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Hi again everyone! Welcome back.

Let me give you a house hunting update before we get down to business.

I found an adorable house but… It’s not on the market yet. How do I know about it? I’m psychic! Either that or my mom’s hairdresser told her. I’ve been stalking it in every possible way. I’ve managed to get inside three times. (Not only am I psychic, I’m also a ninja). There was an auction at the house last week so I was able to visit it even though it’s not even technically for sale. But send all your good house-hunting vibes in my direction, because this is the one 🙂 I’ll keep you posted!

Okay, back to the (important) topic at hand:

Preventing and dealing with no-shows at your acupuncture office.

We’re going to talk about how to set up systems in your office that prevent no-shows, how to get really clear with your patients on your cancellation/no-show policy, and how to handle the different kinds of no-shows and cancellations that happen in your office.

To get a head start, download the workbook below. The workbook has checklists, worksheets, and scripts for those difficult conversations when you might have to charge a missed appointment fee.

(I don’t usually advocate scripts as I think practice management is not a one-size-fits-all kind of thing, but the scripts in this workbook are a great place to start. You can modify them to make them feel comfortable for you.)

This topic comes up all the time in conversations between acupuncturists that I know, either online or in person. Even Google Analytics, which shows me what people type into Google that leads them to my website, has been telling me lately that people are asking how to deal with missed appointments in their offices.

(As always, the internet is a miracle to me. How does the Google Monster know literally everything? Mind blown.)

Seriously, what’s worse than a no-show patient?

Sitting around, waiting for them to make an appearance… 5 minutes late… 10 minutes late… 15 minutes late… you know at this point they’re not coming. The frustration! As if you didn’t have better things to do than sit around and wait for them.

No-shows used to drive me crazy. Nothing was more rude, in my mind, than the person who missed their appointment and was so careless about it that they couldn’t even bother to call to let me know they’re not coming.

I would sit in my office, irritated and miffed, until my next patient showed up and distracted me.

In brief: I used to take no-shows really personally. Like, REALLY personally. I felt like it was a reflection of how little the patient thought of me and my practice. (Drama much?)

Once I cooled off a little, I would remind myself that occasionally no-shows are inevitable, due to emergencies or the simple fact that sometimes people innocently forget.

Though it’s rare, even I’ve been guilty of forgetting appointments with other practitioners. I just forget, or I mix up the day or the time, and then I’m my own worst nightmare: a no-show. But the truth is, people have busy lives and a lot on their plates.

Even if a patient’s acupuncture appointment with me is a priority for them, sometimes the most dedicated, sincere, and organized patients will slip up and no-show. It happens.

Which brings me to my next point:

There’s a difference between the following types of no-shows (and therefore, a difference between how they should be handled):

1. The person who’s usually on time and missed an appointment out of the blue, on accident
2. The chronic no-show patient who is not being respectful of your time

Today’s tips are geared towards the chronic no-shows.

Presumably, these are the ones who are A) making you crazy and B) wasting time that you could be spending with other patients.

For the sincerely accidental, usually-spot-on-time-and-so-happy-to-see-you patients, we’ll touch on how to handle them as well. They require less mental energy and a little forgiveness, in my book. But we’ll get to that later.

Before we dive too deep into this, let’s talk about no-shows versus last-minute cancellations for the purposes of this article.

A no-show is a patient who doesn’t call to let you know that they won’t be able to make their appointment; they just don’t come.

A missed appointment from a cancellation is a patient who calls to let you know in advance that they won’t be able to make it.

There are two kinds of cancellations:

Last-minute cancellations: If you have a cancellation policy that requires people to give at least 24-hour advance notice, then last-minute means anything within 24 hours of the appointment.

The idea is that they’re calling too close to the appointment time for you to reasonably be able to find another patient to fill their appointment slot. For this reason, last-minute cancellations are not much better than no-shows. However, they are certainly more polite.

Cancellations at least 24 hours in advance of their missed appointment: (Or with enough advance notice to satisfy whatever your cancellation policy dictates.) Self explanatory.

What I’m talking about today includes how to prevent and deal with both no-shows and last-minute cancellations.

I don’t worry much about people who cancel with more than 24-hours advance notice. They were polite and let me know in advance, and thankyouverymuch for that.

So when I’m talking about how to prevent no-shows, I’m also including last-minute cancellations as well.

So what do you do?

No-shows used to make me nuts until I got better about three important things:

1. Making an effort to be more zen about no-shows and deciding not to take them personally.
2. Creating a cancellation policy and being prepared to implement it.
3. Being very clear with patients about my cancellation policy so there is never any surprise or confusion.

We’re going to talk about all three points. But let’s start briefly with #1:

1. Make an effort to be more zen and not take no-shows personally:

Adopting a “zen” attitude means (to me) accepting that I cannot control everything. It means realizing that even after I put my cancellation policy in place and got very clear about charging for missed appointments, no-shows are still going to happen occasionally.

(This Type A personality takes a deep, deep breath into her belly and repeats her life manta: I cannot control everything. I cannot make people do what I want them to do. I will let go of the outcome.   >>    So, I’ll let you guys know when I’ve fully embraced this concept. I’m still… how would I phrase it?… not so good at this. Can you relate?)

Some things are always going to be out of my control. (Gasp!) I know. I want my day to go exactly as I planned it; exactly as it appeared on the schedule. But I can’t control other people.

I feel like this is one of the major life lessons that I’ve learned from being an acupuncturist. I can’t make people listen to my advice. I can’t make people live a healthier lifestyle.

I can only do what’s within my power to convince them to take my advice. After that, it’s in their hands.  The same goes for no-shows and cancelled appointments. I can only do my best to prevent no-shows by making sure that my cancellation policy is clear and my patients are aware of it. After that, I must take a zen approach: that certain things in life will always be out of my control. Se la vie.

In addition, it helps me to remember that people are rarely thinking of me when they make decisions. When they no-show or cancel at the last minute, they’re not thinking, “I hate Michelle and I hate acupuncture and I never want to go back to that place.”

No. They’re probably thinking, “What am I going to make for dinner?” Or, “I’m nervous about those needles and not sure I can go back for my second appointment and I’m too embarrassed to call.” Or something – anything – that has nothing to do with me. It ain’t all about me, so I don’t take it personally anymore.

2. How to Create a No-Show/Cancellation Policy for Your Acupuncture Office:

To create your cancellation policy, there are a few things you have to decide:

1. How many hours in advance must a patient cancel in order to avoid being charged the no-show fee?
2. How much should you charge for no-shows or last-minute cancellations?
3. What kind of wording will you use? How long or short should it be?

This is where the workbook is necessary. The first page outlines everything you need to write up a cancellation policy in the next five minutes.

3. Be very clear with patients about your cancellation policy so there’s never any surprise or confusion.

Okay. So you’ve created a Cancellation Policy. Now, how do you make it easy for you to enforce? Because it ain’t ever gonna help if you don’t use it. Use it or lose it, baby:

• Let your patients know it exists (in repeated, but gentle, ways).
• Outline rules for yourself to follow on how you plan to use it.

Why #1? If you feel confident that your patients are all aware and clear on your cancellation policy, you’re less likely to feel guilty about putting it into effect. (I know you feel guilty/weird about it, or you wouldn’t be reading this.)

Why #2? I know sometimes it’s hard for acupuncturists to say the words, “You missed another appointment, and I have to charge you a fee.” So the better prepared you are for it mentally, the more likely you’ll actually do it. At least that works well for me. If I’ve already decided how I’m going to do or say something, then it rolls off my tongue more easily. Then the decision stress is removed from whatever the action is.

So if it helps you, decide ahead of time exactly when you want to put your policy into effect. In other words, under what circumstances will you waive the fee? Under what circumstances might you feel it’s still necessary to charge  them, but maybe you’ll discount the fee? Etc. etc.

If making rules ahead of time doesn’t float your boat, that’s fine. You can be flexible with how you enforce the policy, and you can do so on a case-by-case basis if you prefer. Whatever. However your brain works to make you feel more comfortable with the idea of enforcing the policy, do that.

How do you let your new and current patients know about your cancellation policy in a friendly (low-pressure) way?

• Add your cancellation policy to your initial patient paperwork
• Add your cancellation policy to the back of your business card, under the appointment reminder section
• Create handout of the cancellation policy to give to regular patients as they come in for treatment
• Make signs with the policy for your office
• If you have an email newsletter for your patients, send out a friendly email about the new policy
• Consider mentioning the new no-show policy on office voicemail for a few weeks

Again, the worksheet is helpful here. All of these and a few more ideas are outlined in the checklist.

When letting your patients know about your new (or updated) cancellation policy, feel free to include an explanation of why the policy is important. For some patients, understanding the “Why” makes it meaningful for them and more likely to be respectful of the policy/able to take it seriously.

You can explain, for example, that you need a cancellation policy because:

Whenever you make an appointment, you have that time set aside specifically for that patient. If they don’t give you adequate warning about not being able to come, then you won’t have enough time to fill that time slot with another patient from your wait list.

All right. So you’ve done everything you can to prevent no-shows. How do you deal with the occasional no-shows that are going to happen?

The workbook has the scripts I like to use. This is a rough outline of how I go about deciding whether a no-show is a serious enough offense that I need to charge them the fee.

Again, I don’t usually advocate using scripts because what feels comfortable for me to say might feel unnatural coming out of your mouth, and vice versa. I included the scripts in the workbook because I feel like it’s helpful to have a starting point. But modify them however you need to.

Here’s a rundown of my plan of action with a patient who ends up being a no-show:

• After a patient is 10-15 minutes late, I give them a friendly call. If they answer and say they aren’t coming, I find out why. If they totally forgot and have never done this before, I usually give them a pass on the fee but let them know that I am giving them a pass this time.
• This is important. Let them know that you have a cancellation policy, but because it was an honest mistake, you’re not charging them. If you tell them you have a cancellation policy, then the next time it happens you can feel even more justified in charging them, because you know they’re aware of the policy.
• If they don’t answer, I leave them a message letting them know that they had an appointment they are late for but that I hope they’re on their way. I also drop in there that there’s a missed appointment fee if it turns out they can’t make it.
• If it’s their first missed appointment I let them know I might be able to waive the fee, but I need them to call me. I almost always waive the fee for first missed appointments, but I want to talk to them so I can reinforce my point above: that I have a cancellation policy and I’m waiving it for them this one time.
• Otherwise, if they no-show and I can’t get in touch with them for over a week, or if this is a repeated no-show, I would send them an invoice for the missed appointment fee in the mail.
• People do pay the fee! You’d be surprised; sometimes patients even pay the fee before you even get a chance to charge them. They know they missed an appointment, and they just send a check in the mail.

However. If someone has no-showed on you more than twice, it’s time to consider some tough love.

My favorite method of handling this is to tell the patient that you can’t put them on your schedule because of how often they don’t come for their appointments. It takes time away from patients who could have that time slot. So you won’t schedule them in advance, but if they want an appointment, they can call you on the day of and ask if you have any slots open. That way you’re putting them in a time slot where you didn’t already have anyone scheduled, and if they no-show (as they often do), then it’s not a loss for you.

Telling patients who no-show multiple times that you aren’t willing to put them on your schedule might seem harsh but at that point it’s time for some tough love.

They’ve been ignoring your no-show policy already, and they clearly don’t respect your time.

You’re teaching them that if they are going to be your patient and enter into a cooperative and productive patient-practitioner relationship with you, they need to respect your time, as a clinician and a business owner.

If you’re worried that patients will be offended and not come back to your office:

Some acupuncturists worry that patients will be offended if you charge them a fee. Again, remember the difference between the chronic no-show and the patient who is awesome but just accidentally missed one appointment.

For the person who honestly forgot, I don’t usually charge them. I let them know I’m waiving the fee, which they appreciate.

And, like I said above, for first-time offenders who have never missed an appointment before, I usually waive the fee. I feel like this makes it almost impossible for people to be offended if I do have to charge them later on. It means they’ve already missed one appointment and we’ve had the chance to discuss the policy out loud. So no surprises there.

For people who have no-showed or last-minute-cancelled on you repeatedly, it’s time to charge them even if you think they might not be thrilled about it, for the reasons discussed above.

If they decide not to come back because you charged them a puny little no-show fee, maybe you’re better off. They were making you crazy anyway, weren’t they? They were messing with the energy in your office, wreaking havoc with your stress levels, and not being respectful of your time. So do what you gotta do and don’t worry about their reaction.

And finally, I don’t think most people get too upset about a cancellation policy being enforced.

Why? Because cancellation policies are standard in other medical offices. Does your MD worry about offending you if you miss an appointment and you get a fee invoice in the mail? No, she doesn’t. She knows you signed the paperwork (even if you didn’t read it thoroughly, that’s not her problem), and she sends you the invoice.

If you’re really stressed that people will be offended to receive an invoice for a missed appointment, considering cutting them a little break. For example, if your missed appointment fee is $35, then let them know that, but say you’re only charging them $25 because it’s rare for them and it was probably an accident.

Again, download the workbook for more specific steps to help you actually put all of these tips into action.

Those are all my tips for preventing no-shows in your office. Make it happen and stop letting the no-shows stress out your life:

• Get that cancellation policy in place.
• Use these tips so you don’t feel worried about implementing when you need to.
• And ultimately, once you’ve done everything you can do to prevent no-shows, be like Elsa – Let it go.

Question: How do you deal with no-show and last-minute cancellations in your office?

Please let us know in the comments below!

The more we share with each other, the better decisions we can each make for what works in our individual practices.

Cover image via Pexels.

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