Small practices can act fast on no-shows. The challenge is the data, a physician leader says

Physician practices that blame missed appointments on patients may be overlooking the real causes, and the fixes, said a physician who became a health care operations leader.

No-shows are an operational issue that can be studied and reduced, said A.G. Ghanim, M.B.B.Ch., health care senior manager at the University of Michigan. He also is founder of ZLinQ Consulting, with a six-step process to define, diagnose, prioritize, design, implement and optimize solutions for patient no-shows.

Practices that take time to diagnose what drives their own missed appointments can cut no-show rates sharply, sometimes with simple, low-cost changes.

"The more you study no-shows, the more you understand how to deal with it and how systems can actually benefit from it," he said. Ghanim, who was a presenter at the Medical Group Management Association (MGMA) 2026 Annual Conference, discussed no-shows in a video interview with Medical Economics.

What does a no-show really cost?

Published research shows no-shows are a worldwide problem, with average rates of roughly 23% to 30%, Ghanim said. The financial loss from a missed visit is only part of the cost. Behind every appointment are hours of work by scheduling and prior authorization staff, much of which must be redone when a patient doesn't arrive.

He saw the effect firsthand while managing a pain clinic, where an anesthesiologist, surgeon, nurses and staff could all be waiting at 7 a.m. for a patient who didn't come. Unlike some outpatient clinics, that kind of setting can't simply overbook.

Patients pay a price, too. At large institutions, new patients may wait a year to see certain specialists, and a missed visit can push care back much further.

"So it's affecting not just one patient, actually affecting two patients: the patient that missed the appointment and the potential patient that could have covered this appointment," he said.

Why don't reminders fix the problem?

Many practices that seek his help have already tried reminders and other measures without much success, Ghanim said. They act before they understand what is causing their no-shows.

His approach starts with defining the problem, diagnosing it and identifying the most important drivers, which can take several weeks of collecting data. There is rarely a single cause, he said, and the more drivers a practice addresses, the more its rate improves. Some clinics he has worked with went from a 19% no-show rate to 7% or 5%.

"But you do not act before you understand," he said.

He cautioned against easy explanations. Some clinics in low-income areas assume poverty explains their no-shows, but Ghanim said everyone, rich or poor, wants to be healthy. Clinics in those areas improved significantly once they investigated the real reasons, he said.

"This is one of the symptoms. This is not the cause," Ghanim said.

Do small practices have an advantage?

In some ways, yes. Independent physicians can put a new workflow in place almost immediately, while a large health system may need weeks to align departments such as a centralized scheduling team, Ghanim said.

"In a small independent practice, basically, you own everything. If you have a plan, the plan can be executed tomorrow because you are the big boss," he said.

The trade-off is data. Small practices may lack advanced electronic health record (EHR) reporting or data staff, making it harder to pinpoint causes. Large systems have the data but move slowly. Either way, once leaders see what is driving their no-shows, they tend to commit to the fix, he said, and the solutions may not require much money.

That matters most for services with thin margins, such as sleep labs, where losing one or two patients a night is costly.

"So it's very important for them, especially when you have a very thin profit margin, to understand that 1% or 2% no-show rates can affect your income over the whole year," Ghanim said.

Medical Economics was in San Antonio at the MGMA Annual Conference, Sept 27-30, celebrating 100 years of MGMA, attending sessions and speaking with industry leaders. Follow our coverage on our MGMA conference page.