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How to Reduce Patient No-Shows, Proven Strategies You Need To Know

Christopher J. Trick
July 29, 2021

Each year, the healthcare industry loses over $100 billion due to patient no-shows. Learn the tactics used by ultra-high-performing practices to reduce the number of missed appointments and their associated costs.

Patients miss appointments for a variety of reasons, from forgetfulness to unforeseen circumstances. Absences can be excused, but they often pose serious problems for a therapist’s practice. 

First, missed appointments cost money. The healthcare industry loses $150 billion annually due to patient no-shows, and healthcare facilities experience 19 percent of patients failing to make scheduled appointments. This leads to the loss of over $150,000 per provider every year, and on average, $200 lost for every patient no-show.  

Second, missed appointments waste time. On average, it takes about 8 minutes to schedule or reschedule an appointment.  Whenever patients fail to arrive on time, a carefully crafted schedule can turn into a hectic frenzy of “are-you-still-coming?” phone calls, further wasting time that could be spent providing care, scheduling other patients, or answering questions. This leads to the loss of over 30 minutes per provider every day.  This would represent two hours of effort for the front desk or scheduling coordinator in a four therapist clinic.  You can see how easily a few patient no-shows can ruin practice efficiency and patient flow. 

Finally, patient health is negatively affected by missed appointments. When patients chronically miss their scheduled appointments, they are depriving waitlist patients of the opportunity to get the care they need. Consistently late or no-show patients undermine employee morale, leading to increased anxiety for staff and physician burnout. This can translate into a lower quality of care.

Despite how frustrating no-shows can be, though, all hope is not lost. Here are several tactics practice owners and office staff can deploy to address patient no-shows and last-minute cancelations.  

Having a full schedule will lead to a better patient flow

Create and communicate a patient no-show policy 

The Medical Group Management Association (MGMA) reports that 42 percent of patients who miss appointments say they are unaware of a therapist’s patient no-show policy. When patients do not show up for appointments, they deny other patients the opportunity to receive care and deprive therapists of revenue. 

While it may seem obvious or even unnecessary, a no-show policy provides the foundation for expectations between the practice and the patient. Making patients aware of your practice’s policy for patient no-shows allows staff to hold patients accountable and ensure that a therapist’s time is respected, so all patients get the care they need. It will be up to the therapist or staff’s discretion on how strictly to enforce this policy.  However, communicating a policy sets the foundation and expectations for all parties involved. 

In a physical or occupational therapy setting, therapists should require a cancellation 24 hours in advance if a patient is not able to show up for an appointment. Eventually, every service provider will be forced to make a difficult decision: continue working with a challenging client or part ways.  If patients repeatedly miss their appointments without notice, therapists may terminate the relationship.  

It is advisable to give patients a polite “final” warning that another missed appointment or last-minute cancellation will prevent them from being seen again.  During this final warning, remind the patient of the policy they agreed to and that their constant canceling/non-attendance reduces appointment availability for other patients that need help.  As part of this final warning, many practices have found success in requiring patients to attend informational sessions detailing the importance of timely appointments.

To hold patients accountable, therapists should keep patient credit card information on file. While this is often used as a deterrent, staff can use their discretion to determine if a charge is appropriate. Charging patients can help therapists recover lost revenue; it also reminds patients that regardless of whether or not they are present, they still have to pay for a therapist’s time, making it more likely that they will remember to be on time for their next appointment. 

Patients who are repeatedly disrespectful of you and your staff warrant a charge or even cutting ties. However, many therapists understand that there are extreme circumstances—patients who are single parents, disabled, or rely on public transportation, for example—that may merit a fee waiver. 

Patients who do regularly show up to their appointments, however, should be rewarded with prizes, such as discounts, raffles, or gift certificates to local restaurants. These prizes serve as a way to recognize patient loyalty and ensure that regular customers return.

Ultimately, it is important to set an empathetic policy and highlight the impact of missed appointments on other patients. Enforcing the policy will send the message that appointment times are commitments to be honored.

Here is an example of a patient no-show policy:

Our goal is to provide you with the best therapy services to reach your maximum potential and to improve your quality of life. We would like to inform you of our therapy attendance policy to ensure that you are getting the treatment that you need and other patients are not missing out on possible therapy times that they could have received.

Please read through and initial on the line that you have read and understand each statement:

____ CALL TO CANCEL OR RESCHEDULE. If you miss one therapy appointment without calling or canceling at least 24 hours prior, you will be charged a $25 fee.

____ATTEND ALL YOUR APPOINTMENTS. If you miss three (3) consecutive therapy sessions and do not call, you will be discharged from therapy at the discretion of the therapist.

____ BE ON TIME. If you are more than 10 minutes late to a 30-minute appointment, it is up to the treating therapist if you will be seen that day.

____ If you have multiple cancellations, instances of tardiness, or missed appointments, it is up to the discretion of the primary therapist to discharge you from therapy.

All scheduling is on a first-come, first-served basis. We understand that both your schedule and our schedule can change and we will do our best to accommodate any changes that arise. Please inform us if you would like a copy of this form or if you have any questions about our appointment policy stated above.

Please provide the best phone number in the event we need to contact you. ________________________________________________

Please sign that you understand and agree to the above policy:

_______________________________ (Patient/Guardian) __________________ (Date & Time)
_______________________________ (Staff member) __________________ (Date & Time)

Cut patient no-shows with omni-channel reminders 

Electronic reminders—phone calls, for example—are more effective than appointment cards. One survey showed that nearly 75 percent of practices using appointment reminders had a single-digit no-show rate, meaning no more than 25 percent of practices using phone reminders report a no-show rate of over 10 percent. 

Only making calls, however, is limiting, as 90 percent of patients prefer consistent contact across all digital platforms. Given the fact that therapists and front office staff do not have time to make calls to each patient, they should use omni-channel reminders (more than one type of communication—phone, email, and text) to gain a competitive advantage. 

For example, say a patient received a phone call about his or her appointment, but he or she becomes preoccupied with other matters. That patient may then receive a reminder through email and then again later through text. The patient now has three different reminders of his or her appointment, an approach that has been shown to reduce patient no-shows by 48 percent

It is also possible that patients prefer to be contacted in a certain way—via text instead of a phone call, for example. Information on preferred communication methods can be collected during the patient intake process.  Therapists can then tailor outreach strategies to each patient’s preference when looking to send out reminders, making patients feel their needs are respected. This increases the likelihood that patients will see the reminder and show up for their appointments. 

In addition to holding regular patients accountable, communicating with patients through multiple digital avenues ensures a therapist’s practice optimizes patient flow. Using Omni-channel reminders leads to 90 percent higher retention rates, as people will be more willing to seek out and stick with the services of a therapist who engages with them through various modes of communication. 

When therapists and their staff make repeated, personalized attempts at interacting with potential patients, patients feel that their health is a top priority. UC Today reports that “Excellent interactions—consistently and across all touchpoints–are the foundation of an effective customer experience that will build long-lasting customer relationships.”

A call reminder may look like this: 

Hi [customer name],

This is [your name] calling from [business name] to remind you of your upcoming [service description] on [day, month, number] at [time].

Please confirm your appointment by giving us a call back at [phone number] or emailing [email address]. Thank you!

An email reminder may look like this: 

Hi [customer name],

Just a friendly reminder that you have an upcoming appointment with [business name] to [service being provided].

Date:
Location:
Time:

CLICK LINK BELOW TO CONFIRM YOUR APPOINTMENT:
[secure link]

If you have any questions or concerns, please don’t hesitate to get in touch with us at [email address or phone number].

Thanks!
[business name]

A text reminder may look like this: 

Hi [customer name],

This is an automated reminder from [business name] about our upcoming appointment at [time] on [month, date]. Please reply “OK” to confirm.

Call us at [phone number] if you have any questions.

Get Our Communications Guide

Download our free templates: No-show policy, email reminders, text reminders, and patient survey. 

Text reminders so that patients to remind them of upcoming appointments

Use efficient scheduling strategies 

Patients will respect a therapist’s time only if they feel that their time is also respected. Some patients indicate that appointment lead times are too long. This may result from tightly booked schedules spanning weeks or even months, indicating high demand for a therapist’s services, but patients who wait longer than a month for an appointment are three times less likely to show up for an appointment.  An analysis of 4.2 million appointments scheduled in 2016 by 13,000 providers found that shorter appointment lead times can have a major impact on reducing patient no-shows.  This data shows cancellation rates for first appointments are closely correlated with how far out those appointments are scheduled.

It is important, then, to make sure that patients are seen by their therapists as soon as possible to minimize wait times and ensure that patients do not miss appointments. Patients who can see their therapist in a timely fashion are more likely to continue that therapist’s services, increasing a practice’s profitability and patient satisfaction. 

Here are four effective and highly efficient scheduling strategies: 

  1. Book appointments from noon
    • Book the first batch of appointments from noon backward, and book the second batch from noon onwards. New evaluation sessions can be scheduled for the morning, and treatment can be scheduled for the afternoon. Any gaps in both the morning and afternoon schedules can be used for meetings, saving both time and money by reducing the amount of paid hours for staff. Booking schedules from noon will keep schedules tight, preventing patients from feeling that they can reschedule at any time, and as a result, they will feel obligated to show up to their appointments at the scheduled time.
  2. Quickly fill schedules by having patients book their own appointments
    • A survey from PatientPop shows 42 percent of all patients prefer to self-schedule their appointments. Patients can book their appointments online, choosing a date, time, and provider that works best for them, making them feel in control of their healthcare decisions. Allowing a patient to self-schedule sends the message that therapists respect a patient’s time and needs; it also allows patients to become actively engaged, making it more likely they will show up to their appointments or, if a conflict arises, call in advance to cancel or reschedule. 
  3. If patients fail to show up for their appointments, there should be a list of additional contacts to notify about last-minute openings, making up for lost time and revenue
    • Healthcare personnel should use an automated waiting list, notifying other patients via email or text as soon as another patient cancels an appointment. Waitlists should consist of patients who are scheduled for later in the week and those who tried to book an appointment on a particular day but were unable to due to a lack of open spots. Patients will appreciate the chance to see their therapist earlier, increasing the likelihood they will continue to use the therapist’s services in the future.
  4. Avoid overbooking 
    • Overbooking can create longer wait times, scheduling conflicts, and overcrowded waiting rooms. This can lead to lower quality of care for patients, as therapists become overwhelmed with tasks. Overbooking can also lead to an increase in no-shows. If wait times are too long, patients may feel disrespected, or that they can show up late to an appointment, and as a result, they may refuse to show up to appointments, or they may use another therapist.

Identify areas for improvement through KPIs and patient feedback 

Practice owners should track key performance indicators (KPIs) such as how long it takes to book a patient, the number of no-shows, demographics of which patients miss appointments, and how frequently cancellations occur to identify areas for improvement. 

If your practice is not tracking patient no-shows and cancellations, now is the time to start. In doing so, you are guaranteed to uncover unique demographic and logistical trends that can help you predict the likelihood of patient attendance.  

To this end, practice offices should use a practice management system, a software that tracks these important metrics and manages daily operations like scheduling and billing. With the necessary information, changes can then be made to get better results.

For example, there may be patients who continually miss appointments. A PMS can identify these patients and how frequently they miss appointments. Front office staff and therapists should look to see whether this trend reflects a pattern and if so, make a list of these patients and track them down to figure out why they are not showing up. 

University of Missouri faculty used EHR and practice management data to research patient no-shows characteristics and trends.  They found:

  • Medicaid recipients had a higher rate of no-shows than any other insurance beneficiary type. 
  • Patients who had appointment times outside of public transportation were less likely to show. 
  • Patients who lived five to 10 miles away from the practice were most likely to make their appointments, whereas patients who lived 19 to 60 miles away were more likely not to show. Patients who lived more than 60 miles away almost always made their appointments.
  • Young, single men had the highest no-show rates.
  • Attendance was best at mid-morning appointments on Tuesday, Wednesday, or Thursday.

Interesting findings for sure.  The faculty noted, “We really do think [the findings are] probably practice-specific.”  Every practice will uncover different trends that may or may not be addressable.  Regardless, the first step is tracking the data. 

Some patients may have legitimate reasons for missing appointments, and a solution can be devised to accommodate a patient’s needs; other patients who seem careless and inattentive can be rejected and replaced by those more willing to respect a therapist’s time and show up promptly to their appointments.

It may also help to get feedback from patients after an appointment through a survey, as it can provide valuable information about which aspects of the patient journey to improve. Therapists should try to find solutions to their patient’s problems, as persistent problems may discourage patients from showing up to their appointments or seeing a particular therapist.

For example, some patients may indicate that after-hours care is not readily accessible to them. Though it is important for therapists to take time for themselves, they should designate certain days with extended hours at rotating locations, making patients who need urgent care feel like a priority. Patients who feel that their therapists are readily available to them are more likely to trust their therapists and continue using their services. 

Addressing patient suggestions and grievances will allow therapists to make their services more attractive to current and future patients and, therefore, decrease patient no-show rates. Download a sample survey below.

Get Our Communications Guide

Download our free templates: No-show policy, email reminders, text reminders, and patient survey. 

Utilize Online Patient Intake and Registration

Patient forms, medical history, and intake packets may seem unrelated to an office’s patient no-shows and missed appointments; after all, physical paperwork is typically completed once the patient arrives for their appointment. However, ultra-high-performing practices are able to use patient intake as a tool to build engagement.   

This is done by introducing patient intake paperwork earlier in the process. By giving the patient a “next step” after scheduling and before the appointment, the provider can create “buy-in” with the patient by placing pre-appointment responsibilities on them.  

This process must be intuitive and accessible for the patient. Providers should not rely on patients to print forms out themselves or mail paperwork back to the office. Any therapist will tell you this results in success with less than 5% of patients, and therefore, it is critical to offer digital patient intake forms. Patients should be able to complete and submit information directly to their provider without having to worry about printing, handwriting, or PDFs.    

PatientStudio customers are able to automatically deploy a welcome email once an appointment is scheduled. This welcome email will prompt patients to securely submit demographics, medical history, medications. allergies, insurance information, consent, and more.  PatientStudio customers on average see a 95% engagement rate with digital patient forms.  

Through PatientStudio, providers can use dashboards to get real-time insight into which patients have not completed or engaged with their intake packets. This is a valuable insight to determine which patients are likely culprits for a patient no-show or missed appointment. As a best practice, we recommend calling any patients that have not completed paperwork online a day before their appointment.

Ready to reduce patient no-show rates? Discover how PatientStudio’s integrated practice management software can ensure therapists and patients develop mutual respect for one another’s time. Schedule a demo today.


Tags

Patient scheduling, text message reminders


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