Strategies to minimize no-shows

September 26, 2016

No-shows are both costly and frustrating for allergists, resulting in lost revenue and reduced access for patients who need to see you.  Do you know your practice’s no-show rate, track it monthly and review no-show data to identify trends?  Understanding the reasons for your no-shows is key to developing a successful strategy to address them. 

Common causes of no-shows are:

  1. Lack of connection to the physician or staff.  New patients tend to have higher no-show rates.
  2. Appointments booked far in advance. Patients forget, see another physician, or just start to feel better.
  3. Confusion about the need for the appointment.
  4. Personal issues such as transportation problems, copays or high-deductibles, and scheduling conflicts.

What are some best-practices and strategies for allergists to reduce their no-show rate?

1. Appointment confirmations

These are critical, and should be done at least 48 hours in advance. That way, you still have time to fill any cancelled appointments.You can either use personal appointment confirmations or go the technology route.

  • Personal confirmations do require staff time, but they also provide a personal touch and allow you to reschedule the appointment if it no longer works for the patient.  They provide an opportunity to confirm the purpose of the visit, review instructions and paperwork, and address any patient concerns.
  • Technology is available to confirm appointments by automated call, text or email.  Ask patients their preference and provide the type of reminder they want. 

“We remind all patients of upcoming office visits one to three days ahead of time. We also call all our shot patients the morning of their injections that are scheduled. Although the reminders in the morning for allergy injections takes significant time and effort, it does keep most of our patients on track for their allergy injections. We also send them a letter if they are more than six to eight weeks out from their last injection warning them that they can be off injections if they go more than 10-12 weeks off,” said Kevin McGrath, MD, FACAAI.  

2. Implement a patient-practice agreement

Set clear expectations by implementing an agreement that outlines the practice’s commitment to the patient as well as the patient’s commitment to the practice.The practice promises to see the patient when needed, to do their best to run on time (with few exceptions), and to respect the patient.In return, the patient promises to follow the jointly developed plan of care, to keep appointments, and to let the practice know in advance if they are unable to keep an appointment.

3. Discharge repeat offenders

Patients with repeated no-shows should be discharged from your practice.Set a limit of three missed office visits.

4. Collect a down payment

Consider collecting a non-refundable deposit of $50 from patients with multiple no-shows.

5. Overbooking

Allergists with very high no-show rates might want to consider overbooking your schedule.Review your no-show data to determine if certain days/times have more missed appointments, and adjust your schedule accordingly. Start slowly, by adding one extra appointment at a time to avoid overwhelming your schedule.

A different type of overbooking can be used for clinics in underserved communities.Rather than discharging chronically ill patients with high no-show rates, create a separate overbooked schedule just for them.Let them know they are on probation and will be placed on this overbooked schedule when they make appointments; if they show up, they will be seen behind the regularly scheduled patient for that time slot.If they mend their ways and consistently show up for appointments, you can take them off probation; if not, consider discharging them.

6. Same-day appointments

If a lot of your no-shows are caused by appointments booked far in advance, you may want to look at improving patient access. Consider blocking 1-2 appointments in your schedule to be released 24-48 hours in advance; that ensures same-day access for patients and discourages booking way in the future.

Charging for no-shows? This strategy has become less popular, as it isn’t very effective and annoys patients.  Plus, the cost to bill for and collect these fees is often more than the fees themselves.

No-show rates vary by practice and depend on geographic location, patient demographics, scheduling practices, etc.  Start by calculating your no-show rate and investigating the causes.  Benchmark against your own performance and work to improve it.