Build Profits by Managing Cancellations & No-Shows

By Adam Cmejla,
President of Integrated Planning & Wealth Management, LLC

Oct. 7, 2015


Cancellations and no-shows add up to lost revenues. Available systems can automate a solution and build profitability.


MEASURE CANCELLATIONS & NO-SHOWS. Track cancellations and no-shows with an EHR or PM system.

IMPLEMENT CONFIRMATION PROCESS. Set up automated calls and messages to patients through available services.

TARGET REPEAT OFFENDERS. Note and contactpatients who frequently cancel or fail to show up. Encourage repeat offenders to bewalk-ins.

Time is the greatest commodity. Reducing no-shows and cancelled appointments is a key to preserving your time and profitability.

When I started as a financial advisor, a client shared a semi-serious joke: “Being a business owner is great! You only have to work half days. You just get to choose which 12 hours you want to work!”

I laugh at that statement, but it’s true. You have 24 hours in a day, and what you do with that time as a business owner has a direct correlation to the top and bottom line of your practice. In the end, though, the bottom number is only as good as what goes in on the top. And the top number will only be healthy if the volume of patient flow is steady and consistent. One of the best ways to keep this number healthy is to do everything that you can to minimize the number of no-shows and cancellations that your office experiences.

Measure Cancellations & No-Shows

The first place to look for this data is in your practice management software. Pull reports from the previous day, week and month, and compare those metrics and look for trends. Do you experience more no-shows in the morning or afternoon? Are Saturday appointments heavy cancellation days? All of this data can help you better evaluate where there may be deficiencies in your patient communications system.

Because every practice is different, and has different business models and patient systems, it’s difficult to share a basic metric that is the end-all “pass/fail” for a practice. Rather, I would focus on making sure that you systematize your business so that you have more patient exams per day. One no-show in a day when there are 10 patients scheduled hurts the revenue much more as a percentage than one no-show in a day where you have 20-25 patients scheduled.

Here’s the math of one missed appointment per day using the Management & Business Academy standard of $306 average revenue per exam: 1 missed appointment per day x 5 days per week x 50 weeks per year x $306 per apps = $76,500 lost per year.

Effective Reminders

How You Phrase It Matters

Be direct and include a clear call to action: “Mrs. Smith, please confirm your appointment for Tuesday, July 3 by texting “c” to confirm.

Requiring the patient to text “c” to confirm, forces the patient to take an action and be proactive, making it more likely they will follow through.

Implement a Recall & Appointment Confirmation System

This is one of the most obvious solutions, but not all recall and confirmation systems are created equal. Pre-appointing contact lens follow-ups should be standard operating procedure to ensure patient well-being, but there is more leeway for opinion in the decision of whether or not to pre-appoint annual comprehensive exams.

Gone are the days when a mailed postcard two weeks out reminds patients of their appointment. We live in an age in which technology and the multimedia, multi-touch approach has a much more effective and efficient impact on your patients. Consider implementing a recall system that offers multiple touch points. An example could be a postcard mailed 30 days out, an e-mail a week out, and a text message or phone call (depending on their preference, providing they opt in and agree to the text program) the day before the patient’s appointment.

If you’re implementing an e-mail-based approach only, make sure that you have multiple points of contact with them, and that your subject line prompts them to take action. Something like “A reminder of <<Patient First Name>>’s eye exam appointment – Please Confirm!” People like seeing their name written in correspondence, and having it in the subject line will grab their attention. The “Please confirm by pressing ‘C'” ensures that they know action is required.

In addition, make sure that your options in the e-mail do not include a cancellation feature. Remember, you want to give them options, but options that (in the end) work out well for both their ocular health and your business. Rather, make sure that the two options are links to either “Confirm” or contact your office to reschedule.

Make sure the right people are in the right seat. What I mean by this is to make sure that the patients you have in your recall system are the type of people that you want to see back for future visits and exams. We want to make sure that revenue is increasing in the practice, but at the same time we want to make sure that we’re always doing what’s in the best interest of our patients. Surrounding yourself with the right type of patients allows you to build the practice you want with the patients you want to serve.

For example, you know that your contact lens patients will need to have their Rx renewed every year, so that is one set of patients that you absolutely want to have in a communication system.

Identify & Manage Repeat Offenders

If you have patients who routinely fail to show up for appointments, or who consistently cancel at the last minute, talking with your patients from a point of compassion and genuine interest can go much further than a “tough guy” no-show fee policy or refusing to set an appointment and require they be a walk-in. To each your own in your own practices, but I’ve found that kindness and understanding of what caused the issue can help in the long run.

Editor’s Note: When dealing with the Medicaid population, your no-show rate could be as high as 50 percent.

You may also want to look to the operations within the practice to ensure that reminders are being implemented by the staff. Even though the task may be delegated, it’s possible that days go by when the task doesn’t get done. Make sure your staff is being held accountable for their tasks by having either a print-out with staff initials next to phone calls, or having them document in your practice management software that calls were made.

Making sure that you have an effective patient communication system is key to ensuring that no-shows and cancellations are as low as possible. This allows your time as the optometrist to be spent seeing as many patients as possible, thus ensuring a thriving and growing practice.

Adam Cmejla, CFP®, CMFC®, is a Certified Financial Plannertm and president of Integrated Planning & Wealth Management, LLC, a financial planning and investment management firm that works with optometrists.For more information: Contact Adam at 317-853-6777 or

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