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How to prevent no-shows in your practice


No-shows and cancellations are an annoying part of any optometry practice. They are disruptive and costly, but mostly they are rude.

No-shows and cancellations are an annoying part of any optometry practice. They are disruptive and costly, but mostly they are rude.

There have been a variety of strategies employed over the years to minimize the impact of these aggravating realities, but none have been successful at alleviating them.

Our industry is not alone in this battle to make sure that appointments are kept and customers meet their obligations. Many of our attempts to decrease no-shows have been modeled after others industries.

Previously from Dr. Rothschild: 5 zones of your practice that need TLC

How other industries do it

No-shows are probably most common in the airline industry.

So many things impact your ability to get on every plane-in every city-every time.

Weather, delays, and travel to the airport all play a major role. Multiply that times the number of people who fly every day, and it’s amazing we ever make it on time.

It used to be relatively common to board a large airplane with only a handful of people on it. The expense of a semi-filled plane finally became too much to absorb, and the airlines adjusted. Now most flights are full-no matter what.

How do they do it? They over sell.


Airlines have had a bigger no-show problem than the rest of us, and the industry has done a lot to minimize the problem.

Airlines now commonly over-book flights, meaning they sell more tickets than they have seats available. If too many people show up, then gate agents bribe the passengers to take the seat of a no-show on another flight. They say, “If your travel plans are flexible, we can offer you a travel voucher for $200, $300, $400.”

Would it work in eye care? Yes, but I don’t recommend using it.

The airline industry’s effective policy to combat no-shows seems to be working, but the tradeoff is an ever decreasing level of customer satisfaction. We continue to be customers of airlines, mostly because we feel like we have no choice-and they know it.

Related: 3 steps to staff empowerment

Eye care is not to the point where we can turn our patients away because “the other 2:00 p.m. appointment” showed up first.

That would be rude, and we are not rude people.

Some advocate overbooking your schedule to account for no-shows and moving faster through your scheduled appointments if everyone does show up.

That works, but I argue that if you are routinely putting yourself in this situation, you are cheating your patients by rushing though exams and not giving each patient the attention he deserves.

Which, in essence, is also a little rude.

Non-refundable deposits

Some hotels now employ the non-refundable deposit technique when making a reservation to decrease the amount no shows.

The logic is that if you have already paid a deposit, you will make every effort to keep the reservation.

However, if you do become a no-show, we already have your money.

Some practices go down this road.

The $20 cancelation fee that we print on our appointment cards to threaten no-show patients is the offspring of this technique.

Most of the time, practices don’t actually bill the patients the fee because that would be rude-and it may cost you the patient. Yet, it is put on the appointment card to demonstrate how important it is that you keep your appointments with us.

Related: Stop cheating your patients

Are you really going to send your patient a no-show bill for $20, then ask her to come back?

Feels a little rude to me.

No-shows are rude, but sometimes they are simply unavoidable. In eye care, the most effective method of fighting no-shows is to make it clear that it is rude.


Which is ruder?

Here are two scenarios that we optometrists love so much:

1.You are passing through a town where your family lives, and think it would be nice if you can connect while you are there.

You call and say, “Maybe I can drop by and visit for a few minutes if it isn’t an inconvenience to you.”

If it doesn’t work out, you call to and say, “I am so sorry, maybe next time.”

2. Your family member invites you to a special event at her home. You accept and tell her you will be there to spend the night.

She cooks your favorite meal, prepares your room, and shares with you all the things you can do during your visit.

When she calls to see where you are, you let her know that something suddenly came up and you won’t be making it after all.

Which is ruder-one or two?

Related: Why you need a practice mission

No-show reduction systems

We all employ some type of system that is designed to minimize no-shows and cancellations.

This system is an intricate network specific for our practice and depends on a number of factors-including whether or not we pre-appoint exams (Pre-appointments always increase no shows, I have found).

We employ reminder calls, which are sometimes strengthened to confirmation calls.

Sometimes we will cancel appointments that we haven’t confirmed-allowing an overbooking scenario.

We email, text, and even send postcards.

Technology allows us to automatically work this no-show reduction system through a variety of techniques. Even the act of verifying insurance and completing paperwork prior to the visit is intended to help with no-shows.

We all put a lot of energy, time, and money into helping patients remember their scheduled appointments.

But is it coordinated properly and setting the tone you wish to set?


Evaluate your current no-show policy

Look carefully at your entire system.

The fact is that when no-shows get out of hand, we try to fix them by adding a new solution without considering what we are already doing.

Every action you employ should work cohesively and use the same language in getting patients to keep their appointments.

Review the whole process at the same time and envision these messages across the entire span of time that the appointment exists.

The largest example may be the pre-appointment-an appointment one year from now.

Related: 5 tips for planning a successful event at your practice

Look at the appointment card, is it hand-written or printed from EHR?

Are you going to mail a postcard? When? What does it say?

Have you subscribed to an automated service that sends text messages or emails? What do those messages say?

Who makes phone calls? Professionals who just make great calls or a worn-out staff at the end of a busy day?

What if you can’t reach patients? Do you leave a message or simply keep trying until you get someone on the phone?

Key techniques to employ

“We are beginning to get ready for your visit,” and “We are ready and looking forward to seeing you.”

These two phrases, when properly timed and put into the appropriate reminder system, have been the most effective at reducing our number of no-shows.


They don’t work in a quickly worded voicemail message, but they do if the intention of each phrase is communicated well. These phrases should be the cornerstones of your reminder/confirmation system and should be included in all communications.

About one week out, make it clear that you are, “beginning to get ready.”

“We are looking over your record from last year, we are verifying your insurance, and we are asking if you have any special concerns we need to address at this time.” In the world of EHR, there is no reason to not begin documenting concerns prior to the visit.

One or two days before the appointment, make it clear that you have been doing your part.

We have verified your insurance, or at least tried. We asked you about your concerns and we know what is on your mind. We know what you need, what you want, and we are ready for you. We are looking forward to your appointment.

Related: Recovering from a fire in the optometry practice

Follow up

If the patient doesn’t show up, call to express concern and reiterate how much you did to get ready for him. Rudeness is a tough habit to break, especially when patients don’t know it’s rude.

We have more tools available now than ever before to stay in touch with our patients.

The techniques you employ must be well coordinated and match the personality of your practice.

I still believe that hearing a friendly human voice is the most effective method of communication-especially when dealing with the reduction of no-shows.

My practice employs a calling service who makes these calls for us, and it is worth every penny.

Calls matter, but they don’t work if an overworked staff rushes through them at the end of the day.

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