Navigating Appointment Cancellations and No-Shows

Ten strategies that can help you protect your practice’s time and profitability

Brett Wells, DDS

As a dentist with multiple offices, I can tell you that recently, running our business has felt like running one of those obstacle course races—dealing with the mud pits of dental insurance, the rope ladder climbs of marketing, and the zip lines of employee relations. The challenges of practice management in today's environment are too numerous to count, but I want to shed some light on one in particular. To many clinicians, it seems like our patients' mindsets have taken a wild turn. They now expect the moon and the stars, often with little regard for our time and expertise. And let's not forget the skyrocketing cancellation rates that we've experienced since the COVID-19 pandemic hit. It's like a whole new level of frustration.

In my dental offices, I've personally witnessed a rising rate of cancellations and no-shows, and research confirms this trend. It used to be that most offices' no-show rates were below 10%. But according to data from Dental Intelligence, now, the average is approximately 11% to 15%, with 10% being considered "good." The loosening of cancellation protocols during the pandemic allowed patients to easily bypass our policies, and this leniency, among other factors, has resulted in a snowball effect. But don't despair; it's not all doom and gloom. If you haven't yet addressed the cancellation problem at your practice or if you just have no idea where to even begin, here are 10 strategies that have helped us immensely at our practices.

1. Have a Policy in Place

Don't let appointment cancellations catch you off guard. Implement a policy that mandates a minimum 24-hour notice for cancellations (or even better, 48 business hours), and ensure that all patients review and sign it as part of their new patient paperwork. Basically, this policy forces your patients to acknowledge that your practice must be notified of any cancellations so that they don't abuse any systems that you have in place. You know the deal.

2. Institute a Fee for Cancellations

Protect your practice by putting a cancellation fee in place. This fee does the obvious: it provides patients with an incentive not to cancel. This is controversial, but I believe it's essential in today's climate. At our practice, for cancellations within 48 hours or no-shows, we typically charge $75.

Clearly document your cancellation fee policy and have patients sign it. When patients call to cancel with insufficient notice, remind them of the policy. For no-shows, be sure to notify them ahead of time that they're about to be charged. And we try to show a little grace when we can tell that it's needed.

Although, yes, you may lose some patients; that's not actually a bad thing. Your patients who typically cancel on you actually cost your practice more money. Therefore, filtering out unreliable individuals can only financially benefit your practice in the long run.

3. Collect Deposits for Scheduled Treatments

By collecting deposits or full out-of-pocket payments up front, you can tackle appointment cancellations head-on. In our office, we require a $75 deposit for appointments that will last longer than an hour (eg, crowns, root canals, implants, scaling/root planing, whitening, etc). When your patients pay for a service before they've received it, they are more likely to not cancel that service. They've already committed. Implementing this strategy has dramatically slashed cancellations on the restorative side for us. No one wants to waste that money.

4. Be Strategic About Scheduling

One technique that we like to use with our patients is to have them "double-check" their calendars at the time of booking to ensure that their proposed appointment time will work because this requires their active effort. In addition, we emphasize the value of the appointment by highlighting specific concerns or benefits, such as mentioning a gum reevaluation during the scheduling of a dental cleaning.

If your practice uses a text messaging service or email reminders, have your team encourage your patients to sign up for it. That way, you can get them actively thinking about their appointment during booking and be reminded of it while they're gone. This plays into the next strategy.

5. Implement an Appointment Confirmation Protocol

We've noticed that using texting and emailing reminder services has significantly lessened our cancellations, and that's because they take advantage of patient engagement pretty efficiently. However, there's definitely a science to it. The formula that we've tested and found to be the most effective includes the following check-in times and actions:

• Two weeks prior. Send a reminder via text/email.

• One week prior. Request confirmation via text/email.

• Three days prior (if not confirmed). Send another confirmation request via text/email.

• Two days prior (if not confirmed). Contact the patient by phone.

• Three hours prior. Send a final reminder via text/email.

This system can help you and your team efficiently stay on top of appointment confirmations and keep your no-shows at bay.

6. Make It Personal

The great thing about using texting and emailing services is that you can spice them up a bit with your own personal touch. Instead of calling your communications "confirmations," refer to them as "reservations" and link each one to a specific provider. For example, you can say, "Hey Betty, just a friendly reminder about the 1-hour reservation that you've got with Courtney this Friday for your dental cleaning. Any questions on your mind?"

This messaging technique is an easy way to help your patients feel more considered and reinforce that a specific individual has set aside time for them, and that's what matters here. When they feel like an important client rather than just a customer, then they're more likely to show up for you.

7. Promptly Schedule New Patients

There's a specific way that we go about scheduling new patients, and it's pretty simple: don't delay. Aim to book them within 1 week or 2 weeks at most. New patients are typically the ones who make up the majority of your no-shows. And we get it. Joining and returning to a new office can be daunting. That's why you've got to act fast. Make them feel welcome, sign them up for your confirmation services, and get that appointment on the books stat. Waiting longer increases the risk of cancellations and no-shows. Get them in the door as soon as possible and keep the momentum going.

8. Consider Double-Booking High-Risk Patients

Yes, you should consider double-booking, especially for patients who are known to present a high risk of canceling or not showing. Consider labeling these patients as "high risk" in their charts to indicate to your team that they can be double-booked. Other appointments that you should consider double-booking include those that are unconfirmed. We're talking about the patients who you've reached out to multiple times in order to confirm their appointments yet you've heard nothing back.

At my practice group, we conducted an analysis of 10,000 patient appointments from the first quarter of this year and found the following:

• Unconfirmed appointments had a 33% no show/cancellation rate.

• New patient appointments had a 12% no show/cancellation rate.

• Hygiene appointments had a 9% no show/cancellation rate.

• Restorative appointments had a 6% no show/cancellation rate.

We know that double-booking can be a little uncomfortable. However, if you know your patients well enough, this strategy can help you and your team optimize your appointment utilization without "breaking up" with your high-risk patients. Just make sure that you carefully consider how it could impact your patient experience, and you'll be good to go.

9. Break Up With High-Risk Patients

We know this sounds a little harsh, but you really shouldn't hesitate to end it with the patients who constantly flake on you. At our practices, if you rack up cancellation/no-show fees and continue to repeat these offenses, we demote you to "same day only" status. These patients need to call in on the day itself to snag an appointment. And if they continue to cancel or fail to show, we bid them farewell. It's all about maintaining a reliable and committed patient base, and the best way to do that is by setting boundaries.

10. Offer a Membership Plan

If you want committed and loyal patients, consider offering a membership plan. In our practice, members are stellar patients—they show up, embrace treatment options, and keep renewing their plan year after year. Because they subscribe to their preventive services, they've already paid, which means they're fully committed. You can streamline this process by implementing an automated software platform that does all of the hard work for you, and you'll likely find that your cancellation rates plummet.

Everybody Wins

Last-minute cancellations and no-shows will always be an unfortunate part of the game, especially in this post-pandemic world. There's no magic bullet, but that doesn't mean that there aren't solutions. By implementing these strategies, you and your practice can reduce the amount of cancellations that you experience, and hopefully, you'll see more loyal patients as well. It's a you win and they win kind of thing, and we all like those.

About the Author

Brett Wells, DDS, maintains a private practice in Raleigh, North Carolina, and is the founder and CEO of DentalHQ, the leading automated software platform for successful membership plans.