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Doctors, auto shops, personal trainers crack down on no-shows

| Wednesday, Oct. 3, 2012, 5:20 p.m.
Bernie Gebhardt in the lobby of the Northern Family Medicine offices in McCandless Thursday, October 4, 2012. A few years ago, the practice was logging as many as 300 n0-shows and last minute cancellations a month, but since a new fee system was introduced, that number has dropped significantly. (Philip G. Pavely | Tribune-Review)

Patients who skip appointments at Northern Area Family Medicine are billed $25 if they cancel less than a day in advance and $50 if they simply don't show up.

“Three years ago, we had a terrible problem,” said Bernie Gebhardt, director of the McCandless practice that is part of Genesis Medical Associates Inc. “I ran a report and saw that we had almost 300 no-shows and cancellations in a month. I thought, are you kidding me?”

Since Northern Area — which sees around 100 patients a day — began charging the fees in October 2009, missed appointments plunged to about five a month.

Other Western Pennsylvania medical practices and service professionals, tired of waiting, are employing some combination of tough love, personal appeals and creative scheduling to minimize dead time and lost revenue.

Physicians nationwide appear to be logging more missed appointments and many are taking steps to ensure patients get to their offices, said Kenneth Hertz, principal with the Englewood, Colo.-based Medical Group Management Association's health care consulting group.

The weak economy and insurance changes likely play into the problem.

“Patient responsibilities for medical costs are increasing. So when it comes time for me to go for a follow-up visit, and I'm feeling fine, and I know it will cost me $20 or $40, I might no-show,” Hertz said.

Patients irritated by having to wait a month or more for openings might go elsewhere and then neglect to cancel, Hertz said.

The association and other business groups haven't tracked members' numbers of no-shows, but census data show working-age Americans made an average 3.9 visits to doctors and other medical providers in 2010, down from 4.8 trips in 2001. Experts conclude many patients are trying to avoid out-of-pocket payments.

Dr. Rajiv Varma, a pediatric neurologist and president of Allegheny County Medical Society, said his practice at UPMC Children's Hospital in Lawrenceville trimmed its missed appointments rate from about 25 percent to 15 percent by opening its schedule only two months in advance.

Patients tended to forget about appointments, or run into schedule conflicts, when setting dates four months to a year ahead, and the 20 doctors in the practice encountered problems, too, Varma said.

Some family practices use “on demand” schedules that run no longer than a week ahead, to minimize forgotten appointments. That wouldn't work for a specialty practice such as his that covers a wider geographic area.

“For someone coming from Altoona or Erie, we can't say, ‘Come in at 2 p.m. this afternoon,' ” he said.

Customers of Cochran Automotive, the region's largest auto sales group, can schedule service at any of the dealership group's 19 branded stores using an online, continuously updated schedule that sets appointment times and gives names of service advisers. Nine call center workers process phoned-in requests for oil changes, state inspections and mechanical work.

One minute after a slot is filled, an email confirmation goes out. A second message is sent two days before the appointment.

No-shows “used to be a big issue for us,” said Dirk Harper, Cochran's director of customer care and owner loyalty.

Because the system is precise, customers keep about 90 percent of appointments, compared to a typical 75 to 80 percent for dealerships that handle all but top luxury brands.

“It's not just, ‘Aw, come in tomorrow morning,' ” he said, although Cochran welcomes walk-ins. Its dealerships service 5,500 to 6,500 cars a month.

Personal trainer Joann Brickley keeps no-shows and last-minute cancellations to a minimum by charging her full $80-an-hour fee.

“I sell a product and that product is not available to another person if it's already been sold,” said Brickley, who has a Squirrel Hill studio. “I make it very clear it's not a punishment; this is business. I have lost people because of it but not very many.” Brickley said she reschedules appointments when possible.

Northern Area Family Medicine sometimes waives its missed appointment fees — in a snowstorm, for example. It gives unpaid accounts to a collection agency. And Medicaid patients aren't assessed fees.

Dr. Scott Tyson, a pediatrician, said his practice with offices in Mt. Lebanon, Peters and Robinson raised its no-show fee from $25 to $50 about 18 months ago. “We've probably not charged it more than a half-dozen times,” he said.

Reminder calls the day before and an effort to get patients into examining rooms on time help to keep missed bookings low, about 2 or 3 percent of the 180 daily patients, Tyson said.

Still, “I had a triple the other day — three 20-minute appointments” that one family skipped. “That's a block of time you could have given to somebody else,” he said.

Singh & Dayalan Medical Associates physicians and other care providers talk to patients who've missed an appointment about why they need to show up when expected, especially if they have a chronic condition.

Those suffering with a bad cold or the flu “get here nine out of 10 times,” he said. No-shows at the Genesis practice in Ross are a bigger problem in its behavorioral health division, Hogue said. The practice has a $25 fee.

Premier Salon & Spa at Macy's, Downtown, asks for 20 percent down for groups such as wedding parties or someone booking an expensive treatment such as a $300 keratin smoothing treatment, Manager Dennis Leary said.

More salons are penalizing no-shows but Premier's rate is low, around 5 percent. The 11th floor business keeps a regular clientele.

“We get a lot of transient business, too,” Leary said. “A lot of our no-shows are people staying in the hotels.”

Kim Leonard is a staff writer for Trib Total Media. She can be reached at 412-380-5606 or

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