No-shows: Why they happen and how to stop them

By Jules Murtha | Fact-checked by Barbara Bekiesz
Published May 18, 2022

Key Takeaways

  • Patients who miss appointments may face health challenges due to discontinuity of care, on top of wasting their healthcare facility’s resources.

  • Doctors can use no-show prediction models—such as those based on data imputation methods and local weather patterns—to identify potential no-show patients.

  • Physicians who treat patients who miss appointments can utilize no-show policies including gentle reminders, no-show fees, and specific exceptions.

How often, on average, do your patients fail to communicate that they’ll be missing an appointment? Some healthcare facilities report no-show rates ranging between 3% and 80%, according to a study published in NPJ Digital Medicine.[]

When patients don’t show up, everyone suffers.

The patient sacrifices continuity of care, the healthcare facility’s resources go to waste, and you’re left with a window of time that could’ve been used more efficiently. To prevent no-shows, doctors can implement an interpretable prediction model based on the patient’s data and local weather patterns.

Why do patients ditch appointments?

Patients fail to show up to scheduled appointments for a number of reasons. A 2019 study published by the Kansas Journal of Medicine found the following five primary causes for no-shows at urban academic residency clinics:[]

  • Forgetfulness. Patients are busy. They often forget they have an appointment scheduled amid the hustle and bustle of daily life.

  • Transportation issues. Many patients don’t own cars, especially in urban areas. Public transportation may be inconvenient or unreliable, and the same is true for rides from friends or family. Sometimes a patient just can’t get to your office.

  • Personal health challenges. If your patient’s symptoms have worsened or another issue has developed since you last saw them, they may  miss an appointment due to physical pain or immobility.

  • Professional and familial obligations. Outpatient care isn’t a top priority for some patients who have work and family obligations. They may put their own healthcare on hold while they tend to a family member who needs them or who has fallen ill.

  • Miscellaneous challenges. Wait times, financial barriers, and unpredictable weather changes all contribute to no-shows.

Other factors related to missed appointments include scheduling conflicts, traffic, environmental factors, socioeconomic status, and being on public insurance.

Fortunately, there are strategies physicians can use to address no-shows before they occur.

Prevent no-shows with prediction model

Physicians can use a predictive model to gauge the likelihood of no-shows based on patient data and local weather patterns.

This interpretable methodology, as described in the NPJ Digital Medicine study, relies on a data imputation strategy, based on missing-ness indicators in each patient’s records. This allows patients with incomplete records to be included in the model, which gives a more accurate prediction. Usually, only complete patient records are considered in baseline predictive models, but in the study’s database, that would have been only about 23%.

In addition to utilizing the full breadth of patient records, an efficient prediction model will exploit local weather patterns to anticipate the likelihood of no-shows. Bad weather may not only affect transportation issues, but it may also negatively impact patients’ mental health or physical condition, making it harder for them to leave home.

Considering factors like wind speed, humidity, ambient temperature, and atmospheric pressure will increase your predictive model’s accuracy, according to NPJ Digital Medicine.

Once you have a good idea who’s likely to miss appointments, schedule appointment reminders through email, text messages, and phone calls. Figure out the optimal frequency for sending these reminders to maximize this strategy.

Stick to a no-show policy

Regardless of the type of predictive model you may use, it is a good idea to develop (and maintain) a no-show policy.

The Texas Medical Association suggests committing to a progressive policy that addresses no-shows by reminding patients why it’s crucial that they keep their appointments.[] Under this policy, a patient who fails to communicate that they’ll miss an appointment receives a warning that they’ll be charged a no-show fee in the future.

Remember: You’re not allowed to bill patients for missed appointments if they’re on Medicaid.

You can, however, help Medicaid patients get free transportation to appointments through state programs. You can bill Medicare patients for missed appointments if this is done consistently. When in doubt, read through payer contracts before charging patients for no-shows.

Additionally, make your policy clear on your website, patient intake forms, office signs, and appointment reminders. You can make exceptions only for patients in crisis.

Finally, document patients who’ve missed appointments, and follow up with a phone call as necessary.

What this means for you

No-shows create problems for patients, healthcare facilities, and you. To minimize them, implement an interpretable prediction method based on patient records and local weather patterns. Further reduce the likelihood of no-shows through email, text, or phone call reminders in advance. Commit to your policy regarding no-show consequences. Implementing a no-show fee may further reduce the incidence of missed appointments and keep patients more faithful to their own healthcare.

Related: Should you fire your patient?
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