Cancellation Policy has been a hot topic among health professions these days, more than ever.
My colleagues and I have been having so many lengthy, deep, and enriching discussions about this topic, as well.
And we felt that this needs to be shared because we want everyone to know and think.
Let's go over what the cancellation policy really is and how it actually saves all of us, including YOU!
Introduction
Cancellation policies are common across many industries that sell time, space, skill, and/or knowledge. Tickets for flights or events, hotel rooms–most have cancellation policies that state no refund upon purchase or within a certain period from which the service is scheduled to be rendered. This allows the businesses to stay afloat and continue to serve their customers.
As a community-based healthcare service, my professional Chinese Medicine and Massage Therapy practice falls under this category. I run a self-funding and fee-for-service business - a micro one-(wo)man show. My patients book the room and my presence for a specific time period on a specific day to receive a treatment that uses my skills and knowledge. So I have a cancellation policy in place just like any other businesses. It is hard to fill suddenly emptied spots on short notice even with a waitlist!
Reality
Working at a clinic doesn't mean most of us are on salary. The industry norm is to either rent a room and run an independent business under the clinic brand, or provide care within the clinic based on a commission/split contract. Either way, the only source of income is the fees collected from our patients. We don't get paid an hourly salary whether patients are scheduled or not. If a clinic doesn’t respect the cancellation policy and collect the fees, practitioners don’t get paid.
This also means independent contractors don’t get sick or vacation pay. No benefits either, unless we pay for them ourselves (or are under their family’s insurance plan). Yet we still face inflation like everyone else does, and we also have monthly and yearly overheads to maintain our businesses.
Challenges
Despite this, many practitioners encounter some degree of resistance from patients when we enforce the agreed upon cancellation policy or charge for no shows. For each patient, it happens just once or on very rare occasion for a very legitimate reason, so they can feel that the fees should not be charged to them.
Many colleagues or clinics don’t attempt to honour the policy to collect the losses. I myself used to be in this group, I have waived the fees multiple times for the same patient to avoid push back, feeling uneasy to enforce it, or potentially losing the patient.
But the occurrence of last-minute cancellations and no shows are increasing to the point they are out of control.
Boundaries
My colleagues and I speculated that one reason for the resistance might be partly (or largely) because patients have developed a rapport with their practitioner through their therapeutic relationship. Thus the policy is taken personally, leading to the resistance.
We do feel close to our patients and care for them, but the relationship between the practitioner and the patient will never be a friendship or personal. There are boundaries to be maintained when the therapeutic relationship begins and the cancellation policy is agreed upon. The practitioner-patient relationship must be respected.
A health appointment is fundamentally different from plans to meet friends for coffee.
It is time for us to revisit boundaries.
You might now wonder if this whole thing is all about money. It isn’t. We would rather be paid for the treatments we provide. All we want is to provide care to the patients we deeply care for. Income from cancellation fees isn’t rewarding, but it does help us meet our basic needs.
Multitude
We also roughly estimated that the annual loss from uncollected fees could be as high as a month’s worth of income. I have had more than half of appointments cancelled at the last minute on a particular day and no fees were recouped. I was left unpaid wondering how I was going to pay my bills.
Following my initial shock and survival response, I thought about how my patients’ health was affected by their missed health appointments.
Then I also thought about other patients who might have wanted to come in for the treatment that day if the schedule had been clear.
This was another moment of realization about how impractically this community-based pay-per-use health profession is structured and operated, and then I was reminded of this saying:
Last minute cancellation hurts 3 people;
The person who missed their appointment
The person who might have been able to get it otherwise
The practitioner
Consequences
And here are some important facts about the cancellation policy that actually have a direct impact on all of us including YOU.
When the cancellation fees are not collected, we might potentially face:
fee increases. Service fees could significantly increase beyond the rate of inflation as the business/practitioner tries to recoup the loss from the uncollected fees with existing sources
less availability. Your practitioner might consider picking up another, more stable job to supplement income, which would result in fewer hours for the health business
loss of access to care. A clinic/practitioner might go out of business or retire early due to insufficient resources or burnout, and you health journey could be interrupted as a result
The good news is these consequences can be avoided if everyone shows up to their appointments and all last-minute cancellation fees are collected.
Strategies
Here are a few recommendations to manage your health appointments and maximize your healing opportunity.
Commit to your health. Health is of utmost importance and keeping your appointment is your responsibility. Put your health on the top of the list and plan things around it.
Plan ahead. It might be helpful to go over your upcoming schedule each week so that appointment reminders don’t come as surprise
Try the waitlist. If you don’t see the availability for the day/time you’d like to come in, please add yourself to the waitlist. Otherwise there is no way of knowing that you might have wanted to receive care on the particular day and time to let you know that the appointment became available
Re-evaluate your treatment plan. If your current treatment plan is not working for your lifestyle, talk to your practitioner to re-evaluate the plan so that your visits can be reduced with more strategy- based interventions.
Same day booking. If your life/schedule is truly unpredictable, wait to check availability on the day you’re free. Also discuss your situation with your practitioner so that together you come up with solutions. This is not the most recommended strategy as there is no guarantee that there will be an appointment available, but it’s still better than missing appointments you can’t make.
Participation
Lastly, to equally participate in the cancellation policy and further help patients and beyond, I personally offer the following as a care provider at my business:
Virtual/phone appointments. Patients are encouraged to switch to this type of appointment if they cannot be physically present at my office for their appointments. Working on strategies is an investment, and it is just as important as (or even more important than) getting needles or my hands on your body. I am also capable of helping minor acute conditions - most of them can be effectively dealt with virtually. Please take every opportunity to support your health
Donation: I’ll donate 30% of the collected cancellation fees to the charity of my choice
Reduced rate for rescheduled treatments. If I ever cancel appointments on my patients within the cancellation policy window, the cancellation policy will not be applied to the appointments. And a reduced rate for the rescheduled appointments will be offered when the care is delivered within a set period of time
Hopefully by now, you can see that enforcing a cancellation policy is not meant to be a punishment for something you had little/no control over. Rather it is in place to ensure that the healthcare business survives to continue to serve you.
Thank you for respecting and complying with cancellation policies of all businesses and helping us stay afloat.
Together, we can keep the treatment fees affordable, as well.
In health,
Akari