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American Academy of Family Physicians
Friday Oct 12, 2012

No shows = lost revenue

Medical practices average a 5 to 7 percent no-show rate, according to the Medical Group Management Association (MGMA). No-show appointments are a reality of every medical practice. While you may not be able to eliminate them, there are ways to reduce no-shows and the negative effect they have on your practice.

Maintain patient access. The longer you require a patient to wait to be seen, the more likely they will find care from another provider, especially if it is something they need to be seen for right away such as an ear infection or strep throat. In these cases many patients do not call to cancel the future appointment with you, they just don’t show up as they have received care somewhere else.

Make sure you have assigned acute appointment slots in your schedule every day to see these patients the same day they call. Seeing just one more patient per day can accumulate into a large amount of additional revenue each year.  According to Michael O'Connell's MGMA Connexion article, "10 ways to manage better during difficult financial times," adding just one more patient to your schedule each day can add $25,000 to the annual bottom line for primary care (estimating $100 for a new patient visit).

Remind patients. Remind patients that they have an appointment with your practice. Assign staff to remind patients at least 48 hours in advance of their appointment or consider using an automated appointment reminder service if it makes financial sense for your practice.

Require appointment confirmations when appropriate. Long appointments such as procedures or complete physicals take up a lot of time on a physician’s schedule. For these types of encounters you may want to require that the patient confirms the appointment with you. Confirming long appointments can prevent huge gaps that can have a negative effect on your day. Confirmations can be done using automated reminder systems or personally asking patients to call back to confirm the appointment rather than leaving a message and hoping they received it.

Manage chronic offenders.
Identify the patients who chronically miss appointments. Place a note in the patient’s record for the schedulers to see during the scheduling process. If a chronic no-show patient requests an appointment, try double-booking them with a quick visit or give them an appointment at the end of the day where the missed appointment will not disrupt patient flow.

Dismiss chronic offenders from your practice.
Patients that repeatedly no-show for appointments can be terminated from your patient panel. Develop a policy for your practice to dismiss these patients and be consistent with every patient. For example, allowing a specific number of no-shows prior to dismissal gives the patient an opportunity to accidentally miss appointments before being terminated from the practice. Three missed appointments prior to termination is a reasonable policy to put in place.

Consider charging no-show fees.
If you have tried other methods to decrease your no-show rates and are not seeing results, you may want to implement a policy to charge a fee for patients that do not show up for appointments to recoup some of that lost revenue. 
There are some important aspects to consider before moving forward with a no-show fee policy:

  • Some payers allow charges for no-shows.  Is your office capable of tracking who can and cannot be charged the no-show fee?
  • What is your patient population like? Can the average patient afford to pay the fee for a no-show appointment? Will they ignore these charges and make it difficult for you to collect the fee? You don’t want the implementation of a no-show policy to lead to a more complicated problem of collecting the fees from your patients.
  • Will the amount of the fee charged compensate for the amount of time it takes to bill and collect from no-show patients, or will you be losing money on this effort?
  • Your patients may seek care from another physician. If the patient does not approve of the no-show fee, they may leave your practice voluntarily and you could lose that patient and the revenue of future visits.


How do you keep no-shows from ruining your day in your medical practice? Click on “Comments,” below, and share your ideas and best practices.

–Renae Moch, MBA, CMPE, Practice Management Strategist for the American Academy of Family Physicians

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