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The Definitive Guide to Patient Cancellations

The Definitive Guide to Patient Cancellations

COVID-19 has changed the world and healthcare forever. A decade of innovation has been crammed into a few months for medical organizations. Telehealth was adopted, quickly, en masse. Social distancing has caused a change in office design and workflow. Insurance coverage took a radical change. In addition, medical organizations are adjusting to working remotely, while individuals with families are juggling work, childcare, and distance learning requirements! Because of all these changes, old strategies for schedule management do not work anymore. So, we need to rethink patient cancellations and their impact on healthcare for the new normal into the digital front door.

Patient cancellations are one of the most damaging revenue factors in healthcare. Understanding schedule management, types of patient cancellations, how to fill them, and how COVID-19 has impacted them even more, is key to growing patient volume and revenue.

Two types of patient cancellations

There are two types of patient cancellations: one when they tell you and another when they don’t. Our definition of patient cancellations and no-shows are as follows:

Cancellations

A patient cancellation is when a patient gives notice before the appointment that they won’t make it.

No-Shows

A patient no-show is when a patient does not show up for the appointment and does not give notice. We recommend reading The Definitive Guide to Patient No-Shows for a deep dive in preventing no-shows.

The financial impact of patient cancellations

While patients may cancel for many reasons, getting the cancellation early is considered a win. According to an athenahealth study, the probability of a patient no-showing increases every day out they are booked. Once a patient cancellation turns into a no-show, you can no longer recoup the revenue for that appointment.

Lost revenue from unfilled cancellations:

Average appointment value: $150
The average number of unfilled cancellations per day: 2
Number of working days per year: 261
Lost revenue from missed appointments: $78,300
Please keep in mind this does not include the revenue opportunity of diagnosing the patient.

Providing patients access to earlier care and encouraging patients to cancel as soon as they know they will not make the appointment are two of the quickest ways to realize revenue and ensure strong provider utilization.

Breakdown: Patient Cancellations

The number of cancellations per provider per day is dependent on many factors including patient demographics, patient volume, provider specialty, location, seasonal factors, and geographical constraints. Orthopedics, Dermatology, Primary Care and Pediatrics are the four specialties with the highest average cancellation rates per day.

At QueueDr, we looked at thousands of patient appointments and analyzed the date and time of cancellation. We saw an overwhelming trend on time of day, most cancellations happened before noon, regardless of the day of the week or time of the year. Here were some other trends we discovered:

  • Mondays have the most patient cancellations, 23% of appointments are cancelled on Monday.
  • Patients are most likely to cancel Wednesday appointments, 21% of appointments scheduled for Wednesday are cancelled
  • December, June, and July have fewer cancellations than the other months.

For more on this, read our blog post,” What Days Appointments Are Most Likely To Be Cancelled”

We assigned the cancellations categories to breakdown which appointment type is the most cancelled. Office visits, for example, represent non-acute, non-follow-up appointment types for established patients in a practice. Annual visits represent well-visits, physicals, annual exams. We received many questions about medical appointment types and how to organize them, so we wrote a whole guide dedicated to appointment types.

We found that 45% of all cancelled appointments were follow-ups, whereas only 5% of the cancellations were procedures.

Graph of cancellations per appointment type

Looking at over 200,000 appointments in July and August during the 2020 pandemic, telehealth cancellation rates were 23% whereas in-office cancellation rates were 37%. Today, these rates are leveling out when compared to earlier in the pandemic.

Geographical impact on patient cancellation rate

Some specialties in certain geographical areas have lower cancellation rates than others. A major determining factor has to do with geographic demand and scarcity for a specialty.

Rural Americans makeup 15-20% of the population and face major disparities in healthcare.  The AAMC (Association of American Medical Colleges) published a study, “Health Disparities Affect Millions in Rural U.S. Communities” some of the inequities. While higher demand caused by a lack of supply (vs. too much demand) can result in lower cancellation rates, high demand alone is not enough to lead to lower cancellation rates. There is another factor, “replaceability”. Replaceability is the ability for a patient to find another doctor in the same specialty. Replaceability explains the link between improving patient access and lowering patient cancellation rates.

If there is a high demand for a specialty AND high replaceability (lots of doctors in that specialty) that will lead to higher cancellation rates since the high demand will create long patient wait times and patients have the ability to find another doctor.

However, if there is a high demand for a specialty and low replaceability, then it will lead to low cancellation rates.

COVID-19 has impacted different geographic regions’ ability to handle cancellations and fill rates. Heavy case regions had very different day-day than low case areas. The pandemic has forever changed the healthcare landscape and how to bring patients to care.

Breakdown: filling cancellations

The average provider’s staff fills about 15% percent of cancelled appointments. Since COVID-19, every slot matters more. There are fewer in-person appointments available due to social distancing and the sanitization process between visits. Telehealth averages 1-5 minutes lost on technical difficulties. These factors make it more important to optimize your schedule and ensure each available appointment is filled.

Factors that influence the fill rate:

  • Lead time – staff fill rates for cancelled appointments, that are cancelled within 24 hours of the appointment, can be 50% lower than cancellations with a longer lead. The staff has more time to find a patient, while patients have more time to adjust their schedules to accommodate a doctor’s availability. Telehealth has a shorter required lead time. Offering clinically relevant patients, booked further in the future, last-minute telehealth appointments, allows you to improve patient access, optimize your provider schedule, and realize revenue sooner.
  • Demand and replaceability – medical organizations with higher demand and low replaceability have higher fill rates because there are more patients who want to fill that cancellation.
  • The number of schedulers – medical organizations with a higher ratio of schedulers to patient cancellations will have a higher fill rate. However, the added overhead is usually not cost-efficient, particularly if there are alternatives.

Moreover, COVID-19 brought layoffs, furloughs, and smaller budgets. The administrative staff is being asked to do more manual work such as COVID-19 screening and communication of telehealth procedures. In addition, many administrative functions are being done at home while employees are trying to balance work and family/child care needs, which is also impacting their performance.

Bottom line – you have fewer available staff being asked to do more than ever.

Best practices for managing patient cancellations

  • AI schedule management – automate all your scheduling tasks so staff can focus on the ones that need attention. No-shows, provider cancellations, patient cancellations, reminders. Automate everything to allow your staff to focus on tasks that require a person to person interaction.
  • Open access – strict templating requires more work for the staff and extends patient wait time. Make it easy. Any patient can go anywhere. Allow this to be passed to online scheduling as well!
  • Schedule balancing – when you have cancellations or uncertainty in your schedule, you may find more room for provider burnout. You can balance your schedule to even out the number of appointments going to each provider.
  • Utilize telehealth – if a last-minute cancellation happens within an hour, it’s basically impossible to fill with another in-office visit, but it is possible to fill with a telehealth appointment. Conversely, if a patient cannot make it into the office, they might be able to make that appointment work as a virtual appointment.

Since COVID-19 has affected budgets for medical organizations, we recommend you also:

  • Focus on your existing patients – use direct patient messaging to encourage patients to get caught up on care. Allow them to rebook via text message or link instead of having them call the office since your team is already overburdened.
  • Confirm your booked appointments – use patient reminders to confirm with patients already booked or give them the option to cancel. Set these to more than 24 hours before the appointment to allow that cancellation to be filled. For appointments that are cancelled with less than 24-hour notice, fill them with telehealth appointments.
  • Make your digital front door exemplary – every new patient that does book an appointment with your medical organization counts more than ever. Make sure their patient access is quick and simple. Focus on shortening the patient wait time and simplifying their ability to get care sooner!

Conclusion

Cancellations are a real problem for medical organizations. COVID-19 has complicated this issue even more because budgets, staff allocation, patient willingness, and fear have impacted decisions on care. Automating your schedule can help alleviate these concerns.