Eli's Rehab Report

How patients value your services is key to their attendance.

No-shows and cancellations are no stranger to an outpatient rehab clinic, and they are frustrating to say the least. This double-edged sword not only affects your patients’ progress but can also put a dent into your daily cash flow.

While many factors are out of your control, you can significantly reduce no-shows with this 3-step approach.

1.  Establish Your Policies Up Front

Your clinical success as well as your business success depends so much on your first visit. The more the patient respects you and understands your policies, the less likely he is to jump ship.

Most important: Spell out your cancellation policy in writing, and have patients sign it, as well. “When our patient first comes in, they sign a welcome information sheet that includes an understanding that they may be charged a fee for canceling without 24-hour notice,” says Barry Inglett, PT, CHT, Cert. MDT, with Mailly & Inglett Consulting and Wayne Physical Therapy & Spine Center in Wayne, NJ. Be sure to verbally reiterate the policy, as well, he says.

Some clinics will even discharge the patient after a certain number of cancellations.

Tip: Explaining why attendance is important from a clinical perspective can soften a potentially punitive tone. “I always say to a patient, ‘It’s critical that you can come at this frequency because we want to resolve this as rapidly as possible,’” Inglett says.

A good time to verbally reinforce your cancellation policy is when you’re reviewing the plan of care, suggests Lynn Steffes, PT, DPT, president of Steffes & Associates Consulting Group in New Berlin, WI. Even better, “Share examples of patient stories where attendance translated into better results,” she says.

Be reasonable: “If the patient has a good excuse, we’re not going to charge them; if they’re abusive, then we will,” Inglett says. “It’s always clear up front before we charge someone because it can be a very negative thing, and we don’t charge the first time,” Inglett says.

2. Take Additional Preventive Measures

As you may know, despite signing a form on the first day, people can forget the cancellation policy or even believe they’re an exception to the rule. Because of this, taking further preventive steps is important. Steffes lists the following ideas that can help:

• Do pre-appointment calls.
• Use email and text message as additional reminders.
• Give the patient your business card on the first visit in case of scheduling changes.
• Schedule toward the front-end of the week. For example, if a patient is coming three times a week, schedule them on Monday, Tuesday, and Thursday, so they can reschedule within the week if there’s a cancellation.
• Compliment and thank patients for their timely attendance.
• Confirm next visit upon exit. You can use the following script: “Is there anything else we can do to help you today? We look forward to seeing you on _____. Thanks again for coming!”

Key: Above all, the patient needs to value what you’re doing. Inglett finds that some practices with a repeated no-show problem have built an image that lacks clinical credibility. “Some places operate more like a gym environment or a social atmosphere, where people do exercises that they check off a card, which minimizes the importance of a skilled therapist,” Inglett says. Consequently, “patients don’t perceive you as important if they can ‘resolve it on their own’ in the gym.”

3. Evaluate and Address Problem Areas

When you do run into cancellation issues, deal with the issue right away. “Do prompt follow-up calls for no-shows within 10 minutes, and say ‘we missed you and want you to get better,’” Steffes says. “Tell the patient that their therapist will need to document the reason for the cancellation, and immediately reinforce the value of the visit. You might say, ‘Since we know the importance of your visits, let’s look at getting it rescheduled right away!’ and offer rescheduled visit times.”

For repeat offenses, investigate for patterns, and follow up with a targeted solution. “Are certain service lines susceptible to no-shows/cancellations? Are certain therapists higher or lower with patient attendance issues? Are there certain days of the week?” Steffes says.

Ideas: If Fridays are a bad day, you might provide a snack that day, Steffes suggests. Or, if you have repeated problems with Medicare patients, perhaps stick to phone call reminders instead of relying on email or text.

If a patient refuses to reschedule, encourage him to call back if he changes his mind, Steffes says.