Medical Billing Blog

Simple Tips To Reduce Patient No Shows

Posted by Barry Shatzman on Wed, Sep, 26, 2012 @ 14:09 PM

Reducing No ShowsMost medical offices have procedures in place that attempt to address the inevitable cases of last-minute cancellations and patient no shows. There are a number of tricks to handling them effectively to minimize their frequency and the damage they can do to the practice’s revenue in general. After all, a medical practice is a business, and the best business solutions are those that yield the greatest positive effect with the lowest overall cost financially and with the least effort. In the case of patient no shows, it is important to realize why and when they occur in order to devise the best combination of ways to respond to them and mitigate their effect on the schedule—and your revenue—over all. 

And the effect on revenue can be substantial: One month during 2012, a dermatology practice booked a little over 1300 appointments. Of those, 296 were cancellations of one sort or another, a 22% cancellation rate. Of the 296 cancellations, 127 were no shows. Although the practice had an opportunity to re-book the cancellations they knew about in advance, the no shows were a different story. Hypothetically, if each of those no shows represented a mid-level office visit for an established patient (99213), the gross revenue lost to the practice would be about $7,500 for the month, or a little over $90 thousand for the year…and that’s nothing to sneeze at.

Let’s face it, nobody tries to be late or cancel an appointment just to upset your schedule. The most common reasons for no shows don’t have anything to do with you as a provider. There are times when patients have unavoidable emergencies, or they wrote down the appointment wrong or forgot the appointment altogether. Sometimes patients don’t show because of personal economic reasons that they might not feel comfortable sharing with your staff: Maybe they owed a previous balance and were unable to pay it; they lost their job and can’t afford their co-pay; or lost their insurance coverage. In this economy, it has even become common for patients to cancel or no show on appointments because they can’t afford or are unwilling to schedule a half or whole day off work to see the doctor for 15 minutes. Sometimes, patients don’t show up simply because they are feeling better and no longer feel the need to visit the office.

While you, as a physician, have little control over whether appointments are cancelled or patients don’t show, there are a few pretty good methods of mitigating the damage they do to your practice and your revenue. Some of the fixes involve money, time, and common courtesy, but they all involve taking a proactive approach to ensuring appointments are kept or that cancelled appointments are not only filled with other patients, but that the patient cancellations are also re-booked for other times. 

Reminder calls: In 2007, the American Journal of Medicine published results of a three-month study of the effect of reminder calls on no shows(1). The results showed that if a patient was reminded of their appointment, no-shows were cut almost in half. There are three different types of reminder calls: personal, automated voice, and email.

  1. Personal: Have a dedicated staffer call patients a day in advance to remind them of their appointments. This task can be set aside for the last hour of the day. Although this is the most expensive method of communication, it is also the most effective method because it’s the most personal. In general, patients would rather hear from a person than a machine. If your staffer is able to connect with patients in advance, everyone benefits because patients who might not have showed are given an opportunity to reschedule, and staff gain an opportunity to refill the appointment slot with someone from the waiting list. Unfortunately, this method tends to get skipped on days when the office is particularly busy.
  2. Automated: Programs are designed to pull your appointment schedule and automatically leave a message with your patient. Again, most practices have the calls set for the day before. Each call costs an average of 20 cents. The biggest advantage is that the automated system never gets pushed aside because of higher patient care priorities, and if the resulting no shows were cut by half, this could represent a boost in revenue of $45 thousand over a year.
  3. Email: Offer your patients the option of receiving email reminders. The biggest hardship here is trying to get your patients’ email addresses, and you also need to be careful that the electronic communication doesn’t become a patient’s way of receiving free medical advice, or inappropriate sharing of protected health information.   

Your practice is not likely to completely eliminate no shows or last-minute cancellations, but the reminder calls should significantly decrease their occurrences. And with smaller numbers of openings, it should become easier for your staff to develop a call list of patients who are able to come in for short-notice appointments. These patients can fill empty time slots, and you won’t have gaps in your schedule or your revenue. Also, have a staffer assigned to call and reschedule every missed appointment. In today’s economy, it’s important that you don’t wait for the patient to call you back. 

Many patients who don’t keep appointments also have a limited sense of the value of an appointment in financial terms or in personal terms. If your office has a history of seeing patients later than their scheduled time, patients may become conditioned to arrive late in order to shorten their own waiting time. If patients sense that they must share your attention with others during their appointed times, they may rationalize that being a no show is acceptable because you always have two or three other patients whom you’re juggling at the same time that you’re supposed to be seeing them. Over time, you and your staff can instill in your patients a sense that their appointment time is valuable if you observe a few common sense rules for setting schedule priorities:

Stay on Time: See your patients on time, be honest, and offer options if you are running behind. It’s a shame when a patient has to schedule a day off from work for 15 minutes with a physician. Patients tend to mirror the way they are treated, and will generally have more respect for your time when they know that you have also respected theirs.

Chronic no-shows: Most scheduling programs can track no shows when used properly. Once you start tracking, you may discover that your no shows are typically the same small group of patients. Schedule repeat offenders for a time that least affects your overall schedule. 

No-show fees and same-day cancellation fees: The decision to apply charges for no show and same day cancellations is personal to each provider. We have offices that use them with discretion, offices who charge only for hard costs such as formulated IV treatments, and offices that refuse to use them altogether. Levying such penalties against patients can certainly reduce the numbers of no shows that your office incurs, but may have a negative impact on the patient’s sense that your staff understands when unavoidable scheduling conflicts arise. Regardless of whether you choose to pass on these costs, it’s wise to set a limit on the number of times a patient can no show before you take corrective action. Some offices use a three-strike rule. After a patient has a third incidence of no show or late cancellation, staff may be instructed to only schedule that patient for same-day appointments, or even to discharge patients who accumulate a set number of no shows in a given year.

Providers, staff and patients all play a role in keeping a practice healthy and its schedule running smoothly. When all the actors understand the value of a scheduled appointment, the show goes on without a hitch. One of the keys to making this happen is to stay in communication with patients about their appointments and to afford them your undivided attention when it’s their turn in the exam room. Essentially, the key to avoiding no shows is to have proactive methods of communication before, during, and after the appointment.

(1)   Parikh, et al. “The Effectiveness of Outpatient Appointment Reminder Systems in Reducing No-Show Rates.” American Journal of Medicine, The  Vol. 123, Issue 6, Pages 542-548