No-Shows: New Ways to Tackle a Persistent Problem

Shelly Reese


May 11, 2016

In This Article

Searching for a Silver Bullet

If you've been in practice for any length of time, you know that getting patients to keep their appointments can be a persistent problem. In an attempt to address the challenge, many practices are experimenting with new technologies that make it more convenient for patients to make appointments they'll actually keep and cancel those they won't.

Over the years, practices have used myriad strategies—mailed appointment reminders, personal and automated phone calls, fees for missed appointments, overbooking, or some combination thereof—as a way to remind patients of their upcoming appointments, encourage them to cancel those they don't plan to keep, or financially compensate the practice for the ones they miss.

Early adopters say such tools as texted appointment reminders and patient self-scheduling helping them reduce their no-show rates, and they're positioning them for the brave new world of consumer-driven healthcare.

Many have adopted a cost-driven approach. Charging patients for missed appointments—although still a hotly debated practice—has become relatively routine. Many practices incorporate no-show policies into their patient consent forms and post signs in waiting areas reminding patients that they will be charged—often $25 or more—if they miss an appointment and fail to cancel without providing adequate notice. Some practices dismiss patients after just a single no-show, although most allow for two or three missed appointments before severing ties.

But charging patients for missing their appointments remains controversial. Melissa Stratman, CEO of Coleman Associates, a Boulder, Colorado-based consulting firm, worries that the practice drives a wedge between patients and their doctors.

Given that phone calls and reminder calls only work up to a point and that not all practices are willing to impose no-show fees, many practices are exploring emerging technologies to help them address the problem.

Lately, emerging strategies for addressing no-shows are taking advantage of the ubiquitous use of mobile technologies, to make it more convenient for patients to schedule and confirm appointments.

MetroHealth, an integrated public health system in Cleveland, Ohio, has been using texted appointment reminders for nearly 4 years as a way of improving show rates, says David Kaelber, MD, chief medical informatics officer. Like many safety-net providers, MetroHealth has a huge no-show rate. "We have clinics where the rate can be 20%, 30%, or even 40%," says Dr Kaelber, "which makes it more of an imperative for us to address the issue."

MetroHealth's electronic medical record (EMR) automatically analyzes patient records to identify those that include a cell phone contact number. Currently, MetroHealth has textable numbers for about 40%-45% of patients in its MyChart system, Dr Kaelber says. Those patients receive an initial text informing them that they've been enrolled in MetroHealth's text message reminder system and giving them an opportunity to opt out of the system. Those who don't opt out—and only about 2% do—automatically receive texted reminders about future appointments.


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