What to Do When Patients Miss Appointments

By: Peter G. Fernandez, DC

Preventing patients from quitting prematurely is one of the most important procedures in a Chiropractor’s practice. There should be a concentrated attempt by the CA to keep a patient on his treatment schedule or from prematurely dismissing himself from care.

Keeping patients on their prescribed treatment schedule is imperative—for the patient’s health benefit. The doctor has recommended a specific treatment frequency to heal the patient. It’s the frequency of care that produces the optimum results. Anything interfering with the patient’s frequency of care interferes with his recovery. If a patient decides to come to your office once per week rather than the prescribed three times a week, he will get well two-thirds slower—or not at all. This is not acceptable. Remember, your job as a professional CA is to reinforce the doctor’s prescription of care.

The second reason a CA must attempt to keep a patient on their prescribed treatment schedule is malpractice liability. When a doctor places a patient on a treatment schedule and the patient misses an appointment and the CA doesn’t repeatedly attempt to reschedule the patient, the doctor then becomes guilty of malpractice because he/she has abandoned the patient. For this reason alone, the re-appointment procedure must be followed to the letter.

The Cost of a Missed Appointment

Another factor to consider is the tremendous financial loss to your practice when patients miss their appointments. Why is a financial loss of concern to you? Without adequate finances your salary won’t be able to be paid, you won’t get raises or bonuses, and the practice may suffer to the extent of closing. For example, if your doctor averages $50 for an office visit and works an average of 250 days a year, one missed or broken appointment a day will cost him $12,500 per year.

Two missed or broken appointments per day will reduce his income $25,000 per year. Four missed appointments per day result in $100,000 a year loss.

This amounts to $8,333.33 per month. That could pay the rent, increase your salary, give you bonuses, make the monthly payments on a new clinic building, or perhaps be used on advertising to double your practice income.

Reluctant to Call a Patient Who Missed Their Appointment?

Some CA’s are reluctant to call patients to reset their appointments because they fear the patients’ answers. The CA thinks the patients will say, “The doctor hurt me,” “Chiropractic doesn’t work,” “I can’t afford the care,” etc., etc. These answers are extremely rare, less than one percent. Research, by consultants, has shown the four main reasons patients state why they missed their appointments are: (1) they forgot, (2) they feel better, (3) there is a scheduling mistake, and (4) they are too busy. Frankly, patients appreciate the reminder/confirmation calls.

Common Objections to Rescheduling Appointments, and the Proper CA Responses

Too Busy

Patient: “I’m sorry I can’t keep my appointment this morning. I have to go to the beauty shop.”

CA: (Don’t say: “That’s okay.” Instead say: “I understand.” Then educate the patient on the importance of making up their missed appointment. Then re-set their appointment.) “I understand, but it’s very important that you not break up the frequency of your adjustments. It’s the frequency of your adjustments that will get you well. It’s like going to an orthodontist for braces for your teeth. He’ll put you on a schedule of once – twice a week to tighten the braces. It’s the frequency of tightening the braces that will straighten your teeth. The same is true of your care in our office, it’s the frequency of your adjustments that will correct your spinal subluxations (misalignments). I have an appointment time available at 3 or 5 this afternoon. Which would you prefer?”

Patient: “I’ll take the 3 p.m. appointment time.”

Patient: “I can’t make it in today. My schedule is too hectic.”

CA: “I understand, but it is important that you follow your treatment plan in order to help you get maximum correction in the least amount of time. It’s the frequency of your adjustments that will get you well. It’s like going to an orthodontist for braces for your teeth. He’ll put you on a schedule of once – twice a week to tighten the braces. It’s the frequency of tightening the braces that will straighten your teeth. The same is true of your care in our office, it’s the frequency of your adjustments that will correct your spinal subluxations (misalignments). Please don’t do anything to break up the frequency of your adjustments. Will you be able to come in tomorrow morning or afternoon?”

Patient: “I’ll just come in on my regular schedule …”

CA: “I understand, but it’s very important that you not break up the frequency of your adjustments. It’s the frequency of your adjustments that will get you well. It’s like going to an orthodontist for braces for your teeth. He’ll put you on a schedule of once – twice a week to tighten the braces. It’s the frequency of tightening the braces that will straighten your teeth. The same is true of your care in our office, it’s the frequency of your adjustments that will correct your spinal subluxations (misalignments). The doctor wants to get you in later today at ___ or ___ (or tomorrow at ___) so you can keep on your schedule—it’s really important.”

The above scenarios will work in many cases when the patient understands why they need to remain on their recommended treatment schedule.

Treatment Frequency

Patient: “Look, I just can’t come in every day. I’ve got a lot of things to do.”

CA: “Jane, it seems like a lot of visits, but your problem is severe and is compounded by the tension of the busy schedule you have. That’s why Dr. ________ scheduled you three times a week …. to get maximum correction in the least amount of time. It’s very important that you not break up the frequency of your adjustments. It’s the frequency of your adjustments that will get you well. It’s like going to an orthodontist for braces for your teeth. He’ll put you on a schedule of once – twice a week to tighten the braces. It’s the frequency of tightening the braces that will straighten your teeth. The same is true of your care in our office, it’s the frequency of your adjustments that will correct your spinal subluxations (misalignments). I’ll do my best to accommodate you on times. Once you see the results you will get, you’ll be glad you made the effort. Which is best for you—morning or afternoon?”

Financial Problem

Patient: “I want to cancel my appointment… I’m worried about the cost. I’ll wait until I know what my insurance will pay.”

CA: “I appreciate your concern about payment, but let’s not let it interfere with or delay your progress. Please continue to take care of the payments as you have agreed to and let us worry the about the delayed payment from your insurance company. Your health is first, finances second. It’s very important that you not break up the frequency of your adjustments. It’s the frequency of your adjustments that will get you well. It’s like going to an orthodontist for braces for your teeth. He’ll put you on a schedule of once – twice a week to tighten the braces. It’s the frequency of tightening the braces that will straighten your teeth. The same is true of your care in our office, it’s the frequency of your adjustments that will correct your spinal subluxations (misalignments). I have appointment times available at ______ and ______. Which would you prefer?”

Patient: “I can’t afford it …”

CA: “I realize it’s a difficult obligation. But you should come in and discuss it with the doctor. I know it’s sometimes embarrassing, but you know the doctor will be more embarrassed than you if he heard you stopped coming for your treatments because of the cost. Let’s get you in to talk it over with the doctor. I have an appointment available today at ____ or _____. Which would be most convenient for you?”

Sick

Patient: “I am sick…”

CA: “Oh, I’m sorry to hear that. What seems to be the problem? Let me put you on hold while I tell the doctor of your illness.” (After pause) “The doctor does want you to get in to see him tomorrow so he can take care of your health problem. I have appointment times available tomorrow morning at ______ or _______. What time would be convenient?”

Patient: “I have been ill…”

CA: “We were sure that was the case. That’s why the doctor asked me to call and set up an appointment later today at ___ (or tomorrow at ___).”

Feels Better

Patient: “I feel fine and won’t be coming in any more.”

CA: “I’m delighted to hear you are feeling good. But don’t make the mistake of stopping your care without talking to the doctor. I know Dr. Fernandez will have special instructions if you aren’t going to be coming in regularly. Could you come in and talk to him later today? I have appointments available at ___ or ___. Which would you prefer?”

Patient: “That last adjustment really did the trick. I feel great.”

CA: “That’s fantastic! However, remember when Dr. _______ talked about relief and correction? You’ve gotten relief, but it’s important that we finish the job to make certain you continue to feel great. It’s very important that you not break up the frequency of your adjustments. It’s the frequency of your adjustments that will get you well. It’s like going to an orthodontist for braces for your teeth. He’ll put you on a schedule of once – twice a week to tighten the braces. It’s the frequency of tightening the braces that will straighten your teeth. The same is true of your care in our office, it’s the frequency of your adjustments that will correct your spinal subluxations (misalignments). Would you rather come in this morning or this afternoon?”

Problems

Patient: “I had car trouble.” or “I missed my ride.” or “I have a baby sitter problem.” or “There is a sickness in my family.”

CA: “I’m sorry to hear that. Could you make other arrangements because it’s the frequency of your adjustments that will get you well. It’s like going to an orthodontist for braces for your teeth. He’ll put you on a schedule of once – twice a week to tighten the braces. It’s the frequency of tightening the braces that will straighten your teeth. The same is true of your care in our office, it’s the frequency of your adjustments that will correct your spinal subluxations (misalignments). Let’s reschedule your appointment and get you in here later today (tomorrow). We are here until _____ p.m. We open in the morning at _____ a.m. Which would you prefer?”

Mistake in Appointment Time

Patient: “I thought my appointment was next week…”

CA: “That’s why the doctor wanted me to call to clarify your schedule. He wants to see you today at ___ or ___. Would that be convenient for you, or we can make it tomorrow at ___ or ___.”

Measuring the Effectiveness of Your Reactivation Phone Calls

Once a CA utilizes these re-appointment scripts for a few months and becomes comfortable with them, she can expect a 98% rescheduling rate on the day of the missed appointment, a 45% rescheduling rate the next day, and a 5% rescheduling rate one week after a missed appointment. This procedure is very effective in rescheduling patients… if it is done promptly. The longer the time between the missed appointment and the re-activation call, the less response can be expected.