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INTRODUCTION TO THE DEFINITIVE GUIDE TO PROVIDER CANCELLATIONS AKA BUMPS

Provider cancellations aka bumps occur when a provider cancels on the patient because the provider is not available. This is contrary to patient cancellations which we covered here. Most commonly providers cancel appointments to perform emergency care, a weather forces an office closure, or a provider is going on vacation. If you're curious, we've already examined when appointments are most likely to be cancelled too. Some practices don’t use the term bump, but call them provider cancellations. We will be using the terms bump and provider cancellations interchangeably.

Alright, we got the housekeeping out of the way, you still with us? QueueDr has focused on scheduling automation for missed appointments for six years so we get quite nerdy about provider cancellations, hence why we are devoting a whole guide to them.

WHY PROVIDER CANCELLATIONS DESERVE THEIR OWN GUIDE

While provider cancellations are not as common as patient no-shows or patient cancellations, they have a significant impact on healthcare scheduling operations. Patient no-shows account for 5-10% of appointments, patient cancellations for 20%, and provider cancellations for about 1-2%. Provider cancellations are so disruptive for three reasons.

I had an appointment!

First, the office having to reschedule the patient is the inverse of what usually happens. It reminds one of the famous Seinfeld bit on reservations.



Bad Timing

Second, providers cancel at inconvenient times for the staff. If the office closes for a snow day, that same snow impacts the staff and their families. It’s made more difficult since many healthcare scheduling systems don’t allow remote access, so staff have to drive in to access the schedule!

Sheer Volume

Third, there is the sheer volume of calls that need to be made, within a tight timeline. When a provider cancellation occurs, an entire day’s worth of patients need to be called and rescheduled. Offices often have to pull from other teams (ex. Billing) to get all the calls made as fast as possible.

WHY PROVIDERS CANCEL APPOINTMENTS

Here are three reasons providers cancel appointments at health systems.

Acts of A Higher Being

The most common reason provider cancellations occur is due to weather related closures. The reason offices close is for the safety of their providers, staff and patients.

Medical Emergencies

Not all specialities have to navigate the waters of provider cancellations daily. The most common specialties to cancel are OBGYN and surgical specialties. OBGYNs frequently have to leave the office at a moment’s notice because a patient goes into labor. Surprising no one, newborns don’t stick to a schedule, so an OBGYN has to be nimble. We’ll get into some solutions for this problem later. Surgeons are also called into the OR when they are scheduled to be in the office.

Vacation

The third major reason provider cancellations occur is that a provider is going on vacation. I don’t mean to make it seem like a provider is leaving to take the afternoon off. Most commonly, a patient is booked for their appointment 6 months or more in the future. When an office learns of a provider vacation, they have to bump patients affected. This is yet another argument for not scheduling patients more than 3 months in advance. We dive deeper into patient access practices in The Definitive Guide to Patient Access.

BEST PRACTICES FOR MANAGING PROVIDER CANCELLATIONS

Based on our analyses, health systems reschedule 30-50% of bumped appointments within a week of the original appointment. Part of the reason is process and part is purposeful. How should an access center deal with provider cancellations?

Contact the patient about the provider cancellation

First and foremost, apologize for the inconvenience. An access center should already know to contact a patient. But your humble author once showed up to an 8 am appointment with 1 inch of snow on the ground to find the office closed for two hours. No notice, apology, or anything.

Set standard cancellations reasons

Some healthcare scheduling systems have a specific cancellation type called “Bump” which staff should use when cancelling an appointment. Make sure to educate them. For those without this cancellation type, create a cancellation reason called provider cancellation. We recommend for weather cancellations and another for provider unavailable. Make sure staff use them by educating them and monitoring the use. We find that staff do not use the correct cancellation reasons because they weren’t trained AND because they do not see a reason.

Two reasons the right cancellation reason matters

Data Integrity
First, using the correct cancellation reasons allows a health system to analyze the prevalence of cancellations. Including provider cancellations as regular cancellations will throw off the numbers and make it look like an office has more cancellations than they do.


Tighter healthcare scheduling workflow
Second, it makes it quite hard for staff members to pull a report or utilize a bump list to reschedule those patients.

Use a bump list

Most healthcare scheduling systems have a bump list. If not, pull a report based on cancellation reason and call those patients.Reschedule patients off the list as you reach them.

Autonomous Patient Access

AI-enabled autonomous patient access helps health systems across the country. It's their competitive advantage to manage daily and long-term fluctuations within their schedule. It's a great way improve patient access, eliminate patients falling through the cracks, and reduce at risk revenue. The most sophisticated ODSM solutions are fully automated and completely customizable so your staff doesn’t have to do any extra work. In addition, autonomous patient access combines provider reschedules, waitlist management, filling cancellations, and patient appointment reminders in one automated solution.

Open up the provider’s schedule

Does the provider have time on their schedule blocked off that you can open up? If so, use it!  If you have your appointment types setup correctly as outlined here, this task is a lot easier.

Offer alternative providers

The patient won’t be excited to know they are being rescheduled, find out what is most valuable to them, seeing the same provider or being seen earlier. If they want to be seen faster, try offering the patient other providers who have more availability on their schedule.

Don't reschedule everyone

Remember, if a patient doesn’t need their appointment, then don’t reschedule them. When your access center is making your provider cancellation calls, make sure the patient still needs to be seen. For example if their rash disappeared or if they have a follow-up a week later, don’t reschedule them!

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WAYS TO MAKE PROVIDER CANCELLATIONS SUCK LESS FOR YOUR PATIENT EXPERIENCE

Provider cancellations are not fun. However, if dealt with well, the patient experience won't suffer.

Set expectation for the patient experience

Make sure the patient knows bumps are a possibility. Tell patients when they book their appointment that there is a possibility that the provider may have to cancel. The day will come when a provider cancellation occurs and the patient won't be surprised! We’ll share data below on what appointment times are most frequently bumped. However you can look at your health system cancellation reports to identify trends.

Don’t schedule patients more than 3 months out

The probability of cancellation, whether it be no-show, patient cancellation, or provider cancellation increases the further out you book an appointment. The probability of providers cancelling for vacation is highest for appointments booked over three months out. HELPFUL TIP: align your booking windows with your vacation request requirements so you have less overlap. Ex. If physicians are required to request PTO 3 months out, encourage your scheduling to book no further than 3 months out. Find more on this topic in The Definitive Guide to No-Shows.

The team approach

It takes a village…a patient’s care should be the same way. A patient shouldn’t be reliant on just one provider. In an instance where a provider cancellation occurs, a patient’s care suffers. The most successful OBGYN offices let patients know that while they can choose their provider, their provider might not be available. It sets expectations upfront and improves patient experience. This method can be applied to all specialties, creating a culture of preferred providers with team treatment. Allow patients to select their preferred provider but let them know they will be scheduled based on their clinical needs and the provider who is available.

THE DATA ON PROVIDER CANCELLATIONS

After reviewing thousands of provider cancellations, we compiled the most frequently bumped dates, times and months.

Top five most bumped appointments

1 (and 2). Monday and Thursday at 9am
3. Friday at 9 am
4. Monday at 10 am
5. Wednesday at 9 am

The lesson

Be weary of morning appointments. They have the highest rate of patient and provider cancellation.

Seasonality

We’ve talked about the main reason for provider cancellations above. The data reflects this seasonality. December, November, October, and July are the most bumped months. Those are the months dominated by vacations and inclement weather.

CREATIVE IDEAS TO TRY

We talk to health systems daily and the current workflow for provider cancellations has two major flaws. The workflow is labor intensive for the staff. This can be alleviated using Autonomous Patient Access. Automation is the only answer to rising patient consumerism and decreased economic resources. Second, providers who bump are quite busy, thus it may not always be possible to rebook patients promptly. Access centers may have to book a patient out months, a topic we dive into in depth here! So here are two ideas that may help. We’d love feedback on them. These are for providers that frequently bump patients

    1 . Leave one day open every two weeks just for bumped appointments.

    Choose your “least busy” day and have part of it completely open for bumped appointments. If the spots are open the morning of, then use those slots for any call-ins. Think of it as open access for provider cancellations.

    2. Have a part-time provider whose sole job is to see bumped patients.

    This can be a costly solution and requires selling patients on the team care approach. However, having a floating provider who goes between offices just to see patients bumped can help and can improve patient access. It’s something we’ve proposed in The Definitive Guide to Cancellations.

CONCLUSION

Provider cancellations flip the paradigm of cancellations on its head. Instead of a patient cancelling, it is the office cancelling on the patient. Because of this, the bump workflow requires attention to maintain a good patient experience.Every patient must be notified and dealt with regarding the unfortunate scenario. Bumps are very common for many practices and offices must communicate that reality to patients. From autonomous patient access to unconventional schedule utilization, there are many ways healthcare organizations can improve both the patient and staff experience when it comes to provider cancellations.
Enjoy That Reading?
Check out The Definitive Guide to No-Shows.
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