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Everything You Ever Wanted to Know About Reducing No-Shows and Cancellations In Your Practice

Don't have time to read? Listen now.

Understanding Why Patients No-Show

Missed appointments can have a huge impact on your healthcare practice. The wasted staff prep time and unnecessary holes in your schedule can lead to lost revenue. Not to mention the effects your patients will feel from the interruption in care, longer wait times, and decreased accessibility.

No-shows are, unfortunately, pretty common. No-show rates have been shown to range from 15-30 percent in general medicine clinics and urban community centers, and as high as 50 percent in certain specialties (click here to see the national average no-show rate for your specialty and here to calculate your no-show rate).

Very few things in your practice are as frustrating as someone who doesn’t show up for their appointment or cancels at the last moment. You’ve already prepped, reviewed the file, scheduled staff, and then suddenly—you’re standing there without a patient to see.

The reason a patient fails to show up for an appointment often has to do with one of the 3 Fs: finances, fear, or forgetting.

Finances. Financial concerns are one of the most common reasons patients fail to show up for an appointment they’ve scheduled. No one likes talking about money, not even in their own families. However, for the sake of your patients and your practice, this is a conversation that needs to be had from the very beginning. Try to be straightforward, open, and honest with patients about your fees, which insurance you accept, and your payment expectations and billing practices. Being clear about policies and payments, and answering questions in advance of treatment decreases the risk of a patient becoming a no-show.

If patients are concerned about money, there are options you can share with them. Offering a program such as CareCredit can provide patients with simple financing to cover larger expenses like extended treatment plans. There are also programs through Medicare and Medicaid that may be available to them as well. If you offer payment options, such as breaking the cost of a large expense into smaller, monthly payments, you’ll be doing your patients a wonderful service.

36% of patients simply forgot their appointmentsFear. Healthcare exams of any kind can be intimidating or even frightening for some patients. The sterile atmosphere and not knowing what to expect can make certain patients uncomfortable enough that they will procrastinate or no-show for annual exams or follow-up appointments.

Some patients become a no-show because they fear getting bad news, while others worry about being lectured for putting off procedures or not following their provider’s advice. As patients age, procedures such as colonoscopies, stress tests, glaucoma screening, or tooth extraction become a realistic concern for them and something over which they may feel moderate to severe anxiety. The key to relieving most healthcare-related fears is information and education. Most fear is a result of facing the unknown. Patients who don’t feel that they know what to expect may choose to avoid the unknown and either cancel their appointment at the last minute or simply no-show at your office.

Cultivating an office full of compassion is a great antidote to fear. Read more about the power of compassion in our guide, “Discover the Secret Sauce of Patient Satisfaction”.

Forgetting. People today are living increasingly busy lives. We rush from place to place, scrambling to get everything done on our to-do lists. It’s easy to see why patients may forget a scheduled appointment. Studies show that 36 percent of missed appointments are because they simply forgot. One of the best ways to fight forgetfulness is through the use of appointment reminders. Check out the next section in this guide to read more about the best ways to use appointment reminders in your battle against no-shows. 

Creating Appointment Reminders that Fight No-Shows

23% of patients missed appointments without a reminderThe number one reason patients say they miss a doctor’s appointment—36 percent of all no-shows, according to one study—is simply “I forgot.” But new technologies can play a major role in greatly reducing that number. Reaching out to patients via email, text, phone call, or even social media has been shown to be effective in reducing no-shows, and can be personalized for each patient’s or patient groups’ preferred method of communication.

It’s more than just picking up a fancy new method of communication; using technology to remind patients of appointments actually works. A study by the Robert Wood Johnson University Medical Group found that 23 percent of patients who didn’t get a reminder missed their appointments. The number of no-shows fell to 17 percent when patients were sent an automated appointment reminder. Another study showed that the no-show rate among patients who received email reminders decreased by 35 percent.

Automated reminders are simple to use and allow you to remind patients in advance of their appointment. Using automated reminders can nearly guarantee that your patient will receive the reminder in plenty of time to accommodate the appointment time, or at least to give adequate time to reschedule.

Here are a few tips for creating effective appointment reminders:

  1. Choose just ONE method of contact (text, phone, or so on) for each patient and stick to it. Studies show that this is way more effective than scattering reminders across different platforms.
  2. Send an extra message if you have a patient that has scheduled far in advance (eight weeks or more) because those patients are statistically MUCH more likely to forget.
  3. 35% less no-shows from email remindersWhen sending reminders, always remember to take your cancellation policy into consideration. If you charge a fee for appointments cancelled with less than 24-hours notice, for example, you should make sure to send a reminder prior to that time.
  4. Send reminders on a set schedule that works for your patients. We recommend using the 1-2-1 method. One week before the appointment, two days before, and one hour before. Just remember 1-2-1, and you’ll be golden.
  5. Include personalized information such as:
    • Appointment date and time
    • Reason for visit
    • Doctor they will be seeing
    • Office location
    • Confirmation they can make it
  6. Add dynamic messages where needed. How many times have you had to reschedule an appointment because someone forgot their insurance card, or to not eat before they came, or whatever it may be? It’s happened to everyone. Too many times. Dynamic appointment reminders are an awesome way to prevent this problem. Technology has reached the point where you can automatically add instructions to appointment reminders based on the type of appointment scheduled. Instead of relying solely on your patients’ memory, you can set pre-visit instructions to be automatically included in specific types of appointment reminders. Not only will this save you time, but it will also reduce the number of rescheduled appointments.

For more tips on creating the perfect appointment reminder, check out this webinar. 

Or check out this blog to learn more about reducing no shows in your practice. 

Reminders reduce no-shows 30-50%

Which Type of Reminder Works Best?

To best avoid no-shows, you need to understand which type of appointment reminder will work best for each patient. An extensive 2017 study found that using the right method to remind patients of appointments is one of the best ways of ensuring they actually show up. It’s also way more efficient for your office. You don’t want to waste time calling a patient who is more likely to respond to a text message or email reminder.

But people are constantly on their phones, right? While this is true, most people aren’t actually speaking with another person. How is that possible? Because most “phone” conversations are actually happening through text messages. Thank goodness, now we don’t have to listen to everyone else’s conversations.

Actually calling someone on the phone is becoming an outdated and ineffective way to communicate. We’ve come so far from the days of three-hour phone calls, that phone calls even feel intrusive. This is true with our business relationships as well as our personal ones. Patients don’t want to stop everything they are doing to answer their phone, so as a result, they don’t.

90% don't answer incoming calls

So how do they want to be reached? Research shows that the following are generally favored as appointment reminders (in this order):

  • Mobile messages—both text messaging and email
  • Phone calls
  • Electronic calendar reminders
  • Postcards
  • Social media reminders

Again, wherever possible, it’s best to find out what each patient prefers and adapt to them.

In addition to sending the right type of appointment reminder, makes sure these messages are automated. By automating tasks like appointment reminders or confirmation/cancellation emails and filling last-minute openings—as well as other notifications to engage patients—healthcare facilities can drastically cut revenue loss as well as reduce their staff’s workload, letting them focus on delivering the best care possible. It’s a win for everyone.

If you’re wondering what you need to look for in a texting solution, we’ve created a checklist for you.

Filling Last Minute Cancellations

Sometimes, no matter how responsible a patient is, circumstances prevent them from making their appointment. It’s frustrating for you and for your patient as well. It’s estimated that around one in four scheduled appointments will end up being canceled by patients. This doesn’t even count the appointments where no one shows up. This refers to the patients who contact you and cancel. These cancellations lead to big holes in your schedule and a loss of revenue.

But there is good news. A cancelation means there’s a chance for you to fill that appointment. If the patient hadn’t contacted you, they likely would have just been a no-show. A cancelation is way better than a no-show! The best way to tackle last minute cancellations is by keeping an active wait list.

Many offices use wait lists to fill vacancies in their appointment schedule due to cancellations and once again, technology is making the process better. Special messaging apps and programs can immediately alert patients on the wait list of an opening through text or email, rather than requiring a staff member to call each individual patient to fill the slot. The feature improves patient access to care and their relationship with the physician, as well as reducing the amount of revenue lost due to no-shows. Research has found that 91 percent of patients would accept a last-minute appointment due to a cancellation if they were offered the slot.

Starting a wait list is easy. Simply:

  1. Collect the names of patients who would like to be seen earlier than your next available appointment as well as the best way to contact them.
  2. Set up your system to immediately alert patients of a schedule opening via group email or text message. Text message is typically the best option as it is read faster and more regularly than email. In fact, 90 percent of text messages are read in under three minutes.
  3. Let the patients come to you! You can quickly fill the slot and make both that patient AND your bottom line a lot happier.

90% of text messages are read in under 3 minutes

For more tips on creating schedules that work for you, read the blog post, “6 Ways to Schedule Patients Effectively and Efficiently.”

Staying HIPAA Compliant when Texting or Emailing Patients

It can be a scary world of compliance out there. We need to keep things private and confidential and secure. We see stories in the news and media about data breaches on nearly a daily basis. It’s important that we have regulations in place to keep patient information confidential. But reaching out to patients via text and email are typically their most preferred options.

Fortunately, you can be compliant with email and text, communicate with patients, and build a thriving practice. You simply need to understand how to communicate and still stay within the boundaries of the law.

HIPAA in a Nutshell

Enacted in 1996, HIPAA stands for the Health Insurance Portability and Accountability Act. HIPAA provides rules around uses and disclosures to keep protected health information (PHI) private. What is PHI?

The HIPAA Privacy Rule defines PHI as “individually identifiable information transmitted or maintained in any form or medium by a covered entity or a business associate.” Wow. That’s a mouthful. 

 HIPAA regulates:

  • How and when to disclose PHI
  • Ways you have to protect PHI
  • Patient rights to access their own information
  • Receiving and communicating PHI via text message or email

Receiving and Communicating PHI via Text Message or Email

Let’s say a patient texts or emails you a question (or a picture) about a health issue they are facing. Now what?

Patients are allowed to send you any PHI that they want. That is their information and they have the right to do with it as they please.

Things are not quite so easy for the practice. If you would like to enter into a conversation about a patient’s health, you need to make sure you are covered. You are not allowed to forward that information or continue an electronic conversation about PHI in an unsecured way without the patient’s consent.

The best thing to do in a situation like this is to reply with a message requesting the patient’s consent to discuss their PHI.


“Hi John. It looks like you’d like to discuss your health in a little more detail. Email (or text) is not a secure way to do that. Do you still want to carry on a conversation?”

Once the patient gives you permission, you are then allowed to continue the conversation without concern of violation.

HIPAA requires you to make patients aware of the risk of communicating their PHI via an unsecured channel and to obtain their consent prior to doing so.

If the patient is not comfortable discussing their PHI over text or email, you should move the conversation to a secure method such as a phone call, secure patient portal, or in-office visit.

Remember—your obligation is to make patients aware of unsecured communication and to receive authorization before discussing PHI on an unsecured channel.

To learn more about HIPAA, TCPA (Telephone Consumer Protection Act), CAN-SPAM (Controlling the Assault of Non-Solicited Pornography And Marketing Act), CASL (Canada’s Anti-Spam Legislation), and more, read our guide here.  

Developing Effective No-Show Policies

no-show-policyThe best no-show policy a practice can have is actually the policy to avoid them wherever possible. However, there will be times that, no matter how much effort you put in, patients will simply not show. And they may become repeat offenders. Many practices are trying a variety of no-show policies in order to discourage no-shows and recognize patients who arrive on time to appointments.

Here are a few examples of no-show policies that you can try:

  • Straight fee—This is the most commonly used no-show policy. Each time a patient misses an appointment (or is a certain number of minutes late for that appointment), they are charged a fee. 
  • Fee, erased upon return—When a patient no-shows, a small fee is added to their bill. The fee is removed once the appointment is rescheduled and the patient arrives on time.
  • Reward policy—Other practices are trying to reward patients for keeping their appointments and coming on time. Each week, patients who’ve kept their appointment are entered into a drawing for a gift card or other reward.
  • Detention policy—Several practices have also tried a “detention” policy. Patients who miss an appointment are required to attend a 30-minute session at the practice that focuses on healthcare issues and the importance of keeping their appointments. Only after completing the session are they allowed to reschedule their appointment. While it may seem that extra time or resources devoted to a patient who no-showed is counter-intuitive, many providers see this as a way to improve communication and goodwill with patients.

It’s easy to put all of the blame of a no-show on the patient. But there may be times where you could be contributing to the problem. To read more about that, check out this blog post.

We know. No-shows are the bane of every practice. They are annoying, costly, and make life difficult for your entire staff. By implementing some of these tips, you can keep stay ahead of no-shows, helping your practice run more efficiently and profitably. Your staff will spend less time mired down trying to quickly fill last minute appointments and your patients will be happier and have been health outcomes. That is a win-win for everyone. For more info on how to reduce no-shows and cancellations in your practice, check out some of the solutions Solutionreach can give you.

Or click here to learn more about creating no-show policies that won't scare off your patients.