Broken appointment blues

Aug. 1, 2005
Dear Dianne: Our practice has been experiencing a problem with broken appointments, especially in hygiene.

Dear Dianne:

Our practice has been experiencing a problem with broken appointments, especially in hygiene. One day, only five of my 10 scheduled patients made their appointments. One day about two weeks ago, only two out of eight people actually showed up. Days where everyone shows up are very rare. In fact, I can’t even remember when I had a day with no downtime. Needless to say, my production has been poor. Although my doctor hasn’t said anything to me directly, he told one of the front-desk assistants that he might have to cut my days from four to three if this keeps up.

I need to work full time to pay my bills, and I am very worried about this situation. Is there anything I can do to help with this problem?
Worried in Wisconsin

Dear Worried:

There are several issues that need to be addressed here. Let’s break down the problem and look at possible solutions.

Does your practice have a scheduling coordinator? Someone has to be in charge of maintaining the schedule. Keeping warm bodies in chairs is one of two primary functions of the front desk, and the other is collections. When no one is held responsible for the daily schedule, breakdown can occur.

In most dental practices, there are two business assistants with no real defined duties. Both people perform the same basic functions at the front desk, such as answering the phone, collecting money, opening mail, filing, verifying insurance, and making appointments. Neither person is held responsible for any particular body of work, and as long as the schedule is full, collections are good, and the practice overhead falls within acceptable industry standards, inefficiencies at the front desk are not noticeable. That doesn’t mean there are no inefficiencies, just that inefficiencies are not glaringly evident.

A better arrangement is to have one person designated as the scheduling coordinator and one as the financial coordinator. With this arrangement, people can be held accountable for particular bodies of work, such as scheduling and collections. Job performance, good or bad, can be measured by the percentage of collection (should be 98 percent or more) and number of units of downtime (5 percent or less).

Confirming appointments can be good and bad. Years ago, when I managed the business functions of the front desk, confirming appointments was part of my job. Back then, no one had answering machines. When I was unable to confirm patients’ appointments during regular working hours, it was my job to take their numbers home with me and call after hours. I did not like this, but it was part of my job.

However, I do not know of another profession on earth that goes to the lengths we do in dentistry to confirm appointments. What other profession cajoles, harasses, even begs patients to come to appointments they scheduled? If you think about the big picture of confirming appointments, there is a subtle idea that is perpetuated: We’re not sure you are really coming, and we want to confirm that you are coming. It’s like we expect the patient not to show. People actually live down to our expectations!

Here’s a novel idea. Why not ask our patients? “Mrs. Jones, do you require a courtesy confirmation call?” If the answer is yes, then make a note that the patient requests a call. If the answer is no, then the scheduler (front desk or hygienist) should say, “Great! I’m going to mark you confirmed in my schedule. Thank you for being dependable!” For any hygiene appointment scheduled three, four, or six months ahead, the patient should be informed that s/he will be receiving a “confirmation card” in the mail (or even better, a confirmation e-mail) about three weeks before the appointment. The card should contain information similar to the one on the next page.

The last statement in the card does not mean the patient will not receive a confirmation call, but it does send the message that a call may not be forthcoming. Patient charts should be pulled several days in advance and scanned to see which patients have a history of broken appointments. Any patient in this category should be treated differently than someone who has no negative history, and a confirmation call is prudent.

Some offices place confirmation calls to patients’ answering machines and ask them to please call back to “let us know you got this message.” I find this annoying and even punitive to the many dependable patients, plus it ties up the business assistants with extraneous phone calls. This tactic should be used only with patients who have proven to be unreliable.

It is not acceptable to leave confirmation messages on machines with two groups of patients: new patients, and any patient who has a history of broken appointments.

It is imperative that these patients be spoken to directly, which might call for an after-hours call. For a risky patient who is difficult to reach, the call should be made a minimum of two days from the appointment and should sound like this:

“Hi Mrs. Jones. This is Mary at Dr. Smith’s office. I’m calling regarding your appointment on Wednesday, May 5 at 10. I need to speak to you about this appointment. Could you please return this call by tomorrow, May 4, before noon? The number is ... before 5 p.m. and ... after 5 p.m. Thank you for your consideration.”

Be discriminating about who you allow to schedule a continuing-care appointment three, four, and six months out. Scheduling the continuing-care appointment is good and acceptable for most patients. However, if a patient develops a history of broken appointments (either late cancel or no-show), s/he should not be afforded the privilege of prescheduling. Patients in this category should be sent a card informing them it is time to call for an appointment. Hygienists should be on guard about allowing undependable patients to preschedule.

Your patient base is probably like many others in that they are spoiled. Now is the time to start a change, and this is accomplished one patient at a time by holding them responsible for missing appointments. Any patients who miss appointments without contacting the office should receive repercussions, preferably with a letter that says something like this:

“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 broken appointments. 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.”

In the event of a second broken appointment, a more strongly worded letter should read:

“There seems to be a problem coordinating your busy schedule and ours. Unfortunately, it has been recorded that you missed your scheduled appointments on ... and ... A broken appointment affects three people: (1) the doctor or hygienist who was prepared for your visit, (2) another patient awaiting time to receive needed dentistry, and (3) 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 mean terminating the patient relationship. The doctor would make this determination.

Many offices charge a token amount for broken appointments. My thoughts on these charges are:

• The fee has to be substantial to cover the real cost of lost production

• It creates negative missionaries in the community

• The majority of people do not pay these fees, which clogs up accounts receivable with uncollectible monies

• Patients leave the practice angry.

I prefer to deal with chronic offenders one-on-one rather than using the shotgun effect and blasting the whole patient base.

One contributing factor in the broken appointment issue is job loss. Many people have come to rely so heavily on their third-party benefits that they think they can’t go to the dentist if they lose their benefits. This is sad, and something over which we have no control. However, the more value we give the patient, the more importance the patient will place on the care we deliver.

Of course, there are legitimate reasons why patients have to occasionally miss appointments. Every situation needs to be weighed on its own merits. However, the situation you described in your letter points to an out-of-control situation at the front desk in which patients abuse their appointment privileges.

Keeping the hygiene department healthy and growing is vital to a practice, as the hygiene department typically drives the rest of the practice. This affects everyone’s paycheck! To summarize, I have outlined some steps you can take to help with the problem. Another thing you can do is to share this article with your doctor and/or business assistants.
Best Wishes,

Confirmation Card

Dear Harriet,

Our records indicate you have reserved time with our hygienist on Monday, May 14, 2005, at 10 a.m.

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!

Dr. John Doe, 123 Any St., Any City, USA 12345
Telephone - 555-555-5555
Office Hours: 8 a.m. - 5 p.m.

Please consider this card your confirmation.

Dianne D. Glasscoe, 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 for speaking or consulting, call (301) 874-5240 or email [email protected]. Visit her Web site at