Chris Barrow’s Blog

Dear Coach

I am becoming increasingly worried at the rate of cancellations and FTA’s that we experience for hygiene appointments.

Do you have any experience of working with practices that have solved this problem?

Dear Dentist

Over the last few weeks I have been looking at cancellation and FTA rates for hygiene appointments in several of my clients’ practices and a disturbing picture is beginning to emerge.
You might want to consider the following questions very carefully before you read on:

a. What is the cumulative cancellation/FTA rate in your practice for the last 12 months?

b. If you were to reduce your cancellation/FTA to 5% per annum – what difference would this make to your bottom line profitability?

A couple of examples may illustrate.

In Practice “A” I was looking at 2003 figures with the owner. If each hygienist had been 100% booked, they would have earned an average of £750 per working day.

The actual 2003 figure was £430 per day.

The reason was cancellations and FTA’s.

So we ran a sensitivity analysis on his 2004 budget and cash flow forecast (In Excel) and realised that if we could increase the average daily yield to just £650, it would add another £100,000 to his gross revenues in the year.

In Practice “B”, the two full-time, salaried hygienists have measured a cancellation/FTA rate of about 25%. We calculated that a 5% rate would increase gross revenues by £70,000 in 2004 – adding a considerable bottom line profit to the business – enough, in fact, to finance the practice development plans for the next 5 years.

So the next place to go was – to examine the current system in place – and in each practice the system was the same.

a. Patients receive a phone call about 48-24 hours before the hygiene visit, to remind them;

b. If they give at least 24 hours notice, they are allowed to cancel without charge.

So here we have what I call a “cancellation permission policy”.

I am a busy patient – I have either a business to run, a job to hold down or a family and home to manage.

My day is full of “to do’s” and pressure.

The easiest way I can grab an extra hour is to cancel that hygiene appointment – and it may well save me money and a little discomfort – after all, I won’t die will I?

Now I know that we read in the dental press about setting up strong patient education systems – so that they know all about the benefits of good hygiene – protecting their investment and all that.

And I know that the overwhelming majority of hygienists do a great job both in the patients’ mouths and in education.

But it’s still an easy way to re-gain lost time in my own schedule – and it’s free!

So let me suggest a radical alternative that I have seen in some practices.

“Our normal business policy is to request credit card confirmation of all first appointments for new patients to see a dentist and for all routine hygiene appointments.

When you arrange your next hygiene appointment we will simply take your credit card details and they will be securely held with your patient records.

If you are unable to attend for your appointment, a charge will be made for the time allocated to you.

However, in the case of genuine emergency, we reserve the right to use our discretion in waving the charge.

The benefit of this to you is that we recently calculated that cancellations and missed appointments were costing the practice £x per year. We took the view that the majority of our patients would prefer this lost revenue to be passed on to those who cancel, rather than shared by all of the patients in the form of extra price increases – we hope you agree that this seems the fairest solution?”

So there we are – I now stand back and wait for your response – including, of course, the famous “so do we pay them when we fail to turn up or run late?” Always a classic – you tell me.

I think its time to get real with this.