Low reimbursement is forcing doctors to crack down on no-shows

Increasing fines is one way to recoup lost revenue:

For health-care professionals, the charges are a way to recoup the administrative costs of running a business. After all, they point out, assistants and receptionists need to be paid whether or not a patient shows up. And doctors typically aren’t salaried, they’re paid only for patients they treat. Some patients understand that. But for them, the fees still are one more health expense to shoulder, atop rising insurance premiums and co-pays.

Comments

Gasman
The old “My time is worth as much as the doctor’s time” argument.
In the greater metaphysicial sence this is true, as we all have a finite amount of time in life. It could be argued that the patient with a short life expectancy could be entitled to the consideration of extra worth to their remainint time.
But in the real economic world time is measured in money. The economist would value time as the relative value of the lost earning potential; keep a CEO waiting 5 minutes and it’s $1000, keep a busboy waiting 5 hours and it’s $30. Alternatively the value of time could be determined by the individual; how much would they spend to have no-waiting service in a concierge office setting. For $2000 or so people can buy the privilege of no waiting time.
Some will complain that this is somehow unfair or non-egalitarian. But how is this any different than a trip to Six-Flags amusement park, where for just $10 extra on your ticket you get to go to the head of the line at every ride. Time is money and the market has responded. Just like the offices that often waive no-show fees for genuine emergencies or first time absences, patients could cut the system the same slack on the idea that the delaying emergency someday could be theirs (‘ I’m sorry sir, I would love to treat your heart attack now, but it would throw off our schedule somewhat dreadfully and we can’t keep people waiting you know’ ). Just like docs can give patients walking papers for chronic absences, patients can also walk if their doc is chronically tardy.
Anonymous
The door swings both ways. I have no problems with people billing the self-important, I can make you wait, providers who fail to keep timely appointments followed by the threat of litigation to ensure that the providers realize that their chronic overbooking will no longer be accepted.
NoAcuteDistress
It is a policy in my office (and a point of pride) that patients be seen on time- barring any highly unusual, unforseeen circumstances. Patients will behave the way their physicans behave. Habitually tardy doc? You’ll get habitually tardy patients. Patients will come to understand that their appointed time belongs to THEM and they’ll maximize their encounter if they show on time. Likewise they come to understand the the next slot belongs to the next patient and will become respectful of those boundaries.
My patients continually remark on how ours seems to be one of the very few offices around which manages to see their patients on time. They ask how I do it and why others can’t seem to manage. My answer: “That’s simple. Those other doctors don’t value your time the way they value their own.”
Anonymous
I never run late for my patients. My secret: I don’t see patients when they show up late. They complain, but when I explain to them that it is unfair to all of the patients after them, they usually understand. And they never show up late again!
Anonymous
Anon 2:01, how do you define late? Is it 5 minutes? 10 minutes? Half an hour?
We’re struggling to come to grips with this issue too and are interested in hearing how others handle it.
Do you regard no-shows in the same category as people who need to cancel or reschedule an appointment?
Anonymous
I give patients a 7 minute window (sounds arbitrary, but I schedule 20 minute blocks and I thought that 10 minutes was too long). If they show up after the window, they are not seen. No exceptions (unless it is life-threatening). All patients are told of the 7 minute rule when they schedule their appointment, and they also get it in writing when they establish with the practice.
I am employed, and my employer will not allow me to charge for no-shows or late appointments. I guess it is punishment enough that they are not seen and have to wait up to a month to re-book.
If a patient has 3 no-shows, late appearances, or cancellations within less then 24 hours, I dismiss them from my practice. I’m booked so heavily that it is completely unfair to other patients to have people chronically book and not show.
Jeff Barson
Everyone has a problem with no shows.
Since I run exclusively cosmetic practices, I’ve found that the no show rate has been curiously similar to other clinics. (The total number is less since we see fewer patients but the percentage is similar.)
It’s always a dilemma; protect your time vs. irritate some of your patients.
We handle this on a case by case basis. If my staffs feel a patient is ‘a problem’, we discuss our options. A frank discussion is usually the best choice.
Anonymous
Anon 10:57:”The door swings both ways. I have no problems with people billing the self-important, I can make you wait, providers who fail to keep timely appointments followed by the threat of litigation to ensure that the providers realize that their chronic overbooking will no longer be accepted.”
If you behaved like that, I would discharge you from my practice forthwith. Yes, your time may be valuable to you, most patients feel that way, but unforseen problems occur at unpredictable intervals that can occasionally upset the best planned working schedules. Appointments are not guarantees, although it is reasonable to expect both parties to do their utmost to keep the appointment timely. All the same, you have paid nothing in advance. You have come seeking my services and expect time to be set aside for you which it generally is and at the time you expect. But to think yourself entitled to bill your physician because he or she is late for you in the service of another does nothing but betray your own unreasonableness. I try to respect schedules, but I would find you an unsuitable patient in my practice.
As you seem to interpret delay as a sign of self-importance, then perhaps you are better suited to a concierge practice, where light booking is the rule to accommodate those who would prefer the privilege
of assured punctuality. An important person such as yourself deserves nothing less.
Rebecca
I am a patient who was scheduled for an MRI. I drove clear across the metro area after taking off the afternoon from work, to make this appointment, only to find out the technician wasn’t there and no one called me.
How is this fair to me? I explained to them that I charge a no show, because my time is worth something. I was in the middle of preparing for our national sales meeting and didn’t really have the time to take off. Now the clinic is saying my request is too much. I am not requesting much, only $250 in vacation time that I had to take, and for my travel time.
They were willing to pay for a taxi to drive me across the river to another clinic that would give me an MRI, which would have wasted another 4 hours of my time.
I really think doctors and clinics should start thinking of this as a business relationship. If any of my vendors at work canceled on one of our scheduled appts, then I wouldn’t bother giving them a contract or an order. I would call them on it. Is it so much to ask for?
My comments only,
Rebecca
http://www.purifyyourbody.com
p.s. I did “fire” this clinic. I requested my medical records and now will go to a larger clinic closer to home (more impersonal service but at least they have more than one technician who knows how to use the MRI machine).

Low reimbursement is forcing doctors to crack down on no-shows

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