Practice Management

Cut down on no-shows by charging for missed appointments?

Q As our participation in managed care has grown, so has the number of no-shows. To deal with the problem, some of our colleagues have started charging patients who don't cancel appointments at least 24 hours in advance. We're thinking of doing the same. How much should we charge? And how and when should we break the news to patients?

A Although the AMA endorses a fee for no-shows—provided the patient is fully advised of the policy—our experts don't recommend it. Besides being difficult to collect, these fees may violate your managed care contracts and sour patient relations.

Instead, tell your staff to emphasize the importance of keeping appointments when the patient calls to ask for one. Then have employees send reminder cards, or have them call the patient to confirm an appointment the day before it's scheduled. In the case of a chronic no-show, send a letter stressing that the patient's good health depends on honoring appointments, and that he will be discharged if he misses another.

If you choose to implement a no-show fee, have your staff advise patients of the policy when they make an appointment. And include a reminder on your billing statements.

How far to go to make staff feel appreciated

Q One of the partners in our practice owns a beach house. We've been tossing around the idea of awarding one week at the house to an employee and spouse. We'd draw a name out of a hat at our annual year-end party. Will this boost morale, or cause trouble?

A It's likely to boost morale. But rather than raffle off a week for one staffer, you might consider allowing all employees to sign up for a weekend that's convenient for them, assuming that's practical and the doctor who owns the beach house is willing. Such a ritual will build staff loyalty.

Don't blame capitation for treating patients poorly

Q A patient who was 20 minutes late for an appointment complained that our nurse practitioner turned her away, forcing her to schedule another appointment. When I confronted the NP, she defended her decision by saying we're paid capitation for this patient, so we lost no revenue by refusing to see her. Was she right to turn the patient away?

A Perhaps, but not for the reason she stated. Your office policies should be blind to patients' insurance coverage. If the patient routinely arrives late for appointments, though, there's nothing wrong with asking her to reschedule or making her wait until all other patients have been seen.

When you need a crash course in managing a practice

QI'm planning to purchase a primary care practice from a physician who is retiring. My problem: I know very little about the business side of medicine. Where can I find a CME course that would help me make better-informed business decisions?

A Check with your state medical and specialty societies and nearby universities. You can also search online. Several Web sites, including the AMA's (www.ama-assn.org/iwcf/iwcfmgr206/cme?229227364) and educational institutions' list CME courses that might help. If you strike out, consider hiring a consultant to brief you on what you'll need to know.

Edited by Kristie Perry,
Contributing Writer

Do you have a practice management question that may be stumping other doctors, too? Write: PMQA Editor, Medical Economics magazine, 5 Paragon Drive, Montvale, NJ 07645-1742, or send an e-mail to mepractice@medec.com (please include your regular postal address). Sorry, but we're not able to answer readers individually.

Kristie Perry. Practice Management. Medical Economics 2001;13:150.