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Practice Pointers: How to handle no-shows


Getting tough is not enough. You've got to discover—and try to eliminate—the reasons why patients skip appointments.

For many practices, missed appointments are like a perpetual flu-always keeping them under the weather.

You can fill some empty slots with walk-in and same-day appointments, but probably not all of them, and such substitutes usually won't generate as much revenue as regular visits. One study took these factors into account and estimated that no-shows robbed a family practice residency clinic of 14 percent of anticipated revenue.

Diagnose the problem: Who are your no-shows? One traditional way of countering broken appointments is by overbooking patients. However, this does nothing to curb the problem, and it creates others instead, says Curt Mayse, a St. Louis consultant with the accounting and consulting firm LarsonAllen. "On days with fewer no-shows than expected, the doctor will fall behind," he says.

What's worse, longer wait times in the office due to the vagaries of overbooking tend to encourage no-shows. Research suggests that patients who don't feel respected by their doctor-"Hey, my time is valuable, too"-feel a greater temptation to skip.

To get serious about fixing the no-show problem, first diagnose the causes. For example, the longer out the appointment time, the greater the chance of a patient missing it. Forgetfulness, too, is a leading cause. No-show patients tend to be younger and male. Medicaid patients also are more likely to skip, partly due to transportation problems.

To get a picture of what's happening in your practice, query your practice management software for all no-shows over the past three months. Produce a table with columns for patient gender, age, insurance status, day of the week the appointment was made for, morning or afternoon appointment, new or established patient, and physician-any variable you'd like to explore. You may discover that most no-shows are new visits in the afternoon, or occur with a cold, uncommunicative doctor in the group, or on Fridays.

Remove access barriers that encourage skipping Patients are more likely to keep their appointments if you become more accessible. If you're experiencing an inordinate number of no-shows for appointments scheduled months in advance, consider adding an extra physician, nurse practitioner, or physician assistant so patients can get in sooner.

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Jennifer N. Lee, MD, FAAFP
© National Institute for Occupational Safety and Health
© National Institute for Occupational Safety and Health
© National Institute for Occupational Safety and Health
© National Institute for Occupational Safety and Health
© National Institute for Occupational Safety and Health