What’s Your No-Show Rate?

Anyone working in an allergy practice knows that no-shows are a problem, but not every practice knows its no-show rate. Here’s a quick definition:

No-show rate: The percentage of appointment time lost because patients don’t show up or cancel at the last minute

To calculate your practice’s no-show rate, simply divide the number of no-shows (including late cancellations) by your total number of weekly appointments.

For example, if your practice typically sees 50 patients each week, and you have five no-shows, your no-show rate is 5 divided by 50, or 10 percent.

Determining your practice’s rate gives you an objective starting point from which you can make changes to address it. No-show rates vary by practice, but they’re typically somewhere between 5 and 10 percent (although they can be much higher). What influences a practice’s rate? Some factors include:

• Geographic location
• Patient demographics
• Scheduling practices
• Types of payers (commercial insurance, Medicaid, self-pay)
• Appointment types (new patients vs. established patients; appointments booked far in advance; appointments for certain types of tests or procedures)

We’ll cover some of these factors in more detail when we discuss common causes of no-shows later in the module.

Common Causes of No-Shows

What keeps patients from showing up as scheduled? You probably have a few ideas already, but let’s look at the most common reasons for no-shows and late cancellations. Patients miss appointments because...

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• They didn’t get an appointment confirmation.

  Perhaps your practice has a solid appointment confirmation system, but no system is perfect. Patients miss confirmations because their contact information is out of date, they don’t check their voice mail, or they didn’t get the text message you sent until it was too late to cancel and rebook.

• They don’t feel connected to the physician or staff.

  New patients tend to have higher no-show rates. This makes sense when you consider that people are more likely to show up when they have a personal connection to their care provider and feel engaged in their treatment plan.

• They booked their appointment far in advance.

  Patients who make appointments months or weeks in advance are more likely to simply forget about their appointments. Sometimes they’ve managed to see another physician in the meantime and they forget to cancel their original appointment. Or they might just start to feel better, making them forget why they made the appointment in the first place. This can be particularly relevant in cases where you need to wait for a patient’s reaction to subside before you can reliably test for an allergy—often, patients feel better before their next scheduled appointment and do not return.

• They’re confused about the need for the appointment.

  This can happen with scheduled follow-up appointments. If the patient’s symptoms have improved, she may not understand why she should still come back for a follow-up. Sometimes these patients cancel the day of their appointment, but it’s often too late to book another patient.

• They have personal issues preventing them from showing up.

  Patients might have transportation problems—their car broke down, or they missed the bus that would have gotten them to their appointment on time. Or they might have financial issues and are worried about being able to pay their copays or high deductibles. They might also have simple scheduling conflicts. Patients from certain demographics or with certain types of insurance (or no insurance) may be more prone to no-shows than others, so it’s important to keep track of these factors to help pinpoint the causes of no-shows.

Benchmarking and Creating Your Plan

Now that we’ve explored common causes of no-shows and some strategies to address them, let’s talk about how to put a no-show improvement plan into place at your practice. Creating a plan involves four steps:

• Benchmark your practice’s no-show rate.
• Gather data on the causes of patient no-shows.
• Identify the top causes of no-shows for your practice.
• Implement strategies to address those causes.

Let’s walk through these steps.

1. Benchmark Your No-Show Rate

   This step should be fairly simple, and you might have already done it using the formula we covered at the beginning of the module. Here it is again for review:

   No Show Rate and Costs Calculator
   No shows per week (including late cancelations):	*required
   Total # of weekly appointments:	*required
   Your no show rate is: 0%
   Cost per each no show:	$
   The cost of your no shows is:
   0 per month	0 per year
   CalculateReset

   For comparison purposes, recent MGMA benchmarks show median appointment no-show rates of 5% to 7%.¹  Some allergy practice managers cite higher rates of 10-15%. It’s most important to measure your own rate and use that as your starting point for improvement.
   
   It’s also a good idea to compare your no-show rate to your own on-time performance. Is your office chronically running behind? If so, this might make it easier for patients to justify missing their appointments. If possible, address long wait times in your plan so that patients feel valued and are more likely to show up.

2. Gather Data on the Causes of No-Shows

   You already know the common causes of no-shows generally, but in this step, you’ll want to drill down to the specific causes of no-shows at your practice. How do you find this information? You’ll need to train front office staff to ask patients why they missed appointments and to track what they find.

   This can be a sensitive question to ask. In some cases, such as late cancellations, a patient might volunteer the reason she’s missing her appointment, in which case your staff can document that reason. For example, maybe the patient calls to say her car broke down and she can’t make it, so she’ll need to reschedule. When a patient simply doesn’t show up, though, front desk staff will need to follow up with the patient within 48 hours. Here are some tips for those follow-up calls:

   • Express concern for the patient’s well-being, and ask if everything is okay.

     For example: "Hi, Mr. Brown. We were sorry to miss you at your appointment with Dr. Hernandez this morning, and I just wanted to make sure everything is okay."

   • Often, a patient will voluntarily explain their reason for not showing up. If he or she doesn’t, you can gently ask. Make sure the question is not framed in an accusatory way.

     For example: "Our practice is working on gathering data about missed appointments so that we can better meet our patients’ needs. May I ask why you weren’t able to come in? Did you receive your automated appointment confirmation call? Is this contact information I have for you correct?"

   • Be sure to reschedule the patient’s appointment, and at the end of the call, courteously remind him or her about your practice’s no-show policy.

     For example: "You are confirmed for an appointment with Dr. Hernandez next Tuesday, the 15th, at 10:30 a.m. You’ll receive a confirmation call two days before. Please remember that if you miss another appointment without giving us 24 hours’ notice, our policy is to require a deposit of $50 when you schedule your next appointment. We’d much rather just see you next Tuesday, though! Please give us a call if you have any questions or can’t make it for some reason."

   A patient’s stated reason for missing an appointment is just one piece of data you’ll want to collect. You’ll also want to keep track of objective details that might influence no-shows. You might have the ability to do this with your practice’s scheduling software. If not, you can create a shared spreadsheet where staff can enter information. Here’s what you’ll want to track:

   • Provider
   • Appointment day and time
   • Appointment type (new vs. established patient; new issue or follow-up)
   • Date the appointment was made
   • Patient’s demographics and insurance carrier
   • Patient’s diagnosis and reason for visit
   • Patient’s reason for cancellation/no-show
   • Whether appointment was confirmed

3. Identify the Top Causes of No-Shows

   Once your staff has kept track of no-show data for a sufficient period of time--a couple of months at minimum--you’ll hopefully start to see some trends in your data. What are the top causes of no-shows for your practice? Maybe patients who are scheduled for early-morning Monday appointments are the most likely not to show up. Or maybe patients with higher copays often miss their appointments. Make a list of the top causes of no-shows so you can begin to address them.

4. Implement Strategies to Improve Your No-Show Rate

   We’ve already talked about the strategies you might implement to reduce your practice’s no-show rate. These include:

   • Good appointment confirmation practices
     • Collect accurate contact information
     • Confirm, rather than remind
     • Call at least 48 hours in advance
     • Use a third-party vendor to automate reminders
   • Implement a practice-patient agreement
     • Explain your commitment to patients and what you expect in return
   • Determine consequences for no-shows
     • Consider implementing a three-strikes-and-you’re-out policy
     • Collect down payments from repeat offenders or for patch testing or other testing with specialized equipment
   • Adjust your scheduling practices
     • Limit daily appointment slots for patients likely to no-show
     • Consider overbooking
     • Reserve a few same-day appointment slots
     • Offer a patient online scheduling option
     • Offer telemedicine appointments
     • Keep a list of patients willing to come in on short notice

So how can you figure out which ones will be the most beneficial to your practice? Refer to the top causes you identified, and go from there. If many no-show patients say they didn’t receive a confirmation call, you’ll know you need to refine your practice’s confirmation procedures. If most of your no-shows happen at the same time of day, you can double-book those appointment slots to minimize lost time and revenue. If you have long-standing patients who seem to be used to treating their appointments as optional, you can create a new practice-patient agreement that spells out expectations and consequences of missing multiple appointments.