The authorisation that cannot be used

It goes wrong in the middle and only becomes visible at the end, when the time cannot be made back.

How it happens

Twenty visits authorised. Twice a week. A window that looks comfortably long enough. Everything on schedule for two months.

Then, in the last fortnight, it becomes clear there are four visits left and three appointments to put them in.

Nothing went wrong dramatically. Somewhere in the middle there was a closure week, or annual leave, or a public holiday that took out a Monday, and each of those quietly removed an appointment the plan was counting on. None of them was worth noticing at the time. Together they were four visits.

The arithmetic is trivial and nobody does it, because at the start the window looks generous and at the end it is too late.

Count the dates, not the weeks

“Twelve weeks at twice a week” is twenty-four appointments only if all twenty-four dates exist. The useful count is not weeks multiplied by frequency — it is the number of dates that actually fall on the chosen days, inside the window, minus the ones that are unavailable.

That difference is usually two to four appointments over a normal course of treatment, and two to four is exactly the size of gap that becomes a problem.

Cancellations need spare dates, not extra visits

If roughly 15% of visits do not happen, twenty scheduled visits produce about seventeen. The instinct is to schedule three more. That does not help, because the problem is not the count — it is that a visit cancelled in week three has to be recovered somewhere, and if the schedule already runs to the last available date there is nowhere to put it.

What helps is spare dates at the end. Scheduling earlier in the window, or leaving the last week or two unbooked, gives a cancelled visit somewhere to go. Those two approaches sound similar and behave completely differently.

Reassessments are visits

A reassessment takes an appointment slot like anything else. It is easy to plan them separately — “we'll reassess at six weeks” — and then never subtract them from the total, which is a reliable way to end up two visits short.

Count them in the sequence from the start. If the authorisation is twenty and two of those are reassessments, the treatment plan has eighteen visits in it, not twenty.

The two levers, and who pulls them

When the visits do not fit there are only two things that change the arithmetic: more dates per week, or a longer window.

Which of those is appropriate is not a calendar question. Increasing frequency is a clinical decision. Extending the window may need authorisation. Both may be fine, both may be impossible, and a scheduling tool has no business having an opinion about either — it can only tell you which one you would need, and by how much.

What it does buy you is the conversation happening in week two rather than week eleven.

Front-loading is a real decision

Scheduling more heavily at the start of an episode and tapering has a clinical rationale of its own, and it also happens to solve the calendar problem: the spare capacity ends up at the end, exactly where cancellations need to be absorbed.

Whether it is right for a given course of treatment is a clinical judgement. It is worth knowing that it is also the scheduling-robust choice, because the two considerations point the same way more often than people realise.

What a calendar cannot tell you

How often anyone should be seen. Whether a plan is clinically appropriate. What a payer will authorise, or renew, or refuse — those rules vary by payer, plan and setting, they change, and any tool presenting them as settled is overstating what it knows.

All the calendar can answer is whether the visits fit. That turns out to be worth answering, because it is the question nobody asks until the answer is no.

Frequently asked questions

Why do my authorised visits run out of time?

Because dates get removed in the middle — a closure, annual leave, a public holiday taking out a day of the week you use. Each removes an appointment the plan assumed, and because the first two-thirds looks on schedule, the shortfall only becomes visible when it is too late to make the time back.

Should I schedule extra visits to allow for cancellations?

That moves the problem rather than fixing it. What helps is spare dates at the end, so a visit cancelled early can be recovered later. If the schedule already runs to the last available date, there is nowhere to put it.

Do reassessments count as visits?

They take an appointment slot, so yes. Planning them separately and never subtracting them from the total is a common way to end up two visits short.

What can I do if the visits do not fit?

Only two things change the arithmetic: more dates per week, or a longer window. Which is appropriate is a clinical and authorisation question, not a scheduling one — but knowing which lever you need, and by how much, is what makes that conversation possible early.

Does front-loading help?

It puts the spare capacity at the end, which is where cancellations need absorbing, so it is the scheduling-robust choice. Whether it suits a particular course of treatment is a clinical judgement.

Does this decide clinical frequency or check authorisation rules?

Neither. Frequency is your decision and an input. Payer rules vary and change, and no tool should present them as settled. It counts dates.