I often receive emails from dentists and office managers asking me about practice management issues. Here is a question about a common office dilemma—cancellations and broken appointments.
I'm hoping to pick your brain on a new policy that we might implement regarding late cancellations and no shows in the hygiene department. We currently do not have any late cancellation fees in place, but this issue is becoming a greater issue than it has been in the past. We're considering charging our full fee if there are two broken appointments without approval from the office manager or doctor. If a patient refuses to pay, he or she will be dismissed from the practice. I know late cancellations and no shows are a big issue for everyone, and usually our appointment reminder postcards, emails, texts, and phone calls do the job of reminding people of their appointments well in advance. Our patients seldom cancel their appointments for treatment. It happens more in hygiene. How would you suggest I inform our patients of the new policy? I don’t want to simply send a mass mailing or mass email. Please let me know your suggestions to address this issue.
Sincerely, Rob, Office Manager
Communication in the beginning is key. If the problem is in the hygiene or recall department and not with the doctor's treatment schedule, your have to look at the message patients take away from the six-month recall and the periodontal maintenance. Determining per day the number of cancellations and no shows that are six-month recall versus periodontal maintenance will give you a clue as to the value perception patients have for their appointments.
If patients are being dismissed from their hygiene appointment with, “You're doing great with your oral hygiene so we'll see you in six months,” you're opening the door to patients' control over when they decide to see the hygienist again. When I hear that from my hygienist I know I can slide another three to six months without much change since I am “doing great.”
If your goal is to have patients return exactly at their preappointed six-month visit, the message should include a call to action. “Your oral hygiene is good. I would concentrate the electric brush more on the lower anteriors because there was calculous buildup along the gum line that is irritating the gum. You also have some fracture lines on teeth numbers eight and nine and appear to be bruxing with the lower anteriors because they have small chips. I do not want you to go longer than six months because I'm monitoring these areas. You can schedule your appointment now or if you want or we can remind you by email, text, or phone a month before you're due to schedule an appointment. Would you like to reserve time now or have us contact you?”
The reason that it is not prudent to preschedule all patients is that some will do so to make you happy but will have no intention of keeping their appointment. Their schedules change frequently or they're self-employed and don’t know when their next work project will start. These patients like to keep their options open and should seldom be scheduled too far in advance. They're often available to take last minute cancellation appointments because of their flexible working hours. Other broken appointments occur when patients who have dental insurance lose their job and insurance benefits, or their insurance changes to out of network between appointments.
My experience with developing recall strategies is to look at the system and analyze it for its failures. If you're pre-scheduling, don’t offer someone the same time on the same day of the week every time. This teaches them that this is “their time” and they'll become hostile if you cannot always accommodate their "time." People’s situations change, and when someone retires it's inefficient to continue to book the exact time on the exact day even though a patient could very well come in another time.
Hold some prime time appointments open each week to accommodate new patients. Studies show that hygiene visits are valued by patients and are a main motivator for calling the dental office other than emergencies. If you postpone seeing new patients longer than two weeks, you might lose them to the dentist down the street. If you see a number of cancellations or no shows for new patients, this is a sign that they didn’t wait for you to make the time for them.
Whether you can legally charge for a broken appointment depends on if you have a written appointment policy that a patient has agreed to abide by. The policy should be visible on your website and in any written financial or treatment plan agreements. If you turn an account over to a professional collection agency, they may or may not be able to collect for broken appointment fees. This depends on the signed financial agreement and would be subject to federal and state laws.
Communication with patients is critical to reducing cancellations. When patients understand how appointments work in your practice, they will respect your time. You must respect patients' time also. Running late without an explanation is poor customer service. If a patient cancels an appointment the day of the appointment, every effort should be made to save that appointment.
If you are in network with insurance companies that have policy provisions that allow you to charge for excessive broken appointments, check to see what their requirements are to bill for those broken appointments. The ADA Current Dental Terminology has two active codes: D9986–missed appointment, and D9987–cancelled appointment. You can bill for these but it doesn’t mean they're covered benefits under a policy.
Communicate the value of regular care, offer convenient scheduling with a variety of times, and remind patients about their appointments. In the office, make sure all team members understand, communicate, and follow cancellation policies consistently. Include cancellations as a regular topic on your daily huddle agenda.
So, Rob, before you decide to charge the full fee for two broken appointments, I would make sure the policy is in writing and has been explained to patients when they make their appointments. Some practices report that charging a broken appointment fee is a deterrent to last minute cancellations, and others report that patients consider the charge bad customer/patient service. Whatever you decide to do, make sure it is legal and ethical to do so.
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Belle DuCharme is director of training and CE for eAssist Dental Solutions. She has been a dental clinical and management professional for several decades, and the last several years she has become a devoted writer, speaker, and instructor for the dental profession. She has been a senior writer and contributor to eAssist training programs for three years, and is also a seminar presenter, blogger, newsletter editor, and author of numerous articles for eAssist Dental Solutions and other management publications. Belle can be reached at firstname.lastname@example.org.
If you attended high school in the late nineties and early aughts, it's likely that you used the family computer in the den to type up your essays or do research. It's also likely that much of your time "doing research" was actually tooling around on AOL with an open Microsoft Word window so if your parents walked in you could smoothly play it off like you were truly doing work.
The more things change, the more they stay the same.
EssayTyper is a site that allows you to plug in virtually any subject, then brings you to a Word-style webpage where you can write your essay. But you don't have to "write" anything. Not technically. Just bang on the keyboard and words appear.
Go ahead, try it. I used "economics" then pressed that button on the right.
Immediately, a paper appears.
The title is prewritten: "Innovative or Simply Post-Modern?"
And then, some computer magic.
Just start banging on keys.
Bang on the home keys, bang on the number keys. Press enter! Press delete! What will they think of next?
And here's a look at what's happening on the screen:
It's very fun, but we wondered if students were actually trying to pass off these generated papers as their own.
See, the first sentences of "Truly Jobs" (all EssayTyper papers are pre-titled) reads as follows:
Steven Paul "Steve" Jobs was an American pioneer of the personal computer revolution of the 1970s. He would come to be known as the entreprenur, marketer, and inventor, and cofounder, chairman, and finally CEO of Apple Inc. who transformed "one industry after another, from computers and smartphones to music and movies.
And a quick search proved it was just a rewrite of Jobs' Wikipedia page. So was our EssayTyper paper on Business Insider, and "Mad Men."
In 2012, The Atlantic published "Write My Essay, Please!" uncovering the truth behind sites similar to EssayTyper and the people who use them.
"Essay writing has become a cottage industry premised on systematic flaunting of the most basic aims of higher education," Richard Gunderman explains in the Atlantic piece. "The very fact that such services exist reflects a deep and widespread misunderstanding of why colleges and universities ask students to write essays in the first place."
While EssayTyper is free, and pretty useful for fooling your parents into thinking you're actually sitting on the computer and doing legitimate work, Gunderman says the bevvy of sites out there that appoint real people to write term papers for students is alarming. And, he points out, paying someone to write an essay for you isn't technically plagiarism.
"In this case, assuming the essay-writing services are actually providing brand-new essays, no one else's work is being stolen without consent," Gunderman writes. "It is being purchased. Nevertheless, the work is being used without attribution, and the students are claiming credit for work they never did. In short, the students are cheating, not learning."
A quick Google search for "how to find out if student is plagiarizing" serves up tons of tips and tricks for exhausted teachers and parents. A site called PlagTracker lets you type in a phrase or sentence to run against the rest of the internet. I copied and pasted the first sentence of "my" Steve Jobs essay.
The process took about twenty seconds (and PlagTracker offered to speed it up if I paid.) Here were the results.
My content was "81% plagerized from 5 sources," but none of those sources were listed as Wikipedia.
Brooklyn Friends School teacher Kathleen Clinchy agrees that while technology has made it easier to cheat, it's now a lot harder to definitively catch a cheater. She says resorting to old-school interrogation is the way to go.
In an email to Business Insider, Clinchy tells us:
It gets a little tricky because you don't want to accuse a student of cheating, so being able to have a conversation with strategic questioning is a good skill to have as a teacher. In younger grades, like middle school, you can get the parent involved and just ask them to revise the work together (AKA make sure your child stops cheating), but high school is a little murkier.
You also need to watch for students copying or plagiarizing each other too — that's where you just give the kids their papers back together with highlighted similar sentences and just stare at them until they talk.
But Bay Gross, founder of EssayTyper, has made sure to caveat his service to take any potential blame off of himself and the site. "Please don't ever try to use this legitimately," he says on the site. "The magic part is not real ... and that's plagiarism."