Ep. 86: The REAL Solution to Cancellations & No-Shows
There are a few reasons why patients cancel appointments, but one of them far outstrips all the rest—and no amount of reminders or confirmations or cancellation fees will fix it. So this week, Jeff discusses the real problem behind the majority of cancellations and how to solve it so you can start reclaiming your lost productivity.
Links:
The MGE Communication & Sales Seminars - https://mgeonline.com/mge-communication-and-sales-seminars/
DDS Success - https://ddssuccess.com/
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Questions From This Episode
What's the real difference between a patient saying they want treatment and actually being sold?
A patient agreeing verbally to a treatment plan hasn't actually committed to anything yet, the same way telling a salesperson you're sold on a suit doesn't mean you've bought it. The only real signal that someone is genuinely sold is payment, once money has changed hands, whether through prepayment or another agreed financial arrangement, that's the point where showing up becomes far more likely.
Why does Jeff recommend prepayment over a small deposit or cancellation fee?
A small deposit or cancellation fee, even $150 or $250, doesn't come close to covering the real cost of losing two or three hours of a doctor's schedule to a no-show, so it doesn't meaningfully change patient behavior. Full or partial prepayment, sometimes with a modest discount as an incentive, actually gets the patient financially committed, which is what reliably improves show rates rather than just adding a minor penalty after the fact.
What are the three main reasons patients cancel or no-show, and which one actually drives most of it?
Patients forget, a genuine life emergency comes up, or they simply weren't sold enough on the treatment to prioritize showing up. Reminder systems and confirmation calls solve the first reason, and there's little anyone can do about the second, but the third is the actual driver behind most cancellations and no-shows, and it's the one prepayment directly addresses.
How should a practice handle the accounting side of collecting prepayments?
Get the patient scheduled to actually begin treatment quickly, ideally within a few days, since a long wait after prepaying feels anticlimactic and reflects poorly on the practice. It's also worth resisting the urge to spend prepaid funds immediately, retaining a portion until the treatment is actually delivered, especially on larger cases completed over several visits, so there's a cushion available in the rare case a patient asks for a refund.
How can a practice reduce no-shows on the hygiene schedule specifically, since patients obviously aren't prepaying for a cleaning?
By having the doctor personally set the expectation that regular recall visits are a real condition of the restorative or periodontal work being done, not an optional afterthought. Patients generally give more weight to what the doctor tells them directly than to anyone else in the practice, so a doctor stating plainly that follow-up visits are required to protect the work just completed helps make hygiene genuinely important in the patient's mind.
Episode Transcript
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You're about to leave for the day and take a quick peek at tomorrow's schedule. Hygiene looks solid, no openings. Your own schedule looks great too, well above your daily goal, productive. Your first appointment is at 8:30, a large procedure, six crown preps and some fillings, the bulk of your production for the day. You head home feeling good about it.
You come in the next morning, excited to get going, and pull up the schedule again. No patient at 8:30. As a matter of fact, nothing for the next two and a half hours. You ask your front desk what happened, and they tell you Mr. Smith left a voicemail the night before saying he forgot he had another appointment and won't be making it in.
Now you've got two and a half to three hours with nothing but a couple of recall exams, your front desk is scrambling, and the whole mood in the office has taken a hit. Cancellations and no-shows, when I've surveyed dentists and office managers over the years, consistently rank among the top five most stressful and frustrating things that happen in a practice. They throw the schedule off, and they genuinely cost practices anywhere from tens of thousands to hundreds of thousands of dollars a year.
It's not that nobody's tried to solve this. Entire patient management software categories exist specifically to send reminder texts and emails, and there have been countless articles debating whether to charge cancellation fees. Despite all that, it remains a persistent problem industry-wide. So is there a real solution, especially for the doctor's schedule specifically? Yes, there is, and that's what I want to cover this week. My name is Jeff Blumberg, and I'm your host.
Let's start with basic definitions. A cancellation is when a patient tells you directly they're not coming, whether that's three weeks in advance or ten minutes before the appointment, it's technically a cancellation either way, just a rougher version closer to appointment time. A no-show, sometimes called a failed appointment, is when the patient simply never shows up and you never hear from them at all. Cancellations are somewhat better depending on timing, but both end up with the same practical result, an empty slot where a patient was supposed to be.
The impact differs between the doctor's schedule and hygiene. Cancellations and no-shows on the doctor's schedule tend to hit revenue harder and throw off the doctor's own day more broadly, especially when it was a larger procedure. Hygiene naturally sees a higher raw number of cancellations simply due to volume, more patients flowing through that part of the practice.
Why do patients cancel or no-show in the first place? Generally three reasons. First, they genuinely forgot. Second, a real life circumstance got in the way, a family emergency, sudden illness, travel. Third, they simply didn't prioritize showing up, they weren't genuinely sold on the treatment.
Reminder software, confirmation calls, and texts solve the first reason well. There's honestly little you can do about the second, it happens, but it's not the majority driver. The real, primary reason behind most cancellations and no-shows, especially for larger procedures on the doctor's schedule, is that the patient was never genuinely sold in the first place.
What does sold actually mean here, since I think this gets misunderstood? Say you've presented a treatment plan for six crowns, and the patient tells you they want to do it. Does that mean they're sold? It doesn't. Think about it this way: if I'm shopping at a department store and a salesperson shows me a suit, and I say, I'm sold on this suit, does the salesperson actually consider that a sale? Absolutely not. They know I'm genuinely sold when I've paid for it and taken delivery, or at minimum committed to a fitting after paying. Payment is what actually signals commitment.
Apply that same logic to a dental practice. You've presented the treatment plan, told the patient the cost, and now the question is whether they've actually paid. I covered building a financial policy for your practice in a previous episode, and the specifics are up to you, but I'd strongly recommend some form of prepayment discount, allowing a patient to pay for treatment in advance, not the day before their appointment, but essentially at the time they agree to the plan.
You might structure this as half now, half in thirty days, or full prepayment with a discount incentive. If you do split payments, tie that second payment to a fixed date, not to delivery of the treatment. And genuinely, there are more financial tools available today than ever before, debit authorization forms, credit card holds, financing platforms, all of which your attorney or a payment processor can help set up properly.
Once a patient has prepaid, or made a real financial commitment under whatever policy you use, they're genuinely sold. You might think, patients aren't used to prepaying for healthcare, but that's simply not accurate. Think about how people behave everywhere else. You can't walk out of a grocery store with your cart and ask to be billed later. You can't take clothes from a retail store and say you'll mail a check in 30 days. Even getting your car repaired, you don't get the car back until you pay. People are fully accustomed to paying at or before the point of receiving something, this isn't an unusual concept to introduce into your own financial policy.
And here's what actually happens once patients start prepaying, we teach this to clients early in our program: patients' memories genuinely seem to improve. Cars that used to not start in the winter, suddenly start. Kids who used to get sudden stomachaches on appointment day, suddenly feel fine. When someone has actually paid, they show up.
How does this conversation actually go? You've finished explaining a treatment plan, patient wants to proceed, and you, the doctor, state the cost directly. Say it's 13,000 dollars. The patient reacts, that's a lot of money. You acknowledge that genuinely, it is a lot of treatment, then ask how they'd normally handle a payment like this. They might ask about payment plans, or mention a credit card.
From there, lay out the real options. They can prepay today and save a meaningful discount, say 5 percent, 650 dollars off a 13,000 dollar plan. Or they can do half now, half in thirty days, without the discount. Or, if they're specifically asking for an extended payment plan, you can route them directly to whatever financing company you use, have them complete the application, and it's done. In every version, once money has actually changed hands, they're sold.
I've had people ask about instead taking a small deposit, say 250 dollars, to hold the time slot. Honestly, I don't think that's very effective. I'm also not a big fan of cancellation fees generally. What are you realistically going to charge someone who no-shows a six-crown procedure, 150 dollars? That barely covers anything meaningful. It might offset a hygienist's hourly rate for a missed cleaning, but for two to three hours of lost doctor production, it accomplishes essentially nothing. The real fix is getting the patient to genuinely commit financially, that's what actually solves it.
And to be clear, this isn't fundamentally about the money itself. If a patient no-shows, the real loss is that they didn't receive treatment they genuinely needed. Money is simply the medium of exchange that keeps the practice running, pays staff, covers overhead. The actual point is making sure the patient gets the treatment that improves their health and quality of life. But payment remains the clearest, most reliable signal that someone is genuinely committed to that outcome.
Could a patient prepay and later call back asking for a refund? Sure, that can happen. But compare that to the alternative, a patient who never paid at all and simply doesn't show, at least in the prepay scenario, you know quickly enough to potentially refill that slot. If refund requests are happening frequently, say two out of four prepaying patients a day, that points to a deeper issue in your actual sales process worth addressing directly, it shouldn't be a common occurrence.
A few practical notes on implementing prepayment, since we walk clients through this early on. Many practices, especially in the first month or two, actually start collecting more than they're producing, essentially the reverse of the usual dental finance pattern where healthy collections run around 97 percent of production. With prepayments coming in, you might collect 110 percent against 90 percent produced in a given month.
A couple of things worth watching here. First, if a practice is consistently out-collecting production for more than about two months, that's worth addressing directly, since it usually means treatment isn't being scheduled and delivered quickly enough after prepayment is collected. Making a patient wait weeks after prepaying feels genuinely anticlimactic, and reflects poorly on the practice. If you can't get a productive procedure onto the schedule within roughly a week of collecting prepayment, that's a real scheduling gap worth fixing.
Second, be mindful of the accounting side. Prepaid funds represent money you haven't fully earned yet from an accounting standpoint, since the treatment hasn't been delivered. I'd avoid spending that money immediately, retain a reasonable portion, particularly for larger cases delivered over several visits, so there's a cushion available in the occasional case where a patient changes their mind and requests a refund. This protects you from spending money that isn't fully yours yet.
So how does this apply to the hygiene schedule specifically? You're obviously not asking hygiene patients to prepay for a routine cleaning, that would be excessive, and there's no real reason to discount something like that. Some practices do collect payment before the patient goes back for hygiene, which is fine, but prepayment itself isn't the right tool here.
What does work well, something Dr. Winteregg used to tell his own patients, and plenty of our clients use some version of this today: when completing restorative work, tell the patient directly that you're not comfortable doing the treatment unless they commit to returning every six months so you can confirm everything is holding up properly. Framed kindly, this genuinely works, because patients consistently give more weight to what the doctor tells them directly than to anyone else in the practice. If the doctor personally frames ongoing recall as a real condition of the work just completed, it becomes genuinely important in the patient's mind.
This matters because hygiene simply isn't marketed with the same intensity as other services in most practices. Walk into almost any dental office and you'll see signage for Invisalign, veneers, sleep apnea treatment, but rarely anything promoting the importance of a routine recall visit, even though that's genuinely the backbone of the practice. I covered building up a hygiene department more directly in episodes 45 and 46, and part of that is making hygiene feel like a genuinely big deal in your practice, the same way you'd promote any other service.
You can apply this same approach with periodontal patients too. Say you're starting a patient on scaling and root planing, you might say something like, we're going to get your gums healthy over the next several visits, and once we've restored things, I need you back every three months to stay ahead of this, I need your agreement on that before we move forward. Said warmly, this plants the same idea, that ongoing recall is a serious, non-negotiable part of the care plan, not an optional afterthought, which genuinely helps reduce hygiene cancellations and no-shows as well.
Will you ever completely eliminate cancellations and no-shows entirely with this approach? No, that's simply unrealistic, they'll still happen occasionally. But you'll meaningfully reduce the majority of them, on the doctor's schedule specifically when patients genuinely pay at the time treatment is presented, whether through prepayment, which I'd recommend, or whatever financial arrangement your policy allows, and I'd steer away from small deposits, which just aren't very effective. On the hygiene schedule, making recall visits genuinely important in the patient's mind, reinforced directly by the doctor, meaningfully reduces those cancellations and no-shows too.
Ultimately, this comes back to actually knowing how to sell, since an unsold patient is the real root cause behind most of this. If you want to build that skill directly, I'd point you toward two things: the MGE Communication and Sales Seminars, nine days of training here in Florida that genuinely teaches this in depth, link on the episode page, and our sales training available on DDS Success, also linked. I'm not suggesting you shouldn't use reminder software or consider a cancellation fee if that fits your practice, but in my experience, backed by thousands of real client cases, nothing solves this more effectively than what I've just walked through.
Shorter episode this week, I'll actually come in under my usual 30 minutes for once. I hope this helps. If you have questions, email me directly at jeffb@mgeonline.com. If you'd like to learn more about MGE, visit us online at mgeonline.com or call 800-640-1140. Have a great week, give this a try in your own practice, let me know how it goes, and we'll see you at the next episode.