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I know this has been discussed many times here and I searched and cannot find it.  What is your policy on late arrivals?

 

I base it on circumstances. If I have a patient from 300 miles away who is late, I work around it. But if I have a local patient, especially one that is non-compliant in other areas, my tolerance is low.  Do you set a time?  I had a non-compliant yesterday (teenager) who came 18 minutes late (she got busy and lost track of time) for a 20 minute appointment. She has a very serious migraine disorder where she is missing school every day. I refused to see her and my next opening is late Feb.  Her mother is pissed.

 

What is the standard?

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Our group tends to go provider by provider.  Most will refuse to see patients who are more than 15 minutes late for a 30 minute appointment. 

 

I am usually the one who almost always sees people who are late.  I see a lot of patients who come on medical transportation or with a caregiver and I get it that it's difficult.  Our parking is horrible and traffic in our area can be completely unpredictable.  I'm always more accommodating for people who are coming from a distance.  But I usually cut things short.  Almost always I start running behind and then it just snowballs.

 

Wish I had a better backbone sometimes.

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15 minutes late is the standard cut off time here regardless if the appointment is 15 or 30 minutes long. It's amazing to me how many people manage to check in 14 minutes late! Sometimes on a particularly bad day I'll say, "So, you missed your appointment by coming late so we have just a little bit of time to work on your most pressing issue today."

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jmj11  IMHO  I think a patient with migraines that are daily and misses school daily and was late ( I assume it is not a regular occurrence) and did not give you a cock and bull story why she was "18" minutes late deserves more than a 3 month wait to be seen by you.  Kudo's that you are busy but as you know, migraines hurt like hell!  Maybe scheduling in such a way to allow  a little wiggle room for appointments??  If she is a chronic late patient I would see her  and warn her this is not baseball and there will be no second chances.  Depending on where one lives traffic can be a b**ch.  It is here in Houston.  I am a sticker for being early but I have been late due to unforeseen circumstances.  ALWAYS a phone call by the late patient should made as a courtesy.

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To take the other side, TWR, an unscheduled/wiggle/overbook appointment is either 1) more work beyond what the provider has decided is 100% capacity, or 2) if unused, a direct hit to revenue.

 

As "not the clinic owner", I like no-shows because they give me more time to chart, but I realize that each no show costs the clinic that revenue.  Add to that places like Medicare not allowing you to charge for missed or late appointments, and those patients are stealing revenue from the clinic that could have otherwise gone to paying patients, and delaying access for those patients who WOULD have showed up on time.

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jmj11  IMHO  I think a patient with migraines that are daily and misses school daily and was late ( I assume it is not a regular occurrence) and did not give you a cock and bull story why she was "18" minutes late deserves more than a 3 month wait to be seen by you.  Kudo's that you are busy but as you know, migraines hurt like hell!  Maybe scheduling in such a way to allow  a little wiggle room for appointments??  If she is a chronic late patient I would see her  and warn her this is not baseball and there will be no second chances.  Depending on where one lives traffic can be a b**ch.  It is here in Houston.  I am a sticker for being early but I have been late due to unforeseen circumstances.  ALWAYS a phone call by the late patient should made as a courtesy.

I will add her headache story is 95% of the patients that I see every day. In her case when I speak of noncompliance, she texts while in the appointments (and I have to keep telling her to stop) she rolls her eyes at each suggestion for treatment and I have have started her on three preventative medications and she hasn't taken any more than a few days due to her "not likely them." Yet she has called for pain medications twice.  

 

I have many teenagers who are experience horrible daily migraines and are out of school. Most of the time they are are time, their parents come with them, they listen and do what I ask them to do.  If any of those kids came late yesterday, then I would have accommodated them.

 

I am the practice owner and each no-show hurts us.  We schedule long days without a break so when someone is late, there is no where to make up time except to add another 30 minutes or hour to my 10 hour day.

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I have never been a practice owner.

My clinics are supposed to have a 15 minute rule.

If you call and legit have a flat tire or get stuck behind the snow plow - we might spot you - ONCE.

If you are a habitual late person - we start lying to you and tell you your appt is actually 30, 45, or even one hour before your actual time. We NEVER tell these patients what we are doing.

3 no shows and we fire you - wasted someone else's potential to be seen.

 

When patients are late, I often enter the room with - "We didn't think you were coming" and smile really big.

I, too, tell the late patients that we will only have a limited time to discuss their most pressing need due to their tardiness.

That doesn't go over too well some days.

I then tell them that being late now makes me late for the next however many patients who showed up on time (which is 15 minutes before appt time to make sure insurance, etc is good). I remind them that it is not fair to those patients that I am late and they are on time.

 

We try to be lenient in freak snow storms - but - seriously - we all live here - it snows - a lot - deal with it - leave earlier - be prepared - this isn't new..................

 

I take people's cell phones away during the visit - just put my hand out and take it - or tell them I will come back to the room when they are done and I go see the next patient. I left a guy in the room for 20 minutes one day because whatever he was dealing with was obviously more important than seeing me. He came out and wigged on the nursing staff. My best nurse just dead panned him and said "well, are you done with your phone call so she can talk to you?". He went back in the room and shut the door and didn't say one more word.

 

I don't get people being late. It is rude and unprofessional. We had an MA show up 20 minutes late for an INTERVIEW. No phone call, nothing - still expected to be interviewed. The front desk sent her away - said - we don't see late patients - we don't interview late people either. Saved us a problem from the get go.

 

Having patients sign a policy about late arrivals, Rx refills etc and sending them a copy in the mail along with policies for charging for no-shows has helped a lot.

You don't pay the no-show fee - you don't get seen again.

 

Patients need to be held responsible for their behaviors - PERIOD. There is a fine and disappearing line between customer service and appropriate behavior.

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much of this discussion depends on how aware patients are of the policy 

in my prior practice I would give all patients a HAND WRITTEN copy of the late policy which they had to sign agreement towards. They were advised if they did not show up on time they would be billed a 50 no show fee and would not be seen that day. We considered late missing the appointment ... so showing up 15+ minutes late. 

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We give the patient 10 minutes typically. I have the front desk always give the option of waiting in case the next patient no shows (our area and pt population have a high no show rate). If the patient has a believable story and no history of being late or no showing, the front desk will ask me if I'll squeeze them in, which I try to do if I think we can address their issues in that amount of time. I have spots reserved for urgent visits though so if I say no but feel they do need to be seen soon, we can typically get them in within a week or two.  Like Reality Check, it snows here and we try to be more lenient, but it always snows and people should know to leave early. 

 

Our clinic is completely full so we're being more firm on no shows - 3 no shows (consults are worth 2) and you're terminated from whatever provider you've been no showing (and their SP if it's a PA). I give kids 4 chances since it's not their fault they're parents didn't feel the visit was important enough. They can always see a different neurology provider so no one's abandoned. 

 

Essentially, respect our time and the time of the patients after you and there are no problems :) Also, if you're rude to my staff because you decided not to plan well, no one is going to jump through hoops to help your non-urgent problem.

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We give the patient 10 minutes typically. I have the front desk always give the option of waiting in case the next patient no shows (our area and pt population have a high no show rate). If the patient has a believable story and no history of being late or no showing, the front desk will ask me if I'll squeeze them in, which I try to do if I think we can address their issues in that amount of time. I have spots reserved for urgent visits though so if I say no but feel they do need to be seen soon, we can typically get them in within a week or two.  Like Reality Check, it snows here and we try to be more lenient, but it always snows and people should know to leave early. 

 

Our clinic is completely full so we're being more firm on no shows - 3 no shows (consults are worth 2) and you're terminated from whatever provider you've been no showing (and their SP if it's a PA). I give kids 4 chances since it's not their fault they're parents didn't feel the visit was important enough. They can always see a different neurology provider so no one's abandoned. 

 

Essentially, respect our time and the time of the patients after you and there are no problems :) Also, if you're rude to my staff because you decided not to plan well, no one is going to jump through hoops to help your non-urgent problem.

i don't know what disease population you are familiar with, but it has been my experience that neurology patients  (in particular seizure sufferers and cognitively challenged patients) have a difficult time remembering their name, let alone an appointment or even practice location

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Lots of headache patients, but also epilepsy and general neurology. Nothing's really hard and fast - I have plenty of TBI, group home, dementia, etc patients who we are super lenient with and I have a few epilepsy patients who I know I will never term or refuse to see no matter how many times they no show or show up late.  

 

We try to accommodate people the best we can, there's just many many people with well-controlled migraines, peripheral neuropathy, etc that just don't care to show up to appointments and when they do, they're 20 minutes late and scream at the front desk. For a lot of the people who no show or are too late for anyone to squeeze them in, but I know they have current neurologic issues that need to be addressed, we call them so we can make any adjustments we can over the phone, or like I said we open up urgent visit spots.  We're not cold-hearted :) 

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I am a only a wannabe practice owner but I have thought a lot about this issue. My best solution combines two beliefs, community service unlocks the best in people and when you mess up in football practice you pay via strenuous activity. So my goal is to implement a system where you miss an appointment or late to an appointment you owe me x hours of community service. If you don't pay up after 6 months you are removed from the practice.

 

I plan on designing an iPhone application and everything. Even if I lose money with this system it wouldn't matter. This is a big deal to me because I believe I have a responsibility to my future patients but if they do not hold up their end of the bargain we cannot reach our full potential as providers and patients. I even want to incorporate those who do not have reliable transportation, specifically Medicaid. The idea is I will provide transportation both regularly and PRN, but you own me community service.

 

The goal is to filter out the patients who are not serious about their care and attract patients who see their subsidized healthcare as a blessing and not a right. I believe by providing both government insured and privately insured patients more tools along with higher expectations we as providers can continue to see government insured patients with still providing a high level of care to all patients.

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I know this has been discussed many times here and I searched and cannot find it.  What is your policy on late arrivals?

 

I base it on circumstances. If I have a patient from 300 miles away who is late, I work around it. But if I have a local patient, especially one that is non-compliant in other areas, my tolerance is low.  Do you set a time?  I had a non-compliant yesterday (teenager) who came 18 minutes late (she got busy and lost track of time) for a 20 minute appointment. She has a very serious migraine disorder where she is missing school every day. I refused to see her and my next opening is late Feb.  Her mother is pissed.

 

What is the standard?

There is no standard. Everyone has their own way of approaching this. Medical necessity trumps all. After that I tell them they have missed their appointment and I can't make everyone else late so they can be squeezed in sometime later if they want to wait but I can't tell them when that will be. Sometimes I get them in quickly. Sometimes they have to sit a few hours. I believe if you don't manage expectation then expectations become unrealistic.

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I gave people the option of rebooking at a later time/date...if I knew I had a bit of wiggle room later or it was a really minor problem, I'd tell them I could see them when/if there was free time.  Of course, as sas noted, I wouldn't guarantee when that would be.

 

While we're on the subject, what do people do with the overly zealous ones that show up an hour and a half ahead of time?  I know I would see everyone else at their appointed times, since it's not fair to them to have to wait, unless of course a cancellation occurred or someone fell into the above category.

 

SK

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While we're on the subject, what do people do with the overly zealous ones that show up an hour and a half ahead of time?  I know I would see everyone else at their appointed times, since it's not fair to them to have to wait, unless of course a cancellation occurred or someone fell into the above category.

I get them as soon as I can.  It happens reasonably often, since some patients drive 50+ miles to an appointment and are conscientious enough to allow for stupid travel delays.

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While we're on the subject, what do people do with the overly zealous ones that show up an hour and a half ahead of time? I know I would see everyone else at their appointed times, since it's not fair to them to have to wait, unless of course a cancellation occurred or someone fell into the above category.

 

SK

Not a practice owner (PA student) but my dad's a PCP that owns his own practice. He had patients who would do this a lot and before the staff would just check them in when they got to the clinic. After awhile some of them figured this out so they'd purposely started showing up 2-3 hours before their appointment time. It got to the point where it would put others behind their scheduled times. The clinic put a stop to this recently by posting a sign by the front desk that says people will be checked in at their scheduled appointment times. The patients that would show up super early lived in town and weren't traveling 50+ miles away like some of his patients.

 

 

Sent from my iPhone using Tapatalk

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We're pretty lenient with late patients.  Probably because we are always chronically running behind (often we don't even notice a pt that was 15 min late b/c we're running 30 min late).  This frazzles and stresses me out to no end - but my SP seems to care less (he'll roll in in the morning at 8:45 when he knows he had an 8:30 patient scheduled).  We also have a lot of folks that depend on rides from elsewhere.  That being said - the patient you describe in particular jmj11, we probably would of fired.  We'll try as much as we can to help the patient - but they have to work with us and it doesn't sound like your patient has any desire to help herself or take any responsibility for her health. 

 

We also struggle with over zealous early patients - right now folks get checked in in the order they arrive but it does drive me crazy and throw off my whole day when the 3pm pt shows at 2p - because it makes everyone else wait.  Granted, theoretically when you work up to the original appt time of that early pt you should be back on track... but it never seems to work out that way.  

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folks get checked in in the order they arrive but it does drive me crazy and throw off my whole day when the 3pm pt shows at 2p - because it makes everyone else wait.

I will not see patients in this order.  First come are patients who are on time, then early patients, then late patients.  If my MA ever roomed an unrealistically early patient and I was going to have to make my scheduled patient late to see the early patient, I would have them un-room the patient and put the proper patient in.  I've never had to do THAT, but I have left a patient in a room, unseen, while the proper patient was roomed and seen first.

 

I will not tolerate being late myself--It's rude and unprofessional, and I apologize to every patient I see late.  Staying on time is more than just an OCD thing--it's a way to attract and retain professional patients.  We have a 0% medicaid practice, and are intentionally driving our Medicare numbers towards 0% through attrition, so in order to keep a primary care practice full of healthy teens and adults with good insurance, we must keep up with their needs, and on-time appointments is one of them.

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As  a practice owner a while ago in NYC for 10 years, I appreciate the no show no revenue.  It seems that this particular teenager needs to be discharged from your practice as your have not been able to meet her expectations (IMHO).  Less angst for you and you can fill her slot with a patient who cares.  Also the cell phone thing!!!  I am adamant about turning it off and putting it away.  No exception.  That is plain rude!

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just asked a home bound patient to find a different PCP

 

TWO back to back no shows

 

Takes me 10-12 min to drive each way, then to have a no show is just crazy for someone that is supposed to be home bound

 

I don;t feel sorry, it is my time I wasted on the patient, and I will never get that time back.....

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Beyond no-show and late comers - I do believe my least favorite is the "…while I have you in the room for my problem, will you look at Little Johnny's rash?…."

 

One co-pay, me trapped in the room, probably late or barely on time and Mom pulling up the kid's shirt.

 

I have become a bit more forward on these occasions and say - "We didn't know Johnny had a problem or concern. We only made time for you today. You will need to talk to the front desk about making an appointment for him."

 

It still cannot beat my first 3 months in a new town - local grocery store - brand new one in town - I stopped in to grab something for dinner on my way to my house and family. A lady shows me her rash OVER THE FRESH FRUIT in the produce department and wants a curbside - right there. Right then, decided that I could not live in that suburb - no way, no how. I needed to separate work and home by distance, services and rashes……..

 

Then my colleague tells me about the pictures his patients texted him on his personal cell phone when they accidentally got his number while he was on call. Let's just say that hemorrhoids do not photograph well…….

 

Pretty sure Full Moons come more than once a month….

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I will add her headache story is 95% of the patients that I see every day. In her case when I speak of noncompliance, she texts while in the appointments (and I have to keep telling her to stop) she rolls her eyes at each suggestion for treatment and I have have started her on three preventative medications and she hasn't taken any more than a few days due to her "not likely them." Yet she has called for pain medications twice.  

 

 

Really !?  Fire her ass !

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