Digest Number 791 - No shows/ practice management

[Guest guest]

Message: 18

Mon, 13 Dec 2004 09:56:35 -0500

Anne Crowley <blazing.valley

Re: Digest Number 785

 

 

> <<

 

 

 

(There is a strict 24 hour cancellation policy)

 

Anne: This issue continues to plague me. Even if I give this written

notice to people when they start treatment, they always seem to have

something come up. A loyal patient will be forgetful, new patients

don't show up and don't call back, first or second time; even a patient

getting a lot out of treatment will mix up appointments because has

stressful time going on, a patient will have a sick child, they can be

called to a funeral. Well - they all seem understandable and some seem

like emergencies, e.g. sick child - but lost income to me. I get to

know my patients quite well, so they feel like friends as well as

patients. Also I live in a small community someone will come in and

start talking about the local event that was in town.

 

I started calling people a day in advance who I know are more

forgetful. If I started calling everyone and they answer and say, oh, I

forgot or oh, I am really busy let's do it next week.Or they call back -

now that you reminded me, I remember I have this going on. That would

drive me nuts.

 

Anyway - I have to be firm about this again. One year when it was

really out of hand I lost $3K on this, on a rather small beginning

salary. I just think some people think you should not charge them if

things come up in their lives - but it in effect means a payroll

deduction for me.

Any advice?

 

Robbee: Yes be firm (doesn't mean you have to be mean or crass). Have a

policy and honor it. I have a sign on my wall: 24 hour cancelation policy or

full fee is charged. It is written on my appointment cards and patients are

informed of this when they first make an appointment. I do not charge for the

treatments. I charge for my time. A subtle but substantial difference. I have

a fixed fee and whatever i choose to do fits under that (meaning any

combination of needles, moxa, cupping, e-stim or manual manipulation, talk

therapy,

diet, life style advice etc. Actual herbs are extra). When a patient

understands that it is YOUR time that they are paying for, they seem to be more

respectful of the appointment. But that is how I explain it, especially to the

patient who balks at the 24 hour notice, as soon as they realize you can only

see a

fixed number of people in a day, they just seem to take more responsibility

for their part of the agreement. (It is a mutual contract afterall- not only

must they show up, but YOU must be available too!) I failed to mention that I

have a 48 hour cancelation policy for new patients. If a new patient misses

their appointment, it needs to be paid for before another appointment is made.

Of course emergencies are another story, deaths, hospitalization of a loved

one - I do not charge for. I also will let " one " missed appointment a year go

for free on my regular patients (rarely happens). I do not accept pre-payment

for appointments.

 

> I do all of the booking and

> receive payments myself.

 

 

Anne: Do you do this in the last five or ten minutes of their treatment

time?

 

Robbee: Yes. at the very end.

 

 

 

> Help one patient and they will send 7

> others in your direction. (You will end up treating entire

> neighborhoods, circles

> of friends and extended families)

 

Anne: This is true in general. Some people don't refer because they

want it to be " their " escape and secret or " their " practitioner.

 

Robbee: I have not found that to be the case. I have had divorcing spouses

bring their new mates while both continuing to come. As long as you create a

safe place where your patients KNOW that what happens or is said in the office

remains between the two of you, there are no problems. The only thing you

have to be attentive to whom is being booking when, just to keep some people

distanced.

 

Again, perhaps this is different in different locations, but certainly where

I work, reccomendation is the only way people seem to operate with locating

any type of health care practitioner.. My patients would have never picked me

out of a phone book (Or anyone else for that matter) they want a reccomendation

from a satisfied client.

 

> Of course people skills are very important,

> knowing how to take the fear out of health problems and even death while

> reframing issues in an understandable manner for your patients will

> make a huge

> difference.

 

 

Anne:We spent a lot of time learning how to relate to people. A lot of

practitioners from my school treat 1 per hour. I do want to go to 2 per

hour as others have done. When you have something big come up in the

treatment room - and I mean emotional what do you do - reschedule them -

since you will have to stay on schedule. One possibility is have a

third room available to let the patient stay and move in and out until

they are ready to go.

 

Robbee: Well I do not have the luxury of a third room. I work thru whatever

comes up with the patient and tend to get them out on time - even with the

release of large emotional issues. I will not 'treat' if someone is 20 minutes

late. Might have them lie down and do 4 gates and shenmen and reschedule

their appointment, but will not attempt to do a real diagnosed session without

enough time.

 

> knowing how to listen to your patients.

 

Anne:Again, only in the first 10-15mins - I find things come up

(emotional) after needles are in. How would you work this with scheduling?

 

Robbee: I just do the best I can! Usually if emotions are released during

treatment, all I have to do is allow the space for the patient to release them.

If someone is crying, I allow them to cry, bring them kleenix and

water...they do not have to explain their tears, unless they want to speak.

But

USUALLY everything comes full circle within the hour. Perhaps 1-2 times a year

something gets out of hand with an emotional release, and i end up late. If you

are booking patients in this manner the patients have a feel for the rhythm of

the office and acquire an unconscious sense of your timing and work with it.

Right from the beginning, I booked patients back to back so that there was

always the sense that there was another patient waiting, that way it was easy to

bring one session to a close to begin the next. I have found that if people

sense you have time they will take as much of your time as they can. Guess

it's just human nature.

 

hope this is helpful.

robbee

[Guest guest]

Robbee: That was very very helpful. It is so fascinating to listen to

the way people practice and to think through what I do and where I want

to be with it.

 

Thanks again,

 

Anne

 

TashiDelay wrote:

 

>

>

>

> Message: 18

> Mon, 13 Dec 2004 09:56:35 -0500

> Anne Crowley <blazing.valley

> Re: Digest Number 785

>

>

> > <<

>

>

>

> (There is a strict 24 hour cancellation policy)

>

> Anne: This issue continues to plague me. Even if I give this written

> notice to people when they start treatment, they always seem to have

> something come up. A loyal patient will be forgetful, new patients

> don't show up and don't call back, first or second time; even a patient

> getting a lot out of treatment will mix up appointments because has

> stressful time going on, a patient will have a sick child, they can be

> called to a funeral. Well - they all seem understandable and some seem

> like emergencies, e.g. sick child - but lost income to me. I get to

> know my patients quite well, so they feel like friends as well as

> patients. Also I live in a small community someone will come in and

> start talking about the local event that was in town.

>

> I started calling people a day in advance who I know are more

> forgetful. If I started calling everyone and they answer and say, oh, I

> forgot or oh, I am really busy let's do it next week.Or they call back -

> now that you reminded me, I remember I have this going on. That would

> drive me nuts.

>

> Anyway - I have to be firm about this again. One year when it was

> really out of hand I lost $3K on this, on a rather small beginning

> salary. I just think some people think you should not charge them if

> things come up in their lives - but it in effect means a payroll

> deduction for me.

> Any advice?

>

> Robbee: Yes be firm (doesn't mean you have to be mean or crass). Have a

> policy and honor it. I have a sign on my wall: 24 hour cancelation

> policy or

> full fee is charged. It is written on my appointment cards and

> patients are

> informed of this when they first make an appointment. I do not

> charge for the

> treatments. I charge for my time. A subtle but substantial

> difference. I have

> a fixed fee and whatever i choose to do fits under that (meaning any

> combination of needles, moxa, cupping, e-stim or manual manipulation,

> talk therapy,

> diet, life style advice etc. Actual herbs are extra). When a patient

> understands that it is YOUR time that they are paying for, they seem

> to be more

> respectful of the appointment. But that is how I explain it,

> especially to the

> patient who balks at the 24 hour notice, as soon as they realize you

> can only see a

> fixed number of people in a day, they just seem to take more

> responsibility

> for their part of the agreement. (It is a mutual contract afterall-

> not only

> must they show up, but YOU must be available too!) I failed to mention

> that I

> have a 48 hour cancelation policy for new patients. If a new patient

> misses

> their appointment, it needs to be paid for before another appointment

> is made.

> Of course emergencies are another story, deaths, hospitalization of a

> loved

> one - I do not charge for. I also will let " one " missed appointment a

> year go

> for free on my regular patients (rarely happens). I do not accept

> pre-payment

> for appointments.

>

> > I do all of the booking and

> > receive payments myself.

>

>

> Anne: Do you do this in the last five or ten minutes of their treatment

> time?

>

> Robbee: Yes. at the very end.