11.28.14 Issue #664 info@mckenziemgmt.com 1-877-777-6151 Forward This Newsletter

9 Ways to Reduce Cancellations and No-Shows
By Sally McKenzie, CEO

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When patients don’t show up for their scheduled appointments, it throws off your entire day. If your Scheduling Coordinator can’t fill the holes, you’re left with way too much down time and no chance of meeting production goals.

Unfortunately, in today’s busy culture, broken appointments are bound to happen. In fact, on average, 28% of patients regularly don’t show up for their appointments, leading to undue stress in your practice and, worst of all, costing you money. Educating your patients about the value of dentistry and their appointment time is a great way to reduce cancellations and no-shows. It is something every practice should focus on, but there are other ways to help ensure patients are in the chair during their designated times.

Here are nine tips I put together to help you curb cancellations and increase profits at your practice.

1. Don’t rely solely on pre-appointing. Patients have no idea what their schedule will look like six months from now, so you’re just asking for them to cancel when you schedule appointments that far out. Now might be a good time to rethink this outdated scheduling system, because all its doing is costing you time, money and frustration. If you’re not ready to drop it all together, consider implementing a hybrid system and only pre-appoint reliable patients you’re fairly confident will show up.

2. Be thorough. Go over every appointment detail when scheduling patients. Here’s an example of what I mean: “Mr. Tyler, your one-hour appointment is scheduled for Tuesday, February 16 at 11 a.m. If you can’t keep this appointment, please call our office at least 48 hours in advance to allow another patient the opportunity to see the doctor at that time.”

3. Confirm appointments. Designate and train a Scheduling Coordinator to confirm appointments with patients two days in advance. Find out each patient’s preferred contact method, whether it’s email, text or phone call. If the patient prefers a phone call reminder, make sure your coordinator knows it is necessary to actually talk to the patient to confirm the appointment; just leaving a message won’t get the job done. It’s also a good idea to schedule time to confirm appointments after hours to ensure your coordinator can connect with patients who are difficult to reach during the day.

4. Follow up. Your Scheduling Coordinator should check in with every patient who doesn’t show up for a scheduled appointment. Use this as an opportunity to politely remind patients of the importance in keeping their appointments and maintaining their oral health, and to also find a convenient time to reschedule. Your coordinator should follow the same procedure for patients who cancel but don’t reschedule right away.

5. Show concern. Once a patient is more than 10 minutes late to an appointment time, your Scheduling Coordinator should call to express concern about his or her well-being. Here’s an example of what to say: “Mr. Smith, this is Mary from Dr. Huth’s office. We were expecting you for a 1 p.m. appointment today and were concerned when you didn’t arrive. Is everything okay?”

6. Keep a list. Instead of scrambling to fill holes every time a patient cancels or doesn’t show up, keep an updated list of patients who are looking for earlier appointment times, or who you know are willing to move their appointments to fill unexpected voids in the schedule. Call these patients and you’ll be more likely to fill the scheduling holes created by cancellations and no-shows.

7. Flag unreliable patients. After a patient racks up two no-shows, I think it’s pretty safe to say they are unreliable. Instead of putting this patient in the schedule, politely state that you will contact him or her when an opening is available. For example, “Mr. Tyler, we seem to be having trouble coordinating a time that works for your schedule and ours. I don’t have any appointments available at this time. However, I do have all your information and will contact you when there is an opening.”

8. Consider extending your hours. Work meetings and other responsibilities tend to pop up during the day, leading to patients cancelling or even forgetting about their appointments altogether. If this seems to be a common theme with your patients, consider offering evening and weekend hours. Extended hours may make it easier for patients to find appointment times that work for their schedule, and to stick to them.

9. Set a policy. If patients know you have a broken appointment policy, they’ll be less likely to flake out. Communicate your policy to new patients and politely remind existing patients of the policy every time they make an appointment.

Broken appointments wreak havoc on your day and hurt your bottom line. Educating your patients and following these tips will help you to drastically reduce schedule busters, making your practice more efficient, less stressful and more profitable.

For additional information on this topic and more, visit my blog: The Lighter Side

Interested in speaking to me about your practice concerns? Email sallymck@mckenziemgmt.com
Interested in having McKenzie Management Seminars speak to your dental society or study club? Click here.
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Nancy Haller, Ph.D.
Leadership Coach
McKenzie Management
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Cook Up a Successful Practice
By Nancy Haller, Ph.D.

After enjoying your Thanksgiving dinner, give some thought to the planning, coordinating, preparing and serving efforts that were involved. Try adding up how many person-hours were involved before, during and after the holiday feast. Do you invest as much in your practice and in your dental team? Perhaps it's time to put on the apron and get into your “kitchen” for a little work!

Be a Leader
You don’t need to watch a lot of Food Network before you’ll notice a universal constant - every restaurant in trouble has a leadership problem. The owner might be too busy trying to be everyone’s friend in the front of the restaurant to actually run the business, or the chef might be an incompetent bully. Being in the kitchen as well as in dentistry requires someone to be in charge and lead the way. Do some self-assessment. When and how are you most effective? What will you do in the future to use those qualities more often?

Start with a Plan and Follow It Through
Preparation is key. You need to plan everything beforehand to have any chance of success. This includes analysis of the recipes that you plan to prepare and making sure you have all of the necessary kitchen equipment, ingredients and spices. A key element is planning the timing backwards, from when you plan to actually serve the food to your guests to when you will need to start the initial preparations. This need for close planning is also true for your practice endeavors. Make sure you have the right people, and that they have the skills necessary to do the job. Think about the end result you want, and establish regular checkpoints to ensure everyone is tracking according to plan.

One of the biggest challenges in preparing a meal is timing. Not all elements of your dinner require the same amount of cooking time. Certainly there is a need to run an operation profitably, and that in itself can be a monumental task. However, before profit comes a focused, well-run kitchen. When it operates efficiently, watching a kitchen in the heat of service can be very similar to the smooth flow of a productive dental team. By having an effective scheduling system, the doctor and staff are in charge of managing the patient flow. This enables the team to manage the schedule so it becomes efficient and predictable, and creates increased revenues quickly.

Learn How to Mix Complex Ingredients
Having the right ingredients is a great start, but it takes far more to make a great meal. Not all ingredients mix well, nor do they suit all tastes. Furthermore, ingredients will not jump into a pot and cook on their own. A great meal requires special effort and attention. You need the right amount of seasoning and the proper method of combining those ingredients. Your stove and altitude can alter the outcome as can many other factors. The same is true with people. Not all personalities mix easily. Some flavors dominate, others complement, and still others effectively contrast. It takes skill and patience to blend diverse employees into a high functioning dental team. It’s also easy to “curdle” people if you do not treat them with respect or if you “heat” them inappropriately.

A lot of information is exchanged in a busy kitchen. Meeting deadlines with limited resources requires everyone to be a good communicator, passing information to one another. Be a keen observer and listen carefully to the people in your office. This helps you to understand what they need from you to execute well. Morning huddles are important and so are monthly staff meetings. It is also wise to hold individual performance reviews with each team member. These should happen quarterly, or more often if employees are learning new “recipes”.

Expect Messes and Clean Up As You Go Along
You can’t have a culinary feast without using a lot of pots and pans. There will always be messes and it certainly is the least fun part of the job. Anticipate and prepare for conflicts and unexpected incidents that need your attention. Learn how to give behavioral feedback and hold employees accountable to your practice values. Clean up as you go along to avoid a sink full of dirty dishes that keep accumulating.

Assume the role of “master chef” in your office. Leadership is a skill, just like cooking. It takes practice, discipline, creativity and adaptability. It's also not all about the end result. The process is how you get there. Just as a simple recipe becomes a delicious experience in the hands of a good cook, in the hands of a good leader a group of people becomes a high performing team. Bon Appétit!

Wishing you, your personal and professional families a very Happy Thanksgiving.

Dr. Haller provides training for leadership effectiveness, interpersonal communication, conflict management, and team building. If you would like to learn more contact her at nhaller@mckenziemgmt.com

Interested in having Dr. Haller speak to your dental society or study club? Click here

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Jean Gallienne RDH BS
McKenzie Management
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Question and Answer
By Jean Gallienne, RDH BS

Question: In our office, we schedule new patients with the doctor for a comprehensive exam and x-rays. Periodontal charting is done, and if we discover areas with pocketing that warrant the need for further treatment, the periodontal chart is given to one of our hygienists to make recommendations. The chart is then given to the front desk to call and schedule the patient for scaling and root planing.  

At the next appointment, the patient is scheduled for scaling and root planing with the hygienist, followed by an appointment for the patient to come back for prophylaxis. They are then scheduled for their periodontal maintenance appointment in three, four, or six months.

My question is, can and should we be doing our treatment this way? At the last office I worked in, we saw the patient for their first appointment, then had them back for a prophylaxis or scaling and root planing depending on individual needs. Three to four months later, the patient was back in for their periodontal maintenance appointment if we did scaling and root planing. I am not sure why my current office does the prophylaxis appointment after the scaling and root planing. Is that legal coding? I need to know the proper procedure so I can address this with the other office staff members and we can start the correct procedures accordingly.

Answer: This is accurate coding as long as the work that is being done matches the code. If the work being done does not match the code being used, then it is fraud. It is great that the patient is scheduled with the doctor first for the comprehensive exam and periodontal charting. It is also great to have the patient return for root planing, as long as they are not expecting to have a hygiene appointment that day. If the patient is expecting a hygiene appointment, then something needs to be done – even if just the prophylaxis appointment is completed and root planing is scheduled later. If the prophylaxis is done that day, the hygienist would only concentrate on the healthy areas.

If the prophylaxis is completed, the hygienist would reinforce the need for the patient to return for scaling and root planing by going over the periodontal etiology. Then the patient would return on another day to begin the scaling and root planing. At this scaling and root planing appointment, the hygienist will only be working on the areas that warrant the periodontal therapy.  

Many offices do a prophylaxis prior to root planing because the hygienist is seeing the new patient first, and the patient is expecting to have a prophylaxis appointment that day, not just an exam and x-rays (of course, the laws in your state need to be followed). If the patient has been given financials to review and has accepted treatment, and if time permits for the root planing to start at that appointment, you could go ahead and start the root planing that day. However, many offices do a prophylaxis shortly after scaling and root planing is complete. There are a few reasons for this:

1) The patient took so long to get through root planing, they want the entire mouth cleaned at one time. This way when the patient returns for periodontal maintenance after the prophylaxis, all areas are finished at the same time. Many offices call this a fine scale.

2) The hygienist is able to truly concentrate on the periodontally involved areas during the root planing appointments, thus providing more quality time spent in these areas. The prophylaxis provides additional time to work in the healthy areas of the mouth. 

3) The prophylaxis is a good opportunity to evaluate how the patient’s mouth is progressing. It is also a chance to provide care to the non-diseased areas of the mouth and fine tune the patient’s home care routine before returning for the periodontal maintenance appointment.

All patients should have their first periodontal maintenance appointment no more than three months after scaling and root planing. Patients should not go any longer between appointments until they have been reevaluated and it is determined by the current health of their mouth that they can space appointments out further and still maintain their periodontal health. 

Keep in mind that some insurance plans will not cover the prophylaxis unless it is scheduled a certain number of days after the root planing. Unfortunately, the amount of days is usually longer than what we want, because we still want the periodontal maintenance appointments to begin three months from the prophylaxis. In this case, the patient may end up paying out of their own pocket. It may be best for the Financial Coordinator to include the prophylaxis appointment as part of the patient’s amount that is due, then if it is covered they are happily surprised. 

If a patient leaves the comprehensive exam without knowing they have a periodontal condition that needs treatment, then you have a problem. It is recommended that the patient be informed by the doctor, in person. This allows the doctor to support the need and importance of the scaling and root planing appointment, and the perceived value may increase in the patient’s eyes. This also allows the patient to ask a clinician any questions they may have, rather than an administrative person over the phone.

If the patient is told what is needed by the Financial Coordinator and given the estimated cost before leaving, the case acceptance may also go up. If there are financial concerns, the Financial Coordinator can help reduce these for the patient. The non-verbal communication that is lost by doing it over the phone is enormous. Face-to-face communication is still the best form of communication.

Interested in improving your hygiene department? Email hygiene@mckenziemgmt.com and ask us about our 1-Day Hygiene Training Program or call 877-777-6151

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