Minimizing Cancellations & No-Shows

As we know, patients who regularly attend nutrition counseling sessions receive continuous care and are supported in making sustainable changes, both of which directionally point to better outcomes. Additionally, fewer cancellations means greater patient retention and schedule regularity, which improves the experience of our dietitians.

While cancellation and no-show metrics are not evaluated as a part of your annual performance evaluation, they do have a direct impact on patient retention which is evaluated as a part of your annual performance evaluation. While no single metric tells the whole story, if patients see value in our service, they will try to attend appointments. That said, we understand there are several factors that influence cancellation & no-show rates, including insurance coverage, unexpected conflicts, and emergencies. While there are some factors outside of the dietitian’s control, the strategies below can help reduce no-shows and cancellations

• Evaluate causes of cancellations

  • Reviewing recent causes of canceled or no-showed appointments can provide insight on effective strategies for reducing them.

    • If several cancellations occur due to patients having other conflicts, you can focus on setting expectations for scheduling.

    • If several cancellations are a result of patients stating they received “no value” from the session, you can review the Nourish standards of care or work with a CQM on Nourish’s value proposition.

• Set clear expectations around scheduling

  • Setting the expectation during the patient’s initial session can impact the rest of the patient journey with Nourish. It’s important to make sure the patient has a clear understanding of appointment frequency and policies, which is well detailed in our Standards of Care.

    • Establish consistent recurring appointments for best care.

      • “Initially, I recommend weekly appointments to help you get started working toward your goals and make sure your time slot doesn’t get booked in my schedule. After a few sessions we can reassess appointment frequency and this should always be at your convenience. How does that sound?”

      • “Most patients start with weekly appointments. I encourage scheduling 5 appointments in advance to make sure appointment slots don’t get booked up and to get a great kick start toward your goals. We can always reassess appointment frequency as we go, and see what works best with your schedule.” 

    • Encourage patients to reschedule through the Patient Portal. 

    • Remind patients of Nourish’s No-Show & Late Cancel fee.

• Set clear expectations on goal setting, progress, and scheduled sessions

  • Some patients cancel because they have set a short term goal which they have not yet met. It’s important to let them know that meeting with you is valuable whether they have met their goals or not“

    • "I am here for support and strategies and part of that is goal setting. That said, whether you meet your goals or not should not impact our plan to meet. In fact, if you don't complete a goal, it's really helpful for us to meet so we can dive in deeper and identify any potential barriers and possibly modify the goal so it’s more achievable.”

  • Set a maximum of three realistic goals for the patient to work towards between sessions. Make sure to get the patient’s feedback on how confident they feel completing the goals within the time frame. Some helpful questions to ask:

    • “On a scale of 1-10 how confident do you feel in achieving this goal?” (If patient says 7, ask how what we could do to increase confidence to a 8 or 9)

    • “Do you feel like you have enough time to reach this goal? If not, should we break it down into smaller parts?”

    • “Do you anticipate any barriers to your goal that may come up this week? Let’s figure out how to manage them together so you feel successful.”
      

• Be alert to patients that cancel frequently

  • You can see the number of times a patient has canceled/no-showed/rescheduled in their profile in the Provider Portal. If you notice patterns, it can be helpful to touch base with your patient to ensure they are scheduling a time they can commit to.

• Be proactive in asking patients about their upcoming schedule conflicts

  • Ask patients if they anticipate upcoming schedule conflicts. Be particularly proactive around times of the year when we see conflicts more often such as summer when vacations are more common, fall when school starts, or holidays near the end of the year.

• Make sure appointments that should not be on your calendar are deleted

  • Appointments should rarely be fully deleted (as it removes records of the appointment, making it more difficult to recall a patient’s history). However, there are certain situations where deleted appointments are acceptable, such as:

    • When you agree in advance that an individual appointment within a set of recurring appointments will be skipped.

    • When a patient requests to cancel all future appointments. (In this case mark the next appointment as canceled, and delete the rest.)

•  Add additional hours of availability

  • A more flexible schedule increases the likelihood of patients rescheduling in the same week, thereby preventing cancellations.

• Make sure patients are getting appointment reminders

  • Patients can customize appointment reminders under ‘Notifications’ in the Patient Portal. They have the option of e-mail, SMS, and Push reminders. Make sure they are receiving reminders and that they don’t have them unintentionally turned Off.

• Follow best practice procedures if a patient no-shows

  • Sometimes, a patient forgets about an appointment despite reminders. Our best practice procedure for no-shows can help prevent future cancellations.

    • 5 minutes after session begins:

      • Reach out to patient via email and/or phone (using *67 to hide your number). If a patient doesn’t answer, leave a HIPAA compliant voicemail encouraging them to contact you via email.

      • “Hi. This is [insert RD name] with Nourish, I’m sorry you missed your appointment today at [insert time-use patient’s time zone]. Please contact me through e-mail or message on the Nourish App. You can also reschedule through your patient portal using the Nourish App as well. Hope to see you soon!”

  • 15 minutes after session begins:

    • Close out of the video session, document appointment status in the chart note and monitor email for response to your earlier communication.
      

• Have I evaluated common causes of cancellations?

• Am I setting clear expectations around scheduling in the initial session?

• Am I regularly setting clear expectations around goal setting and progress?

• Have I identified patients who cancel or no-show frequently and addressed/set boundaries?

• Have I been proactive about asking patients about upcoming plans/schedule conflicts?

• Have I checked my schedule to see if there are canceled appointments that should have

• been deleted?

• Do I have adequate hours of availability to reschedule patients?

• Did I confirm my patients are receiving appointment reminders?

• If my patient doesn’t show for an appointment, am I following best practice for reaching out?