As a physical therapist, you know that attending physical therapy treatment sessions consistently is essential for patient improvement. And you also value your therapists’ time and energy put into treating patients. But how can you ensure patients are as invested in their plan of care as you are by attending their scheduled visits? Unfortunately, cancellations and missed appointments not only affect the course of treatments for patients, but they also have a large impact on therapist resources, clinic revenues, and patients waiting for an appointment.
Without a cancellation policy, people may think missing appointments isn’t a big deal to you and your business. Having a solid policy in place puts more value on your team’s time and services, and maintains clinic resources and the bottom line. It also helps you treat patients in the most effective and efficient manner – so they can get healthier, faster. Here are a few points to take into consideration when developing and implementing a cancellation policy for your practice.
Determining the cancellation policy
Cancellation policies are quite common for a large number of businesses, particularly ones in which an appointment is scheduled for 1:1 service (ex. physician’s offices, hair stylists, massage therapists, etc.). So why should physical therapy clinics be any different? At the heart of it, all of these businesses (including PT clinics) are providing a service for someone and their business and patient success depends upon people showing up for their appointments.
According to a 2021 study of an outpatient orthopedic physical therapy business with clinics across the U.S., the two largest factors that most predicted a no-show for an appointment were previous cancellations and time between visits. Taking this into consideration, it makes sense to try to mitigate these factors as best as possible. One way to do this is by creating and enforcing a cancellation policy.
Now, what should your clinic’s cancellation policy include? The two most important components to decide upon are:
- The window for allowing cancellations
- The fee if someone cancels outside of this window
Reasonable and popular time frames for cancellation are within 24 or 48 hours of the appointment. You may want to increase it depending on your ability to backfill patients into an open time slot after a cancellation. As such, 72 hours may make more sense for your clinic. It could be helpful to look at some of your clinic statistics such as the number of people on the waiting list, unscheduled current patients, existing open time slots, etc.
The second item to determine is the fee. Should the fee be punitive? Should it be the cost of an average treatment session? Or would a smaller inconvenience fee be more appropriate? A quick internet search of physical therapy clinics indicates rates are commonly between $45-$75, with some increasing the fee if more appointments are missed.
Like a lot of things in physical therapy and life, there can be some gray areas that will require assessment on a case-by-case basis. For instance, someone will cancel after the window, but will have a good reason. Your clinic will have to make the tough decision on when to charge the fee and what constitutes a reasonable excuse (i.e. emergencies, illnesses, etc.). You may also need to make more informal or formal decisions when it comes to how many missed or canceled appointments an individual can make. If someone is consistently canceling appointments, but it is within the cancellation window, what do you do? Also, how many out-of-window cancellations or no-shows does your clinic allow? Will you allow one emergency cancellation or will you charge the fee regardless. Will you have two or three “strikes” and then charge?
In order to answer these questions, first, take a look at your current patient population and why people may be missing appointments and the behaviors you would like to resolve. Then discuss as a team what elements to include in the policy to reduce cancellations and no-shows. Remember there are different approaches and structures for different clinics and no one-size-fits-all cancellation policy; just do what feels best for your practice. Whatever you decide, make sure to keep it fair and consistent and communicate it to your patients in advance so no one is surprised about any additional fees.
Communicating the policy to patients
Once you’ve decided on what to include in your cancellation policy, now it’s time to communicate the what, when, and whys to your patients. A great time to do this is as part of their initial paperwork and evaluation. Have patients read and sign the policy as part of intake paperwork. Then each therapist at the initial evaluation can reiterate the policy and why it is in place. Some key ideas to tell patients include:
- What: The amount of the fee
- When: It will be assessed after (X number of missed appointments/cancels)
- Why: It helps ensure attendance at scheduled visits meets their plan of care so they can get better, faster
If people understand these elements they may be less likely to cancel or not show up to an appointment. It is helpful if the therapist can review the policy with them as part of the initial evaluation instead of it just being another piece of paperwork they sign.
Supporting the policy
In a perfect world, if someone missed an appointment without an excuse, they would be charged a fee, realize they made a mistake (for whatever reason), pay the fee, and then feel motivated to attend their next visit and happily continue on through their plan of care. However, in reality, there are likely more feelings involved about assessing the fee and what it means moving forward. There may be a fear of how a patient will react to being charged (i.e. discontinuing treatment, negative reviews, etc.). However, know that if you have communicated the policy upfront, sent reminders, and maintained engagement through each session, you have done your best to serve the patient and they do have the ultimate responsibility for showing up.
Some ways to avoid having to charge someone a fee for canceling include staying at the top of the patient’s mind and keeping them engaged with their treatment by:
- Having patients book online, which has been shown to decrease cancel rates based on Prompt research
- Making sure patients are scheduled according to their full plan of care to avoid long periods between appointments
- Sending appointment reminders via text/email
- Providing a patient with a small goal to achieve by their next visit (i.e. “Let’s see if you can get X degrees more of range of motion of your affected body part by your next appointment)
- Reminding them of their next appointment and giving them a preview of what you plan to progress at the next session and how it will help them
Cancellations and no-shows are an inevitable part of all physical therapy businesses. It is important to have a cancellation policy in place that is clear, reasonable, and enforceable. However, the best policy is to reduce cancellations as much as possible through patient engagement, support, and appointment reminders. After all, having patients consistently show up for physical therapy is what will help them improve and reach their goals!
About the author:
Chelsea Krotser is an outpatient orthopedic physical therapist and freelance writer. Drawing on her experience as a PT as well as her former life as an accountant, she is dedicated to providing an insightful clinical and business perspective. She loves writing about all things related to physical therapy. You can find her on Instagram @chelseakrotser.