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No-shows can be a huge drain on medical practice finances. Time that is booked but ultimately generates no revenue is a loss that comes right out of your bottom line. It’s similar to what airlines experience when they have an unsold seat – which is why airlines so often resort to overbooking, and some practices do, too. But if you’ve seen the negative media coverage about the impact of flight overbooking on passengers, you already know what a stressful gamble the double-booking “solution” is. It’s all but impossible to predict which patients will fail to show up — so you could end up with too many arriving at the same time. Even when overbooking helps reduce lost revenue, it can create other problems — like long waits, rushed visits, and stressed out physicians — that lead to unhappy patients and higher marketing costs.

Practice managers and physicians often throw up their hands in frustration about how to deal with no-shows, especially if they’re already taking steps to remind patients, or perhaps even charging a no-show or late-cancel fee. There’s no doubt about it, trying to improve your practice no-show rate can be challenging. But there are a few ways to look at the problem that practices sometimes miss. Consider if any of these ideas might help you reduce the cost of no-shows to your bottom line.

Reevaluate Your Appointment Slots

Practices often have standard appointment slots that they haven’t reviewed in a while. We recently worked with a practice that had used only two slots for over a decade: 30 minutes for established patients and 45 minutes for new patients. When we looked at how long visits were actually taking, we found that more time was usually set aside for the visit than was necessary.

Besides reducing the overall number of productive slots the practice had available, these over-long slots amplified the impact of any no-shows. Even a single no-show usually left a 45-minute hole in the middle of the schedule – ouch.

By tweaking the timings just a bit (30 minutes for new patients, 25 minutes for established, 15 minutes for quick follow-up), the practice added several daily slots to its schedule. The team is also implementing other efforts to reduce their daily no-shows, but they’re pleased that the time slot changes alone have immediately improved productivity and reduced the bite that no-shows take out of daily revenue.

Review Your Reminder Rules

Consumer communication habits have changed dramatically in the past five years. Many patients, especially millennials, are unlikely to answer a call or listen to a voicemail from a number they don’t recognize. This trend can render phone reminders completely ineffective in practices that cater to busy parents and young adults, such as pediatrics and OB/GYN.

Most practice management and medical records systems now offer automated email or text reminders. Be sure your practice is collecting and updating this information for every patient, and making note of their reminder preferences.

Be sure you’re reminding far enough in advance. When patients book a follow-up visit that is six months away, it’s likely they’ll have forgotten about it in the interim. An additional reminder for these visits (e.g., at 30 days before) gives patients a chance to reschedule if they’ve forgotten the appointment and now have a schedule conflict.

Remember, too, that even your standard reminders should allow patients enough time to cancel without violating your policy. If you want patients to cancel at least 24 hours ahead, be sure to call, text, or email (or all three) two or more days out. And don’t hesitate to use more than one reminder method to improve the odds your patient will receive the message.

Analyze No-Show Patterns

Sometimes, patients are failing to show up for reasons they’re not revealing to your staff. Periodically analyzing your no-shows in aggregate can reveal patterns. For example, are follow-up appointments after procedures frequently skipped? Patients may misunderstand how important these visits are to keep – if staff are prepared, they can head the issue off at the time of scheduling or in their reminder calls. Some patients may even misunderstand their insurance – for example, they may skip a follow-up visit because they’re feeling better and want to save money, not realizing that the visit is part of a global package and won’t cost them anything.

Reviewing the health plans of no-show patients is useful, too. If Medicaid patients are frequent no-shows, is transportation an issue? Staff may be able to discreetly offer later or earlier slots that make it easier for patients to get to your practice before or after work or via public transit.  Other health plans may have a higher-than-average no-show rate if high out-of-pocket costs concern patients. If staff is prepared for this issue, they can suggest payment plans to make affording care a little easier.

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