How to Stop Those Money-Draining No-Shows

Shelly Reese


November 20, 2012

In This Article

A New Way to Schedule Follow-ups

The clinic has also begun piloting a program for patients needing follow-up appointments months in the future. Rather than scheduling an appointment 4 months in advance, patients are asked to call and make an appointment closer to the date. If a patient hasn't called to schedule an appointment within 1 month of the designated time, a pop-up message appears on the medical assistant's computer advising her to schedule a visit. The pilot, which is being tested with one of the clinic's care teams, has reduced the team's no-show rate to less than 8% and is being expanded to a second team.

Today, Peterson Clinic's no-show rate is generally below 10%. Customer service has improved -- patients no longer queue up outside hoping for an appointment – and patients are directing their friends and family members to the clinic. "We're getting more patients from word of mouth," Ma says. "We don't have to post big banners to get new patients."

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," says Nick Fabrizio. 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," he says. "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. Stephen Lawrence, a professor at Leeds School of Business, University of Colorado at Boulder, and coauthor of an article on the subject, says, "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, Lawrence advises 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, he says.

Even when the Peterson Clinic's no-show rate was high, Harpreet Ma says that she used overbooking only as a last resort, because "if everybody shows up, it's crazy."

Charging patients who don't show up for their appointment is another solution that comes with strings attached. Whereas some patients will regard the fee as akin to a bank overdraft charge and pay it, many will ignore it or become angry with the practice. What's more, Nick Fabrizio says that a practice shouldn't even consider charging unless it has put "sound practices in place so that they know it's not their fault when patients fail to show."

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," he says, "so I see it as a toss-up."

Whichever approach you take, one thing's certain: no-shows won't fix themselves.

"To truly fix the problem, you have to get proactive," Melissa Stratman says.