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Tips for managing failed, broken and rescheduled appointments

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Tips for managing failed, broken and rescheduled appointments

Failed and broken appointments are a massive drain for the practice.

It’s a lost opportunity to help a patient, so it’s important to understand and figure out why they happen and to learn how you can prevent them.

The goal will be to retrain the patients about their appointment. It’s important they know this is a time that’s reserved just for them.

And then you need to monitor how well things are going with the broken appointments and look for improvements .

The difference between a failed, broken and a rescheduled appointment

So first let’s define what’s the difference between a failed appointment, a broken appointment and a rescheduled appointment.

Failed appointment

We’ll say a failed appointment is a no-show when a patient isn’t there at the time of the
appointment, no notice has been given by the patient and it’s the appointment time or later and we haven’t spoken to the patient prior.

We might call them on the phone, reaching them on the phone at the appointment time or after the appointment time, but pretty much if they’re not there by the appointment time and we haven’t heard about it before their appointment time, that’s a failed appointment.

Broken appointment

A broken appointment is an appointment that was changed with less than 24 hours’ notice.

The patient is calling the office to reschedule the appointment, but there is less than 24 hours until the appointment time, making it a broken appointment.

So it has to be from less than 24 hours before the scheduled appointment time or up until almost the time of the appointment to be considered a broken appointment because the patient is not giving us more than 24 hours notice to reschedule.

Rescheduled appointment

A rescheduled appointment would be when a patient calls more than 24 hours in advance of the appointment and gives us more time to change the appointment so it can be used by another patient.

What can we do to improve these failed, broken and rescheduled appointment?

First thorough documentation is necessary.

You need to know the frequency and the reasons these things are happening so that you can improve them.

You can’t really prevent them without an understanding of how the patient thinks about and feels about these appointments.

So you need to ask what are the patients saying?

When they call to break an appointment.

Are they giving you reasons? Are they giving you excuses? You need to document these.

You need to ask the patient, “tell me again why is this appointment being broken? I need to record this in your chart and know what to say to the doctor when he asks.”

And then write this information down.

If it’s a broken appointment, less than 24 hours notice given or a failed appointment with no notice given by the patient, you need some documentation after talking to the patient.

You need to have the belief that patients can be trained to behave differently once they understand the policy.

That’s the goal here. To change the behavior of the patient and to encourage them to prevent these broken appointments.

You want a system that trains the patients to keep their appointments. This is not about trying to punish anyone. You just know this is valuable time, extremely valuable time that can’t be wasted as an opportunity to help a patient.

So from the very first phone call when you make the appointment, you need to review with the patient that this is a valuable time reserved just for them, and this is a time when you’ll be here for the patient and we need more than 24 hours’ notice to reschedule an appointment.

If someone does call less than 24 hours and it’s a broken appointment, let them know that this is a broken appointment, tell them “we’re looking forward to seeing you. What’s going on?” Make this a teachable lesson.

Help them know that these appointments are valuable. It’s not easy to reschedule and tell them, “let me see when the next available appointment is open.”

Sometime in the future you can set the time, maybe it’s 30 days away, but we want to be in the habit of changing the behavior and reducing these broken appointments. 

Your tone of voice will be helpful because patients have to be able to hear your disappointment, they have to hear how you feel about this broken appointment.

So let the disappointment come through to the patient, just letting them know that it’s a disappointment.

If this is the first time it’s happened with a patient, you could go ahead and reschedule them a certain number of days into the future and you may or may not want to consider locking the account, which requires signing a form prior to rescheduling.

But we can talk more about locking accounts ahead and how that tool can be used. The important thing to remember is to document the call conversation. We want to be sure other staff members will be aware of what the patient was told and know the expectations for the future.

What to do when patients break appointments?

You may or may not use the locked account if this was the first broken appointment and the patient has called 12-24 hours in advance to change the appointment because luckily it wasn’t a failed appointment.

You may just tell them, “perhaps I never told you or maybe you forgot. But we typically have a broken appointment policy when there’s less than 24 hours’ notice you have a form that you have to sign to unlock the account when appointments are broken, I’ll make an exception this time, but I’m going to note it in your chart.”

Then you can reschedule the patient for 30 days or whatever the time period is in the future without having them sign the locked account form.

But again make a note in the chart not only the the reason the patient gave for breaking the appointment but also record the consequences for other staff to read in the future.

If it’s a second broken appointment, and they’re calling 12 hours in advance again, and you have already had that warning conversation, you can have a slightly different conversation.

You can definitely take the time to express disappointment and the comments used before.

And then also mention to the patient when appointments are broken, the office is not going to be able to fill that appointment in time. There are so many other patients that are waiting for their treatment, and it’s going to be practically impossible for us to call one of these patients with such a short notice and to see if they can come in, make sure the patient knows what’s going on and why you are disappointed.

Consider if it’s worth rescheduling the patient for a second broken appointment or probably you could use the tool like locking the account where paperwork needs to be signed before rescheduling and a certain amount of time is waited.

But if it’s the first time for a failed appointment, and no notice was given by the patient, it’s now the time of the appointment or later and we haven’t heard from the patient, then from the first failed appointment, the patient has to be handled in a slightly different
manner.
You may not have a conversation with the patient on the phone if you weren’t able to reach them. You may just send a broken appointment letter.

But if it’s past the appointment time and then you’re able to call and reach the patient, express the disappointment using the same type of comments we discussed before, but you also have to express that why it’s so significant that failing your appointment and not calling ahead is so disappointing.

You have to explain to the patient, there were other patients who wanted the treatment at the same time and we told them no because we were expecting you and we just can’t have this happen again.

So if no contact was made on the phone with the patient, go ahead and follow the protocol, which might be locking the account and requiring a form to be signed before rescheduling.

Make a note in the chart to wait a certain number of days to reschedule and send a letter to the patient. If the patient insists, if you are able to reach the patient and they insist they’d like to be rescheduled, this might be a good time to ask for a deposit. If someone wants to avoid coming in person to sign to unlock the account, they can pay a fee- like $25, on the phone with the credit card and they don’t have to come in, or otherwise they can stop by the office and sign the unlock form without paying.

So these are two tools that are not punishments, but you are just trying to change the patient’s behavior.

If the patient doesn’t want to make a deposit and they don’t want to sign the form, then you have your answer about their commitment to future appointments. 

And at least now instead of finding out on the day of the appointment when they don’t show up, we know now how serious they are.

What is locking an account from scheduling more appointments?

This is just a process where patients are noted that no further appointments will be made until the patient stops by the office to sign some paperwork to unlock the account.

Previously scheduled appointments may also be cancelled until this is done.

Then appointments will be made after the account is unlocked for a later date. There may be
some waiting period.

The goal of locking an account is to change the behavior pattern, and reduce failed appointments, even if we’re not charging a fee.

And then the next thing is monitoring progress. So staff should monitor how well they’re doing with broken appointments and failed appointments.

You can run reports to see how many codes pop up and hopefully they’ll decrease over time.

Preventing the broken appointments and the failed appointments along with re-educating your patients is a continuous process that requires constant team attention and focus.

Managing broken, failed, and rescheduled appointments

Take time to review the appointment policy with the patient prior to scheduling. Ask the patient for commitment. “Will you call us more than 24 hours in advance if you need  to reschedule this appointment?”

The key takeaways is to record all the broken and failed appointments in the notes and be sure patients know and understand how the appointment system works. More than 24 hours notice from the appointment time is needed to reschedule without breaking or failing the appointment. 

Appointments are reserved just for the patient and this message needs to be shared withthe patient.

The doctor and the staff can mention to the patient that they noticed the recent changes or cancellations at the next visit. This way the patient knows the clinical team is aware.

And this is where the system and the protocol comes full circle and has the impact with the patient, with the team working together you can really make that happen.

Document all the broken appointments and failed appointments in the record!

Place a note beside any patient’s name or in the appointment note for patients who tried to change or reschedule an appointment and the appointment coordinator was successful in discouraging them because we want to then thank the patient for keeping their
appointment. And we need to be on time!

If the patient calls to cancel , don’t respond. “Okay, let us know when it’s convenient for you to come in for the appointment.”

The appointment is to help them with their health and it’s important for them to have this appointment. So we need to make an effort to keep the patients, help them keep their appointment and ask if there’s a way that we can help them keep their appointment.

And don’t ask, “do you want to reschedule now or call us when you are able.”

Instead, it’s better to say, “let’s reschedule your visit now”.

If the account is locked, encourage the patient to pay $25 or come in to unlock the account as soon as possible so that we can get them re-scheduled again. Let them know we want to to see them.

Do not threaten the patient. Get them to see your side of the situation. Help them recognize they broke the appointment and they should have contacted you with more notice about their appointment. So it’s okay to sound disappointed if they cancel appointments without adequate notice.

The goal is to reduce the broken and failed appointments through communicating and educating your patients.

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