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The Psychotherapy No-Show

Empty waiting room.  Wait 10 minutes.  Call the client.  Get voicemail, or, “Oh, geez, I forgot, I’m all the way across town, guess I’ll just see you next week.”

You have to charge for missed sessions.  You just have to.  Heck, my OWN analyst charges me for a session every week, and it’s up to me whether or not I show up!  (He lets me shift the time when I need to.  I’m more impressed than resentful.  Actually I’m not resentful at all.  You mean you’re not conscious of any resentment?  Anyway.)

Good article from the Psychotherapy Finances website summarizing some guidelines on how to enforce a no-show policy without being a hard-nose.

8 steps for eliminating no-shows and cancellations

An empty therapy hour is like an empty airline seat–it represents lost income that can never be recovered. And while most clinicians employ written policies making clients responsible when they cancel appointments without notice, in our experience the rule is frequently waived.

A better strategy is to nip the problem in the bud by adopting policies that cut down on no-shows. In this report, we offer advice for doing just that from three practice consultants quoted frequently in PsyFin.

1. Explain your policy on the phone when clients make their first appointment, says California clinician Holly Hunt. It might seem that starting the therapeutic relationship that way would be a turn-off–but Hunt says her first-session no-shows actually decreased after she started doing it.

2. Try to establish a connection with the client over the phone at first contact, says Wisconsin’s Karen Carnabucci, rather than just covering the basics and making an appointment. “When they arrive, it feels like our second appointment rather than our first,” she says. “I also refer them to my website so they get another connection in addition to my voice.”

3. You can be firm without being hardnosed. In Florida, Dwight Bain does it this way: A) clients get one free cancellation; B) thereafter, they must give 24 hours notice; C) a missed session has a $75 price tag–not the full fee–which for Bain is $165. The policy is spelled out clearly at intake, both in writing and verbally.

4. Do some trouble-shooting. If clients seem to have trouble making it to their appointments, says Carnabucci, try changing the day or time. “They may have issues around child care, or late hours at work. I try to address that. I tell them, ‘Maybe we should consider a different time.’”

5. Follow the lead of many physicians and dentists: Call patients a day in advance to remind them. Bain hired a college student to make these calls, and reports that his no-shows fell by 30%-40% almost immediately. Of course, clients need to sign off on that. Your intake form can include language like this: “I understand that [the therapist] will make a discreet phone call to remind me of my appointment 24 hours in advance. I prefer that the following telephone number be used for this purpose: ________.”

6. Don’t put off collecting for missed sessions. As with any collection job, the longer you let it go, the less likely you are to collect. Ideally, clients should pay at the next session. So after no-shows, you should have that bill ready and waiting. (That’s a big reason why we recommend that you accept credit card payments. It allows you to say, “Forgot your check book? No problem–I take Visa and Mastercard.”)

7. Make up your mind how tough you’re going to be if clients just won’t pay. Not very, Bain recommends. He says he collects for no-shows “about 95% of the time,” but never uses a collection company. Remember that many lawsuits and board complaints have their genesis in hurt feelings over money.

Hunt advises clinicians to send one bill after a no-show–but then drop it. “My experience is it doesn’t add anything to send two or three or more bills. Usually if a client doesn’t follow through on the first bill, it’s just a lot of effort with diminishing returns.”

8. With managed care clients, you may be able to bill the client directly for missed session. But you should check with the company first. (Many managed care plans do allow this, but most EAPs don’t.) And remember that you have to bill the managed care rate–not your full fee.

Contacts: 1) Dwight Bain, Winter Park, FL, (407)647-3900            (407)647-3900     www.lifeworks group.org; 2) Karen Carnabucci, Racine, WI, (262)633-2645 (262)633-2645      www.lakehouse center.com (Carnabucci is also quoted in the “Marketing” article beginning on page 4); 3) Holly Hunt, Long Beach, CA, (562)987-8947 (562)987-8947      www.essentialsofprivate practice.com.


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