No-show patients

Oct. 1, 2009
by Dianne Glasscoe-Watterson, RDH, BS, MBA

by Dianne Glasscoe-Watterson, RDH, BS, MBA
[email protected]

Dear Dianne,

Our office has seen a sharp increase in the number of no-show patients in hygiene recently. Our front desk assistants blame the problem on the sluggish economy. Actually, unemployment is fairly low where we live. We have not been hit with enormous job losses like other areas.

We do preschedule six-month recall visits for patients, and we used to send out reminder cards about a month before the appointment. However, we stopped doing that some time back because we felt it cost too much. We make confirmation calls two days ahead of an appointment, and most of these go to answering machines.

Can you give us any ideas to cut down on the number of no-show patients?

Hannah, RDH

Dear Hannah,

It is obvious that what used to be effective in patient communication regarding appointments is not working so well now. Your office needs a completely updated and fresh strategy for controlling cancellations and broken appointments.

Let’s start with prescheduling hygiene appointments. There are some basic rules you should follow.

1. Be discriminating in who you allow to preschedule a preventive appointment. Don’t automatically schedule people who have a history of disappointment or cancellations. Such patients should be told they will be contacted directly to schedule an appointment.

2. For appointments scheduled six months ahead, your office should still be sending out reminder cards. The message on the card should read like this:

“Dear Harriet,

“Our records indicate you have reserved time with our hygienist on Monday, May 14, 2010, at 10 am.

“Helping you keep your teeth for a lifetime is our goal. It is our pleasure to assist you with any and all of your oral care needs, and we’re looking forward to seeing you soon!

123 Any St.
Any City, USA 12345
Telephone —
Office Hours

“Please consider this card your reminder.”

3. Ask patients if they need a courtesy reminder call. Do not use the word confirmation. The office mindset should be that when the appointment is made with the patient’s consent, it is confirmed. If the patient requests a reminder call, find out which number to call, tell the patient when the call will be placed, and ask if it will go to voice mail.

4. Patients with a history of disappointment should be handled differently than dependable patients. A message on voice mail alone is not an acceptable way of reminding. If the patient cannot be reached during regular business hours, someone must take the number home and call after hours. Such patients should be called two days ahead of the appointment with this message:

“Hi, Mrs. Jones. This is Mary at Dr. Smith’s office. I’m calling regarding your appointment on Wednesday, May 5, at 10 a.m. It is imperative I speak with you directly. Could you please return this call by tomorrow, Tuesday, May 4, at 10 a.m.? The number is . Thank you for your consideration.”

If the patient doesn’t call back, the scheduling coordinator should call after hours to speak to the “risky” patient directly, rather than leaving a message. Additionally, all new patients should be confirmed in person. This may necessitate calling after regular working hours. Business assistants have to decide which is more unpleasant: invoking frustration, aggravation, and worry among clinicians over downtime, or spending a few minutes after hours cementing the appointment and having happy clinicians. I would choose the latter.

5. Front desk assistants have to become proactive in identifying chronic offenders on the schedule. That’s why they should examine the schedule a minimum of two business days ahead of scheduled appointments to give reminders.

6. E-mail and text messaging are two communication tools that every practice should use regarding reminder messages.

7. Every person who misses an appointment without contacting the office) must be notified. Here is my three-part strategy.

First offense letter

“This letter is to inform you of your broken appointment on . This time could have been used for another patient awaiting an appointment. We understand that circumstances may occur to cause these disappointments. Many dental offices charge a fee for broken appointments. However, we have opted to send you this letter with the hope this will not happen again.”

Second offense letter

“There seems to be a problem coordinating your busy schedule and ours. Unfortunately, we have recorded that you missed your scheduled appointments on and . A broken appointment affects three people: the doctor or hygienist who was prepared for your visit, another patient who is awaiting time to receive needed dentistry, and you, because your dental needs have not been met. If you wish to remain a patient in this practice, your full cooperation is needed to see that this does not happen again.”

A third offense would necessitate terminating the patient relationship. The doctor would make this determination.

Controlling downtime in the schedule is a front desk function. Business assistants must take their jobs seriously and be adept at identifying problems ahead of time. They cannot wait until the patient is late and say, “Oh well, I guess he’s not coming. Just take a little break.” They cannot be content leaving desperate sounding messages on voice mail to people who have proven to be unreliable.

The two main duties of business assistants are keeping warm bodies in chairs, and making sure accounts are paid. Everything else is peripheral to these two functions. Business assistants should be held accountable for these two functions. Their effectiveness can be measured by the percentage of downtime against total available time, and the collections percentage against production. The goal for downtime should be 5% or less, and the collections percentage should be 98% or more. Far too often business assistants are baptized by fire into their positions with little training. Doctors/owners must ensure that the people who run the practice, i.e., business assistants, are provided training. In-office consultants can help train business assistants.

While I know of no way to completely eliminate downtime, your percentage of downtime can be reduced with sound patient management strategies. During this time of economic recession, it is more important than ever to expand communication and use effective reminder techniques. Serious business assistants are key components in controlling downtime. As a hygienist, maybe you can suggest a lunch and learn session or staff meeting on strategies to control downtime using the plan I’ve provided.

Best wishes,

About the Author

Dianne Glasscoe-Watterson, RDH, BS, is a professional speaker, writer, and consultant to dental practices across the United States. She is CEO of Professional Dental Management, based in Frederick, Md. To contact Glasscoe-Watterson for speaking or consulting, call (301) 874-5240 or e-mail [email protected]. Visit her Web site at