7 Reasons Why No-Show Appointments Occur (& What You Can Do About It)

7 Reasons Why No-Show Appointments Occur (& What You Can Do About It)

How to Improve the No-Show Rate in a Clinic

While no-show appointments certainly aren’t a new challenge for healthcare organizations, they are one of the most persistent. Missed appointments lead to about $150-$200 in lost revenue for primary care physicians, and even $500 for surgeons — not to mention any costs that come along with associated testing, lab services, or other procedures. Altogether, missed appointments cost the healthcare industry about $150 billion annually.

Even more worrisome, no-show appointments can be highly detrimental to patients’ health and outcomes. As any healthcare provider knows, delaying preventive or needed care almost always results in more expensive and complex treatment further down the line.

Yet despite the harm that missed appointments cause, few healthcare organizations know how to effectively combat the issue — many find that traditional methods like having their call centers reach out to remind patients are only effective up to a point.

But why do patients miss doctor appointments, and what can you do to overcome those challenges? Read on below for our best tips on how to improve the no-show rate in a clinic.

1. Far-Off Appointments

The Problem: When patients schedule an appointment, they’re usually highly motivated to attend — but the longer the gap between when they schedule the appointment and when the appointment actually takes place, the less of a priority it becomes (as the old adage goes, “out of sight, out of mind”). And that gap is only growing over time. In 2022, it took an average of 26 days to get an appointment scheduled, up from 24.1 days in 2017 and 21 days in 2004.

The Fix: When thinking about how to improve the no-show rate in a clinic, keeping patients engaged is critical — especially throughout the pre-arrival process. But don’t just rely on your call center to send reminders over the phone — reach out to your patients through their preferred communication channel. For many patients, that means texting. Text messages have a full 98% open rate, compared to just 20% for emails. Meanwhile, eight in ten people say they don’t answer phone calls from unknown numbers, making phone reminders largely impractical. If you automate your text reminders, you can even reduce the administrative burden on your staff.

Learn More: Automate Pre-Visit Messaging

2. Difficulty Rescheduling

The Problem: Sometimes, life just gets busy — and even if a patient plans on attending an appointment, they’re unable to. Early-morning and late-afternoon appointments are especially prone to last-minute personal and professional conflicts. Many patients are willing to alert their care team and reschedule, but the harder you make it for them to do so, the less inclined they are to follow through. If they have to go through a call center, for example, patients often have to deal with long wait times. They may not even be able to get through to anyone due to high call volume. But making it easy for them to reschedule is critical to avoiding no-show appointments — studies have shown that patients who failed to keep just one appointment with their primary care doctor were 70% more likely not to return within 18 months.

The Fix: It’s important to ensure that you’re offering appointment times that are convenient for your patients in the first place. Before even sharing your availability, consider surveying patients to figure out which times work best for them so that you’re not overwhelming them with impractical options. Once you’ve locked down an appointment time, make sure to send engaging, interactive, and bi-directional reminders and notifications that increase in frequency as the appointment approaches.

You’ll also want to provide patients with an easy way to make changes to appointments via text or online schedulers. When the only way to notify their provider about a last-minute change to an appointment is through a busy call center, patients will often not reach out at all — which hurts healthcare organizations more than anything. Make it easy for a patient to reschedule, however, and you improve the odds that your patients receive the care they need and that your organization doesn’t miss out on its revenue.

3. Anxiety & Stress

The Problem: For many people, going to the doctor’s office is anxiety-inducing enough — but for new patients, it can be even more stressful. It’s difficult to establish trust with a patient who hasn’t had time to build a rapport with their provider and supporting care staff or get to know how they operate. For patients who are already anxious about their health, that can make them all the more prone to no-show appointments.

The Fix: Provide patients with the information they need to get to know you upfront. When you create a more welcoming and transparent digital front door, you can put patients’ minds at ease. A transparency solution that makes it easy for patients and members to search provider reviews, service offerings, and consumer ratings helps them feel confident in the care they’re going to receive. And for those still left with questions, consider deploying a chatbot on your site or scaling your call center team so patients can easily get in touch with the people who can provide them with answers.

Read More: The Guide to Building Your Digital Health Strategy: The Importance of Digital Engagement Across the Care Journey

4. Lack of Preparedness & Ongoing Education

The Problem: More often than not, pre-arrival instructions are dense and difficult to understand. It’s not uncommon for pre-appointment or pre-procedure instructions to be 10 pages or more and full of dense medical jargon, making it daunting for patients to even begin reading them. And if patients are only sent pre-arrival instructions one time, it’s very likely to slip their mind.

The Fix: If patients aren’t engaging with your current pre-arrival instructions, it’s time to rethink the format. Research has shown that video instructions improve a patient’s understanding of and comfort with procedures, as well as adherence to the pre-procedure guidelines when compared to written or verbal instructions. Other good options include visual-heavy PDFs, surveys, and checklists.

Beyond simply changing the format of the instructions, you may also want to change how you deliver them. Rather than sending all of the instructions at once, consider distilling them into a series of bite-sized modules that you distribute over time. Given that 61% of patients want more proactive engagement from their providers, this can be a better method than simply throwing all of the information at the patient early on and hoping that they’ll remember it in time for their next appointment.

For best results, create an automated pre-arrival workflow that delivers the content daily or every other day as the appointment approaches via text message or another preferred communication channel.

5. SDoH & Accessibility Challenges

The Problem: Healthcare just isn’t as accessible for some patients as it is for others. Take, for example, patients who live further away from their providers, or who don’t have reliable transportation. Increased distance from providers is correlated with higher no-show and cancellation rates, while an estimated 3.6 million US patients miss their appointments due to transportation issues. And of course, you can’t dismiss the importance of social determinants of health (SDoH) challenges, like low-income patients being unable to afford to take time off of work for appointments.

The Fix: When distance or transportation is causing no-show appointments, introducing wayfinding and navigation support is a quick and easy way to make a difference. Consider adding detailed directions to your facilities — including public transit routes — to your home page as well as sharing them via text with patients. For those who consistently struggle to make it to appointments, offering alternative, omnichannel care options — such as telehealth, online symptom checkers, and remote patient monitoring — can be especially appealing.

For other accessibility challenges, take a three-step approach:

  1. Understand what you’re up against: Research common SDoH data in the zip codes you serve, and survey patients about what prevents them from getting access to the care they need.
  2. Identify solutions: Inventory the resources, programs, and assets you have at hand to help patients overcome the challenges they face, and build relationships with the organizations that provide them.
  3. Dispense information: Share that information with patients — and potentially their family members or caregivers as well — to connect them with the appropriate solutions.

6. Cost & Payment Challenges

The Problem: It’s no secret that healthcare in the US is often prohibitively expensive for patients. In fact, 38 percent of US adults have skipped a medical visit, test, treatment, follow-up, or prescription refill within the last year because of cost. That figure jumps to 50% among low-earners, but even 27% of high-earners say that costs have prevented them from accessing care before. And regardless of their income status, all patients want to know what they owe, why they owe it, and whether there are easy payment options available.

The Fix: Provide transparency in your pricing and offer simple payment options. Even after a 2019 executive order compelled hospitals to shed light on their pricing, many health systems bury this information deep within their site — and some have yet to come up to compliance. Making this information easily accessible, however, can often lead to no-show appointments.

If you don’t already, you’ll want to offer payment plans for patients who can’t pay for everything upfront, and partner with tech vendors that allow patients to make simple, pain-free digital payments. Just as critically, you’ll need to educate patients about the payment options available to them — so make sure to proactively share this information with them via text or another preferred communication channel.

Read More: Understanding the Importance of SDoH at the Local Level: Perspective from Providers

7. Financial Literacy & Understanding

The Problem: Even for those directly involved in the healthcare industry, insurance plans can be complex — so it’s no wonder that patients have trouble understanding them. One Kaiser Family Foundation study presented patients with a 10-question survey that tested their insurance comprehension and found that 42% of patients got less than seven correct. Needless to say, when a patient isn’t sure whether or not their insurance plan will cover a certain cost, they’re much less motivated to pursue that care.

The Fix: Create informative but engaging content that breaks down complex insurance topics into simple-to-understand terms, and share it with your patients. Use videos, infographics, Q&A sections, factsheets, and other types of content to define common insurance terms like “co-payment” and “deductible,” list which insurance plans you accept, explain how the payment model works, and more. Share this information as part of your automated, pre-arrival text workflow.

Between the pandemic and growing staffing shortages in healthcare, no-show appointments are a problem that’s only becoming more urgent over time. It’s not enough for healthcare providers to hope it gets better with time — they need to learn how to improve the no-show rate in a clinic and take action before it reaches a crisis point.

You may not be able to solve the problem overnight, but the sooner you act, the sooner you can recoup missed revenue and provide patients with the care that they need.

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