How I Cut Hygiene Cancellations from 15% to 5%

Ever watch a full day turn into Swiss cheese before 9 a.m.? We’ve been there—and we found a fix that didn’t rely on bigger fees or tougher forms. Our hygiene cancellations fell from 15% to 5% when we stopped leading with penalties and started leading with conversations that make appointments feel scarce, personal, and important.

If you’re tired of last‑minute holes and tense phone calls, start with the words your team uses before anyone thinks about canceling. Subscribe, share this with a colleague who hates no‑shows, and leave a quick review telling us your toughest cancellation scenario—we’ll tackle it in a future episode.

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Transcript

The Perfect Morning Ruined

Paul Etchison 1:22

You ever walk into your practice on Monday morning and you're just excited to get into the week and everything like the sun's out, you walk into your practice, you got your coffee in hand, take a sip, temperature, perfect. Beans, perfect beans. Everything is perfect. Say hello to the front desk. Hey Dolly. Hey, Marge. Hey Ethel. How's your weekend? You know, stuff like that. And then all of a sudden, you see that somebody answers a phone call while the other front desk person starts going through the voicemails from the weekend. And lo and behold, your perfect day is ruined by cancellations. They were left on the voicemail over the weekend, and your beautiful day that was so full now has a bunch of holes in it, looks like Swiss cheese. And now you just want to throw your hot coffee in your eyeballs and go cry in your office. Have you ever been there? I'm sure you have. And you just wonder, how does this keep happening? What can we do? How do we keep the patients on the schedule? Why do they always cancel on us? Why does nobody take us serious? We are real doctors, ladies and gentlemen. We are doctors like the medical doctors. We are not the fake doctors. We deserve the respect that the doctors do as well. And here's the thing: your cancellation problem, you've got it. Every office has a little bit of a cancellation problem. Some are bigger than others, but I assure you it is not a policy problem. Policy is part of it. It's a conversation problem. And I know this for a fact because I have fixed the cancellation problem at my office to watch it go from 15% all the way down to five to watch it skyrocket fairly recently, all the way almost to 20%. And I changed my strategy and it failed hard, really bad. And my team hated me for it because they didn't like my new policy. And I didn't even involve them. I just said, this is what we will do, and you will do it because I am the boss. And I said so. And you know, if you listen to this podcast, that's not how we do things here. And I'm not surprised it didn't work. But that's what we're going to talk about today: the cancellation policy, the one that didn't work, and the one that does, and why it does, and how you can do this at your practice and clear up this horrible inefficiency that you just tend to overlook day by day. Now, you are listening to the Dental Practice Heroes podcast. This is the podcast for practice owners who want to work fewer clinical days, increase profits, and build a team-driven practice that runs without them being the bottleneck. I'm your host, Dr. Paul Etchison. I'm a dentist, I'm a coach, I'm the author of two books on dental practice management, and I'm also the owner of a large group practice in the South Suburbs of Chicago. And on this episode, we're going to talk about the biggest pain point on the hygiene side. It is those same day GD cancellations. What actually causes them? What actually fixes them? And how do we cut our cancellation rate from 15 to 5%? Which literally, when I did this at my practice, because of our volume, transformed us to the tune of almost$400,000 per year. Kabooms. All right, let's get into it. Now, like I mentioned, there was a point in our practice where a hygiene cancellation rate just kept getting higher and higher. I didn't know why, but all I knew is that every month I watched it and I said, man, that is a big area of inefficiency. Let's start strategizing solutions. So it was about 15%, which, if you want to talk about numbers and metrics, what should we be shooting for as far as cancellation rate? You know, the benchmark is anything less than 8%. So you know that is what it is. And what I'm talking about is cancellations, reschedules, no shows, anything that doesn't adhere to your policy of giving you enough time to fill that. Like so a lot of practices are 48 hours. My practice, 24 hours. Why? Because it's just easy. 24 hours is easy. Do I necessarily think that 24 hours is enough time to fill a last-minute cancellation? No, not really. But I think it's just a lot easier to uphold. And that is the decision I've made as a practice owner. I want my team to feel comfortable upholding it because if they don't like it, they're not going to do it and it's not going to do anything. So 24 hours it is, maybe one day it'll be 48. If yours is 48, more power to you. You do your thing. I do mine. But I'm going to talk about me today. So we sat down as a team, we started brainstorming what's going on. And what we noticed is that there was a lot of vagueness and there's a lot of like, is this an acceptable cancellation? But should we enforce it here? How do we enforce it? What about this family? They've got all these cancellations. What about when junior and the daughter cancel, but the parents still come, or maybe the whole family cancels? Like, what do we do in all these situations? So it really resulted in us talking about what's acceptable and not. And we went through that. But ultimately, that needs to be in your policy, but it's not the most important part. Like I said, this is not a policy problem. So we fixed this. We got it from 15% to 5%. This was about 2019. Amazing. This is the policy we had for a very long time. Now, recently, about last spring, I noticed it was getting bad again. So what I should have done is said, let's go back to the old policy and just make sure we're doing it because it worked. It already worked. Why reinvent the wheel? But no, Dumb Paul said, hey, I'm going to be a hard ass and we're going to do it this way. So you might remember, you might have heard an episode. Maybe it came out last spring, maybe in the summer. And I said, This is our new cancellation policy. I'm a baller and this is what we're going to do. We're charging everybody, regardless. I don't care if something happened, it was an acceptable excuse. You get charged. Everybody gets charged. And they're like, You're a greedy D-bag dentist. You're just taking all my money, you greedy D-bag. And I was like, Well, no, we're going to take all your cancellation fees. We're going to donate to charity because I don't want your money. I want you to come to your appointment. That's the point. And we did this, and my team was fairly uncomfortable about it. We had a lot of upset patients. And it kind of just went back to where we were just letting it go. You know, my team started getting addicted to the exceptions again. And I don't blame them. They get tired of getting yelled at. So this is the thing about cancellation policies. It's not about the charge. The charge is not what motivates your patients to come in. The charge is like a penalty, sure. But we know, I mean, we always hear it. Negative reinforcement is not a good way to influence behavior, right? So the thing is, is like when we have to charge somebody, does that even work? It results in negative reviews, it results in people leaving the practice. You know it. It's just never comfortable. And your team hates it. They hate being the bad guy on the phone that says, Eek, you know what? You're supposed to give us 24 hours, but you didn't. And we got to charge you now. So here's the first point I want you to understand. Policies, they're good to have, but it's not the policy that changes the behavior. You might have it on your new patient forms. You might put it at the ass end of your text messages on your confirmations. You might put it on your router sheets. Maybe it's on your treatment consent forms. Perhaps it's on the treatment plans that you give to the patients. Maybe they even sign something right next to it that says something about the cancellation policy. But here's the thing: if written policies actually worked, damn, practice management would be very easy. They don't work because they're passive. And the fact of the matter is, nobody reads them. Nobody reads them. They're everywhere. Think about that HIPAA form. I couldn't even tell you what's on the HIPAA form. What is on the HIPAA form? We make all our patients sign. Do you even know? Have you ever read that thing? You know, maybe I read it once. I can only remember what's on it. Something about how we're going to send their information to insurance companies or something. But that's what it is. People are used to signing forms that are just business, legal stuff, and they don't read it. So just putting it on a form, just putting it on a sign, just putting it on your text messages is not going to help your cancellation policy. Is it going to hurt it? No, absolutely not. But it's not going to be the saving grace. Patients don't emotionally commit to showing up to their appointment because they check a box on a tablet. It just doesn't work that way. They will commit, however, because they feel the weight of the appointment when they schedule it. Okay. How many times when your front desk might be explaining it to a patient, oh, we've got this cancellation policy, I've got to charge you this. And they're just like, I didn't even know. I didn't know that, even though it's written everywhere. So if your cancellation rate is high, not because your policy is unclear. It's because your expectations weren't felt by the patient. So I want to ask you a question to really think about here. Okay. So we have our cancellation policies on our new patient paperwork. We put it all over our forms, our confirmations, and all that stuff. But then the patient calls to cancel. What is a reasonable just save rate for that person on the front desk? Your best verbal person that's going to explain that cancellation rate and is going to say, hey, Mrs. Jones, is there any way you can make it? I mean, it's really important that you come. You know, we got this cancellation policy. What's a reasonable save rate? I would say, I don't know, 15%. It's hard to say. But the fact of the matter is, is we want that appointment. We want our cancellation policy to be reduced right at that step. Big, that's our heavy artillery. That's where we think it's supposed to happen. And what I want to share with you today is if we get to that point, it's too late. It is way too late, and it puts us in a really crappy position. So we want our patients to respect our time. And the thing is, they will respect our time and they will respect their appointment if we make it sound important. So this is like psychology. If your team is making an appointment, they say, okay, I'll see you on the 25th at two. That sounds very casual. But what if they said, okay, on the 25th, we've got an hour reserve with you and Pam at two o'clock. Now we don't double book appointments. So if anything changes, we just ask that you give us 24 hours ahead of time so that we can give that appointment to anyone else. Does that make sense to you? Do you understand that? Are you okay with that? Are you good with that before we lock it in? Things like that. And I'm not going to go through too many verbiages because we do this in our course that I have online. We have our cancellation course online. We also have the three-day summit, the three-day virtual I just did. And it's separated all into categories. And that is the most updated cancellation verbiages I have. They're the same ones I use with my team. So check that out, dentalpracticeheroes.com. But you have your team presented in a way that we're making it real. They have appointment time reserved with a human. Her name is Pam. Pam is my first hygienist, so I'm just using her as the example. And we're letting them know we don't double book. Like if you don't come to your appointment, Pam is gonna be so sad. She's gonna be sitting there all day for an hour. She's not gonna have anything to do. She's gonna be crying. Do you want to make Pam cry, Mr. Jones? Sure, you don't. So you need to come here so that Pam has somebody to play with. And if you can't make it, you better give us enough time so we can get another friend to come for Pam's play date. All right. So the words matter. We have reserved with Pam for this long. We don't double book. We've got other patients waiting. They want to come in. If you can't make it, we want to give it to the other patients. So we want to make it sound intentional. We want to make it sound legit. And that's where we save the cancellation policy. Now, another important part of that is that we have to ask for confirmation. We've got to say, does that make sense to you? Are you good with that? Do you understand our policy? Things like that. It's not just a passing thing, like, hey, please remember if you don't give us 24 hours, we're gonna charge you$50. Okay, it's all good. Thanks so much. Hey, I see you. You know, it's it can't be like a brush over a thing. It's gotta be something where they stop and they go, Yeah, I'm good. Yeah, I got it. Like they got to think about it for a second. Because that's the thing. They're gonna know that we mean it when we set that appointment. Now, hopefully, when somebody calls to cancel, we still want to save 15% of those, but we're gonna have a whole lot less people doing it. Now let's talk about the thing with like whole families. Like, what do we do when a whole family wants to book their hygiene appointments all together? And we know this is great. It's gonna take care of like half of our day. But if Junior is sick, the whole family will cancel. So what do we do? Well, when they call to cancel, we'll let them know it's$75 per appointment. That'll fix it. No, that's just gonna piss somebody off. You say to Mrs. Jones, just hey, Mrs. Jones, we are totally comfortable seeing all of your family together, but this is a lot of time that we're reserving only for you and your family. So if anything happens, if one person gets sick or something comes up, we need you to keep your appointment. You can't just cancel the whole day because that's gonna put us in a really tough position and trying to give those appointments to patients that are waiting. So I can give you this appointment, but please, please, please just promise me that you will honor it and you will keep it. And if you can't, you will give us as much notice as possible so that we can give those appointments to other patients. Now, when you do that, the patient now hears. It's important to you. Okay, it's important to you, so they're gonna make it important to them. Now, let's talk about the$75 fee. Does it matter?$75,$50? You know, this is something we talked about in a meeting recently in my practice, and I don't think it matters. Do 67. I mean, I don't care. 69. I don't care what you charge. Whatever the cool number is nowadays, Dorks, you know, I don't know, but it's 50, 75. It doesn't matter because as far as my policy goes, we're not gonna charge the patient. So it's just there is an empty threat. If somebody calls and they must cancel and they're within that window, meaning like they didn't give us enough time, I want the person on your team to act really inconvenienced, but I want them to reiterate that this is the policy. And I want them to say it fairly seriously. So the patient's like, oh crap, man, they really do mean it. I remember when they told me when they made this appointment. I didn't think they meant it then, but now I feel like they really mean it. And then you're gonna do this. You're gonna say, hey, as a courtesy this time, I'm gonna wave it for you this time as a courtesy, Mr. Jones, but you gotta promise me in the future you will give us more notice. Does that sound good? Mr. Jones is gonna be like, thank you so much. You guys are so kind. So here's what we did. We know we weren't charging the patient. Our team knew this. We knew we were gonna waive it. So we are now comfortable talking about the policy again because we know we're not gonna get into a fight over it. The patient's gonna be thankful that we waived it. Now we just reiterated to them we mean business. And then this is what we do at our office. We actually charge it in the computer, we adjust it off, and then we print a statement showing that and we mail it to the patient with a letter explaining our cancellation policy. So if they didn't think we meant business when we told them when we scheduled the appointment, and they didn't think we meant business when we told them when they canceled the appointment, well, they're sure as shit gonna know we mean business when they get the letter in the mail. So what happens if they do it again? If they do it again, we're gonna explain it to them again and we're gonna charge them. I think we gave them plenty of warning. You know, some people say, we're gonna give you two strikes. We've done this in my office, two strikes. I haven't seen a whole lot of difference, two strikes versus one strike, but we charge them at that point. And I find it really, if they're gonna huff and puff about it, they're kind of unreasonable. And maybe I don't want them at the practice. Maybe that's a nice way for, you know, I charge them and then they say, you know, do you want to reschedule? And they say, you know what, I'm gonna call you back. And maybe they never do. And maybe that's like a good thing. We don't want them. Let them be someone else's problem. People that are chronic cancelers, they just don't honor time. It's something inside them, it's in their character. So, you know, those are the people that when they go to the grocery store, they load up the trunk of their car and they go and they put that shopping cart just right there on the curb. They don't walk it back to the thing. Those are the people that cancel. They do stuff like that, and I'm pretty sure they steal from poor people or something. They do horrible things. They're horrible people. But here's the thing: when you get to that point, the patient has shown you a pattern. So you can do that thing where you dismiss them from the practice. You write them a certified letter, you go through the process, they call, they're all pissed off. Maybe they'll write you a one-star review, or you just put it on them. Hey, we told you our policy. You knew it. I know you knew it because we explained it to you really well, and you broke it again. So here you go. You got charged. And in the future, we're gonna charge you again. You might even want to ask for a deposit now going forward, you know? And they're gonna do one or two things. They'll put the deposit down and they'll be a great patient. Or they'll just call you back and they never will. Either way, you win because they can go be someone else's problem. So have your team realize that it is important for us to honor this because we need to take care of all of our patients. And this really screws over our patients that need to get into our office. But the fee, it's not that secret weapon that's gonna save everything. It's just kind of that backbone, that thing that sits there that gives the team a little bit more to stand on when they explain what the expectation is. It's not there to generate revenue, it's not there to cover the overhead. We know it doesn't cover the overhead. I mean, it barely for a lot of offices, it doesn't even cover an hour of the hygienist time. So that's what we do. That's how we make cancellation problems work. So one of these things is that it's unfortunate. If you make this change tomorrow, you probably won't see full improvement for six months because you got people that are already scheduled six months out in hygiene. But I truly believe you can get your cancellations down. We did it again. And this is why when we did it in 2019 with the same policy we're using now, it worked versus when we just did recently, we said we're charging everybody because it's not about the charge, it's about the conversation. And the conversation needs to happen well before they get to that cancellation phone call. So I want it to be a verbal conversation at your new patient appointment. I want it to be part of the new patient forms, but I want it to be a verbal discussion about that specific part. And I want you to ask the patient, do you understand that? That's something we take very seriously in our practice so that we can take care of everybody. It's important for us to take care of everybody. You could also lean on the hygienist shortage if you want to. I mean, they're all true things. We're not lying. And then you're gonna tell it to the patient when you make the appointment, whether that's someone at your front desk, whether it's a hygienist, maybe it's an assistant doing it in the back. We're going to have that brief conversation. We're gonna ask for confirmation that they understand. And then because we know that we're not gonna charge the patient, we're gonna waive it, it should be very easy and non-confrontational for our front desk to now have that conversation another time should they try to cancel. Now, obviously, there's a lot more that goes into the cancellation policy. This is all part of Dental Practice Heroes training. This is what we do with our coaching clients. And if you're looking for someone to help you with your practice and how to roll things out like this so that you can see what kind of gains you can get, please reach out to us, dentalpracticeheroes.com/slash strategy. Now, I told you, this saved me about$400,000 one year. And the reason that did is because I said, okay, I am saving X amount of visits from going from 15 to 5%. Each visit, on average,$298, I think was what we were looking at on dental Intel back then. So I just did the math and it was saving us like$38,000 a month or something like that. So if you're wondering where is all the owner profit, crap, it might be in the cancellations. It is such a huge thing that's killing you. So when you can take care of the hygiene cancellations using this policy, but also combine this with pre-collecting to schedule, which is another advanced policy that's in phase six of our omnipractice program, that will nearly eliminate your cancellations. And how much more efficient did you just become? How much more capacity did you open in your practice? Because you're not wasting time by having people that need a profit and they're canceling three times to get into your practice one time. That's three reschedules we had to do. It's a bunch of people we had to reach out to to try to fill the slot. I mean, all that extra work that comes from it. So optimize it. It's a short conversation. It doesn't take long, it doesn't take a lot of effort. Easy to do. Just remember when you talk to your patients, when you talk to your patients about it, it makes it important for them. And as you as the leader of the practice, when you talk to your team about it, it makes it important for your team so that they can talk to your patients. So pay attention to how your team is speaking about the appointments. Make that an area of efficiency, not an area of frustration, and take it seriously because what you do in that moment is going to matter six months from now. All right. Thank you so much for listening today, spending some time with me and your drive to work. I hope you have a great day at work and I hope you have a great week. We'll talk to you next time.