An empty therapy hour is like an empty airline seat--it represents
lost income that can never be recovered. And while most clinicians
employ written policies making clients responsible when they cancel
appointments without notice, in our experience the rule is frequently
A better strategy is to nip the problem in
the bud by adopting policies that cut down on no-shows. In this
report, we offer advice for doing just that from three practice
consultants quoted frequently in PsyFin.
1. Explain your policy on the phone when
clients make their first appointment, says California clinician Holly
Hunt. It might seem that starting the therapeutic relationship that
way would be a turn-off--but Hunt says her first-session no-shows
actually decreased after she started doing it.
2. Try to establish a connection with the
client over the phone at first contact, says Wisconsinís Karen
Carnabucci, rather than just covering the basics and making an
appointment. "When they arrive, it feels like our second appointment
rather than our first," she says. "I also refer them to my website so
they get another connection in addition to my voice."
3. You can be firm without being hardnosed.
In Florida, Dwight Bain does it this way: A) clients get one
free cancellation; B) thereafter, they must give 24 hours
notice; C) a missed session has a $75 price tag--not the full
fee--which for Bain is $165. The policy is spelled out clearly at
intake, both in writing and verbally.
4. Do some trouble-shooting. If clients
seem to have trouble making it to their appointments, says Carnabucci,
try changing the day or time. "They may have issues around child care,
or late hours at work. I try to address that. I tell them, ĎMaybe we
should consider a different time.í"
5. Follow the lead of many physicians and
dentists: Call patients a day in advance to remind them. Bain hired a
college student to make these calls, and reports that his no-shows
fell by 30%-40% almost immediately. Of course, clients need to sign
off on that. Your intake form can include language like this: "I
understand that [the therapist] will make a discreet phone call to
remind me of my appointment 24 hours in advance. I prefer that the
following telephone number be used for this purpose: ________."
6. Donít put off collecting for missed
sessions. As with any collection job, the longer you let it go, the
less likely you are to collect. Ideally, clients should pay at the
next session. So after no-shows, you should have that bill ready and
waiting. (Thatís a big reason why we recommend that you accept credit
card payments. It allows you to say, "Forgot your check book? No
problem--I take Visa and Mastercard.")
7. Make up your mind how tough youíre going
to be if clients just wonít pay. Not very, Bain recommends. He says he
collects for no-shows "about 95% of the time," but never uses a
collection company. Remember that many lawsuits and board complaints
have their genesis in hurt feelings over money.
Hunt advises clinicians to send one bill
after a no-show--but then drop it. "My experience is it doesnít add
anything to send two or three or more bills. Usually if a client
doesnít follow through on the first bill, itís just a lot of effort
with diminishing returns."
8. With managed care clients, you may be
able to bill the client directly for missed session. But you should
check with the company first. (Many managed care plans do allow this,
but most EAPs donít.) And remember that you have to bill the managed
care rate--not your full fee.
Contacts: 1) Dwight Bain, Winter
Park, FL, (407)647-3900, www.lifeworks group.org; 2) Karen
Carnabucci, Racine, WI, (262)633-2645, www.lakehouse center.com (Carnabucci
is also quoted in the "Marketing" article beginning on page 4); 3)
Holly Hunt, Long Beach, CA, (562)987-8947, www.essentialsofprivate