Gain Control Over Broken Appointments by Sandy Pardue

Broken appointments are the biggest source of lost revenue for dental practices and they add a lot of stress. A dental office schedule translates to revenues only if patients actually make it to the practice. When a provider is not busy, they are temporarily unemployed. Broken appointments cost practices serious money that can never be recovered. Before a practice can really gain control over broken appointments, it must first discover all the various things that it may or may not be doing that can actually affect the patient's decision to come in or not. Actions and words, or the lack of them, have a lot to do with how the patients view the overall dental experience.

One thing we know is that patients do not understand dentistry the way we do. If they did, a lot more of them would be accepting treatment and a lot more of them would be lining up to get in the chair. If the patient doesn't see the value and how it will benefit them, it's going to be a lot easier for them to blow it off or call the office to say they can't come.

Top Reasons for Broken Appointments

  • No concrete financial arrangements. They are given an appointment in the future, and no one goes over the treatment plan or makes firm financial arrangements with the patient.

  • Patient doesn't value the service. The patient is not told what's going on in their mouth and what'll happen if they don't come in and get the situation taken care of. They are unaware of why they need to return.

  • Appointment not properly confirmed. The appointment isn't properly confirmed with the right verbal skill or apprehension about the appointment is not detected. Perhaps it is not confirmed at all.

  • Patient objections or considerations are not detected and handled. Most patients have unanswered questions or they do not fully understand their condition or why their dental treatment is important

  • Patient is past due on their account. Patients who owe you money or have a past due balance on their account will typically stay away from the practice.

I think we all agree that broken appointments are not good for the practice. Through our investigations into the causes of broken appointments, we've discovered many times they could have been avoided if the practice had been more proactive. It's easy to blame broken appointments on the patients and it's easy to start threatening a broken appointment fee. But I'd like to see practices be more proactive. With the right protocols in place, practices have more control over broken appointments than they ever imagined.

Gaining Control of Broken Appointments

Utilize the following tips to help you gain control and effectively manage broken appointments:

  • Avoid the word cancellation when speaking to patients. In fact, I recommend you take the word cancellation out of your vocabulary. You want patients to think that it rarely, if ever, happens. Using words like cancellation sends a message to the patients that schedule changes are normal and the practice expects them to happen.

  • Use effective verbal skills at the time of scheduling. Patients need to fully understand why they need to come back for treatment and most importantly what will happen if they don't come back.

    1. When scheduling always say, "We are reserving two hours for you, let's find a time that works for both you and the doctor or hygienist." Tell them you will be calling in advance to confirm the appointment. Request the number where they can be reached directly so that you have updated information.
    2. Always emphasize the value of the dental care provided even during the regular dental visit, as well as clearly explaining the importance of keeping their appointments. Let them know you are looking forward to seeing them when they come back for the treatment.
    3. Use phrases like, "We have an hour saved with the doctor just for you" and "We need to get you back here before that tooth gets worse and wakes you in the middle of a Saturday night when we aren't available."

  • Avoid breaking agreements with patients. Making an agreement with a patient in regards to an appointment time and calling to move it to another time because you had a cancellation is not a good thing to do. Try focusing on all the patients who have outstanding treatment and are not on the schedule. Changing appointments sends a message to the patients that you get changes, so it is OK for them to cancel. I understand there are situations where patients need and want to come in sooner. In these cases, you should say something like, "If we get a change in the schedule, is it OK if I call you?"

  • Never fail to call patients when they are five minutes late. Contact the patient five to 10 minutes after their appointment time and say something like, "Hello Mr. Black, we were expecting you today at 8:00 a.m.; we had an hour saved for you with doctor, we hope everything is OK." Pause and wait for their response. Hopefully they will feel at least a little guilty. If you act like it was not a problem, they will continue doing the same thing. Do not ever scold a patient

  • Be prepared to handle patients calling to break an appointment:
    1. Calls should always, always go directly to the scheduler.
    2. Act surprised and disappointed.
    3. Reschedule at that time, not later.

  • Make firm financial arrangements before scheduling the appointment. Patients with bad accounts tend to break more appointments. Some are past due, others have large unpaid balances, or may not have time if they have kids. Financial arrangements must be made before the appointment is scheduled

  • Have clinical team members reinforce needed treatment. A large percentage of broken appointments begin chairside. Educate your patients and tell them over and over that if they do nothing, it will cost more and get worse.

  • The hand-off between the clinical team and the front desk staff is key. The clinical team and the doctor have already informed the patient of the needed treatment. The patient is escorted to the scheduling coordinator by a member of the clinical team and the turnover goes like this: "It was so good to see you today, Mr. Black. Jamie will get you scheduled for that crown and I'm looking forward to seeing you when you come back." The clinical team member now looks at the scheduler and says something like, "Jamie, doctor wants to get Mr. Black back as soon as possible for a crown." The reinforcement of the needed treatment is very important,

  • Emphasize the value of the next appointment. If the team is not emphasizing the importance of the next visit to the patient while he or she is sitting in the chair, you probably have many more broken appointments than you should. Every patient needing to come back for treatment needs to fully understand why and what will happen if they do not keep the appointment. Every team member is responsible for making sure patients are educated and their questions are answered. If the patient doesn't see the value and how it will benefit them, it's going to be a lot easier for them to not come.

  • Have a solid appointment confirmation system. Confirmation of appointments has a lot to do with the patient keeping their appointment. Confirming the appointment with the patient is very important. Every practice needs to appoint someone skilled to do the confirmations. Start early in the day and confirm for the following day. If you confirm too soon, you will get more broken appointments. Speak directly to the patient. When patients schedule their appointments, let them know you will be calling them the day before to confirm the appointment. Ask them for the number where they can be reached directly.

When Calling to Confirm:
  1. Start early in the day.
  2. Avoid using the word "remind."
  3. Do not say, "I'm just calling to confirm your appointment (saying the word "just" makes the call seem less important).
  4. Pay close attention to their response, words and reactions to your call. The response will tell you a lot about their intentions.
  5. Speak up and speak clearly.
If they start questioning you about the appointment, they may be trying to back out. Be aware if they say things like, "Uhhh, is that tomorrow" or "What is he going to do?" If they sound the least bit apprehensive you need to ask them if they have any questions and make sure you have fully acknowledged them. Get all of their objections handled. If you don't they will most likely confirm and then cancel the appointment. You can send an email to patients unconfirmed at the end of the day. One of the first things you should do each morning is call all patients scheduled for the day who are still unconfirmed.

Email and Text Reminders for Confirmation

It would certainly be wonderful if patients were as excited about coming to the office as they are about going to a concert to hear their favorite performer. We could send them an email, they would show up and you could even get a credit card number in advance. Unfortunately most patients aren't that excited about getting dental work done, so we have to be very attentive to the confirmation procedures. I realize there are patients that prefer text and email for confirmations and we want to accommodate them. Since our number one priority is getting the patients to the office, we have a system that we recommend that will allow you to utilize email but still have the control that helps you create a productive day.

Recommended Email Protocol to Confirm:
  1. A physical card is sent three weeks in advance to prescheduled patients.
  2. A confirmation email or text is sent three days before the appointment.
  3. If they don't confirm from the email, they get a phone call 24 hours before the appointment.
  4. If they confirmed by text or email and they are a no show, they only get confirmed by phone in the future.
This protocol allows you to use technology and get the patients to the office. Our clients have had great success with Lighthouse 360 to assist with emailing and texting patients.

Broken Appointment Fees

Charge broken appointment fees to the patients who you want to leave the practice. Gaining control over your schedule is the best solution. Broken appointments are a huge cause of stress in dental offices. Every missed appointment means lost production and lost revenue. Practices can gain control over this problem by being proactive and knowing what to look for in advance. Although they can't be totally eliminated, broken appointments can be minimized significantly if you follow these strategies.

Sandy Pardue, is an internationally recognized lecturer, author and practice management consultant. She has assisted hundreds of doctors with practice expansion and staff development over the past 20 years. She is known for her comprehensive and interesting approach to dental office systems, and offers a refreshing point of view on how to become more efficient and productive in a dental practice. Sandy is director of consulting with Classic Practice Resources. She is also a consultant to leading dental companies for product evaluation and design. For more information, please e-mail You can find Sandy on by her display name "Sandy Pardue."

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