Re: NO SHOW/CANCELLATION FEES - yes or no?

January 18, 2006

I have had great success with the $50 no show fee/cancel < 24 hours.

My patients have paid the $50 promptly and have apologized (profusely)

for wasting my time. They usually get the check in the mail the same

week or day and reschedule soon thereafter. I have only had to use it

3 times and have had the same response each time. Often the patients

will call before I even alert them and will tell me they know there is

a $50 fee and they will get it right to me. These people have been

professional folks who often overbook themselves. I definitely want

them to know our time is equally important by charging the fee right up

front. I would not want to keep any patient who does not understand

that me waiting for 30-45 minutes for them to no show is not worth $50.

I guess I am a " hard ass " but I am looking for a certain breed of

patients who understand that mutual respect is the core of our

relationship. I think it also shows they really value me and my

services.

On the other hand I am not allowed to charge a fee to the state

medicaid population. I make sure they know in advance that they can

come in for same day appointments and be seen usually within 24 hours.

Many are without adequate transportation, homeless, traumatic brain

injury etc.. so I bend over backwards to make things easy for them BUT

if I have one No show or cancel < 24 hours for no good reason I

terminate them. This happened once last week (only once actually) when

this woman was very lackadaisical when scheduling a FU visit for a CPX.

I told her again and again that she could get a same day appt and could

wait until she was sure she could make the appt. She made her FU

anyway (and I knew she would no show) and she did. I have no problem

sending a termination letter, since I am NOT ALLOWED to charge the fee.

I suspect if I were allowed to charge the fee she would not pay it

and she would be out the door anyway. It is just a matter of time

before one's true colors bleed through.

I guess it comes down to having patients who are extremely appreciative

of me and my services. I give my all to them.

I think not charging professional folks the fee (which they CAN afford)

will keep them undervaluing you or your service and they are likely to

be repeat offenders. " If my doctor does not care and there are no

consequences for no showing, then I'll just go ahead and meet Jim for

our lunch date... "

On the other hand, I do not think the fee would ever fly in a high

volume office which is sooooo disrespectful of the patients time. Why

should they pay for missing a 1 pm office visit if the doctor is always

30-60 minutes late for the same slot. In that case the doctor owes

money to the patient to be fair. I think the article referred to the

standard high volume disrespectful medical model and in that case I

agree with NOT charging a fee.

Our model is different and based on respect so I think raising the

consciousness is necessary. Money is still a good motivator/learning

tool in our capitalistic society so I'll keep charging the fee.

Pamela

Pamela Wible, MD

Family & Community Medicine, LLC

3575 st. #220

Eugene, OR 97405

roxywible@...

> You mentioned you charged a $50 no call-no show fee.Â There was a good

> brief article on that topic in this monthâ€™s issue of Physicians

> Practice.Â They basically advise thinking long & hard before charging

> people for these.Â They said that these patients are ironically often

> your best patients, often young professionals that had a last minute

> change of plans.Â They will often have good insurances & will leave

> the practice more often than not (will usually not even realize that

> theyâ€™ve left, may not request records sent).Â Also, they say that you

> will rarely even collect that fee & may lose a patient that would have

> brought in thousands $$$ in revenue over several years.Â Basically,

> their answer is to just keep track & then discharge them after they

> have 3 or 4.Â That is what I do, & do not bother charging for them.Â

> Â

>

> Â

> Preventing " problem " patients

>

> Hello all,Â I have an inkling that we all have certain patients who

> can grate on us and make

> our days less than pleasant.Â I started tracking things that annoy me

> with a list (and also

> exceptional things that I love about my practice on another list).Â In

> an effort to be pro-

> active I made a patient information sheet called " How to make the most

> of your office

> visist " Â It has worked great!Â When someone calls on a weekend for a

> refill on my cell I

> kindly redirect them to the main answering machine number and mail

> them one of these

> handouts.Â Eventually, I expect to rarely (if ever) receive phone

> calls for refills. It feels great

> to be solution oriented.Â What do you all think?Â Anyone doing

> anything similar?

>

> How to make the most of your office visit....

>

> Office Visits

>

> Medical issues need to be discussed in person rather than " telephone

> medicine " so please

> call when you will need an appointment and as early in the day as

> possible.

>

> It is very likely that you will be able to be seen the same day or

> within 24 hours.

>

> When calling make sure you let Dr. Wible know ALL THE THINGS you are

> coming in for so

> she can give you an adequate appointment slot.

>

> Please BRING YOUR LIST to the appointment.Â Keep a list of questions

> that come up

> between office visits so you will be less likely to forget to discuss

> important issues.

>

> Ask for the REFILLS you will need DURING your office visit to prevent

> running out of your

> medications between visits. In the rare instance that you misjudge and

> do call for a refill

> you must call during the week and allow 24 hours for the refill to be

> processed. Maintain a

> regular pharmacy at one location.Â Make sure you schedule your follow

> up visits and/or lab

> tests BEFORE you run out of your medication.

>

> Please plan to get your lab tests and other specialty exams as soon as

> possible. Please let

> Dr. Wible know if you will be unable to get those tests within a few

> weeks of your visit.

>

> Understand the frequency of follow up visits that you will require. If

> stable on your

> medications with no real medical issues you may be seen yearly. If you

> have chronic issues

> you may need to be seen every 3 months.Â If you have uncontrolled

> chronic issues you may

> need to be seen monthly or even more frequently until things are

> stabilized.

>

> Be prepared with your co-pay at the time of visit.Â If you do not

> understand your insurance

> please make an effort to do so by reviewing the booklet or calling

> your insurer.Â This

> allows Dr. Wible to focus on providing medical care rather than

> calling insurance

> companies and reminding patients about missed co-pays later.

>

> Communication

>

> The cell phone is reserved for emergencies so please do not use the

> cell line unless you

> are on your way to the emergency room or urgent care.

>

> Dr. Wible checks her messages frequently so you should hear back the

> same day. Please

> return phone calls and correspondence as soon as you are able.Â

> Patients who are unable

> to return communication risk being discharged from the practice.

>

> Please let Dr. Wible know about any change in you essential

> information including address,

> phone number, or insurance carrier.

>

> Email is currently available for administrative (scheduling, billing)

> questions. All sensitive

> medical issues should be discussed at your next office visit.

>

January 19, 2006

I have learned a lot through this exchange!

The patients I have trouble with no-showing tend to be new patients to my

practice. If I have never seen them before and they do not call with an

explanation, I terminate them (technically, they were never really a patient

anyway) with a letter sent 24 hours after the missed appointment. I have only

had one patient call me back to ask for another appointment after receiving

his termination letter. I was unwilling to reschedule (he could not remember

why he failed to come to his appointment) and he thought I was much " too

uptight " for his liking anyway. I do not think we were a good match.

I plan to now institute Ernie's step wise plan for my established patients and

see how that goes.

, M.D.

Durango, CO

On Wed, 18 Jan 2006 18:43:57 -0700

Guinn wrote:

> My initial materials include a note explaining that I charge a $75.00

> no-show fee and why. Most people are pleased to find out I only see 10

>patients a day (and amazed). I actually charge the fee rarely, as many

>people have legitimate extenuating circumstances. IT has been paid several

>times, with apologies, by people who no-showed because they were overbooked.

>They have continued in my practice. I also have used a charge for a " no

>show " as a mechanism to move people out of my practice when they were not

>respectful of scheduling.

>

>> Boy, again I think you must have better patients there in Oregon.

>> Believe people here would be livid if they were charged a fee for a

>> no show. I just talked to a fellow doctor the other day that

>> commented that he was personally switching dentists because they

>> charged him for a no show. I agree it is disrespectful of our

>> time, but I just think dismissing the pt after either one or three

>> or whatever is the answer for me. Again though, Oregon sounds like

>> the place to be for doctors. Trust me, your patients sound a lot

>> different than they do here or anywhere I ever worked in residency,

>> etc.

>>

>> Preventing " problem " patients

>>

>> Hello all, I have an inkling that we all have certain patients who

>> can grate on us and make

>> our days less than pleasant. I started tracking things that annoy

>> me with a list (and also

>> exceptional things that I love about my practice on another list).

>> In an effort to be pro-

>> active I made a patient information sheet called " How to make the

>> most of your office

>> visist " It has worked great! When someone calls on a weekend for

>> a refill on my cell I

>> kindly redirect them to the main answering machine number and mail

>> them one of these

>> handouts. Eventually, I expect to rarely (if ever) receive phone

>> calls for refills. It feels great

>> to be solution oriented. What do you all think? Anyone doing

>> anything similar?

>>

>> How to make the most of your office visit....

>>

>> Office Visits

>>

>> Medical issues need to be discussed in person rather than

>> " telephone medicine " so please

>> call when you will need an appointment and as early in the day as

>> possible.

>>

>> It is very likely that you will be able to be seen the same day or

>> within 24 hours.

>>

>> When calling make sure you let Dr. Wible know ALL THE THINGS you

>> are coming in for so

>> she can give you an adequate appointment slot.

>>

>> Please BRING YOUR LIST to the appointment. Keep a list of

>> questions that come up

>> between office visits so you will be less likely to forget to

>> discuss important issues.

>>

>> Ask for the REFILLS you will need DURING your office visit to

>> prevent running out of your

>> medications between visits. In the rare instance that you misjudge

>> and do call for a refill

>> you must call during the week and allow 24 hours for the refill to

>> be processed. Maintain a

>> regular pharmacy at one location. Make sure you schedule your

>> follow up visits and/or lab

>> tests BEFORE you run out of your medication.

>>

>> Please plan to get your lab tests and other specialty exams as soon

>> as possible. Please let

>> Dr. Wible know if you will be unable to get those tests within a

>> few weeks of your visit.

>>

>> Understand the frequency of follow up visits that you will require.

>> If stable on your

>> medications with no real medical issues you may be seen yearly. If

>> you have chronic issues

>> you may need to be seen every 3 months. If you have uncontrolled

>> chronic issues you may

>> need to be seen monthly or even more frequently until things are

>> stabilized.

>>

>> Be prepared with your co-pay at the time of visit. If you do not

>> understand your insurance

>> please make an effort to do so by reviewing the booklet or calling

>> your insurer. This

>> allows Dr. Wible to focus on providing medical care rather than

>> calling insurance

>> companies and reminding patients about missed co-pays later.

>>

>> Communication

>>

>> The cell phone is reserved for emergencies so please do not use the

>> cell line unless you

>> are on your way to the emergency room or urgent care.

>>

>> Dr. Wible checks her messages frequently so you should hear back

>> the same day. Please

>> return phone calls and correspondence as soon as you are able.

>> Patients who are unable

>> to return communication risk being discharged from the practice.

>>

>> Please let Dr. Wible know about any change in you essential

>> information including address,

>> phone number, or insurance carrier.

>>

>> Email is currently available for administrative (scheduling,

>> billing) questions. All sensitive

>> medical issues should be discussed at your next office visit.

>>

January 19, 2006

It depends on what you mean by “legitimate

extenuating circumstances.” That implies that they actually called

& gave an explanation & apology. Those are not usually the type

of patient that causes the problems & refuse to pay a no show fee (I would

not even count something like that against them). I’m talking about

the one’s that do not call, do not give a reason, & just call again

later wanting more appts. Basically, I still think about it in dollars

& cents. If you have nine people that pay the no call-no show fee

& apologize, stay as a patient, etc but have just one patient with good

insurance leave the practice over the fee (ie, a rate of only 10%) then you

will still have lost more revenue over the next year than you gained from

collecting those 9 fees. Sure, that one pt that leaves may just not be a “good

fit” anyways but that is why I usually let them declare themselves with 3

no call – no shows before dismissing them. I always like to

think of how I personally would react. If I called, say, 6 hrs before my

own doctor appt to cancel & then still received a bill for a late cancel

fee I would definitely go looking for a new doctor (as long as it did not

become a habit for me). I think the practice of some doctors charging for

Rx refills falls along the same lines: seems like a good solution to a chronic

office mgt problem but in reality is just not worth the strife it causes for a

few dollars in revenue. Just my opinion of course!

Preventing " problem " patients

Hello all, I have an inkling that we all have certain

patients who can grate on us and make

our days less than pleasant. I started tracking things that

annoy me with a list (and also

exceptional things that I love about my practice on another

list). In an effort to be pro-

active I made a patient information sheet called " How to make

the most of your office

visist " It has worked great! When someone calls

on a weekend for a refill on my cell I

kindly redirect them to the main answering machine number and mail

them one of these

handouts. Eventually, I expect to rarely (if ever) receive

phone calls for refills. It feels great

to be solution oriented. What do you all think? Anyone

doing anything similar?

How to make the most of your office visit....

Office Visits

Medical issues need to be discussed in person rather than

" telephone medicine " so please

call when you will need an appointment and as early in the day as

possible.

It is very likely that you will be able to be seen the same day or

within 24 hours.

When calling make sure you let Dr. Wible know ALL THE THINGS you

are coming in for so

she can give you an adequate appointment slot.

Please BRING YOUR LIST to the appointment. Keep a list of

questions that come up

between office visits so you will be less likely to forget to

discuss important issues.

Ask for the REFILLS you will need DURING your office visit to

prevent running out of your

medications between visits. In the rare instance that you misjudge

and do call for a refill

you must call during the week and allow 24 hours for the refill to

be processed. Maintain a

regular pharmacy at one location. Make sure you schedule

your follow up visits and/or lab

tests BEFORE you run out of your medication.

Please plan to get your lab tests and other specialty exams as

soon as possible. Please let

Dr. Wible know if you will be unable to get those tests within a

few weeks of your visit.

Understand the frequency of follow up visits that you will

require. If stable on your

medications with no real medical issues you may be seen yearly. If

you have chronic issues

you may need to be seen every 3 months. If you have

uncontrolled chronic issues you may

need to be seen monthly or even more frequently until things are

stabilized.

Be prepared with your co-pay at the time of visit. If you do

not understand your insurance

please make an effort to do so by reviewing the booklet or calling

your insurer. This

allows Dr. Wible to focus on providing medical care rather than

calling insurance

companies and reminding patients about missed co-pays later.

Communication

The cell phone is reserved for emergencies so please do not use

the cell line unless you

are on your way to the emergency room or urgent care.

Dr. Wible checks her messages frequently so you should hear back

the same day. Please

return phone calls and correspondence as soon as you are

able. Patients who are unable

to return communication risk being discharged from the practice.

Please let Dr. Wible know about any change in you essential

information including address,

phone number, or insurance carrier.

Email is currently available for administrative (scheduling,

billing) questions. All sensitive

medical issues should be discussed at your next office visit.

January 20, 2006

I'm also doing a step-wise approach- sending my

policy with NS fees AND MAKING A PROMINENT NOTE ON

THEIR CHART after 1 NS.

Gwen

--- Ernie Leland

wrote:

> We also charge a fee for the second no-show ($20).

> First time is a

> warning, second is the fee, third no-show is a

> discharge from the

> practice. We have a few no shows each month. We

> have collected two

> fees. We have discharged two patients that we were

> happy to lose. We

> have ignored a few no shows that did not call

> because they were at the

> ER or other reasonable excuse. I wouldn't dream of

> not having

> consequences for not showing up. If a patient is

> not willing to pay the

> fee on the second no-show, we don't want them. On

> average, they have

> cost us $200 already in lost revenue.

>

> Ernie

>

> ________________________________

>

> From:

> [mailto: ] On

> Behalf Of Brock

> DO

> Sent: Wednesday, January 18, 2006 12:38 PM

> To:

> Subject: RE: NO

> SHOW/CANCELLATION FEES - yes or

> no?

>

> Boy, again I think you must have better patients

> there in Oregon.

> Believe people here would be livid if they were

> charged a fee for a no

> show. I just talked to a fellow doctor the other

> day that commented

> that he was personally switching dentists because

> they charged him for a

> no show. I agree it is disrespectful of our time,

> but I just think

> dismissing the pt after either one or three or

> whatever is the answer

> for me. Again though, Oregon sounds like the place

> to be for doctors.

> Trust me, your patients sound a lot different than

> they do here or

> anywhere I ever worked in residency, etc.

>

> Re: NO

> SHOW/CANCELLATION FEES - yes or

> no?

>

> I have had great success with the $50 no show

> fee/cancel < 24 hours. My

> patients have paid the $50 promptly and have

> apologized (profusely) for

> wasting my time. They usually get the check in the

> mail the same week or

> day and reschedule soon thereafter. I have only had

> to use it 3 times

> and have had the same response each time. Often the

> patients will call

> before I even alert them and will tell me they know

> there is a $50 fee

> and they will get it right to me. These people have

> been professional

> folks who often overbook themselves. I definitely

> want them to know our

> time is equally important by charging the fee right

> up front. I would

> not want to keep any patient who does not understand

> that me waiting for

> 30-45 minutes for them to no show is not worth $50.

> I guess I am a " hard

> ass " but I am looking for a certain breed of

> patients who understand

> that mutual respect is the core of our relationship.

> I think it also

> shows they really value me and my services.

>

> On the other hand I am not allowed to charge a fee

> to the state medicaid

> population. I make sure they know in advance that

> they can come in for

> same day appointments and be seen usually within 24

> hours. Many are

> without adequate transportation, homeless, traumatic

> brain injury etc..

> so I bend over backwards to make things easy for

> them BUT if I have one

> No show or cancel < 24 hours for no good reason I

> terminate them. This

> happened once last week (only once actually) when

> this woman was very

> lackadaisical when scheduling a FU visit for a CPX.

> I told her again and

> again that she could get a same day appt and could

> wait until she was

> sure she could make the appt. She made her FU anyway

> (and I knew she

> would no show) and she did. I have no problem

> sending a termination

> letter, since I am NOT ALLOWED to charge the fee. I

> suspect if I were

> allowed to charge the fee she would not pay it and

> she would be out the

> door anyway. It is just a matter of time before

> one's true colors bleed

> through.

>

> I guess it comes down to having patients who are

> extremely appreciative

> of me and my services. I give my all to them.

>

> I think not charging professional folks the fee

> (which they CAN afford)

> will keep them undervaluing you or your service and

> they are likely to

> be repeat offenders. " If my doctor does not care and

> there are no

> consequences for no showing, then I'll just go ahead

> and meet Jim for

> our lunch date... "

>

> On the other hand, I do not think the fee would ever

> fly in a high

> volume office which is sooooo disrespectful of the

> patients time. Why

> should they pay for missing a 1 pm office visit if

> the doctor is always

> 30-60 minutes late for the same slot. In that case

> the doctor owes money

> to the patient to be fair. I think the article

> referred to the standard

> high volume disrespectful medical model and in that

> case I agree with

> NOT charging a fee.

>

> Our model is different and based on respect so I

> think raising the

> consciousness is necessary. Money is still a good

> motivator/learning

> tool in our capitalistic society so I'll keep

> charging the fee.

>

> Pamela

>

> Pamela Wible, MD

> Family & Community Medicine, LLC

> 3575 st. #220

> Eugene, OR 97405

>

> roxywible@...

>

> You mentioned you charged a $50 no call-no show fee.

> There was a good

> brief article on that topic in this month's issue of

> Physicians

> Practice. They basically advise thinking long &

> hard before charging

> people for these. They said that these patients are

> ironically often

> your best patients, often young professionals that

> had a last minute

> change of plans. They will often have good

> insurances & will leave the

> practice more often than not (will usually not even

> realize that they've

> left, may not request records sent). Also, they say

> that you will

> rarely even collect that fee & may lose a patient

> that would have

>

=== message truncated ===

January 20, 2006

Here is a question my nurse posed to me

along the same line—What about no shows to referred specialists? Ex. you

refer someone to a GI for a colonoscopy and they don’t show up for an

appointment. Technically, you are still liable if there is a cancer, plus it

looks bad for your practice and leaves you in a bind when the patient returns

with continued abdominal pain and now no one to refer to. So even though you

are not losing direct revenue from these no shows,

does anyone have a policy regarding this problem?

Re: NO

> SHOW/CANCELLATION FEES - yes or

> no?

>

> I have had great success with the $50 no show

> fee/cancel < 24 hours. My

> patients have paid the $50 promptly and have

> apologized (profusely) for

> wasting my time. They usually get the check

in the

> mail the same week or

> day and reschedule soon thereafter. I have

only had

> to use it 3 times

> and have had the same response each time.

Often the

> patients will call

> before I even alert them and will tell me

they know

> there is a $50 fee

> and they will get it right to me. These

people have

> been professional

> folks who often overbook themselves. I

definitely

> want them to know our

> time is equally important by charging the fee

right

> up front. I would

> not want to keep any patient who does not

understand

> that me waiting for

> 30-45 minutes for them to no show is not

worth $50.

> I guess I am a " hard

> ass " but I am looking for a certain

breed of

> patients who understand

> that mutual respect is the core of our

relationship.

> I think it also

> shows they really value me and my services.

>

> On the other hand I am not allowed to charge

a fee

> to the state medicaid

> population. I make sure they know in advance

that

> they can come in for

> same day appointments and be seen usually

within 24

> hours. Many are

> without adequate transportation, homeless,

traumatic

> brain injury etc..

> so I bend over backwards to make things easy

for

> them BUT if I have one

> No show or cancel < 24 hours for no good

reason I

> terminate them. This

> happened once last week (only once actually)

when

> this woman was very

> lackadaisical when scheduling a FU visit for

a CPX.

> I told her again and

> again that she could get a same day appt and

could

> wait until she was

> sure she could make the appt. She made her FU

anyway

> (and I knew she

> would no show) and she did. I have no problem

> sending a termination

> letter, since I am NOT ALLOWED to charge the

fee. I

> suspect if I were

> allowed to charge the fee she would not pay

it and

> she would be out the

> door anyway. It is just a matter of time

before

> one's true colors bleed

> through.

>

> I guess it comes down to having patients who

are

> extremely appreciative

> of me and my services. I give my all to them.

>

> I think not charging professional folks the

fee

> (which they CAN afford)

> will keep them undervaluing you or your

service and

> they are likely to

> be repeat offenders. " If my doctor does

not care and

> there are no

> consequences for no showing, then I'll just

go ahead

> and meet Jim for

> our lunch date... "

>

> On the other hand, I do not think the fee

would ever

> fly in a high

> volume office which is sooooo disrespectful

of the

> patients time. Why

> should they pay for missing a 1 pm office

visit if

> the doctor is always

> 30-60 minutes late for the same slot. In that

case

> the doctor owes money

> to the patient to be fair. I think the article

> referred to the standard

> high volume disrespectful medical model and

in that

> case I agree with

> NOT charging a fee.

>

> Our model is different and based on respect

so I

> think raising the

> consciousness is necessary. Money is still a

good

> motivator/learning

> tool in our capitalistic society so I'll keep

> charging the fee.

>

> Pamela

>

> Pamela Wible, MD

> Family & Community Medicine, LLC

> 3575 st. #220

> Eugene, OR 97405

>

> roxywible@...

>

> On Jan 18, 2006, at 11:49 AM, Brock DO

wrote:

>

> You mentioned you charged a $50 no call-no

show fee.

> There was a good

> brief article on that topic in this month's

issue of

> Physicians

> Practice. They basically advise

thinking long &

> hard before charging

> people for these. They said that these

patients are

> ironically often

> your best patients, often young professionals

that

> had a last minute

> change of plans. They will often have

good

> insurances & will leave the

> practice more often than not (will usually

not even

> realize that they've

> left, may not request records sent).

Also, they say

> that you will

> rarely even collect that fee & may lose a

patient

> that would have

>

=== message truncated ===

January 20, 2006

At my risk management lecture last night, they

recommended you add a standard line to your referral

form saying " Please call me if my patient doesn't show

up. "

Gwen Hanson

--- " Brady, MD "

wrote:

> Here is a question my nurse posed to me along the

> same line-What about

> no shows to referred specialists? Ex. you refer

> someone to a GI for a

> colonoscopy and they don't show up for an

> appointment. Technically, you

> are still liable if there is a cancer, plus it looks

> bad for your

> practice and leaves you in a bind when the patient

> returns with

> continued abdominal pain and now no one to refer to.

> So even though you

> are not losing direct revenue from these no shows,

> does anyone have a

> policy regarding this problem?

>

> Re: NO

> > SHOW/CANCELLATION FEES - yes or

> > no?

> >

> > I have had great success with the $50 no show

> > fee/cancel < 24 hours. My

> > patients have paid the $50 promptly and have

> > apologized (profusely) for

> > wasting my time. They usually get the check in the

> > mail the same week or

> > day and reschedule soon thereafter. I have only

> had

> > to use it 3 times

> > and have had the same response each time. Often

> the

> > patients will call

> > before I even alert them and will tell me they

> know

> > there is a $50 fee

> > and they will get it right to me. These people

> have

> > been professional

> > folks who often overbook themselves. I definitely

> > want them to know our

> > time is equally important by charging the fee

> right

> > up front. I would

> > not want to keep any patient who does not

> understand

> > that me waiting for

> > 30-45 minutes for them to no show is not worth

> $50.

> > I guess I am a " hard

> > ass " but I am looking for a certain breed of

> > patients who understand

> > that mutual respect is the core of our

> relationship.

> > I think it also

> > shows they really value me and my services.

> >

> > On the other hand I am not allowed to charge a fee

> > to the state medicaid

> > population. I make sure they know in advance that

> > they can come in for

> > same day appointments and be seen usually within

> 24

> > hours. Many are

> > without adequate transportation, homeless,

> traumatic

> > brain injury etc..

> > so I bend over backwards to make things easy for

> > them BUT if I have one

> > No show or cancel < 24 hours for no good reason I

> > terminate them. This

> > happened once last week (only once actually) when

> > this woman was very

> > lackadaisical when scheduling a FU visit for a

> CPX.

> > I told her again and

> > again that she could get a same day appt and could

> > wait until she was

> > sure she could make the appt. She made her FU

> anyway

> > (and I knew she

> > would no show) and she did. I have no problem

> > sending a termination

> > letter, since I am NOT ALLOWED to charge the fee.

> I

> > suspect if I were

> > allowed to charge the fee she would not pay it and

> > she would be out the

> > door anyway. It is just a matter of time before

> > one's true colors bleed

> > through.

> >

> > I guess it comes down to having patients who are

> > extremely appreciative

> > of me and my services. I give my all to them.

> >

> > I think not charging professional folks the fee

> > (which they CAN afford)

> > will keep them undervaluing you or your service

> and

> > they are likely to

> > be repeat offenders. " If my doctor does not care

> and

> > there are no

> > consequences for no showing, then I'll just go

> ahead

> > and meet Jim for

> > our lunch date... "

>

=== message truncated ===

January 20, 2006

At my risk management lecture last night, they

recommended you add a standard line to your referral

form saying " Please call me if my patient doesn't show

up. "

Gwen Hanson

--- " Brady, MD "

wrote:

> Here is a question my nurse posed to me along the

> same line-What about

> no shows to referred specialists? Ex. you refer

> someone to a GI for a

> colonoscopy and they don't show up for an

> appointment. Technically, you

> are still liable if there is a cancer, plus it looks

> bad for your

> practice and leaves you in a bind when the patient

> returns with

> continued abdominal pain and now no one to refer to.

> So even though you

> are not losing direct revenue from these no shows,

> does anyone have a

> policy regarding this problem?

>

> Re: NO

> > SHOW/CANCELLATION FEES - yes or

> > no?

> >

> > I have had great success with the $50 no show

> > fee/cancel < 24 hours. My

> > patients have paid the $50 promptly and have

> > apologized (profusely) for

> > wasting my time. They usually get the check in the

> > mail the same week or

> > day and reschedule soon thereafter. I have only

> had

> > to use it 3 times

> > and have had the same response each time. Often

> the

> > patients will call

> > before I even alert them and will tell me they

> know

> > there is a $50 fee

> > and they will get it right to me. These people

> have

> > been professional

> > folks who often overbook themselves. I definitely

> > want them to know our

> > time is equally important by charging the fee

> right

> > up front. I would

> > not want to keep any patient who does not

> understand

> > that me waiting for

> > 30-45 minutes for them to no show is not worth

> $50.

> > I guess I am a " hard

> > ass " but I am looking for a certain breed of

> > patients who understand

> > that mutual respect is the core of our

> relationship.

> > I think it also

> > shows they really value me and my services.

> >

> > On the other hand I am not allowed to charge a fee

> > to the state medicaid

> > population. I make sure they know in advance that

> > they can come in for

> > same day appointments and be seen usually within

> 24

> > hours. Many are

> > without adequate transportation, homeless,

> traumatic

> > brain injury etc..

> > so I bend over backwards to make things easy for

> > them BUT if I have one

> > No show or cancel < 24 hours for no good reason I

> > terminate them. This

> > happened once last week (only once actually) when

> > this woman was very

> > lackadaisical when scheduling a FU visit for a

> CPX.

> > I told her again and

> > again that she could get a same day appt and could

> > wait until she was

> > sure she could make the appt. She made her FU

> anyway

> > (and I knew she

> > would no show) and she did. I have no problem

> > sending a termination

> > letter, since I am NOT ALLOWED to charge the fee.

> I

> > suspect if I were

> > allowed to charge the fee she would not pay it and

> > she would be out the

> > door anyway. It is just a matter of time before

> > one's true colors bleed

> > through.

> >

> > I guess it comes down to having patients who are

> > extremely appreciative

> > of me and my services. I give my all to them.

> >

> > I think not charging professional folks the fee

> > (which they CAN afford)

> > will keep them undervaluing you or your service

> and

> > they are likely to

> > be repeat offenders. " If my doctor does not care

> and

> > there are no

> > consequences for no showing, then I'll just go

> ahead

> > and meet Jim for

> > our lunch date... "

>

=== message truncated ===

January 20, 2006

At my risk management lecture last night, they

recommended you add a standard line to your referral

form saying " Please call me if my patient doesn't show

up. "

Gwen Hanson

--- " Brady, MD "

wrote:

> Here is a question my nurse posed to me along the

> same line-What about

> no shows to referred specialists? Ex. you refer

> someone to a GI for a

> colonoscopy and they don't show up for an

> appointment. Technically, you

> are still liable if there is a cancer, plus it looks

> bad for your

> practice and leaves you in a bind when the patient

> returns with

> continued abdominal pain and now no one to refer to.

> So even though you

> are not losing direct revenue from these no shows,

> does anyone have a

> policy regarding this problem?

>

> Re: NO

> > SHOW/CANCELLATION FEES - yes or

> > no?

> >

> > I have had great success with the $50 no show

> > fee/cancel < 24 hours. My

> > patients have paid the $50 promptly and have

> > apologized (profusely) for

> > wasting my time. They usually get the check in the

> > mail the same week or

> > day and reschedule soon thereafter. I have only

> had

> > to use it 3 times

> > and have had the same response each time. Often

> the

> > patients will call

> > before I even alert them and will tell me they

> know

> > there is a $50 fee

> > and they will get it right to me. These people

> have

> > been professional

> > folks who often overbook themselves. I definitely

> > want them to know our

> > time is equally important by charging the fee

> right

> > up front. I would

> > not want to keep any patient who does not

> understand

> > that me waiting for

> > 30-45 minutes for them to no show is not worth

> $50.

> > I guess I am a " hard

> > ass " but I am looking for a certain breed of

> > patients who understand

> > that mutual respect is the core of our

> relationship.

> > I think it also

> > shows they really value me and my services.

> >

> > On the other hand I am not allowed to charge a fee

> > to the state medicaid

> > population. I make sure they know in advance that

> > they can come in for

> > same day appointments and be seen usually within

> 24

> > hours. Many are

> > without adequate transportation, homeless,

> traumatic

> > brain injury etc..

> > so I bend over backwards to make things easy for

> > them BUT if I have one

> > No show or cancel < 24 hours for no good reason I

> > terminate them. This

> > happened once last week (only once actually) when

> > this woman was very

> > lackadaisical when scheduling a FU visit for a

> CPX.

> > I told her again and

> > again that she could get a same day appt and could

> > wait until she was

> > sure she could make the appt. She made her FU

> anyway

> > (and I knew she

> > would no show) and she did. I have no problem

> > sending a termination

> > letter, since I am NOT ALLOWED to charge the fee.

> I

> > suspect if I were

> > allowed to charge the fee she would not pay it and

> > she would be out the

> > door anyway. It is just a matter of time before

> > one's true colors bleed

> > through.

> >

> > I guess it comes down to having patients who are

> > extremely appreciative

> > of me and my services. I give my all to them.

> >

> > I think not charging professional folks the fee

> > (which they CAN afford)

> > will keep them undervaluing you or your service

> and

> > they are likely to

> > be repeat offenders. " If my doctor does not care

> and

> > there are no

> > consequences for no showing, then I'll just go

> ahead

> > and meet Jim for

> > our lunch date... "

>

=== message truncated ===

January 20, 2006

Often I will dismiss a patient on the spot if they no call-no show to a

specialist I have referred them to. However, I don't see how you (as the

referring doctor) could be totally liable for that, as the patient is the

one that did not go. What are supposed to do, drive them yourself? Of course

A lawyer can always argue that the " poor dumb patient " just did not

understand the consequences. That can happen no matter what you document,

so there is only so much you can do to cover yourself.

Re: NO

> > SHOW/CANCELLATION FEES - yes or

> > no?

> >

> > I have had great success with the $50 no show

> > fee/cancel < 24 hours. My

> > patients have paid the $50 promptly and have

> > apologized (profusely) for

> > wasting my time. They usually get the check in the

> > mail the same week or

> > day and reschedule soon thereafter. I have only

> had

> > to use it 3 times

> > and have had the same response each time. Often

> the

> > patients will call

> > before I even alert them and will tell me they

> know

> > there is a $50 fee

> > and they will get it right to me. These people

> have

> > been professional

> > folks who often overbook themselves. I definitely

> > want them to know our

> > time is equally important by charging the fee

> right

> > up front. I would

> > not want to keep any patient who does not

> understand

> > that me waiting for

> > 30-45 minutes for them to no show is not worth

> $50.

> > I guess I am a " hard

> > ass " but I am looking for a certain breed of

> > patients who understand

> > that mutual respect is the core of our

> relationship.

> > I think it also

> > shows they really value me and my services.

> >

> > On the other hand I am not allowed to charge a fee

> > to the state medicaid

> > population. I make sure they know in advance that

> > they can come in for

> > same day appointments and be seen usually within

> 24

> > hours. Many are

> > without adequate transportation, homeless,

> traumatic

> > brain injury etc..

> > so I bend over backwards to make things easy for

> > them BUT if I have one

> > No show or cancel < 24 hours for no good reason I

> > terminate them. This

> > happened once last week (only once actually) when

> > this woman was very

> > lackadaisical when scheduling a FU visit for a

> CPX.

> > I told her again and

> > again that she could get a same day appt and could

> > wait until she was

> > sure she could make the appt. She made her FU

> anyway

> > (and I knew she

> > would no show) and she did. I have no problem

> > sending a termination

> > letter, since I am NOT ALLOWED to charge the fee.

> I

> > suspect if I were

> > allowed to charge the fee she would not pay it and

> > she would be out the

> > door anyway. It is just a matter of time before

> > one's true colors bleed

> > through.

> >

> > I guess it comes down to having patients who are

> > extremely appreciative

> > of me and my services. I give my all to them.

> >

> > I think not charging professional folks the fee

> > (which they CAN afford)

> > will keep them undervaluing you or your service

> and

> > they are likely to

> > be repeat offenders. " If my doctor does not care

> and

> > there are no

> > consequences for no showing, then I'll just go

> ahead

> > and meet Jim for

> > our lunch date... "

>

=== message truncated ===

January 20, 2006

The other thing you can do is have the patient sign an " informed dissent " .

This includes phrases like, " I realize I can die from a missed cancer, I

have been explained everything, have been offered referral for a

colonoscopy, I am electing not to go through with the testing my doctor has

advised, etc, etc. They either sign it & date it, or they are dismissed.

Re: NO

> > SHOW/CANCELLATION FEES - yes or

> > no?

> >

> > I have had great success with the $50 no show

> > fee/cancel < 24 hours. My

> > patients have paid the $50 promptly and have

> > apologized (profusely) for

> > wasting my time. They usually get the check in the

> > mail the same week or

> > day and reschedule soon thereafter. I have only

> had

> > to use it 3 times

> > and have had the same response each time. Often

> the

> > patients will call

> > before I even alert them and will tell me they

> know

> > there is a $50 fee

> > and they will get it right to me. These people

> have

> > been professional

> > folks who often overbook themselves. I definitely

> > want them to know our

> > time is equally important by charging the fee

> right

> > up front. I would

> > not want to keep any patient who does not

> understand

> > that me waiting for

> > 30-45 minutes for them to no show is not worth

> $50.

> > I guess I am a " hard

> > ass " but I am looking for a certain breed of

> > patients who understand

> > that mutual respect is the core of our

> relationship.

> > I think it also

> > shows they really value me and my services.

> >

> > On the other hand I am not allowed to charge a fee

> > to the state medicaid

> > population. I make sure they know in advance that

> > they can come in for

> > same day appointments and be seen usually within

> 24

> > hours. Many are

> > without adequate transportation, homeless,

> traumatic

> > brain injury etc..

> > so I bend over backwards to make things easy for

> > them BUT if I have one

> > No show or cancel < 24 hours for no good reason I

> > terminate them. This

> > happened once last week (only once actually) when

> > this woman was very

> > lackadaisical when scheduling a FU visit for a

> CPX.

> > I told her again and

> > again that she could get a same day appt and could

> > wait until she was

> > sure she could make the appt. She made her FU

> anyway

> > (and I knew she

> > would no show) and she did. I have no problem

> > sending a termination

> > letter, since I am NOT ALLOWED to charge the fee.

> I

> > suspect if I were

> > allowed to charge the fee she would not pay it and

> > she would be out the

> > door anyway. It is just a matter of time before

> > one's true colors bleed

> > through.

> >

> > I guess it comes down to having patients who are

> > extremely appreciative

> > of me and my services. I give my all to them.

> >

> > I think not charging professional folks the fee

> > (which they CAN afford)

> > will keep them undervaluing you or your service

> and

> > they are likely to

> > be repeat offenders. " If my doctor does not care

> and

> > there are no

> > consequences for no showing, then I'll just go

> ahead

> > and meet Jim for

> > our lunch date... "

>

=== message truncated ===

January 20, 2006

The other thing you can do is have the patient sign an " informed dissent " .

This includes phrases like, " I realize I can die from a missed cancer, I

have been explained everything, have been offered referral for a

colonoscopy, I am electing not to go through with the testing my doctor has

advised, etc, etc. They either sign it & date it, or they are dismissed.

Re: NO

> > SHOW/CANCELLATION FEES - yes or

> > no?

> >

> > I have had great success with the $50 no show

> > fee/cancel < 24 hours. My

> > patients have paid the $50 promptly and have

> > apologized (profusely) for

> > wasting my time. They usually get the check in the

> > mail the same week or

> > day and reschedule soon thereafter. I have only

> had

> > to use it 3 times

> > and have had the same response each time. Often

> the

> > patients will call

> > before I even alert them and will tell me they

> know

> > there is a $50 fee

> > and they will get it right to me. These people

> have

> > been professional

> > folks who often overbook themselves. I definitely

> > want them to know our

> > time is equally important by charging the fee

> right

> > up front. I would

> > not want to keep any patient who does not

> understand

> > that me waiting for

> > 30-45 minutes for them to no show is not worth

> $50.

> > I guess I am a " hard

> > ass " but I am looking for a certain breed of

> > patients who understand

> > that mutual respect is the core of our

> relationship.

> > I think it also

> > shows they really value me and my services.

> >

> > On the other hand I am not allowed to charge a fee

> > to the state medicaid

> > population. I make sure they know in advance that

> > they can come in for

> > same day appointments and be seen usually within

> 24

> > hours. Many are

> > without adequate transportation, homeless,

> traumatic

> > brain injury etc..

> > so I bend over backwards to make things easy for

> > them BUT if I have one

> > No show or cancel < 24 hours for no good reason I

> > terminate them. This

> > happened once last week (only once actually) when

> > this woman was very

> > lackadaisical when scheduling a FU visit for a

> CPX.

> > I told her again and

> > again that she could get a same day appt and could

> > wait until she was

> > sure she could make the appt. She made her FU

> anyway

> > (and I knew she

> > would no show) and she did. I have no problem

> > sending a termination

> > letter, since I am NOT ALLOWED to charge the fee.

> I

> > suspect if I were

> > allowed to charge the fee she would not pay it and

> > she would be out the

> > door anyway. It is just a matter of time before

> > one's true colors bleed

> > through.

> >

> > I guess it comes down to having patients who are

> > extremely appreciative

> > of me and my services. I give my all to them.

> >

> > I think not charging professional folks the fee

> > (which they CAN afford)

> > will keep them undervaluing you or your service

> and

> > they are likely to

> > be repeat offenders. " If my doctor does not care

> and

> > there are no

> > consequences for no showing, then I'll just go

> ahead

> > and meet Jim for

> > our lunch date... "

>

=== message truncated ===

January 20, 2006

In the state of Virginia, the courts have

just stated that a treating doctor can be held liable if another doctor ordered

blood work and the treating doctor did not follow up on it (although the

legislature is possibly going to address this on Monday). I mention this simply

because we can get sued for just about anything. I do doubt in this

circumstance the suit would go very far, but I bet a quick thinking lawyer

could find a reasonable case (perhaps you didn’t explain well enough why

the colonoscopy was necessary, so the patient really did not think the visit

was that important, etc). But back to the original point…you actually

dismiss a patient immediately if they do not show up for a specialist

appointment? Do you go over this policy with the patients before hand? Thanks!

Re: NO

> > SHOW/CANCELLATION FEES - yes or

> > no?

> >

> > I have had great success with the $50 no

show

> > fee/cancel < 24 hours. My

> > patients have paid the $50 promptly and

have

> > apologized (profusely) for

> > wasting my time. They usually get the

check in the

> > mail the same week or

> > day and reschedule soon thereafter. I

have only

> had

> > to use it 3 times

> > and have had the same response each

time. Often

> the

> > patients will call

> > before I even alert them and will tell

me they

> know

> > there is a $50 fee

> > and they will get it right to me. These

people

> have

> > been professional

> > folks who often overbook themselves. I

definitely

> > want them to know our

> > time is equally important by charging

the fee

> right

> > up front. I would

> > not want to keep any patient who does

not

> understand

> > that me waiting for

> > 30-45 minutes for them to no show is not

worth

> $50.

> > I guess I am a " hard

> > ass " but I am looking for a certain

breed of

> > patients who understand

> > that mutual respect is the core of our

> relationship.

> > I think it also

> > shows they really value me and my

services.

> >

> > On the other hand I am not allowed to

charge a fee

> > to the state medicaid

> > population. I make sure they know in

advance that

> > they can come in for

> > same day appointments and be seen

usually within

> 24

> > hours. Many are

> > without adequate transportation,

homeless,

> traumatic

> > brain injury etc..

> > so I bend over backwards to make things

easy for

> > them BUT if I have one

> > No show or cancel < 24 hours for no

good reason I

> > terminate them. This

> > happened once last week (only once

actually) when

> > this woman was very

> > lackadaisical when scheduling a FU visit

for a

> CPX.

> > I told her again and

> > again that she could get a same day appt

and could

> > wait until she was

> > sure she could make the appt. She made

her FU

> anyway

> > (and I knew she

> > would no show) and she did. I have no

problem

> > sending a termination

> > letter, since I am NOT ALLOWED to charge

the fee.

> I

> > suspect if I were

> > allowed to charge the fee she would not

pay it and

> > she would be out the

> > door anyway. It is just a matter of time

before

> > one's true colors bleed

> > through.

> >

> > I guess it comes down to having patients

who are

> > extremely appreciative

> > of me and my services. I give my all to

them.

> >

> > I think not charging professional folks

the fee

> > (which they CAN afford)

> > will keep them undervaluing you or your

service

> and

> > they are likely to

> > be repeat offenders. " If my doctor

does not care

> and

> > there are no

> > consequences for no showing, then I'll

just go

> ahead

> > and meet Jim for

> > our lunch date... "

>

=== message truncated ===

January 20, 2006

It just depends on the gravity of need for

the referral. If it were just for a screening colonoscopy, probably

not. But if it were for, say, severe headaches & they do no go to the

neurologist, then yes often I do. Another example is when they are in

chronic pain & I ask for a pain mgt consult because I do not want to be

writing the opioids any longer unless OK’d by a consultant. If they

don’t go, they get dismissed. Poorly controlled diabetics that do

not go to the endocrinologist that I’ve sent them to is another

one. So, no I do not always dismiss for that but if the patient just flat

out refuses to go or repeatedly (more than once) no call-no shows to a

specialist then they are dismissed. The overlying issue here is really

non-compliance & what to do about that more than it is just referrals/no

shows. No, I do not necessarily tell them that info before hand.

Re: NO

> > SHOW/CANCELLATION FEES - yes or

> > no?

> >

> > I have had great success with the $50 no

show

> > fee/cancel < 24 hours. My

> > patients have paid the $50 promptly and

have

> > apologized (profusely) for

> > wasting my time. They usually get the

check in the

> > mail the same week or

> > day and reschedule soon thereafter. I

have only

> had

> > to use it 3 times

> > and have had the same response each

time. Often

> the

> > patients will call

> > before I even alert them and will tell

me they

> know

> > there is a $50 fee

> > and they will get it right to me. These

people

> have

> > been professional

> > folks who often overbook themselves. I

definitely

> > want them to know our

> > time is equally important by charging

the fee

> right

> > up front. I would

> > not want to keep any patient who does

not

> understand

> > that me waiting for

> > 30-45 minutes for them to no show is not

worth

> $50.

> > I guess I am a " hard

> > ass " but I am looking for a certain

breed of

> > patients who understand

> > that mutual respect is the core of our

> relationship.

> > I think it also

> > shows they really value me and my

services.

> >

> > On the other hand I am not allowed to

charge a fee

> > to the state medicaid

> > population. I make sure they know in advance

that

> > they can come in for

> > same day appointments and be seen

usually within

> 24

> > hours. Many are

> > without adequate transportation,

homeless,

> traumatic

> > brain injury etc..

> > so I bend over backwards to make things

easy for

> > them BUT if I have one

> > No show or cancel < 24 hours for no

good reason I

> > terminate them. This

> > happened once last week (only once

actually) when

> > this woman was very

> > lackadaisical when scheduling a FU visit

for a

> CPX.

> > I told her again and

> > again that she could get a same day appt

and could

> > wait until she was

> > sure she could make the appt. She made

her FU

> anyway

> > (and I knew she

> > would no show) and she did. I have no

problem

> > sending a termination

> > letter, since I am NOT ALLOWED to charge

the fee.

> I

> > suspect if I were

> > allowed to charge the fee she would not

pay it and

> > she would be out the

> > door anyway. It is just a matter of time

before

> > one's true colors bleed

> > through.

> >

> > I guess it comes down to having patients

who are

> > extremely appreciative

> > of me and my services. I give my all to

them.

> >

> > I think not charging professional folks

the fee

> > (which they CAN afford)

> > will keep them undervaluing you or your

service

> and

> > they are likely to

> > be repeat offenders. " If my doctor

does not care

> and

> > there are no

> > consequences for no showing, then I'll

just go

> ahead

> > and meet Jim for

> > our lunch date... "

>

=== message truncated ===

January 22, 2006

Do you really have a dozen of these? I have about a dozen that are very

minimally hypothyroid yet they insist they need endocrinology input.

Actually, all you can do is give information, offer your medical opinion

about what she should do, but if she doesn't comply, that is totally her

choice. Just document a discussion about the looming possibilities of

stroke, MI, kidney failure, blindness and amputation, and tell her you'll be

happy to see her after she comes out from the ICU.