The Best Ways to Reduce Patient No-Shows in 2019

Scheduling efficiency is the heartbeat of your practice. And patient no-shows are its nemesis. They're the bane of every medical office, and having strategies in place to reduce them is essential. As PCC's Chip Hart, Director of Pediatric Solutions likes to say, "A practice with a great schedule is always better clinically and financially than a practice with a bad schedule - there really is a difference."

Whatever the cause, from lack of transportation to forgetfulness or financial issues, you will reduce the numbers of no-shows in your office by trying the following tips.

New Data Provides Insights on No-Show Appointments 

Recently, Chip Hart and the Pediatric Solutions team did a deep dive into the data behind no-show appointments at PCC's client practices and discovered variables that profoundly affect the possibility of missed visits at pediatric practices. As it turns out, and to the surprise of conventional wisdom, there's not really a strong difference in no-show rates among the day of the week, time of day, or month of the year. Sure, maybe Monday is slightly more likely than Friday, but it's not statistically significant.

What Hart's team uncovered is that the strongest predictor of a patient no-showing their appointment is... a history of missing appointments. Every patient misses an appointment from time to time. But those chronically missed appointments? They're coming from only 10% of families. That's right - 60% of missed appointments are coming from only 10% of your patient base. 

What does this mean for your pediatric practice? Well, for starters, Hart says,

When you come up with a no-show policy for your practice, you don't need to have it be a blanket policy for everyone. Tailor it to that tough 10%.

Hart provides an example. "Same day appointments almost never get missed. Appointments scheduled two days or less ahead of time almost never get missed. Given that rate, maybe your policy for a patient who chronically no-shows is that they are only allowed to make same day or one-day-ahead appointments. Most practices save time slots for immediate visits, so it's easy to integrate this policy into your existing schedule."

Speaking of no-show policies, does it really matter if your pediatric practice has one or not? Hart weighs in saying, "We can't be certain because the nature of no-show policies differs so much among practices. But the very presence of a policy, no matter how poorly or inconsistently implemented, is important. From our research, it looks like practices with policies do have a slightly lower no-show rate, but that leads to the question - do the policies cause the lower rate, or do those particular practices find it easier to implement the policy consistently?"

New Strategies for Reducing No-Show Rates at Your Practice 

To sum it up, here are the new tips based on Hart's latest findings:

  • Avoid making a blanket policy when it's really just a small segment of your patients who are consistently missing appointments.
  • Consider restricting appointment scheduling to same-day, or only one-day-ahead for chronic no-show'ers.
  • Don't focus your efforts on reducing no-shows for a certain day of the week / time of day / season. It's more about your policy than your timing.
  • If you know a particular patient no-shows frequently, consider double-booking the time slot in anticipation of them not coming. That way you won't miss out on income by having an empty spot in your schedule.
  • Many practices use automated appointment reminder systems. Consider additionally and directly contacting that small percentage of your patients who are most likely to no-show. A handful of calls today could fix a problem tomorrow.

For more details on Hart's study, check out these two posts from Chip's Blog:

7 More Tips to Reduce Patient No-Shows

In addition to the above food for thought, consider trying out the following strategies to improve your no-show rates.

1. Make Daily Reminder Calls

Designate a staff member to make reminder calls each afternoon for the next day's appointments. It can be a good idea to request that patients let you know if they can't make it, and remind them that you would appreciate the ability to offer the time slot to someone else if they know they won't be able to come in. This will prompt a timely cancellation rather than a last minute no-show. When you get a patient on the phone and have a verbal confirmation from them, they are less likely to no-show.

2. Set Up Automatic Reminders

Using an automated notification service to send secure text or email appointment reminders is a good idea even if you are already making reminder phone calls. It provides an additional avenue for reaching patients, and if you have a day when making reminder calls is not feasible, you'll still have your bases covered if you have automated reminders in place. For example, PCC's software includes a feature called Notify that lets you automate reminders for appointments (as well as recalls and account balance notifications). These services are so easy, it doesn't make sense not to use them.

3. Keep a Wait List

Keep a current and specific wait list so that you have options to fill in the gaps. You may want to include the days and times patients are available, and if they are close enough to your practice to take an appointment with short notice. If you do have a no-show, you can refer to this list to fill the time slot and not lose income.

4. Don't Wait to Reschedule Your No-Shows

Rescheduling no-shows after they occur is not a technique to prevent them from happening in the first place. However, the fact that you made an effort to reach out in person to check on the patient shows care and concern, and establishes the kind of personal connection that will make them less likely to no-show next time. Patients who miss an appointment will often make an effort to ensure they don't skip the next one.

It's a good rule of thumb to reach out to patients who no-show right away. If you wait for the patient to call you, you may be waiting in vain. Awkwardness over a missed appointment sometimes prevents people from calling.  Try waiting 10 or 15 minutes past the appointment time, and then make a call that sounds something like,

"Hi there (patient's name), we're calling to check in with you. We had you scheduled for a 10 a.m. appointment today and didn't see you. You may be on your way and running a little late, but if not, we want to make sure to get you back on the schedule as soon as possible."

Keeping a non-accusatory tone, rather than reprimanding the patient for missing the appointment or mentioning no-show fees is the way to go if you want to get that person back in the door. If your office does charge a fee, wait to bring it up until the next appointment when the patient is right there in front of you at check-in.

5. Some Patients Need Extra Reminders

Some patients like to get a reminder at a specific time, outside of when you typically make your daily reminder calls. Even if you call them the day before some patients just won't remember. For these patients, calling the morning of their appointment or even an hour or two prior will negate them becoming a no-show. This may seem like a lot of extra hand-holding, but the small effort it takes you to make an extra call is worth not losing the income from a missed appointment. Some patients may know this about themselves and request a reminder at a certain time. Or when you notice certain patients always forget appointments, suggest trying this strategy to them and watch how it will decrease your no-show rate.

6. Be Proactive with Your Schedule

Almost every practice has that one patient who shows up late for every appointment, every time. Like clockwork, they stroll in the door after their appointment time has passed by, still expecting to be seen. Rather than repeat this pattern every time, punishing them with no-show fees or turning them away from care because you are already with the next patient, you can choose to proactively manage the scheduling of these patients.

For example, some patients are very predictable with their late arrivals, showing up 15 or 30 minutes late every time. When you notice a strong pattern, tell them their appointment is at 10 a.m., have their reminder call remind them to come at 10 a.m., but put them on your schedule for 10:30 a.m. That way when they arrive "late" for their 10 a.m. appointment, they will be right on time for when you actually expected to see them and you will not have a gap in your schedule. This is not meant to be sneaky, and the scenario is uncommon enough that you won't need to employ this strategy too frequently. But with those patients who simply cannot be trained to arrive on time, this tip will save you a lot of frustration in the end.

 7. Have a Written Policy

Standard operating procedure should be that a patient reads and signs a missed appointment policy along with the other new patient paperwork at their first visit. Posting a sign at the front desk with this policy can also be helpful. That way, no one can claim they didn't know about the ramifications of no-showing for an appointment.

It's common to allow one missed appointment free and clear of any charges, but charging a missed appoinment fee for any no-shows after that should help reduce skipped appointments. Some practices will charge a nominal fee of something like $25-35, while others will charge the full cost of the appointment. The details are up to you. Of course, exceptions can be made on a case by case basis, and typically offices do not charge for sickness or emergencies. Additionally, patients with Medicaid legally cannot be charged.

Encourage your patients not to miss their appointment rather than punish them after they do. It doesn't take much effort to impact your results – something as simple as a reminder call can go a long way toward reducing your no-show rates. Give these tips a try and see for yourself.

Editor's Note: This post was originally published in December 2017 and has been updated for accuracy, comprehensiveness, and the latest best practices.

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Tags: business of pediatrics, practice management