Healthcare practice professionals know that when a scheduled patient doesn’t walk through the clinic doors at the appointed time, it sends a ripple of administrative follow-ups in its wake.
It’s simple math.
More missed appointments equals more work for front office staff and concern for patients who are not receiving needed care.
Every telephone call dialed to remind patients of upcoming appointments takes up to eight minutes. So the “call creep,” where one call turns into two and then three calls, can eat up valuable time and resources, especially if you have a high rate of no-shows.
And the revenue loss adds up. Healthcare practices lose an average of $265 per missed appointment that isn’t canceled beforehand — the definition of a no-show. The average national rate for no-show appointments is around 18%, depending on the health care offered, but during the pandemic it shot up as high as 36% for some medical clinics.
For specialty practices, a 2016 practice operations report by the Medical Group Management Association found most specialties had a much lower no-show median of 5%. Some specialties had higher rates, such as neurology and general surgery, with no-show rates for neurology and general surgery as high as 8 percent.
Calculating the no-show rate for your practice is simple:
Add up the number of booked appointment slots for the day, week or month.
Count up how many appointments ended as no-shows.
Divide the number of no-shows by the number of booked appointments.
Let’s say you work at a clinic specializing in post-surgery physical therapy. With four physical therapists on staff, open appointment slots stand at 50 patients per day. Over the course of one day, 12 patients were no-shows. Therefore, the no-show rate for that day would be calculated:
12 ÷50 =0.24 or 24%
However, as the specific weekday affects the percentage of no-show patients, a more accurate no-show percentage would be based on one week. So, for this physical therapy clinic, calculating the no-show percentage for one week looked like this:
48 ÷197=0.149 or 14.9%
That 14.9% no-show rate more accurately reflects the clinic’s average than does the daily rate, because patient behavior changes based on the day of the week. Studies show that Wednesdays and Thursdays usually having a higher number of no-shows, depending on the specialty of the practice.
But all healthcare practices should aim for a lowest no-show rate possible, no matter the type of care the practice provides or whether it mostly sees returning patients, or new ones, who in general have a higher no-show rate.
As Clinic-ology works with healthcare professionals to create more efficient processes and implement best practices, we recommend these top ways to reduce patient no-shows.
1. Make sure patients understand why they need to come.
There are many reasons patients don’t show up for medical appointments, and several are related to confusion and fear. According to the U.S. Department of Health and Human Services, only 12% of adults in the U.S. have proficient health literacy, while 77 million adults have only a basic or below basic understanding of human health.
This shows how crucial for quality healthcare is ensuring patients know why they need treatment using clear, simple and specific language. The alternative is patients not adhering to treatment plans, including showing up for medical appointments.
Clinics should ensure that patients:
Know the seriousness of their condition.
Recognize the risk of not treating the condition.
Believe in the positive effects of the treatment suggested.
Believe in their own ability to complete the treatment plan.
2. Avoid scheduling appointments far in advance.
The higher the lead time for an appointment, the greater chance of a no-show. So whenever possible, schedule appointments as close to the time of scheduling as possible. A 2017 study in the American Journal of Medical Quality found wait times less than two weeks significantly lowered no-show rates in cardiology practices.
3. Use multiple appointment reminders.
Quick, no-fuss reminders for upcoming appointments are a courteous way to jog a patient’s memory and can also increase patient loyalty. Text, emails and phone calls are all useful options. Because patients rely on different communication methods, use multiple ways for the greatest chance of reaching the patient, even if a patient’s preferred method is recorded in his or her file.
4. Send a “Sorry We Missed You” message.
Patients don’t always mean to no-show. Sometimes they simply forget or life gets in the way. Contact no-shows to let them know you’re sorry to have missed them and encouraging them to quickly reschedule. You can also include a reminder of your practice’s missed appointment policy.
5. Have a clear policy in place.
Your missed appointment policy should discourage patients from not showing up for scheduled appointments. Whether you charge a fee for no-shows, reward patients who do keep appointments, or limit the number of no-shows before patients may not reschedule, your policy should be clear and provided in person or through email at the time of the appointment is scheduled.
6. Provide an appointment card or printed copy of appointment.
This tried-and-true method is how many patients, in particular elderly ones, rely on. While technology has created electronic and automated reminder methods, handing an appointment card or a print-out through the front office window provides a tangible reminder along with a personal touch. And for patients without easy access or knowledge of digital communication, physical reminders are the only avenue available.
7. Reward patients for keeping appointments.
While this should be part of your missed appointment policy, it’s worth highlighting. Because who doesn’t appreciate being recognized for good behavior? Just as some policies add a fee for no-shows that is removed once the patient keeps a re-scheduled appointment, so should patients be rewarded for showing up. This can be in the form of a small discount on their bill or a drawing for a gift card for local goods or services.
8. Develop strong patient relationships.
A strong patient-practice relationship could be the best defense against no-shows. This begins with showing appreciation to patients upon arrival for keeping appointments to sending birthday and holiday greetings. Many practices send a weekly or monthly newsletter highlighting important news and trends in health and healthcare, especially tips patients can easily add to their health regiment. This is an effective means to improve patient health, strengthen your relationship with patients, and build confidence in the professionalism and knowledge of your practice.
9. Allow for pre-paid appointments.
Allowing patients to pay ahead of time provides a financial commitment to that appointment. Not only useful for self-paying patients, this can also apply to co-pays and deductibles for patients with third-party and managed care plans. Offering a small discount for prepaid appointments may be more than offset by a lower number of no-shows.
10. Automate, automate, automate.
Automated scheduling and reminders is probably the most effective and perhaps the easiest way to reduce your no-show rate. In one study of 43 Federally Qualified Health Centers, implementing automated reminders reduced no-shows by 49% by converting them into visits.
Using interactive text and email reminders let patients confirm their visits a day ahead of time. This allows a window of cancellation time, so an appointment slot can be re-scheduled and not end up as a revenue loss. These two-way communication method also can:
Offer directions to the healthcare clinic.
Include how to prepare for their visit.
Allow the patient to text or email back questions.
Automated, online scheduling is another tool that reduces no-shows by giving scheduling control to patients, who can see all open slots and choose the one that best suits their own schedule. In addition, allowing patients to cancel and reschedule appointments — within a timeframe spelled out in your missed appointment policy — can free up front office resources. Keep in mind, though, that staff should be trained in the patient scheduling platform to answer questions or troubleshoot if patients run into issues when self-scheduling appointments.
Clinic-ology has found that many private healthcare practices see a significant reduction in no-shows through these top best practices. But often finding time and resources to implement changes in front-office workflows and processes poses the biggest challenge.
Clinic-ology offers training, consulting and workshops, online and in-person, to train healthcare professionals in best practices that are proven to increase efficiencies, patient satisfaction, and practice revenue.
To get started, explore your options today: www.clinic-ology.com
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