Just Say No to No-Shows

Just say no to no-shows

Practices can develop various ways to tackle the problem

Every medical practice has unreliable patients who don’t show up for appointments. One study by the American Osteopathic Association indicated that no-show rates for outpatient practices range from 23% to 34%. This can cause a 14% decrease in anticipated daily revenue.

Obviously, a revenue decrease can be debilitating to your practice — especially if it continues over time. So every practice should develop ways to reduce the number of people who fail to keep their appointments.

What can you do?

First, it’s important to track your no-shows. As the old saying goes: If you don’t track it, you can’t change it. Make sure you know how many no-shows you have and evaluate any patterns you begin to see. Are the no-shows the same patients or the same type of patients? Do they occur at the same time of the day or week? This analysis can help you determine solutions for this problem.

You also need to define no-shows for tracking purposes. Are appointment changes being classified as no-shows? Are cancellations? Typically, the best definition of a no-show is a patient who never arrived for a scheduled appointment and didn’t give previous notice.

Using automated reminder messages — whether by phone, text or email — can be helpful. Although postcards have long been used by many practices, research by FranchiseHelp and Text Request indicates that people prefer text reminders, which have a 209% higher response rate than phone calls. But bear in mind that some patients may not have email or text abilities, so postcards or phone calls may be necessary.

What are some other strategies?

Educating patients about the importance of keeping their appointments may reduce no-shows. It’s important to explain that not showing up for an appointment will reduce the effectiveness of their treatment. After their initial visits, remind patients at every point of contact on how to cancel or reschedule their appointments if necessary.

Also, make sure it’s easy for patients to cancel and reschedule appointments. If you’re using email or text, the patient shouldn’t have to shift to a different device to cancel or reschedule. Listen to your practice’s answering decision tree to ensure that it’s easy to use and that cancellation or rescheduling policies are clear. Phone calls should get answered, if possible, rather than shifted to voicemail.

And when patients do show up to their appointments, it’s a good idea to thank them. Thanking unreliable patients when they do arrive on time can be particularly effective positive reinforcement.

What are the most effective policies?

If you don’t have a no-show policy, create one. There are a lot of different ways to do this. For example, you could have a policy that, after three no-shows, the patient will pay a penalty fee and, after five no-shows, they’ll be charged for a full office visit. No-show fees can be controversial, however. (See “3 problematic no-show approaches.”) Another strategy is to quantify patient fees lost through no-shows and propose sharing any collected fees with staff.

It’s a good idea to optimize your schedule as much as possible. If you have patients who are chronic no-shows, offer them appointment times when the practice is less busy. Doing so allows you to provide peak appointment times to more consistent patients, and those who often don’t show up may appreciate less time spent in the waiting room.

In addition, it’s rather unusual to allow prepaid appointments, but some practices have tried this with success. A patient who has already paid for the appointment has a greater incentive to show up. You could offer a discount to patients who prepay for their next visit or enter the names of prepayers into a drawing for a gift card each month.

Why not be creative?

It’s probably impossible to eliminate no-shows. And people cancel for many reasons, not just forgetfulness. But with consistent policies and some creativity, you can likely decrease the number of no-shows your practice experiences — and keep your bottom line healthier over time.

3 problematic no-show approaches

Some approaches to dealing with no-shows can become problematic in and of themselves. Here are three policies that you may want to avoid:

  1. No-show fees. As mentioned in the main article, it can be tempting to charge a no-show fee — and about 25% of medical practices do so. If you do, make sure patients are aware of the no-show policy. (Display a sign in your practice waiting room and state reminders in various patient communications.) It’s important to keep in mind that, in some states, Medicaid doesn’t allow charging patients for missed appointments. Also, the policy can create additional work for staff to enforce. It also may alienate patients who might have had legitimate reasons for not showing up for an appointment.
  2. Robocalls. If you use automated messages, make sure they allow for an easy way to respond. Recorded messages are far more effective if a patient can select an option to return the call directly and immediately, rather than having to hang up the phone, call the office, go through the phone tree and wait to talk to someone.
  3. Double-booking. If your practice double-books appointments, you’re gambling that some patients won’t show up. But when everyone does come in, double-booking results in long wait times, annoyed patients and minimal time with the physician.

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