Patient Cancellations

By Professor Bob Khanna / 01 Dec 2015

Professor Bob Khanna shares advice on managing late or cancelled clinic appointments

Deposit systems

When I set up my first clinic in Ascot in 1997, I remember having a conversation with my receptionist about a ‘great’ idea that I had – to take a deposit from each new patient to secure a booking. Jackie thought I was joking when I said this and, when she realised I wasn’t, told me that it would never work as, “no one else does this!” I replied, “In that case, there is even more reason to do it!” To this day I have maintained this policy and my Failure To Show (FTA) rates are extremely low.
My belief has always been that we must get commitment from the patient and a simple deposit system can be a very powerful tool to help us do so. Patients are very unlikely to miss an appointment if they are aware that they may be charged and that they have left a deposit with the clinic. The ideal amount for securing a new patient booking should be high enough for them to want to turn up, but not too high that it becomes a deterrent for booking. Ironically, I set the consultation price at £45 in 1997 and this has remained the same ever since. I only see this price as a holding fee and an FTA deterrent, so it is not something the clinic is aiming to profit from. Let us not forget that it is of course in everyone’s interest for the patient to actually attend rather than miss an appointment.
Following a new patient consultation, a patient will need to be booked in for a subsequent appointment for the appropriate length of time, depending on the procedure. I think it is wise to take at least 25-50% (or more) of the full fee of the treatment to secure such bookings. Again, this will commit the patient to treatment and facilitate cash flow for the clinic in order to purchase the appropriate materials required for the case. One should not be hesitant with taking deposits or money upfront as this concept is endemic in today’s society. From ordering a Big Mac at McDonalds to booking a flight, we would be required to pay upfront. Why then, are practitioners so reluctant to operate a deposit system? I suspect it has something to do with an inbuilt duty of care we all have. Being too business-like can make many practitioners feel uneasy. In view of the fact that we receive absolutely no training in business skills as an undergraduate, it is not surprising at all.
However, the necessity of doing so is important and becomes clearer when patients start defaulting on their payments. From cheques bouncing to credit cards failing and counterfeit notes being used – if you have been in business for long enough you will have experienced all of these issues. If you haven’t experienced such problems, the system you operate clearly works so don’t change it! 

Cancellations

There is nothing like a last-minute cancellation to sour your mood as a practitioner, especially if it is for an appointment of more than one hour. However, one has to also realise that certain life circumstances are unavoidable and practitioners must, therefore, be flexible too. The problem occurs when you encounter the ‘serial offender’. This is the patient that is frequently late or, more often, cancels at the last minute, usually on the day, citing, “I’ve been called into work”, “I feel ill”, or that classic... “My car didn’t start up!” So, how do we prevent patients taking us for a ride?
Firstly one must have a clear written practice policy that states the cancellation ‘rules’ that each patient has to sign on registering with the practice. Ideally, this should be updated every year to allow clarification of any changes for your patients. As a deterrent, staff should make it very clear that cancellations inside of 48 hours may incur a late cancellation fee. This fee can either be the full treatment fee or a pay-per-minute fee, for example, £2 per appointment minute missed. 
Since it is more beneficial to retain a patient, from a long-term perspective, one must exercise a degree of discretion. Hence, a first- time offender may be granted a pass, so long as they are informed that, on this occasion, they narrowly missed being charged the cancellation fee. The reception team should document this fee and the reasons for cancellation so you can check how many times it has happened. A fee ought to be taken from the deposit if the patient repeats this activity again. If you are too lenient, the patient may become complacent and keep re-offending. 

It works both ways

All of the above is designed to make the patient respect our clinical time. As I have mentioned previously, rather than for profit, any such fees should act as a deterrent and send a clear message that FTAs and late cancellations are not acceptable.
However, practitioners and clinic staff must therefore appreciate that for this to be fully respected, then it has to be a two-way process. For example, if one is running substantially late (more than 30 minutes) or if a clinic day has to be cancelled at short notice then I think it is only fair that the patient is compensated. Rather than offer a monetary fee, a gift voucher towards treatment at the clinic could be a better idea so you retain their custom. The mere gesture of this will alleviate most of the patient’s anxiety and annoyance, serving as a reminder of how valued they are at the clinic. Retaining patients is a key aspect to a successful business; achieving patient loyalty and respect is a testament to how well they are treated by the whole team, in all aspects of their care, and must not be taken for granted. 

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