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757: 1 Simple Way to Prevent No-Shows – Miranda Beeson

Who do you blame for holes in your schedule? If you said admin, it’s time to reassess your systems! Cancellations and no-shows start in the back, not up front! To help you reduce them, Kirk Behrendt brings in Miranda Beeson, ACT’s director of education, to provide a simple solution for keeping your schedule full of the patients you want. To learn the secret to attracting committed patients, listen to Episode 757 of The Best Practices Show!

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Episode Resources:

Main Takeaways:

  • No-shows aren’t negative profit. It’s no profit!
  • Reducing cancellations starts with building value.
  • Have a quick-fill system to fill holes in your schedule.
  • Strategically fill your schedule. Don't just fill it with anyone.
  • Know your broken appointment rates and track your recapture rates.
  • Consider implementing a reservation fee rather than a cancellation fee.
  • Use your verbal skills when talking to patients about your reservation fee.
  • Don't blame your admin team for holes in your schedule. Look at your systems.
  • Appointments are confirmed at the time of scheduling. Showing up is not optional.

Quotes:

“When we see those last-minute changes in the schedule, those last-minute holes in the schedule, they do produce a lot of anxiety for dentists and practice owners. If you have a really great administrative team member or schedule owner on your team, it also produces a lot of anxiety for them as well. When I was working administratively, when I saw a hole in the schedule, I felt that weight. I was just as stressed out and as anxious as the doctor sitting in his office was.” (2:51—3:17) -Miranda

“These inconsistencies in your schedule like a no-show, you come up with countermeasures like, ‘Maybe we should work longer. Maybe we should pick up extra hours. Maybe I should work on a Friday.’ I joke all the time when I speak at a seminar like, ‘We're all taking 10 weeks of vacation, but we're taking them in 15-minute increments.’ That's a joke, but it's not a joke.” (3:28—3:47) -Kirk

“If we have a plan, it's easier to not freak out. So, number one, we should be tracking data. We should be looking and knowing, what is our actual capacity? What is our open time in our schedule? What are our cancellation rates and recapture rates around all of that? Right off the jump, number one, when I'm talking to coaching clients and they're like, ‘We have these holes in the schedule. We have these holes in the schedule. I'm freaking out. I don't know if they're doing what they're supposed to be doing up there.’ I flat-out say, ‘Did you hit production that day?’ And it's like, ‘You know what? I don't even know.’ So, first things first, if there's a hole or holes in your schedule, before you freak out, look in the upper corner, or wherever it is in your practice management software, and go, ‘Okay. Did we hit our daily production?’ Because mind you, yes, you could be overproducing your daily goal if you had someone in that seat. But you're going to be a lot less anxious and freaked out if you know that even with that hole, you hit your daily production goal.” (4:12—5:02) -Miranda

“If you don't already have your computer software set up to show the daily production amount, I encourage every team to have every operatory and every computer set up to display the production amount for that day. A lot of people don't like to have it up, but I think it's really important to have that there so that you're always scheduling to that production goal. It's really quick and easy to say like, ‘Hole in the schedule.’ That fire starts burning in your chest. ‘Wait a minute. If I just look up there — oh, we're at $12,000 today. Our goal is $11,000. Okay. So, I have a hole in the schedule.’ I say now you have a gift. You have a gift of maybe an hour of your time or 90 minutes of your time that you can then go use administratively. There is not a team that I work with that the doctors or leaders don't wish they had more time to work on their practice, treatment plans, review cases, or do some check-ins. So, you can use that time as a gift to really work on the practice when you have this unexpected “vacation” hour.” (5:07—6:09) -Miranda

“We talk a lot about having the bulk of your production prior to two o'clock. If you can get the bulk of it in before lunch or maybe two o'clock, then you don't have to worry about it as much the rest of the day. [Plan] your day with an ideal day or block schedule and [account] for that production when and where you want it to be, because you have to do deliveries, you have to do post-op checks, you have to do occlusal guard adjustments — and there's no production on those visits. So, if you're counting it by the hour, or even by the visit, you're going to be a little bit skewed. If you look at what you're looking for annually, breaking that down into monthly, breaking that down into daily, and then we can focus on a daily office production goal, then it's really easy for the whole team to rally around where we're at. You can talk about it at huddle. Every day at huddle, ‘Where are we at right now?’ ‘We're at $10,000. Our goal is $11,000.’ ‘Okay. What opportunities do we have in our schedule today to make up for that $1,000 that we're off?’” (7:06—8:03) -Miranda

“If we have systems in place and we know that there's someone who owns the schedule or owns that system and accountability within the practice, then we can feel a little bit less anxious about that hole in the schedule. We know we have a system. We know Julie owns that piece, and Julie is probably working really, really hard up there to make it happen. So, if we have a cancellation or a quick-fill system that the admin team is responsible for, the team can help develop and document that system and make sure that when we see that hole, we have a plan for recovering lost time.” (8:59—9:32) -Miranda

“You don't want to replace one bad behavior with another bad behavior. What I mean by that is, if somebody is not showing up a couple of times, we're going to replace them with somebody who has canceled 11 times. So, this is a big thing, is your quick-fill list is not a list of people that have canceled 11 times that owe you a ton of money. You do have to use some thinking that this is going to be a relatively high-percentage shot if I put them in the schedule.” (10:50—11:15) -Kirk

“If, for some reason, this isn't working, we need to make sure that we look at the system and not Julie. We don't say, ‘Julie, what are you doing up here?’ We say, ‘Julie, do we have a breach in our quick-fill system? I know you have a plan for cancellations. I know we've all aligned around it. Can we pull that out and take a look and see what's going on?’ And Julie might tell you, ‘I've done every step.’ Check, check, check. She has her checklist. ‘I didn't have any takers today.’ That happens sometimes. But it might be that there is something that's missing within that system that we need to think through a little bit differently.” (11:19—11:49) -Miranda

“Don't just throw anyone in there. If you have a hole that's production, ideally, you're going to shoot for production first. If we lose a crown in the schedule, we really want to make sure that our first bet is trying to get more high-dollar or high-production in that spot, not that emergency or that post-op check that we know could really easily come in. So, we want to shoot for that first. And then, worst-case scenario, ‘Okay, fine. Let's go ahead and get two deliveries into the 90 minutes instead,’ and then we can use those delivery times that would have been in the future and maybe put some production in there instead. You’ve got to look at replacing like for like at your first opportunity.” (11:50—12:31) -Miranda

“You do need to track some data points, and here is why. If you don't have any data points, chances are that people are violating you at a very high level, and you have three amazing team members at the front, and they're just filling the schedule, putting out fire after fire, and it's 75% to 80% of their day. What a horrible waste of their day! You're like, ‘Come on, you’ve got to do better!’ And you're like, ‘This is all I do, is manage the holes in the schedule.’” (12:42—13:09) -Kirk

“It is really important to know your data. It's important to know your broken appointment rates. I would say short-notice cancellation, no-shows — really, most of us aren't tracking people who are breaking appointments outside of what you discern 24 hours. Some people say 48 business hours, they consider it a cancellation or a late cancellation. Beyond that, that's more recoverable, so we don't tend to track that quite as much. But those short-notice changes in the schedule, certainly no-shows, [have] a system for tracking those late, broken appointments. Now, if you're using something like Dental Intel or an analytic software, you typically do have to break or cancel the appointment in a specific way relative to your practice management software in order for that analytic system to really track that effectively for you. If you don't have that as an option, you can do it manually. You'd have to have some type of spreadsheet or tally tracker. But the most important thing is aligning on what we consider a true, late cancellation.” (13:19—14:17) -Miranda

“It's really important to track the recapture rate. So, when you have those cancellations, how many of them are we rescheduling in the moment versus our remaining unscheduled? Because, like you said, the amount of work it takes an admin team member to call and fill that schedule is immense. I don't know the data but say it's 10%. If you have one hole, you're calling how many people to try to fill that one hole in the schedule, or auto-blasting, texting, and managing the calls and the texts all at the same time? It's challenging. So, if we can recapture that person right now, that's less follow-up we have to do for calling and texting and emailing those patients later to try to get them back into the schedule. So, it's important to look at both pieces of that broken appointment.” (14:24—15:10) -Miranda

“As an admin team member, it's in your best interest to have that data because it helps support when you're saying like, ‘We are so busy. We need more help. We are so busy. We can't keep up up here,’ because how much of your day is spent recovering that time? You don't have any data, metrics, or proof around what's actually happening up there to be able to support it. It's just this feeling of, ‘I'm swamped. I'm swamped.’ Data and metrics, those numbers allow for us to not have to rely on our feelings.” (16:37—17:07) -Miranda

“Have a cancellation fee, but don't use it. So, the cancellation fee is not, surprise, the one way to keep you from having holes in the schedule . . . So, the number-one thing around the cancellation is, I always say you have to be willing to lose that person as a patient if you're going to charge a cancellation fee. It's not collectible. If they don't pay that balance, it's not like you're ever going to get it. More than likely, you're going to get a bad review on Google or some word-of-mouth around town because people feel like whatever their reason for canceling is much more important than the reason that you wanted them to be there. So, if you're charging them for missing the appointment for this thing that is very important to them, then they're going to look at you as the bad guy. You're the one to blame. So, I do like the idea of having one and being able to say, ‘Within our policy, if we can't recover this time, we do have a cancellation fee. You know what? Let me chat with Dr. Kirk for just a minute. Let me see if he feels like he wants me to move forward with that today. Place them on a brief hold. Great news. Dr. Kirk says you've been such a loyal patient all these years. We're not going to do that today. But just know that if within 48 hours this does happen again, we may need to charge that cancellation fee.’ So, we're fans of, have it. Use it for repeat offenders. If somebody has canceled multiple times, sure. But it has to be someone that's a C patient, someone that you're willing to lose as a patient in the end.” (18:15—19:52) -Miranda

“[Patients being charged a cancellation fee are] not going to go, ‘Oh my gosh, thank you so much! I'm so glad you charged me that because I've been off a little bit, and I just noticed that I've been violating you. You guys charging this fee set me straight. I now value dentistry, and I want to come back.’” (21:24—21:39) -Kirk

“Instead of a cancellation fee — which you should never use — consider a reservation fee instead . . . The biggest impact on your practice is going to come from those high-production cancellations — so, periodontal therapy, your crown visits, your ortho visits, your bridge visits, implant visits. So, rather than a cancellation fee, consider a reservation fee. Reservation fees really help you to know if a patient has skin in the game. I always say even if it's $20, that's more skin in the game than nothing at all. So, I look at periodontal therapy, scaling and root planing visits, crown or greater in terms of production. Some people will do it, in general. But for general recare, periodontal maintenance, preventative visits, I don't know that it's really as relevant because the biggest impact is when you have three-and-a-half hours reserved to do a quadrant of dentistry, and they call and cancel, or they no-show. That's where we get into trouble. So, the reservation fee is primarily going to apply towards treatment. It's going to be for those higher-production appointments. And again, it lets you know if a patient has skin in the game. If they're not willing to contribute a reservation fee, it's also quite a tell on if they truly value and plan on attending.” (22:02—23:23) -Miranda

“I think [a reservation fee] should always be refundable and go towards their treatment when it's simple dentistry. Now, I used to work in a practice that did a lot of full-arch, All-on-X cases. There are significant lab costs that go into developing the provisionals and that whole piece in the beginning from a digital planning process. So, you can have a non-refundable reservation fee, $2,000 or something, that covers what some of you might lose if they were to same-day no-show or cancel two days before their surgery or something like that. So, that's a little bit different when you get into these specialty situations. But what I generally tell clients is the reservation fee applies towards their treatment. And it's great to tell a patient that when you're asking for the reservation fee, ‘This will go right towards your treatment, and it's refundable.’” (25:22—26:14) -Miranda

“You have this percentage of people that are going to say like, ‘Well, I wasn't prepared for that much at all. I didn't know I was going to have a cavity today. I wasn't prepared.’ ‘No problem. What are you comfortable putting towards that appointment for your reservation today?’ Most people are going to say $50 or $100. That's what most people say. If they told me $25, great. That's still skin in the game. If you don't hear a number at the end of that, ‘I just don't think I'm comfortable putting anything towards it yet. I think I'm going to hold off,’ there's a value problem there. That's not a price problem anymore. I always say without value, there's only price. So, that's where I say it's a good tell. If they're not even willing to give you $15 or $20 to reserve the time, are they really bought in? Were they maybe going to be that person that was going to no-show or short-notice cancel to begin with?” (28:48—29:42) -Miranda

“If you're in a dental practice, you know how it feels to have that three-hour appointment on your schedule and to be like, ‘Oh, please let them show up. Oh, please let them show up. Oh, please let them show up. Have they filled out their forms? Oh, please let them show up.’ When you know, you pop in the ledger and you go, ‘Oh, they already paid for half of it. They're going to show up,’ there's this confidence in that where it reduces that anxiety that we're going to end up with a giant hole in our schedule.” (31:43—32:05) -Miranda

“As a general rule, [a reservation fee] can be a great way to avoid having those holes in your schedule that cause that burning anxiety in your chest and, ‘Are we going to be able to make payroll this month?’ because we've had three of these three-hour appointments canceled. Like, let's get a reservation fee going and switch our mindset from that punishment of the cancellation fee to working with our patients on a reservation fee to build confidence and predictability in the schedule.” (33:52—34:17) -Miranda

“Cancellations, holes in our schedule, in general, start with having value ourselves in what we do. It starts with us believing that there's value behind the treatment that we're performing, the services that we're rendering, the experience that we're providing for our patients. So, we have to value what we do in order for our patients to value what we do. And then, we have to be able to transmit or transfer that value through our communication with our patients.” (35:35—36:05) -Miranda

“We say that cancellations start in the chair. They start in the back. A lot of people say, ‘Cancellations, holes in the schedule, it's the admin team's fault.’ You know what? It takes the whole team. So, the best way to mitigate holes in your schedule is to prevent them in the first place. Let's build some value when we're making those appointments to make sure that the patient is going to be more likely to sustain and consider that confirmed from the time that it's scheduled.” (36:05—36:30) -Miranda

“We want to make sure we consider an appointment confirmed when we schedule it. We're not calling to confirm appointments. We're reminding patients that their appointment is coming up. When we're calling to verify — I've been in offices where I hear [admin] say, ‘Mrs. Jones, I'm just calling to confirm that you're going to be able to make it to your appointment on Tuesday at eight o'clock.’ Like, that implies that we could give them the option of not making it to their appointment on Tuesday at eight o'clock. So, if we're reminding them of their visit versus calling to verify or confirm, again, it's a different mindset.” (38:02—38:37) -Miranda

“When you know who your core customers are, and your schedule is full of your core customers, and they value what you do, and they pay their bills, and they don't mind a reservation fee, and they're going to create predictability for you, that is awesome.” (39:04—39:17) -Miranda

Snippets:

0:00 Introduction.

1:28 Why this is an important topic.

3:57 Create a plan by tracking data.

6:17 You don't need all eight hours to be crammed.

8:41 Have a system for filling in holes.

12:32 Have a system for tracking late and broken appointments.

17:51 Should you have a cancellation fee?

25:17 Should reservation fees be refundable?

27:24 Give your patients two options.

31:03 Your confidence creates predictability.

35:25 Final takeaways.

Miranda Beeson, MS, BSDH Bio:

Miranda Beeson has over 25 years of clinical dental hygiene, front office, practice administration, and speaking experience. She is enthusiastic about communication and loves helping others find the power that words can bring to their patient interactions and practice dynamics. As a Lead Practice Coach, she is driven to create opportunities to find value in experiences and cultivate new approaches.

Miranda graduated from Old Dominion University, and enjoys spending time with her husband, Chuck, and her children, Trent, Mallory, and Cassidy. Family time is the best time, and is often spent on a golf course, a volleyball court, or spending the day boating at the beach.
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