booking an online appointment with a doctor

Strategies to Reduce No-Shows


Why patients skip appointments and what practices can do to help 

Missed medical appointments waste staff time, affect practices’ bottom lines and result in negative outcomes for patients. A recent Forbes study found that no-shows cost the U.S. healthcare system more than $150 billion a year and can cost individual doctors an average of $200 per unused time slot. No-shows can also impact patients’ health by interrupting continuity of care. It means that patients are not being seen on a consistent basis, and therefore chronic conditions and medications aren’t being monitored regularly. 

Find out some common reasons for no-shows and what you can do to reduce them and improve overall patient adherence in your practice. 

Most common reasons for no-shows

A recent study published in Risk Management and Healthcare Policy found that there are several common reasons why patients miss appointments. These include: 

  • Forgetting about the appointment
  • Patient scheduling conflicts 
  • Miscommunication

The study authors noted that additional reasons for no-shows include a patient’s misunderstanding or confusion about the disease or the test, long wait time between scheduling and the actual appointment, insurance coverage, language and transportation difficulties.

Even one no-show makes a patient more likely not to return within 18 months or leave your practice entirely. 

Past patient behavior can be a predictor of future no-shows, according to an athenahealth study. Patients who missed even just one appointment with their primary care physician were much less likely to return within the next 18 months. Attrition rates varied by age, with patients 61 and over with one or more no-shows leaving a practice at a rate of almost 73%.

Solutions start with scheduling

Unsurprisingly, the answer to most no-shows begins with better scheduling. Start by offering patients appointment times that meet their needs. “One of the ways you do that is by allowing them flexibility in terms of access. You don’t schedule an appointment for three months out when it’s likely that person doesn’t know what they’re going to be doing three months from now,” primary care physician Christine E. Kistler, M.D., told athenahealth. 

Flexibility, shorter wait times and reminders are all keys to improving scheduling–and ensuring patients show up for their appointments.

In fact, a long wait to schedule an appointment is one of patients’ top complaints. Many practices address this issue by maintaining a patient wait list for next-available appointments and keeping a percentage of slots open for same-day appointments. Other anti-no-show tactics include offering evening and weekend appointments and allowing patients to book appointments online. 

You also may want to consider your current appointment model. Telehealth skyrocketed during COVID-19, and 83% of patients expect to continue to use telemedicine after the pandemic resolves.This is likely due to the convenience and time savings: telemedicine saves patients over 100 minutes of their time compared to an in-person visit. For visits that require testing and face-to-face time, consider the hybrid appointment model.

Give patients choices, Dr. Kistler said, and there’s a good chance they’re going to show up as scheduled — and return for their future appointments as well. Of course, appointment reminders are important as well. Just make sure you’re offering your patients options about how they want to receive reminder messages: by phone, email, and/or text. For more on automated patient communications, see 8 Tech Tips for Eye Doctors.

How patient education plays a role

Beyond scheduling and reminders, another key aspect of reducing no-shows involves addressing why a patient’s appointment is necessary. If a patient doesn’t understand that annual eye exams help detect and treat vision-threatening eye diseases early, for instance, they may not prioritize those visits. 

Or, if a patient feels that they’ve already tried everything with no results — a common complaint of dry eye patients — they may not feel motivated to keep an appointment with yet another doctor. They may also have concerns about the cost of various treatments or procedures and what their insurance will cover. 

Proactive patient education can help clear up fears, concerns and misconceptions that may contribute to no-shows. 

Proactive patient education is a powerful tool in preventing no-shows. Sending patients a video that reminds them to schedule their annual eye exam or to communicate COVID-19 safety protocols in your office is a great way to keep these important aspects of their care top-of-mind. 

For patients considering surgery, you might send them videos about the advancements in cataract surgery and reassure them that it’s not a dangerous or painful procedure. Additionally, videos can help set patient expectations around recovery times, as well as any post-procedure care or appointments they’ll need to address.

View Video

By sharing trustworthy, easy to understand educational materials, you’re reducing the chance of miscommunication and misunderstanding among patients of all backgrounds and health literacy levels, while increasing the likelihood that they will schedule and keep their appointments.

Download The Impact of Narrated Animations to learn how to educate patients on the importance of making appointments.


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