Reducing the No-Show Rate in Your Practice

Every Practice has patients who do not show up for their scheduled appointments. Do you know what your no-show rate is and why patients miss their appointment? Any idea how much revenue your practice loses annually due to no-shows? On average, just 10 no-shows a week can cost a practice up to $57,000 annually for established patient visits (CPT Codes 99213-99215 based on current Medicare allowable rates for Florida).

Patient no-shows not only negatively impact revenues. They could also impact continuity of care for the patient. Determining the reason for the missed appointment will help the practice implement a plan to address the issue.

In order to understand the underlying cause of no-shows, the following information should be tracked:

• Reason given for not keeping the appointment
• Number of no-shows by provider
• Timing: Day of week and time of day most no-shows occur
• Visit type

Reason: Undoubtedly one of the most common reasons for missed appointments is that the patient forgot the time/day the appointment was scheduled, wrote down the wrong information, or they had a conflict. One way to address this issue is to remind the patient the day before the appointment. Live phone calls have the most impact. Unfortunately, most of these calls are made during business hours and patients are less likely to be at home. The utilization of an automated service that allows the patient to cancel or reschedule the appointment can be a great alternative. The use of patient portals, emails, and text messaging are also effective ways to send reminder notices to patients as long as appropriate HIPAA security measures are in place. A study posted by the Internet Journal of Healthcare Administration revealed that the no-show rate for 5,400 patients who received email reminders decreased by 35%, compared to no change in the rate among patients who did not receive the email notice.

Provider: The appointment template should be reviewed and the provider’s schedule adjusted to ensure patients can be seen within a reasonable amount of time after arriving for their appointment. Patients who consistently have extended wait times in the lobby are more apt to miss their appointments. The patient also has to feel connected with the provider and will be more committed to the practice if a strong relationship has been established.

Timing: If most no-shows occur on a specific day of the week or time of day, consider adding more time slots or shortening time between visits. This will not eliminate missed appointments, but may assist in offsetting lost revenue.

Visit Type: Patients tend to forget about appointments if they are scheduled too far in advance. Instead of scheduling appointments (i.e. annual exams) months in advance, ask the patient to call and schedule the appointment closer to the time the visit is needed, and place the patient on a reminder call list so staff can follow up with the patient if the patient fails to call. Also, patients may not see a need for a follow up visit, especially if they feel better. For continuity of care, however, patients should always be reminded of the importance of keeping the appointment.

Charging a fee for a missed appointment has been proven to significantly reduce the no-show rate. The fee should be high enough to deter the patient from missing their appointment. Effective communication with the patient is paramount in successfully implementing a no-show fee. A policy should be developed and the patient must be advised in advance that the practice is going to charge a no-show fee. This information should be included in the patient financial policy and a notice should be displayed in the lobby. Johns Hopkins Outpatient Center (JHOC) implemented a no-show fee policy and realized a 10% decrease in their no-show rate.

The practice’s no-show policy should address how the practice will handle patients who repeatedly miss their appointments. Consider discharging the patient from the practice after the patient has missed a certain number of appointments within a specified amount of time. Based on the reason for the visit (i.e. lab work), an alternative would be to not schedule an appointment but have the patient be a “walk-in” on a certain day if the schedule permits.

The practice can implement ways to offset lost revenue due to missed appointments such as designating one or 2 open slots a day for same-day appointments to improve access to the practice. Also, to fill open slots available because of missed appointments, a list of patients who are able to come in on short notice should be maintained.

Most importantly, providers and staff should develop a relationship with the patient that fosters a commitment by the patient to the practice. The problem of no-shows will never be completely resolved. However, by developing a no-show policy and effectively communicating with the patients, the no-show rate in the practice may be significantly reduced.

Carol Crews is the Director of Healthcare Consulting Services for The LBA Group in Jacksonville, FL and assists physician practice groups with practice improvement and compliance issues. Carol can be reached at ccrews@TheLBAGroup.com.

The LBA Group is a proud member of the National CPA Health Care Advisors Association (HCAA), a nationwide network of CPA firms devoted to serving the healthcare industry. Members provide proactive solutions to the accounting needs of physicians and physician groups. For more information contact the HCAA at info@hcaa.com.