Provider-Initiated Appointment Cancellations arise when the provider will not be available for the encounter. These can occur for many reasons including illness, family obligations, vacation, office closures (for the weather, COVID-19, or the provider being needed elsewhere). Even when planned far in advance these reasons for cancellation can still easily affect the yearly follow-up schedule. Other reasons for a provider-initiated cancellation arise on very short notice, such as tornado warnings or hospital emergencies. Some refer to this as a bumped appointment while others use the more specific term provider cancellations.
Regardless of what we call them, cancellations for any reason can create a significant amount of work for office staff that is not reimbursable. Furthermore, these cancellations, when not handled well can result in angry patients. The fallout can result in future no-shows and bad online reviews.
All of this can be avoided. The scheduling system needs to be structured to accommodate these events. The scheduler needs to know how to address the provider-initiated cancellations and reschedule the patients efficiently.
In most offices, provider cancellations are uncommon, but in some they are commonplace. When commonplace, even the best scheduling system cannot overcome the patient’s irritation arising from frequent cancellations. No-shows and patient-initiated cancellations are covered in other chapters. Cancellations are a problem for several reasons. Provider cancellations are typically less common but are disproportionately disruptive.
Rescheduling an appointment can be a hardship on patients and caregivers. In many cases, one or more individuals has adjusted their schedule to make time for the appointment. Changes to those arrangments can be annoying, especially if changes occur at the last minute. If any time-sensitive tests or prescriptions were to be addressed, the problems multiply. Any system designed to address provider-initiated cancellations must address these concerns.
Irritated patients often drain office resources at multiple levels. They will complain to the front office staff, often in front of other patients. The medical assistants may hear about it as well. Once in the room, the patient may take part in the visit complaining. This detracts from care. It also raises the odds of bad reviews and poor word of mouth advertising.
Cancellations are inconvenient no matter who initiated the cancellation. When the provider initiates the cancellation, it is an issue for the patient. It also creates a problem for the staff. Depending on the cause of the cancellation, it may be good for the patient but very inconvenient for the staff. Bad weather or spiking COVID-19 rates are two examples. In other cases, a cancellation can be a major problem for the patient. The hassle for the patient is likely to translate into increased work-related stress for the scheduler.
When a provider cancels appointments, it is often multiple appointments over a span of a half-day or more. Many calls have to made to reschedule entire clinic days. This becomes even more burdensome, when it occurs at the last minute or when the staff is away from the office. Even a half-day of appointments to reschedule can disrupt the entire office. In some cases, it can take an entire day to reschedule a single provider’s appointment list.
Reasons Provider-Initiated Appointment Cancellations
The most common reason for provider cancellations is weather-related closures. Being a good steward means closing the office for the safety of providers, staff, and patients.
The COVID-19 pandemic has brought this to the forefront of the scheduling world. It seems like the pandemic has caused nearly daily changes to the schedule.
Although it has faded from our collective memories with the recent pandemic, the challenges of clinic scheduling immediately following the 9/11 attacks were substantial., We should account for each of these potential reasons when putting together our scheduling plan, even if a reason is unlikely.
Many specialties face provider-initiated cancellations caused by medical emergencies on a near-daily basis. In other cases, this is all but unheard of. Surgery and obstetrics & gynecology practices are two of the specialties likely to face this obstacle.
Vacations may be scheduled far in advance. Unfortunately (or fortunately) office schedules are often scheduled far in advance as well. Standard one-year follow-up appointments are common for many conditions. When a vacation is scheduled, provider-initiated cancellations ensue.
Managing Provider Cancellations
Most physicians and clinics reschedule cancelled appointments within one to two weeks of the original appointment. This approach attempts to address several concerns. First is trying to keep appointments on schedule. Also, the issues that the appointment was created for are often time sensitive. Another reason is simply that the clinic has set that as a policy. That certainly doesn’t mean that it is the best approach.
Notify the Patient About the Provider Cancellation
Apologize for the inconvenience! Do not assume that the patient knows that the office will be closed. This is a recipe for an angry patient or family. Contact the patient and reschedule during that contact if possible. Multiple calls and phone tag are also annoying. Furthermore, they are costly for the practice. Document the encounter when a patient is informed of cancellation.
Set standard cancellations reasons
Some scheduling systems have a specific cancellation type called “Bump” or “Provider Cancellation,” which staff should use when cancelling an appointment. Make a cancellation type for weather cancellations and another for an unavailable provider. Create standard protocols for using these cancellation types. Tracking this data and managing the cancellation list is very important. The schedulers and the scheduling system need to understand how to utilize these cancellation types and document them correctly.
Documented the Correct Cancellation Reason Matters
Labelling the cancellation correctly allows a practice to analyze the prevalence of cancellations. Including provider cancellations as regular cancellations will artificially elevate the general cancellation numbers. Knowing the cause of cancellations creates an opportunity to address them.
Optimize Scheduling Workflow
Incorrect data impedes workflow. Good data regarding cancellations and reasons behind them empowers the staff and the scheduling system to optimize the rescheduling of those patients.
Physicians who frequently cancel take up a higher percentage of staff resources in comparison to those who rarely cancel appointments. Monitoring this data allows for better management of resources. Monitoring of this data also allows management to better allocate overhead expenses.
Maintain and Use a Cancellation List
Most scheduling systems have a cancellation or bump list. If not, start using one! Better yet, monitor these lists via a reason-for-cancellation report. These systems can be a bit cumbersome but technology can help us optimize the system. When canceling patients, it is best to attempt to complete the rescheduling process during the same call. Phone tag is time-consuming and expensive.
Enhance the Patient Experience
Limit the fallout from a provider-initiated cancellation. These cancellations are destined to annoy some of the affected patients but there are ways to minimize the impact.
Create Appropriate Expectations
Make patients aware that cancellations do occasionally occur. Be aware of your cancellation policy for the patient as well. If you cancel an appointment, the patient will be unhappy if they are ever charged for a patient-initiated cancellation. Make every effort to accommodate patients both during the initial scheduling process and whenever rescheduling is required.
Reschedule Patients in a Timely Manner
The probability of cancellation, whether patient initiated or provider initiated, increases as the time until appointment increases. The further out an appointment is booked, the more likely a provider will schedule a vacation or their own medical procedures. Booking new appointments more than three months out increases the risk of cancellations.
Another provider should cover a clinic for those patients who still wish to be seen, especially when a provider cancels clinic on short notice. Just the offer of this possibility, even when not accepted, shows patients that you care about the effect of a cancellation on them and respect them as individuals. Whenever possible, tell the patient that there will be other medical team members available to care for them.
Monitoring Provider Cancellations
Provider-initiated cancellations occur most often in December, November, October, and July. Not surprisingly, Monday mornings are common times for cancellations.
1. Create open slots or half-day clinics dedicated to rescheduled patients
Create an “open-access clinic” for provider-initiated cancellations. Work as a team to identify the opportunities in the schedule to place the open-access clinic.
2. Have a part-time provider dedicated to rescheduled appointments
Adding staff can be expensive. If there are large numbers of rescheduled appointments coming from one or several providers, then this may be a reasonable option. If provider-initiated cancellations are rare, then this is not likely to be a good option.
Effective automation of this process is just arriving. This provides a real solution that saves time and money.
Provider-initiated cancellations drain clinic resources, aggravate patients, and cost money. The time spent rescheduling the patients alone is significant. Add to that the time spent calming any angry patients and the effort spent coordinating care and the situation rapidly becomes untenable. Create systems that can address the issue and its fallout. Then employ emerging technological solutions. The giant problem rapidly becomes a minor annoyance and can improve the patient experience while diminishing burnout.