How to Stop Those Money Draining Patient No Shows

no shows

Patients who fail to show up for appointments are the bane of a physician’s practice. No-shows reduce revenues, waste staff time, create artificial access problems, and negatively affect patient care.

Although practices may respond to the problem with myriad strategies, including charging patients who fail to show up, overbooking schedules, and making repeat reminder calls, experts say that understanding the reasons patients miss their appointments is key to crafting a successful, proactive strategy.

Why Aren’t Your Patients Showing Up?

Fixing the no-show problem begins with understanding it.

Most practices don’t even know what their no-show rate is, And these practices certainly haven’t taken the time to analyze their patient visit data to identify trends.

Practices need to understand the magnitude of the problem as well as specifics about which patients aren’t making their appointments. That means analyzing 3 to 6 months’ worth of data to spot trends, such as which physicians in the practice have the highest no-show rates, which patients miss the most appointments, and what appointment slots or times of the year have the highest no-show rates.

With those data in hand, practices can start to identify the root causes of no-shows. If the front desk is forgetting to make reminder calls, the scheduling department is booking appointments months in advance, or patients are being forced to wait a long time in the office or are having difficulty scheduling or canceling appointments, chances are that the practice is going to have a high no-show rate.

Six problems account for nearly all no shows:

  1. Patients don’t feel an established relationship with their doctor. New patients, those who tend to see many different doctors in the same practice, and those who don’t feel they know their doctor very well are more likely to miss their appointments than those who feel a close connection to their physician. Taking the time to develop a rapport with these patients can help reduce no-shows.
  1. They don’t appreciate the need for the services that they will receive during the appointment. Taking the time to educate the patient about why a certain test or follow up visit is important and can solicit patient cooperation.
  1. Patients have to wait a long time to get an appointment and may either forget the appointment or decide they no longer need it.
  1. They have to wait a long time in the waiting room. Improving workflow to reduce wait times enhances patient satisfaction and helps underscore the message that the practice takes a holistic interest in the patient.
  1. They don’t feel connected with the practice staff.
  1. They have personal issues, such as scheduling conflicts or transportation problems, which cause them to miss their appointments.

Practices can do a lot to resolve most of these issues, she says, but sometimes they first have to change their attitude toward no-shows. A lot of practices are relieved when a patient doesn’t show up because it gives them time to catch up. The strategy for reducing no-shows has to be part of a paradigm shift so that if a patient doesn’t show up, we’re bummed about it rather than relieved.

How to Tackle the Problem of Forgotten Appointments Obviously, the best way to help a patient keep an appointment is to remind them that they have one. Reminder calls can be opportunities.

Reminder phone calls  either live or automated  or emails if your patients prefer them are an absolute must. Although a study published in the June 2010 issue of the American Journal of Medicine[1] found that patients who received a live call rather than a recorded reminder were less likely to miss their appointments  13.6% compared with 17.3%  having staffers make calls can be challenging.

The calls eat up staff time and can be neglected during a busy day. What’s more, because staffers generally make the calls during business hours, they’re often forced to leave messages. By contrast, automated calls can be made in the evening, when people are more likely to be home, and they provide an opportunity for patients to cancel their appointments by simply pushing a button.

The same holds true when a staffer schedules an appointment, she says. “Saying, ‘We really need you to come back. Is this something you can make work?’ makes a big difference. When patients see you as their advocate, they respond. Your big picture strategy needs to really show patients that you care.”

Convenient Appointments Are Crucial

On the day of the appointment, the front desk follows up with “robust reminder calls” as necessary. “At 8:55 AM, if a 9AM patient isn’t here yet, we call and check up and reschedule them as necessary.

Have You Developed a No-Show Policy?

Although nurturing a relationship may be the most patient friendly way of addressing the no-show dilemma, it can’t reduce the rate to zero. Cars will still break down. Scheduling conflicts will still arise. People will still forget.

Consequently, You have to have a no show policy. If your no-show rate is relatively low, it might be as simple as giving frequent offenders the least desirable time slots, or scheduling them at the end of the day so that everyone can go home if they don’t make their appointment. If it becomes more of an issue, you’ll probably need to lay down the law.

You have to decide what you are going to do. Are you going to kick people out of the practice after their third no show? Some places, such as community health centers, don’t want to kick people out. If that’s the case, then you have to say, Am I going to overbook and, if so, by what factor.

Overbooking can result in longer wait times for patients, but it improves access and revenues. It’s a trade off and for practices with a no-show rate of 20% of more, it starts to make sense.

If you do overbook doing so in the morning so that the practice can get back on schedule during the day as patients fail to arrive. Overbooking early in the day likewise minimizes the chances of staff overtime.

Charging a fee may help you cover some of the costs of a missed appointment, but it goes against the good will of the practice so I see it as a tossup.

Whichever approach you take, one thing’s certain: no-shows won’t fix themselves. To truly fix the problem, you have to get proactive.


Have a great day!

Brian Torchin

HCRC Staffing

Office 610-660-8120

Cell: 267-251-5275

Fax 800-263-1547