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919: Metric Mondays: Cancellation/No-Show Percentage – Miranda Beeson

Cancellations will always happen — but there's a way to reduce and prevent them from happening! In this episode, Kirk Behrendt brings back Miranda Beeson, ACT’s director of education, to break down cancellation and no-show percentage and what you can do if you have high levels of broken appointments. Stop making it too easy to cancel! To learn the secret to getting patients to show up, listen to Episode 919 of The Best Practices Show!

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Episode Resources:

Main Takeaways:

  • Your ideal cancellation/no-show percentage is under 10%.
  • Proactively reach out to patients with unconfirmed appointments.
  • Put a system in place for releasing or keeping unconfirmed appointments.
  • Have a reminder system that utilizes both automated and personal outreach.
  • Be intentional with your language. Don't call to confirm appointments — remind them.
  • Communicate the value of appointments to patients and policies around missed visits.

Quotes:

“Cancellations are not a little deal. They're a big deal because when you have a cancellation, it's not no profit — it's negative profit. You're losing money when you have available providers and there's a cancellation and we don't fill it.” (2:58—3:15) -Kirk

“When we’re tracking changes in the schedule, the ones that matter the most are those short notice changes in the schedule. Because if someone breaks an appointment two weeks out, a month out, a week out, we have time to recapture that to fill that time. But it's those canceled or no-show appointments that happen within, say, 48 business hours of their scheduled appointment. If somebody cancels that or misses that completely, it's really hard to recover that time — and sometimes, we can't.” (3:48—4:18) -Miranda

“[Cancellation and no-show percentage] reflect a lot of things in the practice. It reflects our patient reliability and the expectations that we've built around the schedule with our patients. It certainly impacts our schedule stability, which then leads to profitability. Our team can't be as effective, our patients aren't necessarily having access to the care that they deserve because this is open time that wasn't taken advantage of, and we’re certainly not building value in those appointments. There's something within our culture, in our language, if we see really high levels of cancellations that tells us there's something in the way that we're communicating the value of our time here that's not quite where it needs to be.” (4:25—5:07) -Miranda

“Ideally, you really want [your cancellation and no-show percentage] to be less than 10% as a total number. Really high-performing practices are going to be somewhere under seven, maybe even five to seven. You're doing great if you're less than five. The reality of the situation is you're not going to ever have a practice that never has a cancellation. People get sick, people's cars break down, or they get called into mandatory work meetings. Things like that occur. So, to think you're going to have zero percent cancellation is crazy. But you do want to keep it as minimal as possible.” (5:30—6:00) -Miranda

“When we look at practices with high cancellation or no-show rates, it's going to lead to unpredictable schedules. We're not going to be able to budget and plan financially because we're not going to know what our production is. We can plan and budget based on goals, but if we're losing production because we're having these holes in the schedule over and over again, it will cause stress across the entire team and on our bank account, in the end.” (6:01—6:26) -Miranda

“When you're looking at individual providers and the utilization of their time in patient care, it's going to directly impact that capacity percentage if we're having a lot of no-shows or cancellations. We'll end up with a lot of holes in the schedule, and those frequent no-shows may indicate that there are issues with patient communication and value perception. Maybe we're not default pre-scheduling and reserving with commitment. Maybe we’re penciling people in or giving them the option to, ‘Well, when it gets closer, if you feel like it’s not going to work, just give us a call.’ So, when it shows up, it's a big killer of consistency in both production and patient care.” (6:34—7:14) -Miranda

“It’s really important to make sure that when we schedule that next visit that we’re building that value and that we’re making it really easy to schedule but more challenging to cancel. We don’t want to make it too easy for people to be able to not show up or cancel their appointments.” (7:15—7:31) -Miranda

“If your cancellation percentage is within those benchmarks, less than 10%, maybe you're in the 5% to 7% mark, your team is likely being really consistent with the way that they're scheduling and pre-scheduling. They’re probably aligned around that patient-centered language, building value, and making sure that patients know this is a commitment that we’re making to one another for the next time that you're here. They’re probably reminding patients of appointments, not calling to confirm and leaving that, ‘I'm calling to verify your appointment time tomorrow. If you need to reach out to me or change anything, give me a call.’ We hear things like that a lot on those confirmation calls. Instead, ‘We're reminding you that we’re looking forward to seeing you tomorrow.’ There’s a difference in the way the language is probably happening with your administrative team.” (8:06—8:49) -Miranda

“You should have some type of policy around how you manage [missed visits]. For us, we talk about the ABC system. If someone has canceled short notice several times, we probably have a policy in our practice that we don't put them right back in the schedule. So, your team is going to be good at knowing those systems and fulfilling those systems if the numbers are good. You'll have a reminder system in place, and cancellations that create a temporary gap, you have team members that own filling that gap as soon as possible. You're probably working a priority list. I love calling it a priority list and not an ASAP list or a short call list because I think it makes the patient feel like they're a little more special.” (9:08—9:46) -Miranda

“If you have a really high cancellation percentage, more than likely, if it's happening last-minute, you aren't building that value off the front end. The patients haven't been trained. They don't see or understand that they can't just break an appointment. We've made it way too easy for them to cancel and way too easy to get right back in the next day. Reminder systems are probably not being followed. There might not be a good sequence or someone owning that reminder or confirmation system. Really, a lot of it is around the ownership of that and knowing that there's a person that you can go back to who's accountable for it. Because when someone knows that they're accountable for something, they're going to really try hard and do a great job. Likely, the admin team is constantly scrambling to fill same-day or next-day holes. It's exhausting, so team morale and culture is probably not at its highest peak. The team probably feels frustrated, pretty reactive, and the production is swinging back and forth. Everything feels pretty chaotic when you're having to scramble and plug those holes on a regular basis.” (9:50—10:56) -Miranda

“Learn how to track cancellations and actually cancel or break appointments within your software in a way in which it can be tracked. I can speak for my own self in that I worked with Open Dental for the last many years that I was in practice, and it was two extra steps to break an appointment the right way versus moving it to the pin board and then plugging it into wherever they decided to reschedule. You had to actually assign the 9986 or D9987 codes. It goes into the ledger, then you pull it from the unscheduled list and make a new appointment. It is a couple of extra clicks. But, in the end, admin team members, it's worth those extra couple of clicks because when the doctor comes to you freaked out, stressed out, ‘I feel like we have all these holes in the schedule, and I don't think you guys are doing a great job of managing these cancellations,’ you can show the data if you're actually doing it right in the system. If you don't do it right in the system, you're not going to have clean, clear data and it's all based on feelings.” (11:40—12:42) -Miranda

“It really sucks to be that admin team member who's having to call 75 to 100 people just to get one person to answer the phone, and then maybe they're going to say yes. I mean, you're defeated at the end of the day. So, yeah, let's set our team up for success. [Having] systems is number one. One is going to be a communication system. Like we said, most cancellations start way before the cancellation. They start back when we were scheduling the appointment to begin with. So, start there, making sure that your team is aligned around the language that we use when we're making an appointment. When we use value-building language to make an appointment, people are going to be that much less likely to cancel the appointment.” (13:57—14:39) -Miranda

“[Have] an actual cancellation system in writing, something that's documented so that we know as a team, how do we handle cancellations? All the way down to like, what do we say when we answer the phone and they say, ‘I need to cancel my appointment’? When I was in private practice, I can recite it off the top of my head because I've said it so many times. ‘Oh my goodness, Mrs. Jones. I'm so sorry to hear that you're not going to be able to make that visit today. Dr. Awesome and I were just talking about you at huddle this morning, and we were so looking forward to seeing you. Do you mind me asking what's changed since you reserved this time?’ It rolls off my tongue because that's what everyone said. It was the system for how we responded to cancellations in our practice because it did a couple of things. It connected with the patient, it validated their issue or their concern, and it also mentioned — like, people can't argue with their own data. ‘You reserved this time.’ Also, we have that accountability to Dr. Awesome, and nobody wants to disappoint Dr. Awesome. Now, that doesn't mean people aren't going to still cancel. But that's a piece of your cancellation system, is knowing how to not just say, ‘Okay, no problem. Do you want to come in Tuesday instead?’ because we're making it way too easy for patients to cancel.” (14:48—16:03) -Miranda

“You and I have talked before about avoidable and unavoidable cancellations. There is a difference. I'm super empathetic if somebody truly has an unavoidable reason in which they have to cancel. There's nothing they could do about the fact that their daughter started throwing up this morning and she couldn't go to school. So, we're going to have a little bit of empathy, and we'll have a plan within our system for how we handle these unavoidable cancellations. We're probably going to handle those avoidable ones, those repeat offenders, a little bit differently. So, a communication system when we're scheduling to build value, and then having a cancellation system for what we say and how we handle cancellations when they come in. So, that's super easy right off the jump, keeping it super clean in terms of systems. Then, on the other side is making sure that you are using a reminder system, not necessarily verifying or confirming with that out on the back end of your confirmation calls. Instead, ‘We're really looking forward to seeing you tomorrow. Can't wait for it. See you then, Mrs. Jones,’ and there's not really that open door for Mrs. Jones to say goodbye.” (16:03—17:12) -Miranda

“If it's the day before, and you have a system and it includes automated and personal touch points — that they got an email a month ago, they didn't confirm yet, they got a text two weeks ago, it's still yellow, they haven't confirmed yet, they got another one at five days, they got another one at three days, and it's still sitting there unconfirmed — I'm going to call the patient and I'm going to say, ‘Mrs. Jones, this is Miranda at Dr. Awesome's office. I really need you to give me a call regarding your upcoming appointment. I look forward to hearing from you soon.’ Now, Mrs. Jones is going to call me back because she thinks that maybe there's an issue with her upcoming appointment, versus if I leave a message saying, ‘I'm just reminding you for your upcoming appointment,’ she's probably not going to call back. She's like, ‘Yeah, yeah, yeah. I know about that appointment.’ It's going to stay unconfirmed and we're going to be worried up until the very moment if she's actually coming in. The number of times that people will call back and say, ‘You needed to call me about my appointment?’ ‘Oh, yeah. Just wanted to remind you that we're looking forward to seeing you tomorrow.’ Now, we can mark it green. Now, it's confirmed in the schedule. You’ve got to think about the patient and where they're at.” (17:25—18:32) -Miranda

“Typically, if you have a high level of new patients no-showing or canceling last-minute, I would say you have a whole caveat within your cancellation system just for that that says that if we don't have forms and we haven't received confirmation, even after all five attempts to confirm the appointment, we're going to leave some messages for them. I would do phone, email, text. ‘Hey, we're releasing your appointment because we haven’t heard back from you.’ Now, we can fill it. Everyone always says to me, ‘Well, what happens when they show up?’ I say, ‘No problem. Oh my gosh, Mrs. Jones. We've tried to reach you for like two weeks. Can I verify that I have the right email and phone number? Because we've been reaching out and we haven't heard back.’ And probably, it's not going to happen. I think once I've had somebody actually show up for their appointment. So, be proactive, is my point.” (19:03—19:49) -Miranda

Snippets:

0:00 Introduction.

3:15 Cancellation and no-show percentage, explained.

5:16 How this percentage impacts the practice.

7:59 What it looks like when it’s going well.

9:47 What it looks like when it’s not going well.

11:13 Learn how to track and cancel appointments in your software.

13:00 Ways to impact this metric.

19:58 Final thoughts.

Miranda Beeson, MS, BSDH Bio:

Miranda Beeson has over 25 years of clinical dental hygiene, front office, practice administration, and speaking experience. She is enthusiastic about communication and loves helping others find the power that words can bring to their patient interactions and practice dynamics. As a Lead Practice Coach, she is driven to create opportunities to find value in experiences and cultivate new approaches.

Miranda graduated from Old Dominion University, and enjoys spending time with her husband, Chuck, and her children, Trent, Mallory, and Cassidy. Family time is the best time, and is often spent on a golf course, a volleyball court, or spending the day boating at the beach.
ACT Dental Team

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