How to handle patients who are always late

A column about keeping your practice in good health

By — Posted April 13, 2009.

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Just about every medical practice has chronically tardy patients, the ones who arrive half an hour to an hour after the scheduled appointment time and demand to be squeezed in.

Experts say these patients do more than just try the receptionist's patience. They could cause lost revenue, make on-time patients wait and sometimes force staff to rack up overtime.

They say practices can avoid this problem by changing the behavior of the tardy patient, that of the staff toward that patient and that of the practice itself, if necessary. That means instituting disincentives for the tardy patient that stay in place until their on-time record improves, experts say. Staff should create a system of reminders and scheduling changes to accommodate these patients. But first, the practice needs to establish a tardiness policy, experts say.

"The goal is to change the patient's behavior so they show up for their appointment at the right time," said Jack Valancy, a practice management consultant in Cleveland Heights, Ohio.

Experts say making late patients wait can be effective in changing their cavalier attitudes toward time. Latecomers should be told that because they are late they need to wait until all the on-time patients have been seen. For some practices, this could mean the latecomer is the last person seen that day.

"Everybody who showed up on time should not be punished because of someone else," said Reed Tinsley, a health care consultant from Houston.

Tinsley said if the patient protests, he or she can be allowed to reschedule for another day. But late patients must be told that if they are late again, they will wait again, Tinsley said.

Tinsley said a practice needs to draw the line about how late a patient can be and still be seen that day. He said one hour is a good limit.

Valancy recommends putting chronic latecomers on a virtual doctor list. These patients need to wait until the first doctor in the practice (not necessarily their own doctor) is available, after all the on-time patients have been seen. Do this every time these patients come in, whether they are late or not. Once they establish a routine of coming in on time, they can gradually return to their regular schedule with their regular doctor, Valancy said.

Patients who are chronically tardy can be charged a late fee, provided your insurers don't specifically disallow these fees, said Alice Berkowitz, PhD, executive director of Practice Management Consultant Co. LLC in New York. As a last resort, the patient can be discharged from the practice.

Experts say if staff members notice a patient is continuously running late, they need to take the initiative to preempt any potential scheduling problems.

Call the patient a day or two before the appointment with a reminder of the day and time, emphasizing the time, Berkowitz said. Valancy said studies show reminders reduce the number of no-shows by 20% to 25%, and could work for late-shows, as well.

Call again on the day of the appointment to make sure the patient is running on time. Also, the doctor can give the patient a gentle reminder on why being on time is important for all the patients.

Most practice management software has pop-ups that alert staff to a patient who is usually late and needs to be reminded, experts say. This also allows staff to do some creative scheduling. One medical practice gives the patient an appointment card with a time 30 minutes to an hour earlier than is scheduled in the appointment book, Tinsley said.

Experts say practices can stagger schedules, such as having so many people arrive every 15 minutes, or straddle longer appointments with shorter ones so a tardy person could be squeezed in if there is a gap.

They don't recommend overbooking, as it could backfire by prompting on-time patients to become late patients to avoid the long wait times double-booking often causes.

And, before getting tough on patients, experts suggest the practice look at its own late record. "You need to run your practice smoothly and fairly on time if you expect patients to be on time," Valancy said.

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