Cancellation and No Show Policies: The Good, The Bad and The Ugly

By: Jennifer Heiligman, PT, MPT

Many outpatient rehab practices struggle with patients cancelling their appointments or worse yet, just not showing up.  It is estimated that the no show rate for an outpatient rehab clinic is between 2-4%.  This can have a big impact on your clinic in terms of revenue loss and loss of something just as important, your therapist’s time.  In addition, when patients don’t attend their visits, they have poorer outcomes.

There are many ways to combat no shows including making sure you have appointment times that can accommodate the availability of your patient population and sending appointment reminders.  In addition, a lot of practices create and implement patient cancellation and no show policies. However, there are a number of pros and cons to consider before implementing these types of policies in your practice. This procedure is what we are going to focus on in this blog.

The first step you need to take is to create a written policy.  The policy should be clear and concise so there is no confusion on the part of the patient or your administrative staff who may be responsible for explaining and educating the patient on this policy.     

The primary consideration for the policy includes what is the time period you require the patient to contact the facility within if they need to cancel an appointment?  12 hours? 24 hours? 48 hours?  You want to make sure you are not too stringent or too lax.  The earlier an appointment is cancelled, the more likely you will be able to back fill that slot with another patient, helping to decrease lost revenue.  However, 48 hours may be too far in advance for a patient to realize they need to cancel an appointment.  On the other hand, 12 hours may allow the patient to cancel simply because they wake up that morning and don’t feel like attending therapy that evening.  A 12 hour requirement also may not give your staff ample time to find a patient who is available on short notice to attend that appointment.  The result being an empty time slot on your schedule.  The most common cancellation notification time period is generally at least 24 hours in advance of the appointment.

The next consideration is what are the consequences for a patient that does not inform your practice of the need to cancel an appointment within the required timeframe or just doesn’t show up for their appointment at all?  The most common consequence is a monetary fee.  It would be up to your practice to decide the dollar amount.  Will it be a set amount like $25 for example or will you charge a percentage of the expected reimbursement you would have received if you were able to bill out that visit to the payer?  How would you go about collecting the fee?  Some practices may collect a deposit at the start of care to be used if the policy is not followed, while others may keep a credit card on file with an accompanying signed pre authorization letter and charge the card in the event of a late cancellation or no show.  Keep in mind, it would be a good idea to leave a little wiggle room to accommodate emergencies.  As we all know, life can sometimes be unpredictable. 

The presentation of the policy should become part of the initial registration process for the patient.  Your front office staff should review this policy with the patient and verify that the patient understands the policy and the consequences.  The reasoning behind the policy should also be explained.  It should not be presented as a punishment, but more as a way to help the patient successfully achieve their goals of therapy.  After all, if you don’t attend your therapy sessions, you will not obtain maximum benefit.  Keeping a signed copy of the policy in the patient’s medical record that indicates the patient has read and understands the process is helpful should any issues arise.  In addition, if you want the policy to be successful in decreasing late cancellations and no shows then it will need to be enforced.

There are some risks involved with implementing and enforcing a cancellation/no show policy which should be evaluated.  This includes the potential of alienating your busy patients.  For many patients, legitimate circumstances may occur often that cause them to have to late cancel or even no show for an appointment.  While this does negatively impact your clinic, these patients may have no choice.  If you wish to keep their business, cancels and all, then you may want to waive the fee for at least the first couple instances or risk losing them as a patient.  In addition, some patients may resent the fee and provide negative reviews of your practice to their family or friends and your chronic no shows may decide to just stop coming.

No shows and late cancellations can be extremely detrimental to your rehab therapy practice.  One way to combat them is to establish a cancellation/no show policy that has negative impacts on patients that skip their therapy visits. Implementing these types of policies should only be done once you have educated yourself on the potential backlash including losing patients and possibly receiving negative reviews.  However, if the policies are presented to the patient at the initial point of their episode of care and they are communicated clearly including the reasons for the policy, they can be successful in decreasing the occurrence of no shows.