & Associates Inc. 2018 American Academy of Orthopaedic Surgeons coding and reimbursement workshop pre-course survey (54%) said that no-shows are a “problem” in their offices. That is up from 38% in 2017 and 43% in 2016.

No-shows are like pickpockets who deprive you of the opportunity to fill your block time. Patients who fail to show up and comply with follow-up appointments can impact your outcomes, too.

We believe orthopedic surgeons should take no-show prevention seriously. Although there is no panacea for eliminating no-shows, practices that deploy a multifaceted approach have the best shot at success. Here is a seven-step plan to help eliminate no-shows.

Karen Zupko

1. Develop a written no-show policy

A written no-show policy ensures you and your partners are on the same page about what is expected of patients and how staff should handle the details. Consider how far in advance you prefer a patient call to reschedule. Will you charge a no-show fee? If so, how much?

If you wonder whether a fee can be charged for a missed appointment, you can indeed charge such a fee. This can be done for Medicare and Medicaid patients, as well, as long as rules are followed in those cases. Among those who responded to our 2018 AAOS coding and reimbursement workshop pre-course survey, 32% said they charge for no-shows, which was an increase from 26% in 2017 and 20% in 2016.

Read the complete CMS guidance in this Medicare Learning Network resource and customize the sample no-show policy found at the KarenZupko & Associates website to meet your practice’s needs. Ask a health care attorney to review the no-show policy before you implement it to ensure it follows federal and state laws.

2. Determine what to charge for missed appointments

In our work, we found most U.S. surgeons charge $25 to $50 for a missed appointment, which is consistent with what CMS suggests as a reasonable rate.

3. Train staff to explain the policy

Introduce the no-show policy in a staff meeting or training session and read through it with your team. Talk about when and how they should explain it to patients and where staff should file the signed policies. We recommend patients be told about the no-show policy at the time they make an appointment, on your website and as part of any appointment reminders they receive.

4. Pre-register patients

Modern practices have been pre-registering patients for years. They know patients who provide complete demographic and insurance information prior to an appointment send a signal that says they plan to show up.

Some practices call and pre-register patients by phone. Others optimize productivity by offering pre-registration, including asking patients to complete their clinical history on a patient portal. The latter is preferred by most patients. You can also send or email patients registration forms, asking them to complete and bring the forms to the appointment. All of these methods improve the chances a patient will keep his or her appointment.

5. Use automated appointment reminders

Our firm prefers to use text message reminders. Patients appreciate text message reminders because they are less intrusive and more convenient than navigating the practice’s phone tree, being put on hold or leaving a voice mail. In our AAOS coding and reimbursement survey, 43% of respondents said they use text messages to remind patients of their appointments vs. 32% who used this method in 2017 and 17% who used it in 2016.

Email reminders are our firm’s second choice followed by automated or personal phone calls. Personal phone calls are labor intensive but may be necessary for elderly patients, although plenty of patients who are in their 70s or 80s appreciate text and email reminders.

No Shows graphic

6. Ask the patient for a credit card number to secure the appointment

Aesthetic surgeons, high-end restaurants and upscale spas request a credit card number to secure appointments. This practice is a big deterrent to no-shows and patients not calling to reschedule.

If you decide to request credit card numbers from patients, make sure your practice management system allows payment card industry (PCI)-compliant storage of credit card numbers. Entering credit card numbers in the patient’s electronic account in a comment or other field is not secure and does not comply with PCI-compliant data standards, so we do not recommend that practice.

7. Analyze no-show patterns

Understand your practice’s no-show patterns. Generate a report to determine which days of the week, time blocks and patient types are likely to be associated with missed appointments. Sometimes patients whose appointments are scheduled during the global period think that, if they are feeling well, they don’t need to come in. In some practices, Friday afternoons have high no-show rates.

Issues like these can be avoided by moderately overbooking time blocks that are notorious for missed appointments or agreeing, as a group, on how many postoperative visits are needed for common orthopedic procedures. Set up the scheduling templates to reflect those decisions.

Disclosure: Zupko reports no relevant financial disclosures.

More than half of the orthopedic practices that responded to the KarenZupko & Associates Inc. 2018 American Academy of Orthopaedic Surgeons coding and reimbursement workshop pre-course survey (54%) said that no-shows are a “problem” in their offices. That is up from 38% in 2017 and 43% in 2016.

No-shows are like pickpockets who deprive you of the opportunity to fill your block time. Patients who fail to show up and comply with follow-up appointments can impact your outcomes, too.

We believe orthopedic surgeons should take no-show prevention seriously. Although there is no panacea for eliminating no-shows, practices that deploy a multifaceted approach have the best shot at success. Here is a seven-step plan to help eliminate no-shows.

Karen Zupko

1. Develop a written no-show policy

A written no-show policy ensures you and your partners are on the same page about what is expected of patients and how staff should handle the details. Consider how far in advance you prefer a patient call to reschedule. Will you charge a no-show fee? If so, how much?

If you wonder whether a fee can be charged for a missed appointment, you can indeed charge such a fee. This can be done for Medicare and Medicaid patients, as well, as long as rules are followed in those cases. Among those who responded to our 2018 AAOS coding and reimbursement workshop pre-course survey, 32% said they charge for no-shows, which was an increase from 26% in 2017 and 20% in 2016.

Read the complete CMS guidance in this Medicare Learning Network resource and customize the sample no-show policy found at the KarenZupko & Associates website to meet your practice’s needs. Ask a health care attorney to review the no-show policy before you implement it to ensure it follows federal and state laws.

2. Determine what to charge for missed appointments

In our work, we found most U.S. surgeons charge $25 to $50 for a missed appointment, which is consistent with what CMS suggests as a reasonable rate.

3. Train staff to explain the policy

Introduce the no-show policy in a staff meeting or training session and read through it with your team. Talk about when and how they should explain it to patients and where staff should file the signed policies. We recommend patients be told about the no-show policy at the time they make an appointment, on your website and as part of any appointment reminders they receive.

4. Pre-register patients

Modern practices have been pre-registering patients for years. They know patients who provide complete demographic and insurance information prior to an appointment send a signal that says they plan to show up.

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Some practices call and pre-register patients by phone. Others optimize productivity by offering pre-registration, including asking patients to complete their clinical history on a patient portal. The latter is preferred by most patients. You can also send or email patients registration forms, asking them to complete and bring the forms to the appointment. All of these methods improve the chances a patient will keep his or her appointment.

5. Use automated appointment reminders

Our firm prefers to use text message reminders. Patients appreciate text message reminders because they are less intrusive and more convenient than navigating the practice’s phone tree, being put on hold or leaving a voice mail. In our AAOS coding and reimbursement survey, 43% of respondents said they use text messages to remind patients of their appointments vs. 32% who used this method in 2017 and 17% who used it in 2016.

Email reminders are our firm’s second choice followed by automated or personal phone calls. Personal phone calls are labor intensive but may be necessary for elderly patients, although plenty of patients who are in their 70s or 80s appreciate text and email reminders.

No Shows graphic

6. Ask the patient for a credit card number to secure the appointment

Aesthetic surgeons, high-end restaurants and upscale spas request a credit card number to secure appointments. This practice is a big deterrent to no-shows and patients not calling to reschedule.

If you decide to request credit card numbers from patients, make sure your practice management system allows payment card industry (PCI)-compliant storage of credit card numbers. Entering credit card numbers in the patient’s electronic account in a comment or other field is not secure and does not comply with PCI-compliant data standards, so we do not recommend that practice.

7. Analyze no-show patterns

Understand your practice’s no-show patterns. Generate a report to determine which days of the week, time blocks and patient types are likely to be associated with missed appointments. Sometimes patients whose appointments are scheduled during the global period think that, if they are feeling well, they don’t need to come in. In some practices, Friday afternoons have high no-show rates.

Issues like these can be avoided by moderately overbooking time blocks that are notorious for missed appointments or agreeing, as a group, on how many postoperative visits are needed for common orthopedic procedures. Set up the scheduling templates to reflect those decisions.

Disclosure: Zupko reports no relevant financial disclosures.

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