Every therapist has experienced it: you’re preparing to see your client, the minutes tick by, and they never show up. Or they contact you within hours or even minutes of their appointment to let you know they won’t make it. Either scenario is not ideal and it doesn’t allow you, the therapist, enough time to fill the empty space in your schedule.
No-shows and late cancellations are problematic for several reasons. First, they impact your income. Therapists are typically paid per client session, so every empty therapy hour is a hit to your payroll. Next, it can hurt the therapeutic relationship. It’s inconvenient (and maybe a bit annoying) for the therapist, it can be embarrassing for the client, and these factors can impact the alliance. Finally, it can impede your client’s progress in therapy – especially if it becomes a pattern.
There are several considerations for preventing late cancellations and no-shows.
Here are 3 tips for improving client attendance:
1. Send appointment reminders
Sometimes, life will get busy for your clients and their appointment with you will slip their mind. Sending appointment reminders 24-48 hours before their appointment makes it less likely that your clients will forget. It can also remind them to cancel or reschedule with plenty of time if they need to.
Sending appointment reminders is simple when they can be sent automatically. Therapists at Great Lakes Psychology Group are granted access to a reliable and easy-to-use practice management software that sends a reminder to your clients before each of their appointments.
2. Offer telehealth appointments
Transportation issues, lack of child care, and time constraints are some of the most commonly reported barriers for client attendance. Offering the option for telehealth appointments expands your clients’ access to care.
Most clinicians made the switch to telehealth appointments in response to the Covid-19 pandemic in early 2020. In turn, the majority of psychotherapists and their clients have become familiar with online therapy. Although some clinicians may choose to return to in-office therapy, they may consider continuing to offer online therapy for their clients who prefer it, or on an as-needed basis to prevent late cancellations.
3. Consider establishing a cancellation policy
A late cancellation fee should make it much less likely that your clients will cancel on a whim or fail to show up. The decision to enforce a cancellation policy should be made thoughtfully, however, as there are several things to consider.
In theory, cancellation policies establish clear boundaries in the therapeutic relationship. If a client does need to cancel with short notice or misses an appointment, the fee allows them the opportunity to repay you for the inconvenience and the lost income from their missed session. This may help to establish balance as the therapist gets paid and the client isn’t left feeling ashamed or indebted to the therapist.
In some cases, however, charging a late cancellation fee has the potential to hurt the therapeutic alliance. Sometimes circumstances are outside of the client’s control and they have to miss their appointment. Since cancellation fees are not covered by insurance, your client will have to pay the fee out of pocket. The client may feel frustrated, punished, and concerned about the out-of-pocket costs.
If you decide to enforce a late cancellation policy, be sure to clearly explain the policy to your clients in session. It can also be helpful to provide a paper or electronic copy of your policy for your clients’ reference. Remember that the goal of enforcing a cancellation policy is ultimately to improve client attendance and prevent late cancellations and no-shows. If you find that you’re frequently charging clients for missed appointments, it may be helpful to consider alternative solutions.
Here are some alternatives to charging a late cancellation fee:
- Schedule appointments within a reasonable time of the patient’s request for an appointment; the longer the lapse, the greater the chance of a no-show.
- Develop a call list of patients who are able to come in for short-notice appointments. When a no-show or late cancellation happens, these patients may be able to fill the empty spot.
- Consider asking a patient who has frequently missed appointments with no or little notice to prepay for their next appointment, giving them an incentive to return.
- Schedule repeat offenders during a time that has less of an effect to the overall schedule, during less prime times.
- Track the reasons each patient gives for a no-show. Trends in excuses may help point to solutions.
- Ethically discharge patients who accumulate a set amount (your choice) of no-shows in a year.
