No one likes getting “ghosted” – abruptly being cut off from contact – and that includes when patients don’t show up for appointments. Unfortunately, patient no-shows are common, especially for outpatient clinics, which have an average no-show rate of 27%.
At that rate, more than one out of every five of your appointment slots is not reimbursable. In total, no-shows cost the healthcare industry $1.5 billion each year. All of this begs the question: What is the best approach to handling patient cancellations?
Many factors must be understood to develop a successful strategy for managing patient cancellations, including why patients cancel or don’t show up, and how your practice can improve patient attendance.
Who No-Shows, and Why
A no-show occurs when a patient doesn’t show up for a scheduled appointment and doesn’t provide notice ahead of time. There are many reasons why patients may no-show, including uncertainty about their ability to cover their potential financial responsibilities, a busy lifestyle that may cause them to forget or be over-committed, and even fear about the health impacts of a treatment. They may have misunderstood communication about timing of the appointment, something may have changed with their access to reliable transportation, or maybe they didn't have a great experience during their previous visit and are considering other providers.
A 2020 study from the Journal of Community Hospital Internal Medicine Perspectives outlined the top reasons for no-shows:
- Forgetting about the appointment
- Work-related issues
- Not notified about the appointment
- Childcare issues
- No transportation
Cancellations are better than no-shows, especially when done in advance, because they give your team time to schedule an appointment with another patient from the waiting list or fill up that slot with other work.
According to that same 2020 study, cancellation reasons are the same, but cancellations are more likely to occur when patients were educated on the process to cancel.
Tracking No-Shows
When diagnosing a patient, you first record symptoms before identifying a condition. Similarly, you should track no-show data and trends before deciding on a way to solve the problem.
There are two formulas that can help calculate no show rates:
- No-show rate over time: no-shows / number of appointments = your no-show rate
- No-show and cancellation combined: no-shows + cancellations / number of appointments = no show and cancellation rate
Along with calculating rates, you may also want to identify shared characteristics between patients who cancel or fail to show up. Maybe they tend to fall into a certain age group or are in your office for a specific service. The more information you have, the easier it will be to address the problem.
Having the data is one thing; processing all that information and understanding how to apply it is another thing altogether. Fortunately, the right technology solution can help collect and analyze your practice’s data on patient attendance so you can quickly put what you’ve learned into action.
When The Eye Specialists of Delaware switched to a new EHR system with advanced analytics, they received high-quality data on patients, and the capability for deep analysis of that data. This new source of data helped them identify key improvements that allowed them to optimize their workflow and patient experience. Their chief operating officer, Larry Willis, reflected, “Nextech Advanced Analytics really transformed how we looked at our business. It’s just completely different. The way we can correlate and aggregate data is really impressive.”
How to Reduce No-Show Appointments
After understanding your practice’s no-show and cancellation rates and the reasons behind them, it’s time to perfect your patients’ attendance records. The following eight steps are easy to implement and effective.
- Communicate Via Multiple Channels
- Send Automated Reminders
- Make It Easy to Schedule an Appointment
- Set Up Prepaid Appointments
- Shorten the Wait Time
- Acknowledge Patients Who Show Up
- Remind Patients of Their Next Appointment
- Schedule Appointments ASAP
1. Communicate Via Multiple Channels
When setting up automated reminders or follow-ups after a missed appointment, don’t be afraid to text, email, and call. A 2022 study from the Journal of Medical Internet Research found a multi-channel approach improved patient engagement, outcomes, and attendance.
However, your team likely doesn’t have much spare time to text, email, and call one client. So, if they are sending reminders manually, prioritize the most effective communication channels. A 2024 meta-analysis published in CES Medicina Journal found text messages were the most effective reminders for medical appointment attendance, followed by emails and lastly calls.
Alternatively, you could use an automated reminder system to send multi-channel messages.
Let’s say a patient just left your office and scheduled a follow-up three months from now. Your team could add sending a follow-up text to their to-do list for the week and could make a note to remember to call and text closer to the appointment time as well. That traditional approach can be effective, but having your staff write to-dos and reminders just so they remember to send reminders to patients might not be the most efficient approach.
Technology can simplify everything and be just as effective. For example, your staff could click one button on your practice’s EHR and a series of automated texts and emails, plus one call four days before the appointment, could go out. Make it easier and more effective for your team by investing in an EHR or PM software with automated reminders.
2. Send Automated Reminders
As the above example demonstrates, investing in technology to send automated reminders makes your teams more effective and your reminders more consistent. Automated no-show reminders reduce manual outbound calls and mailings. They can be sent via phone, text, or email with a link that allows patients to reschedule online if needed — empowering them to be more involved in their own care.
3. Make It Easy to Schedule an Appointment
When Pima Eye Institute changed patient portals, they found scheduling appointments was easier for staff and patients. Their staff saved time, and patients could schedule appointments with fewer difficulties. Nextech’s EHR and practice management solution with integrated patient portal has helped clients cut down on clicks to book appointments — from up to 17 with other platforms, down to only two with Nextech.
Investing in the right patient portal is one of the easiest ways to simplify how patients schedule an appointment. When scheduling appointments is easy, patients are less likely to put it off and more apt to reschedule – not ghost – when necessary.
4. Set Up Prepaid Appointments
A good payment system will allow you to set up multiple pricing options, including ways to pay ahead of time. Paying ahead of time provides a financial incentive for patients to show up. To make advanced payment more attractive, your practice can offer discounts to patients who prepay for their next visit.
The ability to pay ahead of time as well as any potential discounts are easier to offer with the right technology. Nextech Payments offers both, as well as monthly memberships and recurring payments for elective services. When money is already on the table – and done so in a way that’s quick and easy to do – patients will be more eager to show up for what they’ve paid for.
5. Shorten the Wait Time
If patients have to wait an hour before seeing a provider, their motivation to schedule a return visit decreases — and they’re more likely to leave a negative review of their experience at your practice. By reducing your practice's average wait time, patients have more motivation to show up and have a better overall experience.
Fortunately, reducing wait times can be as easy as investing in the right administrative technology. For example, software that can streamline processes such as patient check-in/out and payment, keeps patients smoothly flowing through their visits and in and out of your office. After switching EHR and PM providers, Short Hills Ophthalmology had room for six more appointments each day because of time saved.
Southeast Eye Consultants experienced a similar reduction in patient waiting time. Their director, Jessica Catalano reflected, “Nextech increased efficiency since we don’t have to go through a third-party website to process payments anymore. We’re saving exactly 3 minutes and 47 seconds per patient. This adds up to many hours saved per week and has helped create a far smoother patient journey.”
6. Acknowledge Patients Who Show Up
When patients do show up on time or early, have your staff thank them for their promptness. A 2020 study published by Nurse Leader outlines how acknowledgment leads to better attendance and engagement at work. The same principle can be applied to showing up on time for a healthcare appointment: People appreciate when their time and efforts are valued. Help reinforce your prompt patients’ behavior with a genuine expression of gratitude. They’ll be more likely to continue showing up when they’re supposed to and to have a better experience during their visit.
7. Remind Patients of Their Next Appointment
A lack of reminders is the No. 1 reason patients don’t attend appointments. Without reminders, it’s harder to organize childcare, take time off work, or coordinate anything else necessary to attend an appointment. When a reminder is in sight, the appointment is on patients’ minds.
Many practices find it effective to provide a printed card at the end of an appointment with the next appointment date and time. After, they also send a series of automated emails and/or texts. Working with online and offline mediums ensures all patients are reminded via whatever communication method they prefer.
8. Schedule Appointments ASAP
If a patient has an appointment in two weeks, they’re much more likely to remember than if it’s in six months. Whenever possible, schedule appointments sooner rather than later.
The right administrative technology makes this easier. A PM system that has a “find first available” feature makes it easier for your team to find upcoming appointments.
For practices who often find themselves booked out months in advance, the right technology can reduce the administrative workload for your team, allowing practitioners to see more patients each day. Scarsdale Ophthalmology Associates, for example, saw 50% more patients per day once they invested in an EHR that reduced administrative workflow.
Strategies that Don’t Work to Reduce No-Show Patients
Along with learning effective strategies to reduce no-shows, it’s important to understand what doesn’t work. To help, here's a list of common, but less effective, measures.
Voicemail Reminders on Their Own
The year is 2006, and one of your staff’s duties is calling patients who didn’t show up for appointments or canceled. While these voicemails may have worked back then, we’re no longer in the early 2000s.
In 2024, calls are the least effective way to remind patients of an appointment. This doesn’t mean you shouldn’t use them. The more communication channels, the better. It does mean you shouldn’t rely on automated voicemail alone for appointment reminders or to follow-up with patients who canceled.
Charging a No-Show Fee
Charging a no-show fee may seem like a no-brainer — in theory. Patients who don’t show up for an appointment are charged a portion of the bill, which serves as a reminder and incentive to show up next time.
However, a 2023 study by the Journal of Medical Ethics found no-show fees don’t increase attendance and actually create more administrative costs for practices. Plus, many patients who are struggling financially have valid reasons for not showing up, such as lack of transportation or childcare. An extra monetary burden only makes it harder to afford transport or childcare for future appointments.
Double-Booking
Sometimes, practices double-book appointments to reduce the risk of no-shows. Then, in circumstances where both patients show up, one patient simply has to wait longer. While this might help a practice earn more in the short term, it isn’t a sustainable solution. Any move that creates longer wait times will diminish the overall patient experience, which can result in negative reviews for your practice and may lead to more no-shows in the future.
Next Steps After a Patient No-show
After a patient doesn’t show up, there are some steps you can take to ensure they reschedule their appointment and decrease the risk of it happening again:
- Follow up with a “sorry we missed you” message. In the email or text, remind patients to reschedule their appointments. Many EHR and PM systems can automatically send these messages after a cancellation or no-show has been marked in the system.
- Remind patients of the no-show policy and ask if they have any questions on booking or attending appointments.
- Reach out to no-show patients via multiple communication channels.
- Offer a telehealth alternative when possible.
- Create flexible rescheduling options and invest in PM software that lets your team easily change appointments or have a waiting list so you can fill canceled appointments (with advanced notice) easier.
Stopping No-Shows Before They Happen
Technology is changing faster than ever, meaning there are more robust tools at your disposal to track – and even stop – patient no-shows.
Patient portals, for example, can now offer more features to reduce no-shows, including easier-to-use interfaces and access to telehealth appointments. The right patient portal also sends automated messages to remind patients of appointments and offers convenient payment integration.
AI-driven patient engagement tools can allow patients to access important healthcare information faster and even help schedule appointments with more ease. AI can also save precious appointment time – through automatic record-keeping and filling out routine forms – allowing you to spend more time connecting with patients and less time on paperwork. That extra time with patients often cultivates patient loyalty, making them want to come back.
With the right tech stack, scheduling and attending appointments becomes easier for patients.
To learn more about how Nextech’s EHR and PM software can reduce no-shows, get a demo.
Angela Myers is a health and health tech writer with bylines in Forbes and AARP, among others.
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