How to Stop Those Money-Draining No-Shows

Shelly Reese


November 20, 2012

In This Article


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," says Nick Fabrizio, a principal with the MGMA Health Care Consulting Group. 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, says Melissa Stratman, CEO of Coleman Associates, a Boulder, Colorado, consulting firm that helps practices enhance the patient experience. 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, she says.

Six problems account for nearly all no shows, according to Stratman:

  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.

  2. 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.

  3. Patients have to wait a long time to get an appointment and may either forget the appointment or decide they no longer need it.

  4. 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.

  5. They don't feel connected with the practice staff.

  6. 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," Stratman says. "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."