I Will Keep Them From Harm and Injustice (Part 2)

Part 2: Preventing No-Shows


Being stood up is never fun and it’s disrespectful in professional appointments. Unfortunately, it’s not a matter of if, but when patients will miss appointments. People will get stuck in traffic and priorities shifting throughout the day. No-shows will continue to occur, but there are ways to dramatically reduce patients from disappearing.

The problem with no-shows is that healthcare providers don’t get notice of a patient’s status. It could be because of time constraints, monetary constraints (e.g. insurance deductibles), or even physical constraints. The reasons behind patient no-shows may vary by individual needs.

Healthcare providers have attempted to reduce no-shows with a fee policy. One office placed “problem patients” on probation. Others simply absorb the lost time and income. While the onus ultimately rests upon the patient, doctors cannot provide proper care if the patients do not show up. It hurts a patient more than the physician.

In part two of our Population Health Management series, we explore the problem of no-shows, and how to prevent it from occurring.


Challenge #2: Preventing no-shows

No-shows are defined as intended appointments that are not canceled or rescheduled less than two hours before the designated time.

The worst part of patient no-shows is not knowing a patient’s condition. For doctors, this uncertainty is cause for concern because it elevates the risk of pain and suffering. Prolonging a diagnosis and treatment for a medical condition can be both physiologically and financially taxing.

Patient no-shows have been reported to be as low as 5.5% and as high as 30%. Higher rates were particularly apparent for academic practices.

No-show patients may seem harmless since it guises itself as a much-needed break for overworked physicians. But it severely hurts a hospital’s bottom line. Not only does the practice lose revenue, cost per patient increases as well as readmission rates, which may lead to hefty penalties.


Opportunity: Reducing Patient No-Shows

Understanding your patients is critical for reducing no-shows. It begins with observing your practice’s no-show rates. Only 63% of healthcare providers tracked missed appointments. The remaining practices are unaware of the severity of their no-show rates, and would be difficult to measure and improve on performance.

In one study, a 47% of patients are habitual no-show patients. The problem is that the 35% of the habitual no-show patients had close ties with the physicians. This makes no-show policies difficult to implement. In fact, 7% of the habitual no-shows are also 15% of the arrived visits. This makes patient management a complex and sensitive challenge.

Understanding the individual patient is as important as knowing the patient population. Each patient is unique and has different reasons for not attending an appointment. The likelihood of patient no-shows can be attributed to their clinical data, claims history, demographics, and socioeconomic status.


Recommendations: Nurture your Patients

There are many reasons why patients fail to appear without notice. There are ways healthcare providers can reduce no-show rates by focusing on actively engaging at-risk patients.

Traditional methods such as no-show fees, double bookings, or first come first serve practices, can marginally improve no-shows. However, these techniques can cause friction and are as unprofessional as a discount domestic airline.

To focus on the cause, rather than the symptom, healthcare providers should place more attention on long lead times. Doctor’s appointments are often made weeks in advance, which patients have to be diligent to reserve. As the appointment approaches, reminders are often necessary.

Suum cuique is the latin verb for “To each their own.” Everyone has a personal preference. Using a personalized approach encourages, rather than punishes, patients for showing up. And it’s showing results.

Patients are five times more likely to keep an appointment when they receive a call reminder. By receiving reminders, 17.3% of patients missed appointments, compared with 23.1% of patients who received no reminder call missed their appointments.

However, calling to remind each patient is laborious. Patient Relation Management technologies such as CareSkore, actively engages patients using Short Messaging Service (SMS). Texting a patient not only provides clear communication, it is automated, bidirectional, and asynchronous.



When an appointment is approaching messaging technologies can automatically send reminders to patients without using admin time.



SMS technologies that leverage Artificial Intelligence (A.I.) like CareSkore engages patients in a natural conversation. Unlike push notifications, A.I. is bidirectional, which means the computer understands the language and responds accordingly.



Unlike a phone call, text messages can be received and responded without needing the recipient to be actively engaged in real time.


The Patient Lifecycle

No-shows hurt both patients and caregivers. But there are ways to reduce the lost time. Nurturing patients throughout their lifecycle helps avoid no-shows. This does not require a large call center, but the careful implementation of intelligent software. Doctors are here to treat, but they are only as effective as the presence of a patient.