Inside Dentistry
June 2007
Volume 3, Issue 6

Minimizing Cancellations and No-Shows to Maximize Production

Lois Banta

One of the most critical issues facing practices today is failed appointments. If the practice has no proactive plan to minimize no-shows and cancellations, the trend has a tendency to grow, dramatically impacting production, profitability, patient satisfaction, and team morale. Studies have shown that for hygiene cancellations, the cost to the practice in lost time and opportunity could exceed $30,000 per hygienist per year. The author has found for operative appointment failures, the impact is even more significant, and can result in a loss of $100,000 or more in production. Often practice teams place the blame of failed appointments on the patients—their lack of respect for the dentist’s time, their lack of urgency of getting the dentistry done, and just plain rudeness. Although some of the responsibility rests with patients, a significant contributor to the problem is the dental team and the lack of training on communications skills that prevent failed appointments and how to effectively handle and “turn around” cancellation calls.


The number one reason patients cancel their appointment or fail to show up is that they have not bought into, or do not “own,” their needed dentistry. So they seek every reason to cancel because they do not have a reason to complete the care. Studies have shown that patients must hear a dentist’s recommendations and the consequences of not having treatment three times before they truly understand and internalize it. That means the dentist needs to clearly discuss the condition in their mouth, the treatment needed, and the consequences of delaying or declining care with the patient during the examination. The dentist’s diagnosis is reiterated in the treatment presentation by the dentist or hygienist and again repeated by the office manager or financial coordinator during the fee discussion. Within these three mentions, you move the patient from “need” to “want.” Without creating urgency and desire, and getting patients to want their dentistry, you are not going to get a permanent “yes” from them. Other reasons for failed appointments are fear of pain and financial concerns. Patients may avoid the dentist because of previous bad experiences or cancel appointments because they are embarrassed to tell the dentist that they cannot afford needed dentistry. Of course, there are some logical reasons why a patient might miss or cancel the appointment such as illness, traffic, or work issues. But the fear-based, financial, and logical reasons for failed appointments are still opportunities and, if the team is trained to use its good verbal skills, the patient can be guided, and cancellations and no-shows can be minimized.

The philosophy of the entire dental team can inadvertently set the tone for increased cancellations and no-shows. It comes down to what is said and how it is said. Here are some specific situations and some proven techniques to minimize failed appointments, starting with the first point of contact—the new patient call.

The New Patient Telephone Call
The best communicator in the office needs to be the person who is scheduling that first appointment because that is the first impression the patient receives. The way the telephone is answered and how the appointment is set determines the patient’s perception of the financial, scheduling, and care philosophy of the practice. It should be communicated that the dentist’s time is valuable and that the patient has responsibilities, including financial responsibilities. The one thing that should never, ever be said is, “If you need to cancel or reschedule, give us a call.”

Confirmation Techniques
When we use words like “confirm” and “remind” and request patients to call us back, we make it easy for them to call and cancel. Instead, when phoning patients, set the expectation that they will be at their appointment and don’t use any language that indicates that they have the option of canceling. This works equally as well when talking to them directly or leaving a message. A sample script could read: “Good afternoon, Mrs. Jones. This is a courtesy call to let you know that you are on Dr. Smith’s schedule for Tuesday at 3:00. It looks like we are going to get more rain on Tuesday, so remember your umbrella! We are looking forward to seeing you again.”

Printed Materials
Sometimes the wording on reminder cards and brochures sets the stage for cancellations. If a dentist puts in print that 24 hours notification is required for a cancellation, it effectively tells patients that it is acceptable to cancel and gives them an open invitation to do so. When sending out reminder or confirmation cards, they should simply tell the patient that they are on the dentist’s schedule and they are expected in the office on that date and time.

Ensure “Buy In”
When setting the appointment, instead of asking patients if they have any questions, which only requires a “yes” or “no” answer, ask open-ended questions that will engage the patient in conversation, providing the opportunity to verify that they have “bought into” treatment. Ask questions such as “What questions can we answer for you about your financial responsibility at the next appointment?” or “What questions can we answer for you about the procedures we just discussed?” These types of questions promote conversation, which helps to verify that there are no concerns or issues that might lead to cancellations.

Uncovering Cost Concerns
In diagnosing a patient’s dental needs there are many forks in the road. Once need/want is determined, the patient must be enabled to proceed. Often this is a financial issue. During the fee discussion, the breakdown typically occurs when the patient is not offered enough options. That is why it is crucial for a practice to have flexible financial arrangements that include cash, credit cards, and an outside patient-financing program like CareCredit® (Costa Mesa, CA) for no-interest and low-interest monthly payment plans. These options should be offered up front to the patient. Many patients are not comfortable telling a dentist or team member that they cannot afford treatment. If the patient schedules his or her appointment and leaves the practice with cost concerns, he or she leaves with a reason to cancel the appointment or fail to show.


Exceptional verbal skills are developed over time through a proactive and systematic training plan. One of the most effective ways to improve communications skills is through role playing, ideally at each staff meeting. Every week, put a notepad into each operatory and at the front desk and write down every question patients asked and how the team responded. Use this information and work as a team to develop scripts that clearly communicate the practice’s philosophy, especially when it comes to setting and confirming appointments, discussing fees and payment options, and assessing the patients’ “buy in” of their dentistry. It would be wonderful to reduce cancellations and no-shows to fewer than 5% instead of the industry average of 15%. It can be done. Once you start tracking your trends, either through practice-management software or by simply determining the percentage of failed vs completed appointments, just the mere fact of meeting about issues and working as a team to improve communications skills alone can immediately improve results.

About the Author
Lois Banta
Chief Executive Officer
Banta Consulting, Inc
Grain Valley,Missouri

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