Introduction
No-show patients are a formidable challenge for medical professionals, undermining care continuity, adding administrative burdens, and generating scheduling openings difficult to fill. These inefficiencies touch hospitals, health systems, and physician practices of every specialty, location, and model. With the ubiquitous reach of the issue, the methods used for monitoring and mitigating no-shows vary enormously, rendering difficult an understanding of the true depth of the problem and its impacts.
Practice managers, patient experience managers, and call center directors all use different methods to try to reduce no-shows. Some of them, however, use resource-intensive processes or hard-to-enforce procedures and result in disproportionate resource utilization and little effect. Automated appointment reminders are a potential solution, but many organizations continue to have no-shows and use resource-intensive manual processes that are not scalable.
Measuring Patient No-Show Rates
Clinical and administrative health IT system design has made it possible to collect and monitor performance measures, including patients’ no-show rates. The measures facilitate performance comparison against similar markets or the same size organizations, tracking changes over time, and evidence-based resource allocation decisions to drive improvements.
Consistency in definition and identification of patient no-shows is needed, especially in large health systems with numerous clinic sites and heterogeneous management staff. The most frequent errors are:
- Counting cancellations and appointment rescheduling as no-shows.
- Coding a no-show incorrectly as “canceled.”
These errors distort statistics, making it hard to establish a valid baseline or trend towards improvement. Relating no-shows to revenue per missed appointment puts a monetary effect into numbers and enables measurement of recaptured revenue through mitigation.
Calculating Your No-Show Rate
To calculate your no-show rate, tally the number of patients who failed to show up for their appointments and then divide by the number of appointments. Before you do the calculation, ensure that patients who failed to show up for their appointments are tallied.
No-Show Rate = Total No-Shows / Total Scheduled Appointments
Let’s subtract the walk-ins from the total.
Determining an Optimal No-Show Rate
The overall national average for no-shows is 8% to 18%. Community health centers and FQHCs are higher, while specialty clinics such as dermatology or oncology are lower. As much as 50% reduction in no-shows has been achieved using best practices and successful appointment reminder systems, where the rates are as low as 5% or less, yielding revenue and considerable time savings.
Top Five Causes of Patient Appointment No-Shows
- Forgetfulness: The majority of patients just forget their appointments. Additionally, 24% of surveyed patients find it difficult to cancel their appointments once scheduled.
- Time Constraints: Patients will take less than ideal appointment times due to availability restrictions, but then will not arrive because their own schedules will not accommodate it.
- Demographic and Socioeconomic Barriers: Language, age, transportation, or childcare can be barriers to patients visiting the clinic.
- Fear: Medical visit anxieties, such as fear of testing or hearing bad news, can discourage patients.
Effective Strategies to Combat the Leading Causes of No-Shows
- Forgetfulness: Use reminder appointments and include easy cancellation options.
- Time Constraints: Offer flexible hours, nights, weekends, and telemedicine.
- Demographic and Socioeconomic Barriers: Offer language interpretation services, transportation services, and on-site childcare.
- Fear: Welcome the patient, have empathy-trained personnel, and provide education materials to deal with patient fear.
- Financial Matters: Provide transparent costs, manageable payment plans, and educate patients on insurance options.
Best Practices to Minimize Patient No-Shows
Streamline Appointment Reminders with Automation
Modern appointment reminder systems optimize efficiency and reduce patient no-shows by half. Automation eliminates mistakes and provides consistent communication, regardless of clinic rushes or staff shortages.
Prioritize Text (SMS) Messaging in Your Strategy
Effective patient engagement relies on taking advantage of technology that one already has, staying away from usernames and passwords, and not involving further downloading of applications. A method of texting that is accessed universally has demonstrated impressive 40%-50% decreases in patient no-shows in just a few weeks, filling vacant slot times and boosting revenue.
Follow-Up Calls
Ensure that appointments are a commitment between you and the patient. Follow-up calls give some indication of why appointments were missed and a chance to reestablish the patient-provider relationship.
Sample Follow-Up Call Script
Identify yourself: “Good Morning, this is Janie, Dr. Welby’s nurse, calling from Goodwill Clinic.”
Get reason for missing appointment: “I notice that you didn’t come to your appointment today. We’re worried about your health. Dr. Welby wanted me to call and request that you tell us what happened.”
Describe the significance of honoring appointments: “If you fail to honor an appointment, we have lost the time which would otherwise have been spent with someone in need.”.
Provide a fresh appointment: “Would you prefer me to arrange another appointment for you? Which day and time would you prefer?”
Offer assistance: “How can we help you keep this follow-up appointment?”
Other Useful Strategies
- Make appointment reminder calls.
- Use open access scheduling, where patients may schedule appointments in their preferred time.
- Monitor patients’ behavior in an effort to identify chronic no-shows and lateness.
- Urging chronic no-shows to schedule same-day appointments.
- Incorporate completion of appointments as part of care management for chronically ill patients.
- Establish contingency arrangements for staff absence.
- Give prompt telephone answers with proper staffing during busy hours.
- Have a dedicated phone line for cancellations.
Establish a Record of No-Show Explanations
Keep a log sheet to document the causes of missed appointments. Check these reasons at regular intervals to determine patterns and implement proactive steps.
Selecting the Ideal Vendor
Choosing a suitable partner, such as panaHEALTH Care Solutions, recognizes areas of need, tailors solutions, and provides continuous support and education. Such partnership enables healthcare leaders to leverage the solutions required to drive efficiency, optimize patient satisfaction, and create an integrated patient experience.
By applying these best practices, patient no-shows can be reduced by a significant percentage, efficiency improved, and revenue increased.
