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Minimizing Patient No-Shows

Minimizing Patient No-Shows

  • No-shows and same day cancellations have a big bottom line impact: Both leave you no time to fill a last-minute open appointment slot. Most of your expenses are fixed and do not vary whether you see one patient or 30 patients in a day. A missed appointment means your fixed costs (staffing, rent, etc.) are spread across fewer visits, thereby increasing your average cost per service. If you get $100/visit on average and have two no-shows/day, your bottom line could decrease by $50,000 every year.
  • Charging for no-shows has fallen out of favor. As a deterrent, many practices have found no-show charges to be ineffective. The cost to bill and collect nominal no-show fees often outweighs the revenues you receive. Many patients refuse to pay and/or leave your practice. No-show charges anger patients more than most things in life. Is $25 worth getting nailed on social media by an angry patient? Charging for no-shows is particularly ineffective for physicians who run late and make patients wait for them consistently.
  • If no-shows/same-day cancellations encompass 10 percent or more of your appointment schedule, consider overbooking (double booking) by a similar percentage. Study your schedule; some days/times of the week may be more prone to no-shows, so tailor your overbooking effectively. Alternate new and established patient visits, with most of your double-booking being on the established patient front.Make sure your staff understands the math and don't celebrate these schedule holes — empty appointment slots equal less money for raises and benefits. There will be days when every patient shows up. That's okay.
  • Some patients have a history of missing appointments. They only show when they really need you or need a refill. Option A: Lay down the law. Patients who no-show are taking away time from physicians and other patients. If the bad habit continues, go to Option B or C. Option B: Discharge such patients. Three "unexcused" absences over two years is where I like to draw the line. Option C: Collect a down payment. A $50 non-refundable deposit works wonders for patients who frequently miss office visits.
  • We'll do our very best to see you when you need to be seen. We'll do our best to run on schedule. Understand that sometimes visits may take longer than expected. We'll respect you and your time. What we expect in return is the following: Follow the plan you and I establish for your care, including keeping your appointments. If you cannot keep an appointment, let us know so that another patient may have that appointment.
  • Change the office mindset from one of patient reminders to one of appointment confirmations. The latter affirms patients have a responsibility to show up for their appointments; the former is merely a suggestion. Confirmation should occur a minimum of two (2) days in advance Anything less doesn't give you time to fill the appointment slot. Have an after-hour option for patients to leave a message to reschedule. You'll know those slots are now available when patients call first thing in the morning wanting an appointment.
  • Automated appointment confirmation is more cost effective and better at reducing no-shows than phone reminders. Today's technology interfaces with your practice management system and allows for telephone, e-mail, and text message appointment confirmation. At the time of check-in/registration, ask each patient how they prefer to get appointment confirmations. This customization of appointment confirmation delivery improves patient compliance and reduces no-shows.
  • Patients are quick to dispel an automated confirmation call and often do not listen to the entire message. "Yeah, yeah, I know I have an appointment on Thursday." I learned the hard way to use the arrival time, rather than the appointment time, in our automated messages. Mrs. Brown, we're calling to confirm that you will arrive at 9:40 a.m. for your appointment with Dr. Jones on (date) at (location). Please bring your insurance card and ID.

No-shows and same day cancellations have a big bottom-line impact; both leave you no time to fill a last-minute open appointment slot. And a missed appointment means your fixed costs are spread across fewer visits, thereby increasing your average cost per service.

But don't worry, here are several strategies that your practice can use to diminish the number of no-shows and let your patients know your time and theirs is valuable.

To download a PDF of the slideshow click here.

Physicians Practice


Thanks for the practical advice. Certainly, addressing appointment cancellations and no-shows is a very challenging problem and takes a dual approach of prevention and intervention. In working with clients, we have found that a good number of patients who would eventually no-show actually know that they will not be showing up for the appointment but do not have a convenient way of letting the practice know. As Lucien mentioned, this is why appointment confirmations should go out at least two days prior to the appointment. This is a great preventative effort. However, what remains challenging is how to fill that last second opening when you find out about it. Here, an intervention is still needed. Having a list of patients who are willing to take that new appointment is effective but can be a very manual process for the front staff who often are overwhelmed. It was for this exact reason I set out to solve this by automating the whole process at lumahealth.io.

Tashfeen @

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