Your Complete Guide to Patient No-Shows

How much are cancelled appointments and no-shows costing you?

Nothing is worse than being stood up — especially when it affects your bottom line.

Patient no-shows are a longstanding thorn in the side of many eye care practices and can hurt your bottom line, snarl your operations, and result in negative health impacts to the patient. As practices come under increasing revenue pressure, stemming the tide of no-shows is particularly important — and a potentially easy way to pad your bottom line.

Reasons why patients don’t show up for appointments

  • Patient no-shows cost the healthcare industry $150 billion annually
  • For a standard checkup, a no-show can cost your office as much as $200 in lost revenue. This figure jumps considerably for specialty appointments and surgeries.
  • No-show rates vary by practice, discipline, and location, with estimates hard to come by. Many practices which have made a concerted effort to lower their no-show rates got those rates down to around 7%.

No-shows occur when a patient fails to show up for a scheduled appointment with no prior notification to the healthcare provider. Not only is this lost revenue for the provider, but it represents an inadequate use of resources and may even lead to wasted resources. It also can impact the health of patients in the form of missed diagnoses, and lead to patient dissatisfaction when they run into trouble rescheduling their appointment.

So why are these patients going to the trouble to make an appointment and not show up? There are several possible reasons:

Patient-related issues:

  • Patients may not see a no-show as that important to them
  • Their condition may have improved
  • They have fear and anxiety about the appointment, its procedures, or its findings
  • They may not be able to arrange child or elder care in their absence
  • They may simply forget or oversleep
  • Patients may fear the cost of the visit and/or procedure

Environmental-related issues:

  • Patients may not be able to arrange suitable transportation
  • Weather may prevent their arrival
  • Patients, especially those who are older or have physical limitations, may not be able to find suitable parking

Time-related issues:

  • Appointments made months in advance are more likely to result in no-shows or last-minute cancellations

Who is most likely to be a no-show? According to one study, the patients most likely to miss appointments include those who are:

  • Single
  • 34 or younger
  • On Medicaid or who have no insurance coverage
  • Have chronic conditions
  • Live more than 60 miles from your office
  • Are elderly and/or recently widowed or divorced

What happens when patients don’t show up for their appointments?

Two parties are impacted when patients don’t show for their appointments: You and them.

For patients, the impact mostly boils down to delayed treatment and diagnosis. Delayed treatment can add to patient discomfort and result in more involved appointments down the road. Delayed diagnosis can mean patients live with pain or injury, and potentially with life-altering conditions which could be cured or mitigated.

For practices, no-shows can result in:

  • Lost revenue and profit
  • Inefficiencies
  • Wasted resources
  • Increased patient attrition
  • Difficultly building a reliable and accurate staffing schedule
  • A tendency to over-book appointments in the future, which carries its own set of risks

Ways to reduce the number of no-shows at your practice

Understanding why patients are no-shows at your practice is the first step to creating a plan to reduce no-shows. With that knowledge in hand, it is possible to pursue one or a combination of tactics that will reduce the number of no-shows at your practice. Those tactics include:

  • Create appointment reminders: Since many patients simplify forget to show up, an effective reminder system can help fight this. Methods include phone, email, text, and even social media. Stick to one platform for each patient, and consider sending more than one reminder: one week out, one day out, and one hour out, for example. In the reminders, make sure to include personalized information such as appointment date and time, reason for visit, doctor they will see, office location, and a means to confirm that they will be there.
  • Make it easy to cancel: Provide many opportunities for patients to cancel their appointment. No, no one wants a cancellation, but a cancellation is better than a no-show since it gives you the opportunity to fill that time slot. Cancellations could be made by phone, text, or email. Have you moved to a digital scheduling system? If so, cancelling appointments using your calendar can be much easier on patients who may hesitate to look up your number, call, wait on hold, and then engage with staff. Click and done.
  • Starting a wait list: Even responsible patients may need to cancel from time to time. Technology is making this process easier, and special messaging apps and programs can immediately alert patients who are on a wait list that there is an opening.
  • Ban bad patients: No one wants to turn patients (or money) away, but simply banning patients who reach a certain number of no-shows can save you money and headaches in the long run.
  • Don’t reschedule missed appointments: Similar to banning bad patients, this means simply not encouraging them to make a second try, although you may accommodate those who call to reschedule.
  • Develop a relationship with patients: Just like you do with your neighbors and friends, you are less likely to inconvenience people who you have a relationship with. Building a relationship with patients takes time but can go a long way toward easing many aspects of your practice. You can build this relationship in many ways. For example:
    • Treat patients as friends, not transactions
    • Know the patient’s name and greet them by their name
    • Enable your staff to take extra steps to help them feel valued
  • Reward patients for showing up: This could be seen as the opposite of charging patients for a no-show. Charging is tempting tactic that will likely backfire and eventually result in lost patients — including those who would likely never become a no-show but who would recoil at the thought of possibly being charged in the event of a situation that is out of their control. Your reward policy could work in any number of ways — on-time patients are entered into a drawing for a prize each week, for example, or are allowed to spin the wheel for a prize on their way out the door.

Since many of these methods involve communication, make sure you are closely following all HIPAA rules. Need help? A consultant like Eye Care Leaders can offer valuable advice.

Other scheduling strategies your office can use

Besides rewards, reminders, and relationship building, your practice can also strategize to handle no-shows by adopting the right scheduling strategy.

As noted by Eye Care Leaders, there are three scheduling options that can decrease wait times, shorten turnaround times, and maximize efficiency. Those include:

  • Integrated scheduling: Practices create appointment slots for long exams or short follow-ups, with one, for example, occurring in the morning and the other in the afternoon, or alternating by doctor.
  • Top of the hour scheduling: Allowing for a set number of appointments per hour so the doctor’s schedule resets every hour.
  • Cluster scheduling: Grouping patients with similar exam types, conditions, or treatments and scheduling them during a certain time block.

Which scheduling method is best for accommodating no-shows in your eye care office may depend on a number of factors. One factor that you should likely avoid, however, is double booking in anticipation of no-shows. Double booking is an easy way to create rushed visits, poor patient engagement, and hurt feelings, which upsets patients and stresses staff.

An alternative may be so-called open access scheduling, which leave a certain portion of each day open for new patient appointments. By leaving same-day and walk-in appointment times, you can capture a large number of new patient appointments — the very kind who may be likely to cancel or no-show.

No-shows and COVID-19: What you should know

Studies have shown that patient visits to doctors of all types decreased dramatically during the COVID-19 crisis, due in part to reduced practice hours, social distancing rules, and rising unemployment, which caused many people to lose their health insurance.
With lockdowns relaxing, the medical industry is seeing a return to normalcy. This would seem to indicate that no-shows will again become a factor for eye care practices, with one extenuating circumstance: telehealth. Yes, the rise of telehealth during the COVID-19 pandemic had a silver lining: the no-show rate of telehealth visits during COVID-19 was estimated at 7.5%.

To learn more about how you can reduce the impact of no-shows at your practice, don’t hesitate to contact Eye Care Leaders today.

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