How Do I Say…? : Reducing surgery no-shows

Q. I’ve noticed an uptick in no-shows for procedures. How can we get clients to arrive on time for surgeries?

A. Surgical and dental services account for 10.9% of hospital revenue.¹ No-show clients are a serious headache, risking lost revenue and putting extra stress on teams. Missing procedures also has consequences on patients’ health. Try these 8 strategies:

1. Set admission appointments.

Never tell clients they can “drop off” pets on the morning of procedures. Pet owners may assume they can hand you the leash or cat carrier and go. You also risk random arrivals with everyone showing up at once or at the end of check-in time.

Schedule admission appointments every 10 to 15 minutes such as 8 AM, 8:10 AM, etc. Prioritize check-ins based on the length of procedures:

• Admit first: Long procedures of 60 or more minutes such as orthopedic surgeries, C-sections, and abdominal exploratory surgeries.
• Admit second: Medium procedures of 45 to 59 minutes such as spays on large dogs, ear resection, and enucleation.
• Admit third: Short procedures of 44 or fewer minutes such as feline spay/neuter, small tumor removal, and dewclaw removal.

Set expectations when scheduling procedures. Say, “<Pet name>’s admission appointment begins at <time, date>. For 10 to 15 minutes, you will meet with a technician who will answer your questions and confirm how to reach you on the day of the procedure. We will text/email you reminders as the date nears, including presurgical instructions and an anesthetic consent form to review and return in advance.”

“Begins” communicates “Be here, be ready”—not down the street at Starbucks…unless you’re getting lattes for the entire staff. Let clients know that important instructions and medical forms are part of the confirmation process.

2. Send multiple confirmations.

This is especially important if you’re booking procedures weeks in advance. Text and email up to 5 procedure confirmations. Each confirmation serves a purpose.

Include a calendar invite in the first confirmation. Calendar invitations, called .ics files, are saved in a universal calendar format used by several email and calendar programs, including Google Calendar, Microsoft Outlook, and Apple Calendar.² Calendar invites can lower no-show rates up to 25 percent, especially among working professionals.³

Buttons increase click-through rates by 15% over hyperlinks.⁴ Use buttons for important call-to-action requests such as “confirm” or “Reschedule/cancel.”

Five days before the procedure, give clients the last chance to reschedule or cancel. With advanced notice, you can easily fill empty slots. Keep a waitlist or call clients with upcoming procedures to see if they want their pets to be seen sooner. If you can’t fill empty surgical slots, the doctor could start afternoon appointments earlier.

3. Perform preanesthetic testing before procedure days.

Let’s say the doctor diagnoses a pet’s dental disease during today’s checkup and discusses the need for treatment. The technician explains services and fees in the treatment plan. The client agrees and books the procedure for next week. Collect samples for the preanesthetic test today.

Doing preanesthetic testing on the day of diagnosis has 3 advantages:

Clients pay for lab tests today and are financially committed to showing up on the day of the procedure.

You may choose whether to do in-house testing or send it to the reference lab.

Increases clients’ perception of value because the dental treatment cost will be lower when they prepay lab work today.

4. Complete consents in advance.

Rolling Hills Veterinary Service in Bethel, Ohio, cut surgery check-in time in half by automatically sending and collecting digital forms by text and email through Otto.⁵ Forms write back to patient records in its practice information management software, saving administrative time for client service representatives (CSRs).

Because clients have invested 10 minutes of personal time answering patient health questions and authorizing consent, they are more likely to show up for procedures. Your anesthetic consent form will confirm clients’ preferred contact method, give consent, offer additional services such as nail trim and microchip, current medications, the last time the pet was fed, allergies and health concerns, and payment policies. Download an anesthetic consent form at https://www.dvm360.com/view/anesthesia-surgery-and-treatment-consent-form.

5. Provide preadmission instructions.

Clients at VCA Sheridan Animal Hospital & Veterinary Specialists of Western New York in Buffalo get an admission process sheet when scheduling. Instructions explain what to do or not do 10 days before the pet’s procedure, the day before, what to bring, and what to expect on procedure day. Download the admission process sheet at https://bit.ly/3Oh7QBq.

If pets take medications that must be given with food, veterinarians should set protocols on medication administration and fasting. Include special instructions for patients with diabetes.

6. Share your late and no-show policies.

Have cancellation, no-show, and late policies that you communicate upfront during the confirmation process. Clients need to know how far in advance procedures must be cancelled or rescheduled, what happens if they no-show, and how you’ll handle late arrivals. When sending procedure confirmations, include hyperlinks and buttons where clients can click to access policies. Include policies on your online booking webpage and new client registration form. Get a free sample of cancellation, no-show, and late policies at https://csvets.com/policies/.

7. Call clients who haven’t responded 2 days prior.

Expect most clients to confirm digitally and complete online anesthetic consent forms. Abigail Fulton, a CSR and veterinary assistant at Rolling Hills Veterinary Service, says 65% to 75% of clients confirm digitally. She noted that staff can focus more of their time on face-to-face interactions with clients coming into the clinic, rather than speaking on the phone.⁵

If clients don’t confirm or submit forms, call them. Say, “We have reserved a surgical/dental procedure for <pet name> with an admission appointment on <date, time>. We need your confirmation and anesthetic consent form today by <time>. This will help our medical team prepare for your pet’s procedure. I am resending the text/email. If we do not receive confirmation and the consent form by <time> today, this surgical/dental procedure will be released to another patient in need. Please call/text/email us today.”

8. Collect payment upfront.

Requesting deposits for procedures can prevent no-shows—but don’t use the term “deposit.” Check state laws on deposits and partial payments (https://csvets.info/DepositLaws). In New Jersey, businesses must visibly post refund policies. If you don’t, you are liable to give clients cash refunds or credits for up to 20 days after purchase.⁶ Clients also may assume they will get money back if you say “deposit.” Use the term “surgical reservation fee” or “prepayment.”

Explain the payment when booking procedures. Say, “We have scheduled <pet name>’s procedure on <date>. Your admission appointment will be at <time>. You will receive a text/email confirmation and an invoice for your surgical reservation fee of $___. Use the link to pay online. This amount will be applied to the procedure. If you need to change the surgery date, notify us at least X days/hours in advance for it to be refund eligible. We will send presurgical instructions and an anesthetic consent as the date nears.” If fees aren’t refund eligible, explain, “This surgical reservation fee is nonrefundable.”

Take payments through your practice app, text-to-pay links, online payments, or swipe cards if booking procedures in-person. Never take credit card numbers over the phone and manually process payments. Card-not-present transactions are usually more expensive than card-present transactions because they have a higher risk of fraud and chargebacks.⁷ The average rate for card-not-present transaction increases to 2.25% to 2.65%.

When you set clear expectations and provide timely reminders, you’ll resolve your no-show problem.

Need a script for a client conversation? Submit your scenario to info@csvets.com for consideration in future columns.

Best known as the “Queen of Scripts,” Wendy Myers knows the right words will lead clients to accept your medical advice, driving patient and practice health. As founder of Communication Solutions for Veterinarians, she teaches practical skills through online courses, conferences, and onsite consulting. Wendy’s experience as a partner in a specialty and emergency hospital helped her understand issues that owners and managers face. Learn how Wendy can train your team at csvetscourses.com.

REFERENCES

1. 2024 Veterinary Industry Benchmark Report. iVET360. Accessed December 2, 2024. https://ivet360.com/vibr/.
2. Calendar Invites. InEvent FAQ. Accessed December 2, 2024. https://faq.inevent.com/l/en/in-event-registration/calendar-invites.
3. Dean S. 8 Solutions to Patient No-Shows and Missed Appointments. Keona Health. Accessed December 2, 2024. https://www.keonahealth.com/resources/8-solutions-to-patient-no-shows-missed-appointments
4. Data on file. Otto. https://otto.vet
5. How Otto Flow helped Rolling Hills cut time spent on confirmation calls and surgery check-ins in half. Otto. Accessed December 2, 2024. https://otto.vet/how-otto-flow-helped-rolling-hills-cut-time-spent-on-confirmation-calls-and-surgery-check-ins-in-half/
6. Hilst H. Consumer Returns and Refund Laws by State. FindLaw. Accessed December 2, 2024. https://www.findlaw.com/consumer/consumer-transactions/customer-returns-and-refund-laws-by-state.html
7. Rej M. Card present vs card not present transactions. Merchant Cost Consulting. Accessed December 2, 2024. https://merchantcostconsulting.com/lower-credit-card-processing-fees/card-present-vs-card-not-present-transactions/