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    Surgery Cancellations: The Case for Charging
    Sari Nossbaum | July 5, 2017

    Every scheduler has been there. The surgery schedule is perfectly organized, and then something happens the day before to throw the entire day into shambles. It’s too late to slot in a replacement surgery, so the surgeon loses his/her cool and it’s frustrating for everyone.


    frustrated doctor


    No wonder management fantasize about how to penalize patients who cancel at the last minute. While your powers of “punishment” are limited, one way surgical practices deal with patients who wreak havoc with the schedule is to hit them where it hurts – in their pocket.


    Why a change/cancellation fee is justified


    While cancelling or not showing up for surgery may seem insignificant to a patient, it has costly ramifications for the surgeon and practice. Although some surgical practices think the idea of charging for changes or cancellations is a no-go, there are others who have had enough of paying for their patients’ indecision and have implemented a change/cancellation fee.



    It’s not hard to understand why some practices are making this – admittedly controversial – move. The surgeon is usually paying for use of the OR or ASC rooms. And if the patient doesn’t show up, the surgeon can kiss any financial compensation for this slot goodbye – not to mention the expense of the surgical, nursing and ancillary staff who are also involved in the procedure.


    And that’s not even taking into account the time and work that went into scheduling and coordinating the surgery in the back-office – from setting up the appointments to making sure all the paperwork was in order and the insurance companies on board.


    With so many stakeholders put out by just one cancellation, it’s reasonable to request a symbolic charge, even just to make patients think more carefully before cancelling or postponing their surgery.


    How charging a cancellation fee can decrease last-minute changes

    Willamette ENT in Salem, Oregon charges for cancellations and date changes. The practice charges a $100 cancellation fee, which wavering patients find just enough of a burden to deter them from cancelling.

    The practice did not take the cancellation/change fee decision lightly. “We had many conversations about this before we finally wrote and implemented a policy,” explains Teresa Bailey, R.N Surgery Scheduling/Preauthorization Manager at Willamette ENT.


    “The schedulers, doctors, and surgery center staff were becoming so frustrated with the number of surgery reschedules and cancellations we were experiencing. It was especially frustrating for the surgery schedulers as they were spending so much time rescheduling cases and refilling surgery blocks at the last minute.”

    cancelled surgery appointment

    Willamette ENT is upfront about its cancellation fee so patients do not feel misled or uninformed. The policy is included in the patient packet that each patient reviews and signs at their first appointment.


    The practice also charges a last-minute cancellation fee of $250 if a patient cancels their surgery less than 24 hours before it is scheduled to take place. Interestingly, it has rarely had to be implemented and Willamette ENT has found that cancellation rates dropped significantly after implementing the new policy. Often, just the mention of the charge is enough to get a patient to keep their date as scheduled.


    Be aware, you can’t charge everyone (even if you want to)


    There are strict rules governing which patients can be charged for cancellations or no-shows. Medicare or Medicaid patients are exempt from paying a cancellation charge; a factor that Teresa Bailey explains is burdensome. “The schedulers get frustrated by this rule since cancelling, no-shows and rescheduling has been a big problem with some of the Medicaid patients.”


    Some things are just out of our control… when you shouldn’t ask for payment


    While you might be considering instituting a policy of tough love with your patients, don’t be too rigid. Penalizing patients for illness, family emergencies or issues out of their control will probably not get your practice raving reviews on social media. The potential reputational risk is why many surgical practices continue to absorb the cost, despite the hassle and annoyance.


    sick in bed

    Willamette ENT does not charge for cancellations that are caused by reasons out of the patients’ control. Even a patient who becomes too stressed by the idea of surgery and cancels their procedure is not charged. With this policy, the practice maintains fair play on all fronts.


    Give patients full disclosure


    Before reaching the stage of charging, perhaps you need to think about how your practice presents the cancellation policy to your patients. Think about implementing a 24-hour grace period (just like booking a flight on some airlines) in which any change will not be penalized. Sometimes, people think they are free when really they aren’t and the pressure of committing to a date makes them say yes when they should say, “let me think about it.”

    Female doctor explaining diagnosis to her female patient

    This works for Willamette ENT, which suffered from patients choosing surgery on dates that were unworkable. Now, even the threat of being charged a fee motivates patients to carefully check their schedules and stick to their surgical dates. It’s a tactic that is definitely working for their practice.


    Stop the bleeding, and institute a surgery cancellation policy


    Due to the controversial nature of this matter, it is understandable that charging for surgical cancellations or date changes is not for every practice. But, as shown above, if the cancellation rates begin to drop dramatically after implementing such a policy, then the data simply speaks for itself: instituting fees decreases cancellations.


    At the end of the day, your practice needs to determine whether swallowing the costs of ongoing cancellations outweighs the possibility of deterring patients from scheduling their surgery at all due to such a policy. The answer is not clear cut for every practice, but the issue certainly deserves a thorough analysis.

    Surgimate staff and 1 others recommend
    About the author: Sari Nossbaum is the Director of Marketing at Surgimate. When she’s not writing insightful articles about surgical management, she can usually be found on her yoga mat or on her road bike, somewhere...
    Published on July 5, 2017. All rights reserved by the author.

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