Home Dental 652: 7 Proven Steps to Reduce Patient Cancellations – with Dr. Barrett Straub

652: 7 Proven Steps to Reduce Patient Cancellations – with Dr. Barrett Straub

by adminjay


Do you deal with cancellations in your practice? If you’re like most dental offices, the answer is yes. Looking for some training on how to help with cancellations and no shows? Let’s set you and your team up for success with these 7 proven steps. To learn how, watch Episode 652 of The Best Practices Show!

Episode Resources:

Links Mentioned in This Episode:

Send Kirk an email

Get the slides, send an email

Capacity tracker

Main Takeaways:

Mitigate cancellations by being proactive while a patient is in the chair. 

An empty chair is negative profit.

You’ve got to put the right people in the right chairs.

Coding appointments can show you which patients value your time and value what you do.

Make the patient feel like you know them. Are you a transactional or relational practice?

Train people that they can’t cancel.


“Every cancellation that has ever happened in dentistry started at the chair. And what I mean by that is the value, the conversation, and we can’t just pass the buck.Yes everybody has to work together; front and back. But all cancellations start at the chair. If you’re looking to solve the root cause of the problem, then we have to start further back in the appointment, which is the conversation.” (5:58—6:23)

“Research indications why patients cancel. Number one is they do forget…The second reason would be lack of perceived value by the patient. And sometimes by the practice. They feel like they’re doing you a favor by canceling. You ever felt that?…Sometimes we give that perception to patients…Reason number four is something comes up that they would rather do. It becomes a value issue…Number five, they have an emotional barrier. That’s very real. Some feel pain. Some are afraid they’ll receive bad news…and I’m just going to put this off. And lastly some just don’t want to spend the money on dentistry. Things happen, water heater broke, flooded basement, got another bill for one of my college kids.” (6:25—8:11)

“Committing and complying to a time slot are two different things. If I work the front desk at your practice, I’m going to be the gatekeeper…I am going to protect the schedule with my life. So if I put you in here I’m going to look in your eyes and make sure are committing and not just complying.” (9:39—10:07)

“I love the idea of the hygienist becoming more involved in that chair time. It’s easier to cancel on the administrative person answering the phone. It’s harder to cancel on a hygienist or the doctor. And oftentimes patients canceling don’t think the message is going to get back…that is the essence of it; creating the idea that we’re not a commodity, we’re special, we’re unique, this chair time is valuable and we’re not looking for repeat customers who we thank for spending time in our chair. We are looking for loyal patients who appreciate what we offer and know that it’s a partnership and they’ve got to hold their half of the bargain.” (11:44—12:56)

“An empty chair isn’t not no profit. An empty chair is negative profit.” (12:39—13:09)

“One cancellation in most dental practices cuts that profit in half for that entire operatory. If you have a second cancellation in eight patients you are now working for free in that operatory. There is no profit whatsoever. And if you have a third one I can almost guarantee you that you are working at a deficit. Which means you are losing money.” (13:35—13:59)

“There are A patients, B patients and C patients. There are patients that value what you do and they show up and they pay. That’s it…and then there are C patients. C patients don’t really value what you do. They don’t value your time. They don’t show up…it’s just that they haven’t demonstrated a value for what you do…80-90% of your profits come from A patients. 80-90% of your problems come from C patients.” (16:33—17:10)

“I highly recommend you create 3 appointment codes and these appointment codes are different than procedure codes. They’re 3 appointment codes that actually code behavior.The first one is a no show, the second one is cancel, and the third one is late…Team members need to be taught how to break an appointment. A lot of times they drag an appointment which means you don’t collect any data on it…When you have data it removes all emotions. Coding these behaviors can show you which patients value your time and value what you do. You can post the ASA procedure code which is D-9986 no-show or missed appointment to the ledger. And a cancel is D9987. (18:45—20:04)

“So the point is we can actually use data to say “I feel like I’m at 110% at capacity, actually I’m at 87%. It helps us set better strategy in that, let’s do more, do more, do more and a lot of times a lot of us can really have some significant profitability to the bottom line if we just say hey let’s fill the chairs we have. It feels like we’re full, but we can actually add 7% capacity. That’s a lot of profitability.” (22:00—22:31)

“You gotta train people you can’t cancel. So whatever your message machine says, it should say something like this at the end “This machine does not accept any changes in schedule. In the event you need to make a change to your appointment, please call back during the day and ask for Betty. We would be so happy to help you.” (25:20—25:45)

“People don’t really cancel on their friends. And the question I really have for a practice that has a lot of cancellations is, is your practice transactional or is it relational?…What shows me it’s relational is when I see it in your practice. And you’ve got a couple things in place. It’s either the RFR, which is reason for return…or you can do that in what’s called the FORD concept” (26:57—27:40)

“The biggest problem with most dental practices is they don’t give their best energy to things that matter most.” (30:48—30:53)

“We have to value what we do first. And then we have to create value for them. So when it comes to creating value for them, I want to help them understand why they are coming back for this appointment. I want to know about them. I want to find out the purpose. What are their long-term goals. And then I’m going to employ the 4 rules of scheduling when it comes to the schedule itself. #1, if I’m a team member at the front I’m going to say we are going to schedule today and tomorrow first. I’m going to stay focused on making sure we have the right patients in the schedule today and tomorrow…#2 I want to schedule from the start of the day. And then we are going to start from the beginning of the day because we want to get the first 5 hours the way we want them. And then we are going to get new patients in within 7 days. And lastly #4, patients fit into your schedule. Don’t ever say to a patient, what works for you?…You have to create so much value through verbal skills that people rearrange their life to fit into yours.”  (31:50—34:03)

“I want to encourage you, don’t use the word cancellation. Now this is 10 years old. I’m using it today to describe this problem in dentistry, but when you’re talking to a patient do ever use the word cancellation. Because you can trade that word out for violation. I like the words “change in schedule” You can present that as a benefit that you’re going to reschedule for that appointment….make this a regular practice to leave this word out of your vocabulary.” (36:52—37:56)

“If someone is going to cancel, I highly encourage you to put them on hold. Let them sweat this out. For a couple of reasons. You’re going to gather yourself because you want to gather yourself. In the moment you’re going to figure out who is this patient? Are they an A patient, a B patient or a C patient? Because I’m not going to respond the same way to an A patient then I would a C patient…If you’re a C patient I’m going to make it hard for you to cancel this appointment.” (39:00—39:59)

“Don’t be so quick to respond. Enjoy the silence. Ask good questions and help the patient keep the appointment.” (42:39—42:46)

“Most every practice that we see now is way too busy. They have way too many patients and they’re booking every patient out and they have no openings every 6 months. I can tell you right now, you don’t need all of those patients. Your job is to start putting the right patients in your chairs over time and by that process you’ll see the entire practice change. But I need everybody enlisted in this opportunity to make this happen. If I’m a hygienist I’m going to start freeing up the space for C’s and start making room for A’s.” (44:58—45:28)

“I like the idea of booking out 6 months plus 2 weeks, to start to build the type of patient base that we want long-term. It is not good to be booked out continuously all the time. You need space for something that might happen. And the ability to get a new patient in that whole process.” (46:35—46:52)

“If I can get a patient on the phone two weeks from today that has a hygiene appointment and they say anything other than ‘great, I’ll be there’ There’s a 50% chance they’re not coming…You now have a two weeks window you can pull patients forward.” (47:40—48:18)

“You can get almost anyone to call you back if you employ one thing. It’s called curiosity. Never tell people why you are calling. Just create a little curiosity.  (49:38—49:46)

“I think every practice in the world should have a cancellation fee. But never ever ever ever use it. It can be $75 or $100. If you’re charging someone $75 you’re not making any more and you’re just irritating the situation. If you charge me $75 for my 4th missed appointment I am going to get so angry with you that I might go on your website and give you a one star review.” (53:27—54:06)

“[seeing patients who are late] We would usually set a timeframe…like a 15 minute border. If it’s 20 minutes late we just say no because we have to build some value. If they’re 10, 12 minutes late…we offer to see them but we recognize and say “you’re here 20 minutes late. We are not going to get an hour’s worth done” because you’ve then just devalued the 60 minute time slot. So you meet the patient halfway.” (55:23—56:12)

“I love prepayments for all patients because you want to lower your cancellation rate and no show rate, people show up when they have money on the line already. We collect it for any big case.” (58:21—58:39)

“Prepayment for all appointments is not a bad thing. It’s actually a good thing. Because you’re gonna get what’s called commitment. If I’m giving you money, I’m committed to being there. And it’s amazing how much you do upfront, how much less you have to do later.” (59:04—59:18)

“Ken Allen, who is a dentist, he created an incredible system. He said here is what a great patient is to our practice. And he said the line in the sand is 3. Once they’re 3 they get coded and then I have the opportunity to upgrade or reinstate them as an A patient but I’m going to have an honest conversation with them.” (1:02:17—1:02:39)


0:00 Introduction.

5:58 Cancellations start in the chair.

10:20 Owning the chair.

12:40 The real cost of an empty chair.

18:45 Coding missed appointments to get data.

26:57 Is your practice transactional or relational?

36:52 Rescuing the cancellation.

47:30 Calling 2 weeks ahead to confirm the appointment.

49:38 Get the call back.

52:57 Charging a cancellation fee.

55:23 Late patients.

1:04:49 Conclusion.

Dr. Barrett Straub Bio:

Dr. Barrett Straub practices general and sedation dentistry in Port Washington, Wisconsin. He has worked hard to develop his practice into a top-performing, fee-for-service practice that focuses on improving the lives of patients through dentistry.

A graduate of Marquette Dental School, Dr. Straub’s advanced training and CE includes work at the Spear Institute, LVI, DOCS, and as a member of the Milwaukee Study Club. He is a past member of the Wisconsin Dental Association Board of Trustees and was awarded the Marquette Dental School 2017 Young Alumnus of the Year. As a former ACT coaching client that experienced first-hand the transformation that coaching can provide, he is passionate about helping other dentists create the practice they’ve always wanted.

Dr. Straub loves to hunt, golf, and spend winter on the ice, curling. He is married to Katie, with two daughters, Abby and Elizabeth. 

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