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Payments for no shows

Discussion in 'Practice Management' started by scpg-anne, Jun 29, 2010.

  1. scpg-anne

    scpg-anne Member


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    I would appreciate any information any practice has on how to deal with patients who just don't show up and don't let you know. I suppose it depends on whether they are new or ongoing patients but we have several chronic offenders who nearly always change their appointments at the last possible moment. How to enforce a payment fine! Help?
     
  2. I would just say to the patients that are repeat offenders next time you change your appointment within 48 hours or don´t show up for the next one, you will not be treated here.

    The fine system I always see as very negative publicity, but if you want to fine then it must be the normal value of your appointment. ie your time. They pay double before you start the next treatment.

    But why not call these patients 48hours before the next appointment as a reminder, much more positive and if they keep saying I forgot sorry can not come just explain that you will not be able to see them in the future due to they not meeting their responsibility to you.
     
  3. Craig Payne

    Craig Payne Moderator

    Articles:
    8
    From what I understand, it is only possible to legally charge someone for an appointment that they fail to keep if you can demonstrate that they knew they would if charged if they did not keep the appointment.

    Just what is required to demonstrate that will vary from country to country.
     
  4. DAVOhorn

    DAVOhorn Well-Known Member

    This is simple.

    Make an appointment with a local Solicitor.

    Fail to attend without giving notice.

    Ring up 2 weeks later and rebook another appointment.

    Whatever they do you should do.:butcher:

    Failure to attend shows NO RESPECT for you or your practice.:deadhorse:

    Recurrent non attendance is a very expensive way to run a practice.

    make it plain that they will be charged for the appointment whether they attend or not.

    And that you will not offer them another appt until such time as they settle the outstanding account.

    Or make an appointment with their business and do not attend.:drinks

    David
     
  5. Craig Payne

    Craig Payne Moderator

    Articles:
    8
    This is in this morning paper:
    Doctors charging up to $50 for being just 10 minutes late for appointments
    Full story
     
  6. scpg-anne

    scpg-anne Member

    Thanks everyone for your opinions. Yes I agree that to resort to the fine leaves a very bad taste in my mouth and of course is not really good p.r. but... We have a couple booked in for the next few days which we will be contacting verbally, as well as our sms messaging service. Mind you we have done that in the past as well but some very rude people just don't turn up on the day. I think we will have to really impress upon them the problem that a cancellation or no show has on the clinic, especially when they are the last on a late night.
     
  7. Paul Bowles

    Paul Bowles Well-Known Member

    But what happens if you are 15 mins late and the doctor is running 25 mins late. Does that mean that the doctor owes you money???

    This is a ridiculous nightmare to enforce in my opinion.

    At our practice we take a sensible approach - all patients at the time of booking are made aware of our cancellation policy. We are generally fully booked on most timeslots - if a patient fails to arrive that timeslot could have been filled by another patient. We could have filled that timeslot if the patient had given us notice.

    In the end business is business and people have to get paid somewhere in the chain of events. Personally I don't think that is unreasonable.

    In saying that we very rarely have to enforce it.
     
  8. DTT

    DTT Well-Known Member

    Hi Anne

    I use the football system for no show's or very late:-

    1 = I tut and let them know I aint happy

    2 = they get a verbal warning

    3 = they get a charge letter for half the surgery fee.

    Now either they pay it .......or they give me a bollox and think they have had it off :rolleyes:

    Either way I get rid of a nuisance from my practice coz if they have paid they NEVER do it again or..... they are sad people to think I really worry about 40 quid they dont come back EVER coz I never forget a name that gives me grief :D and normality and proper fee earning returns ;)

    None of us need a nuisance in our practice, get rid of them and make sure you let them know why !!

    Bloody NHS put up with it that's why they think they can do it to all of us:mad:
    Hope that helps
    Cheers
    Derek;)
     
  9. Pauline burrell-saward

    Pauline burrell-saward Active Member

    why not look at it another way.

    I get my receptionist to phone the day before to remind them. it takes ( on av.) 15secs for a call which if you have a good deal with a phone co. is free 15secs of receptionist time compared withhalf hour of me sitting with no work is good buisiness

    we even have 3 pts who we phone the next day again.

    the majority of no shows are the elderly who just have poor memories, hardly their fault.

    if any one is more than 5 mins late i say i cannot do them as i dont have the time and ask them to make another appointment. they get the message
     
  10. DAVOhorn

    DAVOhorn Well-Known Member

    Dont forget in the NHS we love DNA's

    We get paid:drinks

    Have time to do paperwork

    Have a cup of tea

    Make that important phone call

    Great

    But in PP a total PAIN:craig:

    David
     
  11. Not if you make your own orthotics and the lab is attached to the practice. Sometime the no-show while hits the back pocket has saved my day so I could glue on that cover that I did not do the night before.
     
  12. lucycool

    lucycool Active Member

    Hi Anne,
    Could you not take a percentage of cost - like a deposit - at time of booking? Therefore they would be less likely not to turn up and they pay less when they have their appt?
    Is this done anywhere? I'm a new graduate but used to do this in my old career in childcare recruitment..
    Lucy
     
  13. Lucy how would you do this when a new patient ring up on the Phone ?

    Old patients no problems, but the new ones ?
     
  14. DTT

    DTT Well-Known Member

    That is the problem I think ?

    Once you have the patient they learn "how it works" quickly and unless they have a memory lapse they fall in with the system and all is well.

    It is the new patients that are the ones that make an appointment and are ill mannered and rude enough not to attend or even notify with a simple message.

    I can very often tell when they make the booking on the phone and say to my wife " bet that one is a no show" just by the attitude and questions asked.

    I was talking to a dentist recently and his take was no shows are the main thing that makes him angry in his working life.

    How you stop it I don't know Ive tried ringing them but are usually on answerphone as they expect the call and if you do get them they feed you a load of Bollox anyway so there's not a lot of point in that.

    So I think it just goes with the job :bash:

    Cheers
    Derek;)
     
  15. healthyfeet

    healthyfeet Active Member

    There's no point doing a 3 points and you're out system, its already cost you £100 by then!
    What we do is take a full pre-payment over the phone (or in person) for all new patients. We explain that the patient can still cancel or change the appointment with 24 hours notice, but if they fail, they will be charged 50% of the fee!
    We very rarely have a new patient not turn up!
    for existing patients that fail, we charge them 50% of the fee, and i explain that we both have lost half, that way i don't feel so bad and they understand that we have both lost out!
    Its worth getting a swipe card machine, and it doesn't cost us anything because we add an extra 50p to the fee if they want to use the facility. (Its best to explain that its a fee the bank charges for them to use their card. Its NOT an additional clinic charge!). They can still pay by cash or cheque. They have a choice, and they are used to paying several pounds as a card fee when they book tickets or holidays so no one complains at 50p.
    50p just about breaks us even on the cost of having the facility available with the quarterly rental + charges for each transaction.
    It should NOT be used as a money making scheme, just an extra available service for our patients.
    Hope thats helpful
    Regards
    Martyn
     
  16. DTT

    DTT Well-Known Member

    Hi Martyn

    I take your point

    BUT

    The card companies charge me 3% on every transaction ... AND I REFUSE TO PAY IT !!! + the rental of the card machine + I understand ( at my wife's company) the card companies are now insisting on a dedicated phone line for security reasons so I don't take cards because it is added expenditure for the patients in the final analysis, ( not sure how you work that out to 50p per patient ??)

    £100 on the 3 strikes and out system..... In practice never gets to that stage coz the patient learns or goes before that is reached and in any case would cost me more if I kept them on in the long run AND ...easier than wrestling with the initial charging and losing patients at that stage I'll wager :rolleyes:

    We all have our different ways to sort out these rude ignorant people that have a contempt and disregard for us and our practice, however any way we get rid of them is fine with me......

    BUT

    A local register circulated between local practitioners may be the answer ????

    Cheers
    Derek;)
     
  17. lucycool

    lucycool Active Member

    I still like the card machine option. In other areas - possibly non medical - people would expect to pay a deposit for a service. I agree that the possible service charges are a pain, but a good way to keep you and your clients sane!!? I haven't had one for a few years but certainly didn't have to use a dedicated phone line..

    Cheers!

    Lucy
     
  18. healthyfeet

    healthyfeet Active Member

    I didn't need a dedicated line and 3% is too much! I pay around 1.8% for credit cards but only 29p i believe for switch and debit type cards plus the £84 rental per quarter.
    Martyn
     
  19. DTT

    DTT Well-Known Member

    The dedicated line is a new thing the card companies are employing as I understand from my wife.

    Her company has had 3 card lines installed for transactions, which I understand will become the norm in the future for security ( not 3 lines of course unless you have the turnover that requires it !! :D)

    Martyn

    1.8% per transaction + £84 per quarter I think would work out to around 3% ??

    I must confess to not having looked into it recently so the rates may have changed ,I dismissed it as too expensive when I did .

    Whatever works for you is the right way but I don't on average lose £84 a quarter on no shows ( my surgery fee is £40) so for me it still is too expensive and the risk of the snatch back from your account by the card company at a later date is removed.:eek:

    Cheers
    Derek;)
     
  20. Dear Worried
    All these are problems caused because you are unaware of one of the 4 main areas of your practice namely The Patient Journey.
    This is all the interactions of your patient with your practice. Especially communication.
    I have taught Practice Management to Osteopaths and Chiropodists for many years and if you would like further help please contact me.
    Never forget the mantra 'it works for me' in other words if you are a non confrontational person your practice procedures have to be like you.
    Yours
    Brian Joseph
     
  21. healthyfeet

    healthyfeet Active Member


    I'm completely non-confrontational. A pre-payment saves any confrontation later!
    M
     
  22. healthyfeet

    healthyfeet Active Member

    If its costing you 3% then tell the patients that they can use the facility for 3%. ie. £1.20 on £40! They have the choice.

    If you're only having 2 failed appointments per quarter you're doing well!

    The other reason that i would still recommend the machine is that sales in products such as insoles, off-the shelf orthoses and moisturising creams etc are much increased when a patient can pay by card! Often patients arrive with the exact treatment fee plus their bus fare home so you will lose out on additional sales!
    What do you do in this cashless society when a patient has a treatment by you and then he tells you he doesn't have a penny on him, only a card?
    Regards
    Martyn




     
  23. DTT

    DTT Well-Known Member

    I'm not a salesman Martyn I'm a podiatrist, I Rx orthotics not sell them and as for creams etc...not really into that either have a few if the pts want them they ask and if they haven't the cheque or cash then they can get them next time or come back for them.

    As I said before the main ones I get for no shows are the new ones and frankly if they are that ill mannered they have no place in my practice ( or would not survive) so it's really no loss to me, ( The joys of getting toward retirement , you can afford to be choosy :D )

    I still think £400 a year and 1.8% on every transaction is is too expensive and to put the cost on top of my fee is an unnecessary burden and as I'm still waiting for the competition locally to catch me up fee wise so any increase is unwelcome.

    I don't know if you Rx orthotics but with the card payment you are open to "not fit for purpose snatch backs from the card companies ? ie after the patients foot pain has gone, they complain to the card company the orthotics didn't work so they are deemed not fit for purpose and their payment is whizzed out of your account and you have no say in the matter. It is becoming a very real problem and I understand from friends in different occupations it is on the increase so....

    As I said if it works for you great, but it's definately not for me at present
    Cheers
    Derek;)
     
  24. healthyfeet

    healthyfeet Active Member

    Dear Derek
    We're all podiatrists! You shouldn't fear selling (or prescribing) items that will benefit your patients. It doesn't stop you being a Podiatrist, and i'm assuming you're practising as a business not as a hobby. You should attend one of Alex Catto's talks on 'selling in private practice'. Doesn't your dentist recommend products for you to buy?
    Martyn




    I'm a podiatrist, I Rx orthotics not sell them and as for creams etc...not really into that either have a few if the pts want them they ask and if they haven't the cheque or cash then they can get them next time or come back for them.

    As I said before the main ones I get for no shows are the new ones and frankly if they are that ill mannered they have no place in my practice ( or would not survive) so it's really no loss to me, ( The joys of getting toward retirement , you can afford to be choosy :D )

    I still think £400 a year and 1.8% on every transaction is is too expensive and to put the cost on top of my fee is an unnecessary burden and as I'm still waiting for the competition locally to catch me up fee wise so any increase is unwelcome.

    I don't know if you Rx orthotics but with the card payment you are open to "not fit for purpose snatch backs from the card companies ? ie after the patients foot pain has gone, they complain to the card company the orthotics didn't work so they are deemed not fit for purpose and their payment is whizzed out of your account and you have no say in the matter. It is becoming a very real problem and I understand from friends in different occupations it is on the increase so....

    As I said if it works for you great, but it's definately not for me at present
    Cheers
    Derek;)[/QUOTE]
     
  25. scpg-anne

    scpg-anne Member

    Wow! Didn't realize that this thread was such a hot topic. Over the past few days we have put up some cancellation/missed appointment policies around the reception area and have now included it on our new patient forms which they have to sign now. As to ringing them the day before; we have a sms message service which automatically sends a reminder and others we consider potential offenders we also telephone. However just last week a husband and wife canceled 2 hours prior to a late 7pm appointment. They have to come back as they have part paid for their orthotics but how rude!!!!!:craig:

    Have instructed recpt to remind the patients of the problems they cause for cancellations. Anyway any ideas/suggestions on what is good terminology to include on our policy?:confused:
     
  26. DTT

    DTT Well-Known Member

    :eek: I think there would be many on this site that would disagree with you !!!

    I have never been one to chase pennies and halfpennies, I believe that to be one of the things that hold back this profession.

    I watch the charges at my dentist and I don't see too many things where the profit margin is so low on top ie £1 on a tube of cream less your 1.8%, and which they charge a proper fee ( note my comment about the local competition catching me up fee wise)

    There is a world of difference in Rx and selling Martyn, My patients get exactly what they need medically and I cant hope to have the buying power of say Boots and they can supply the same for less that I can so I send the patient there. They all appreciate the honesty and lack of pressure involved.

    BUT

    I fear we are getting away from the topic of this thread so .....

    Cheers
    Derek;)
     
    Last edited: Jul 6, 2010
  27. Griff

    Griff Moderator

    Suppose that depends on if you believe in posture control insoles... ;)
     
  28. DTT

    DTT Well-Known Member

    Hi Ian

    :D

    I wondered how long it would be after

    Before he is perhaps "enlightened" :D:D:D

    cheers
    D;)
     
  29. Not me.:drinks Great idea. If you want to learn to "sell in private practice" then I'd agree Alex is the man for the job. Anyone who can sell a flat bit of rubber with a 3.5 degree microwedge under the 1st met as not only an orthotic but THE orthotic, or convince someone that by standing on such a thing and bending ones knees 10 times you've strengthened their posture could probably sell anything to anyone!

    Alex, for them as doesn't know, is the UK supplier for Prof Rothbarts magic insoles which make downs syndrome children look normal, cure autism, make your skull shrink, stop droopy eyelids, and make women fertile.

    But for myself, that is not a course of study in which I wish to enrol. As Derek says, there is a difference between treating a patient using items they can buy and selling them stuff. If its what they need it is generally apparent to them that they need it and I've never felt the need for any "special skills" to encourage them to buy it.

    I'm afraid, like Derek, I'm of the "tell them what they need and leave them to decide if they buy it" school of thought. If my dentist told me I needed a certain toothpaste and I bought it from them, then discovered I could have bought it £2 cheaper from the shop across the road, I'd be angry with the dentist. I went to him as a helathcare provider, not a salesman trying to screw a few more quid out of me by selling me something, whether I needed it or not, when he could have just told me where I could buy it cheaper. If he felt he "deserved" more money from me for his expertise I'd rather he just be honest and add that £2 to his fee.

    The only thing patients can buy from me is my time and expertise, and anything they cannot buy themselves (like a pre fab which is hard / impossible for them as patients to source, or a bespoke orthotic). Thats what I expect from my doctor, the staff in my hospital, the nurse at my surgery and what I WANT from my dentist. Trying to sell me products is what I expect from my hairdresser.*

    I think we as a profession should consider which model we aspire to. The medical or the "in store expert".

    Sorry. Bad day. Rant over.

    Regards
    Robert

    * Ok, those who know me know that I tend to periodically do my own hair with a number 3 all over and never go to the hairdresser, but I've looked at hairdressers so I know they do.:eek:
     
  30. RobinP

    RobinP Well-Known Member

    Damn my wife...she must have bought a pair on the sly!

    Robin
     
  31. Mark Russell Theorised that one had to be wearing the insoles when conception took place for them to be effective. If she insisted on wearing her shoes in bed that might be it!!

    Or you might just be kinky of course :eek:;).
     
  32. RobinP

    RobinP Well-Known Member

    This is not the kind of research I am willing to undertake at this moment.

    This is not me but a fairly accurate representation of my houseshold

    Robin
     

    Attached Files:

  33. DTT

    DTT Well-Known Member

    Martyn

    Would that include rothbarts magic insoles/ots orthoses by any chance ??

    I'm sure Alex includes them in his spiel to show you how to sell them as well :rolleyes:

    Sorry I forgot to answer that one yes as a very successful business and reputation to match for over 20 years:cool:
    Cheers
    Derek;)
     
  34. Mr C.W.Kerans

    Mr C.W.Kerans Active Member

    No shows are infuriating and costly if you run an "on time" appointment scheme; if your practice policy is to "bank" patients as doctors and dentists do, then no problem - just take the next patient waiting and if the original patient shows up later than their appointment time, slot them in if convenient or reschedule - depends on individual practice policy. If you don't have a patient bank, then your time is wasted and you are also out of pocket. I believe that you shouldn't need to look for reimbursement - it should happen without having to ask, and failure to see the fee in whole or part breaks the obligation to see that individual again. Its an individual policy choice.
     
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