*Last Updated 8/27/19
The clock ticks past the hour and your client isn’t there. You wait. You stare at the couch (maybe contemplate taking a nap) and your anticipation builds. Are they not showing up for their appointment?
It happens. People miss appointments. Heck, I’ve missed appointments. For some practices it happens often and for others it is something they worry will happen. More often than not, the worry is because every late cancellation or no-show has been handled on a case by case basis and there are no processes in place.
Creating a new response and way of handling things every time can become exhausting. AND if you have a group practice, it’s not scalable. Your clinicians need some protocols. Protocols help us with our anxiety, ensure we are engaging with clinical outcomes in mind, and help us manage the business of our practices more smoothly. Below we have listed some things for you to consider if you have a no-show including what to do, what not to do, whether to charge for no-shows, and a sample no-show policy.
Protocols for Handling No-Show Appointments in Private Practice
DO call the client to check on their welfare. Leave a message. If they never show for session, follow up with one more call. If you are concerned about the client, you may request a welfare check from the police. Never assume you know the why. Part of our role as a therapist is to set aside our preconceived ideas when we observe and listen. Yes, we all have a bias and yes, you may be thinking you know why the client didn’t show up, but all of that is wasted energy. Reach out and care for your client.
DON’T post on Facebook that your client no-showed and now you are going to watch the latest Netflix series. In fact, don’t post anything about your clients on Facebook and keep their information private. You may think that your social media profiles are only for your friends. People can screenshot your posts and you never know if someone is connected to a client that you see. We are in a different profession where we just can’t afford to spout off our frustrations about work, as this creates privacy issues. If you need to vent, get someone you can consult with or talk to a colleague on the phone or in person. Just keep your client’s information off of the internet.
DO have a no-show policy that charges for missed sessions. This should be in your informed consent and is easy to follow through on when you have a credit card on file, stored in the electronic health record. There are exceptions, and before you make one it needs to be clear to you how you determine those exceptions. If your informed consent says you charge and you don’t, there is not only a business/financial impact to you, but more importantly there is a break in the communication between you and the client. Communication is key, so have integrity when you do uphold your policies. Informed consent is part of the therapeutic relationship and can impact outcomes as well. Don’t avoid the boundaries you have set. You can have hard conversations and so can your clients. You hopefully are a safe relationship for them to practice with.
DON’T go into fear mode. A missed session doesn’t mean that your practice will fall apart. Fear doesn’t help you, and in fact it can be a huge distraction. You are smart and capable. Go back to your marketing and business plan and make sure you have the financial plans in place to account for missed sessions. Your clients and you will get sick, take vacations and have emergencies come up.
DO pay attention to your response. Do you feel relief? Why? This could speak to your work with your client or it could speak to your business as a whole. Evaluate your business processes and where there might be gaps in how you run your business and how it contributes to possibly more no shows.
Don’t let it go on and on. In bootcamp we have our clients do a caseload assessment. They look at who they still have open and seeing them. The evaluate not only the fees and frequency of services but also the outcomes. At some point you may need to refer out, or send a letter to close the case until they return and determine they want services in the future. Each practice is unique in terms of timelines, but we find it good to quarterly review your cases and see if no-shows are an issue with any clients. Also address it in session. But after so many no-shows, it may be determined that a referral is needed. For example, one group practice has a process where if there is a no-show they call the client. They let the client know that they are still on the books for their recurring appointment. If a no-show happens the next week, they call, send a letter, and cancel future appointments until they hear from the client. Then after two weeks, they close the chart and send a final letter to the client. You get to determine the best timeline, but having this process in place can help you stay organized and ensure you are reaching out to your clients after they no-show.
DO analyze the data. If you are having repeated no-shows, this could be for a few different reasons. You may not be working with the right clients for your practice. This can be because of lack of alignment in your marketing or because you aren’t providing a thorough consult to determine fit. The data can also show that you may not be clear about the scheduling expectations and needs of your practice. This happens in the first consult, the first session and the informed consent. There also may be some therapeutic issues happening. You might be struggling to form a connection with clients or your process might not be paced well for the people you are working with. Get some clinical supervision and consultation if this becomes a pattern.
Document your process for handling a no-show. If you have a group practice, go over it with your team as well.
So, let’s talk quickly about how to reduce no shows.
Evaluate your marketing. Are you seeking to attract the right clients for your practice?
Review your initial phone consultation. Are you avoiding discussing fees and frequency thoroughly with your clients? Do you provide a solid assessment to determine fit?
Take a credit card from the beginning. Yes, over the phone at the initial consultation.
Get your informed consent and credit card authorization form signed prior to the session, at least 48 hours prior if possible. This gives you time to follow up with the client and confirm that they are attending the appointment.
Go over your informed consent in the first session and be clear about your policies. Having a credit card on file for my clients has helped so much that I literally can count on one hand how many no shows I have had.
If a person understands your policies and continues to have issues, this doesn’t mean they are not the right fit for therapy. Talk to the client. Seek to understand. Get consultation if needed.
Taking initiative in how you handle no-shows in your practice is another way we can improve outcomes for our clients. Post below how you handle no-shows in your practice.
Sample No-show Policy & Cancellation Policy:
Your therapist has a limited caseload to ensure that there is time and energy to plan for your sessions and to ensure they can be fully focused on you and your needs, return phone calls, etc. If you need to cancel your session, please do so 48-hours in advance so that your clinician can waive your weekly session fee and have an option to schedule a client who is in need during that time. If you cancel after 48 hours or no-show you will be billed for the session time at the full rate. If you have an emergency, please contact your clinician as soon as possible so that they can offer an alternative time or mode of treatment (phone or video), if available.