How Andre Handles Failed, Cancelled and Broken Appointments In Eaglesoft.
I know that no one reading this has ever had a patient fail (“no show”) OR cancel an appointment within their policy limit (24, 36 or 48 hours before) ever!
So, this might come as a shock that this happens in a few offices [wink]. This post will help the few who have had this happen to them, document that disruption in the normally smooth workday.
The ADA has created codes for broken and failed appointments. Woo hoo! The problem with using these codes in Eaglesoft is that posting a service in the Patient’s “history” will update the “Last Visit” date for the Patient. Eaglesoft “thinks” the Patient was at the office having a “service”! By design, Eaglesoft has a process for failed and canceled appointments. The expectation is to remove (“delete”) the appointment from the day. OK, OK. I know there are sooooo many offices who do not like to remove Patients from the day, so they can “see” who did not show up. I get that. But that is what the Schedule Audit Trail report does (show you a list of patients who failed or canceled). But the practice wants to “see” the patient ON the schedule.
Many practices chose to move these failed/canceled appointments to a column on the schedule (sometimes to “bypass” third party confirmation software) but these moved appointments will impact reports (i.e Patient Analysis Report “Patients seen in last 12 Months”, Day Sheet “Patients Seen” etc) and can impact recall. Remember that a “recall date” and “last visit” are two different things. Seeing “who is due to come back in June” is recall. Seeing “who was here in May” is considered last visit. If you look at any reports that show “number of patients seen”, codes created for “failed or cancelled appointments” would include a patient "that was not here” but had a Service posted that day.
If you post a Service Code for Bob Smith, Bob Smith’s last visit will be reflected as TODAY. This has NOTHING to do with Bob Smith's RECALL date. Doesn't matter if you check or uncheck the Update Recall box in the Service Code.
So, what is impacted?
- The Day Sheet see Bob's Walked Out Service Code as a "Patient Seen Today"
- Patient Analysis Report sees Bob's Walkout as Bob being an Active Patient seen in this period
- Money Finder can't see Bob as a Patient not seen in the last XXX months because you posted a Service Code (updating his last visit)
- Patient Master report can't filter Bob out (same as Money Finder)
- Recall Wizard can't "catch" Bob if you use the Patients with Last Visit Date Between option.
- In some third-party confirmation software, if a Patient fails/cancels an appointment and you Walk Out service code, the patient “could” receive a survey for that visit.
Garbage in. Garbage out. Posting a Service Code for a Broken Appointment (as the software is designed today) is garbage in.
One good suggestion is to have the practice create a Block using "Canceled/Rescheduled" as the Description and add Patient names, Appointment times, and providers to the Notes to keep track of these kinds of schedule changes. Using this method all you see is "Canceled/Rescheduled" on the schedule and if you hover over the block, you'll see the names listed in the Notes field of the Block.
OK. It is your practice, and you can do what you want. But what I suggest is to “process” the Failed/Canceled Appointment and not to “post” a Failed/Canceled Appointment.
1) You should have a policy in place that defines what a Failed (“Broken”) Appointment, a Cancelled Appointment and a Neither are.
Here is how I define them:
Failed = Patient does not present for appointment.
Cancelled =
1) Patient cancelled within the [36] business hours of the scheduled appointment and does not re-appoint.
2) Patient cancels and reschedules within the [36] business hours of the scheduled appointment.
Neither = the office mistakenly schedules an appointment and needs to remove it from the schedule but does NOT want it to affect the patients Failed/Cancelled count.
Neither examples:
- Scheduled Jr when it was senior Have to remove appointment. That's a Neither
- Lab work not back. No new appointment scheduled so didn't reschedule just removed from schedule until need to re-appoint.
- Snow fell and canceled day without rescheduling
- Compressor died...
Typically, a Patient who reschedules [36] hours before a scheduled appointment is moved. The only hiccup is that there is not notation in the Account that this happened. I urge offices to create a note in the Account when any change happens in the scheduling of a patient.
I create Administrative AutoNote. Here are my examples to add to the Account Notes in the event of a failed or canceled appointment:
Appointments - Cancelled
Patient Cancelled Appointment without the recommended ___hours’ notice due to “ _____ “ and did not reschedule.
Appointments – Failed Confirmed Appointment
Patient has failed appointment that was scheduled for [ Appointment date and time] that was confirmed.
Appointments – Rescheduled
Patient called and rescheduled an appointment that was scheduled for [ appointment date and time] to [ new appointment date/time ] due to “ ___________ “.
Appointments – Cancelled by office
Contacted patient to cancel appointment for [ appointment date and time] due to [ i.e. power outage, weather, etc ] no new appointment was scheduled due to [ reason ].
Appointments – Rescheduled by Office
Contacted patient to Reschedule appointment for [ appointment date and time] due to [ i.e. power outage, weather, etc ]. New appointment is [ new appointment date/time ]
2) From the schedule find the Patient’s appointment.
a. Right click on the appointment and select Delete from the option window.
b. A dialog window will open (see pic)
a. You now have a choice:
i. Is this a Failed appointment?
ii. Is this a Cancelled appointment?
iii. Is this Neither?
2) Notice the check box for Create Account Note. We suggest that this is checked by default (set up in List>Preferences>Accounting “Create Account Note for Deleted Appointments). This will add a note to the Account that shows “[date] Appointment for [time] in [chair], reason specified as [Cancelled/failed]”. You can add your own note but entering information into the Quick Fill dialog box below and checking the box “Add QuickFill Note to Account” will create an Account Note (it will also be part of the notes in the QuickFill list).
Deleted Appointments from the Schedule does not mean that the Appointment is deleted from the system. They are tracked in the Schedule Audit Trail. Eaglesoft is also keeping track (using this method) of how many appointments a patent has Failed or Cancelled and how many time the office might have moved the patient and the Neither option was used. THAT info is tracked in the Edit Patient screen in the Preferences (see figure xx)
The Patterson Technology Center (“Support”) can help reset an individual or all patients’ failed and canceled numbers if the office choses to forgive this tracking after a period of time, Example: Patient has been with the practice for 20 years and over that time has missed 2 appointments, maybe the 2 are forgiven.
Using the Schedule Audit Trail (SAT) report, you can find ALL appointments that were deleted from the day and who (based on login) which user modified the appointment. FYI… The SAT will “spool” and may take what seems like a long time to print. Be patient.
I often wonder why practice are so concerned with “seeing” failed/cancelled Appointments ON the schedule. If you have a full day of hygiene (say 8 patients scheduled per Hygienist). 3 Patients cancel. 1 Appointment is filled with the same 1-hour appointment type and 1 60-minute spot is filled by 2 kids at 30 mins each. One 1-hour of time is left open. Do you really want a report of the 3 canceled appointments equaling 3 hours. Or do you want a "report" or a "tracker" showing that on XYZ date, we had lost 60 minutes of scheduled productive time? Consider that the 2 kids might have had a higher production than the one adult they replaced.
So... Devil's Advocate here... If the practice deletes an appointment, there is a “hole” in the schedule. The Schedule Audit Trail would show the canceled appointment BUT.... what if Bob was scheduled there 6 months ago. Cancelled 3 months ago, and Mary was scheduled there. She then moved to a later appointment the same day and the "hole" was created. Then the Administrative Crew booked Sally in that spot two weeks ago. THEN Sally canceled yesterday. Tracking this "hole" as a Cancelled Appointment doesn't give the Admin Crew credit for all the time the hole was filled.
If I can give you a report that says you had 15 hours of open Appointment time in Feb of 2021, what will you do with the information? Food for though.
DISCLAIMER:
This is a resource guide and all decisions on each dental office setup should remain the sole decision of the dentist/owner of the practice. Eaglesoft is a registered trademark of Patterson Dental Company. All other software or products mentioned are the property of their respective owners. Although Andre Shirdan was an employee of Patterson Dental, he is not associated with Eaglesoft or Patterson Dental Company or endorsed by Patterson or any other Company Mentioned in this blog
