Eli's Rehab Report

Here's how to make it easy for all patients to show up for their appointments.

Rampant unemployment, soaring medical bills, and no hope on the horizon for the meager budgets many of your patients have to work with mean one thing: your cancellations are bound to keep increasing.

But there are strategies you can put in place to help patients see why showing up for therapy is the most economical choice over the long term, even if paying medical co-pays seems like a challenge in the short term.

Strategy #1: Show Your Value Every Time

Many practices have reported that patients are canceling their appointments or simply not showing up to them because they can't afford their co-pays, which usually run in the neighborhood of $20-$40 per appointment.

"While the co-pay doesn't seem like a lot, many patients don't see the justification for paying $20 for therapy when they're struggling to pay a utility bill or pay rent," points out Amanda Green, PT, with Performance Rehabilitation in Raleigh, N.C.

The only real way to change a patients' minds is to give them a "value-added experience in each physical therapy session," says Mike Studer, PT, president of Northwest Rehabilitation Associates Inc in Salem, Ore.

Do this: Dedicate time during your very first visit to explain to your patient the importance of showing up to their therapy appointments, advises Mark Dwyer, PT, director of rehab services for Olathe Medical Center in Kansas. Set up goals and give patients concrete ways to measure their improvement, such as the ability to walk a specific distance without being winded or the ability to bear a specific amount of weight on a limb.

You should also help patients feel included in the therapy process. Rather than simply going over exercises with them, give patients lots of feedback and the opportunity to become partners in their care, Studer says. For instance, when you see a patient struggling, say to him or her, "I see this is challenging for you. I need you to let me know if it becomes painful so we can make some changes." 

Follow up: You should reinforce the reasoning behind therapy and measure the progress toward your goals at each subsequent visit, Dwyer says. "Let them know what they will be doing differently during this visit compared to the visit before," he suggests. This will help patients see the progression in your therapy approach and better grasp their improvement. "Patients are happy to pay for improvement, but will not see the value in paying for the same thing again and again."

Strategy #2: Never Leave Patients Waiting

No two patients are the same, so no two therapy appointments will be the same -- and you should think about then when scheduling them. "You have to take into consideration each patient. Some appointments will be more involved than others as the patients require more attention," explains Lane Blondheim, PT, with Active Health & Rehab in Montgomery, Ala.

Try this: Use your therapy aides to set up therapy areas, clean up those areas, and prepare the areas with the tools you'll need to evaluate or treat the patient. That way, your therapists can focus on providing the therapy and working intensely with the patient, Blondheim says. Your aides can also provide extra help for complicated patients.

Of course, just as your therapists should be ready at the scheduled appointment time, your patients need to show up when they're supposed to. "Chronically late patients can throw off appointment times for everyone else," and that can make your practice look bad, Blondheim notes.

New approaches: Consider instituting a "chronic lateness" policy that encourages patients to show up on time. For instance, you can build a 15-minute leeway window into chronically late patients' appointment times to account for their time management problems.

You could also offer patients the ability to reschedule their therapy for a later time on the same day if they call within a certain period before their appointed time, which will allow your therapist to move on to other patients. Another option is to perform the therapy in an abbreviated time period, but charge the full co-pay.

Final say: If patients remain chronically late without any notice (say, showing up 45 minutes late), "we refuse to see them that day and make them reschedule for a future date," Blondheim says. This helps reinforce the importance of calling ahead or otherwise letting the practice know when the patient can't make the appointment time.

Strategy #3: Accept The Payment Patients Offer

Many patients may be more willing to keep their appointments if they are given some payment flexibility, notes Tom Howell, PT, with Howell Physical Therapy in Eagle, Ind. For instance, you might collect half the co-pay upfront and then bill for the other half.

You could also look into home therapy or group therapy situations that could come with reduced fees. Many clinics have begun offering incentives for timely payments and eliminated any fees for partial or late payments to encourage patients to continue therapy.

The bottom line: There is no one way to overcome patients' payment obstacles, but your willingness to be flexible and think outside of the box when working with cash-strapped patients will go a long way toward earning their loyalty and keeping them coming back.