Patients backing out of surgeries throw schedules into disarray and can cause costly repercussions for the practice. It’s a perennial problem affecting providers and there is no silver bullet solution.
One way to prevent or at least minimize cancellations is to charge a surgery cancellation fee. While levying fines may reduce last-minute dropouts, there’s more than just the bottom line to consider.
“We have a surgery cancellation policy for a couple of our surgeons but we don’t have a change fee,” said a practice manager at a Colorado based clinic. “We charge for cancellations in most cases, to discourage future cancellations, but in extraordinary circumstances, we’ve waived the fee.”
The cost of punitive measures
Though charging a cancellation fee may seem reasonable and fair to a practice from a business perspective, patients may perceive such punitive measures as an infringement on their rights. If it’s their body, their surgery, and ultimately their decision, surely it’s their right to back out of surgery, too.
Well yes, but this has less to do with rights and more to do with smart business practice. Today patients consider a visit to the physician no differently from that of any other service provider.
As with any business, if the service isn’t up to scratch, or the terms attached are less attractive than those offered elsewhere, customers will make their dissatisfaction known. They will likely take their business elsewhere, but not before letting everyone else know.
Beware: the aggrieved patient
Whereas in the past a disgruntled patient made do with a stern letter addressed to senior management, today, grievances are posted on social media in a heartbeat. Real or imagined, it’s your word against the patient’s – and negative publicity spreads fast. If your practice is active on social media, be prepared to deal with negative feedback when patients discuss their issues with you – and your policies – online.
Impact on the patient
It’s clear why cancelling patients might resent paying a fine after the fact, but what about patients deliberating whether to have surgery in the first place? How could the prospect of paying a cancellation fee weigh on a mind of a patient getting cold feet over elective surgery?
Impossible to tell for sure, but on top of the factors patients typically weigh up before committing to surgery – the risk of the procedure itself, convalescence and rehabilitation, pain and discomfort – there are also financial implications. This is especially the case for people in distressed economic situations or those lacking job security and fearful of taking extended sick leave.
The final straw?
It’s in these touch-and-go cases that a cancellation fee may be the final push that tips the scales in a no-surgery decision – even when the procedure is necessary for the patient’s wellbeing. Perhaps without the added stress of a financial repercussion to consider the patient would have had the peace of mind to arrive at a more prudent decision about their future.
Prevention is the best solution
While the interest of the patient is of supreme importance, it must not be allowed to undermine sensible business practice.
Remember, the surgeon, PA and schedulers have already invested collective time and energy getting the patient this far in the journey to the OR.
Rather than imposing a cancellation fee, the effort to reassure patients uncertain about surgery should be redoubled. While this requires a greater investment of resources on the part of the doctors and staff, the case to be made for scheduling more surgeries is compelling. (It goes without saying that patients should never feel under duress to have surgery unless it is life threatening.)
Timing is everything
If, in the end, your practice decides that certain circumstances do warrant a cancellation fee, you need to decide when and how to inform the patient. Raising the subject at the outset might put the patient off the idea of surgery altogether – or at least through your practice. Fail to mention it at all and you could be pilloried by patients who bail at the last moment for not being transparent enough. Probably the most effective time to bring up the topic of the cancellation fee is when the patient commits to surgery and a date is chosen; then they understand that the time allotted to them could be used by another patient. Correct timing and tone are needed in order to avoid a lose-lose outcome for the practice.
Sweetening the pill
If your practice is undecided on this issue, there are creative ways to soften the impact of a full-on cancellation fee policy. These can include variable rates where, say, a patient pays the full fee if they cancel the surgery less than 48 hours before the scheduled date, but only 50% of the fee if the surgery is cancelled less than a week before, and no fee at all if they cancel before then.
Practices can also show flexibility when it comes to the reasons patients give for cancelling, affording them freedom to judge cases on a patient by patient basis (though this might open a Pandora’s Box of accusations of preferential treatment).
“There is that line between patient relations and our inconvenience that we try to balance. However, it is not easy,” said the practice manager
Ultimately, the decision to implement a cancellation fee policy is for each practice to make, based on considerations of patient demographics, operational costs, and standards of service and care, as well as industry and specialty benchmarks. Sometimes cancellations are just part of the cost of doing business.