Reducing No-Shows (Part 3 of 12)
Thursday, September 30, 2004
Many dermatologists get an unwelcome break in the day thanks to
patient no-shows. No-show ratios - the percent of patients with
appointments who do not show up - hovered around 10% in many
practices we interviewed. That is high relative to other
specialties, and there are some good reasons that dermatology
practices suffer from an inordinate amount of no-shows.
Most practices interviewed by The Patient-Centered
Dermatology Practice had a 10% appointment no-show
One is complicated patient insurance coverage. No-shows are
highest for patients paying for at least some of the visit
out-of-pocket and for patients visiting only for aesthetic (ie, not
covered by insurance) treatments.
Long wait times in some practices also exacerbate the problem.
Patients may need to wait as long as 2 months to get an appointment
as a new patient in some dermatology practices. By the time the
appointment arrives, the patient's problem might have resolved or
she might have found another, more accessible practice to treat
Weak physician-patient relationships also make no-shows more
likely. If a patient sees the same physician each time,
appointments are more likely to be kept. If a patient is forced to
see a new locum at every visit, expect high absenteeism.
Most no-shows can be attributed
- Patients with higher out-of-pocket
- Weak physician-patient
- Patients who don't realize they'll be
Probably the biggest reason patients don't show up is
because they don't realize that they will be missed. They don't
realize the impact on the practice, their physician, or their
health when they skip an appointment. It's up to you to teach
While patients are in the office, physicians should communicate
to them how important it is to keep upcoming or future
appointments, particularly for the sake of the patient's health.
Make new patients familiar with cancellation and no-show policies.
Before the patient leaves or while scheduling a next visit, office
staff should clearly communicate the date and time of the next
appointment and provide an appointment card or other printed
Practices should place reminder calls to patients, preferably 24
to 48 hours before the appointment. Automated systems can handle
the calls for you. It's even a good idea to ask patients to call
back and confirm that they will keep the appointment, particularly
for new patients and procedures.
Although more costly and time-consuming than phone or e-mail
reminders, many practices find that sending postcards or letters
reminding patients of upcoming appointments is the best way to keep
no-shows at a minimum.
Other tactics are to institute repeat-offender policies that
give less favorable times to patients who fail to show up for two
or three appointments without calling. Some practices will even
dismiss these patients after three or four no-shows. At the very
least, try putting a note in your scheduling template either always
to schedule them at the end of the day or to double-book these
patients when their potential not to appear will have less
Some sites we spoke with were considering fining patients who
missed an appointment - charging, say, $20, for a missed
appointment in order to reinforce the need for patient compliance.
This tactic feels good at first but doesn't always work in the long
run. You may find your staff spending an exorbitant amount of time
tracking down the offender just to collect the fine itself. If you
decide to implement a charge anyway, make sure to let patients know
about it in advance; they need to know the consequences in order to
change the course of their actions.
To avoid misunderstandings, establish clear-cut policies and
consequences for no-shows, and stick to them. No-show and
cancellation policies should be detailed and specific. For example,
how far in advance do you expect appointment cancellations to be
made? How late can a patient be before they are considered a
no-show - 15 minutes? 30 minutes? What are the consequences of
missing an appointment without notice - a penalty fee, reduced
access to the practice, or termination?
Include a detailed outline of your cancellation and no-show
policy in your patient handbook (if you provide one), or give a
printed version of the policy to every new and existing patient. An
abbreviated version of the policy can also be posted in a visible
area of the waiting room or near the front desk.
If, despite all efforts, no-shows remain a problem in your
practice, keep clear, consistent records of missed appointments and
follow up on no-shows. If a very ill patient misses an appointment,
make every effort to find out why as soon as possible. While
follow-up calls can be time-consuming, they can be well worth it if
they prevent problems. No-shows may pose a significant liability
risk. A patient who misses appointments and suffers injury as a
result may have a viable lawsuit if he or she has evidence that the
physician did not give clear directions or make reasonable efforts
to make sure the patient complied with advice, including follow-up
Our essay next month will be "Preparing for the Visit."