No Shows… it seems that no matter what we do, we always have them.
Despite the fact that we call every single person on the schedule to remind them of their appointment the day before (the staff personally makes the call. We don’t use an automated system) we found that in 2009, we had 389 no-shows.
Slicing the data
Is 389 a high number of no-shows? I guess it depends on the size of the practice, how many encounters a practice has in a year or how many days the practice is open.
Our practice is open about 310 days a year. If you do that math, that comes out to 1.25 no-shows a day. In 2009, our practice had 10,660 encounters. If you do the math again, you’ll find that the 389 no-shows represent 3.64%.
Further analysis shows:
- 314 patients accounted for 389 no-shows. This suggests that there were few repeat offenders.
1 no-show = 261
2 no-shows = 38
3 no-shows = 12
4 or more = 3
- On average, our patients’ no-show 1.23 times in a single year.
What kind of financial impact did the 389 no shows create?
If one averages, let’s say, $112 a visit, that would mean we lost $43,568. That is assuming none of those 389 no-shows ever came back to the office for their missed appointment. Which wasn’t the case. We often call parents that no-show and ask them to reschedule. The question then is, how many of those no-shows never came back to be seen? Then, we could figure out the loss of revenue. Do you agree?
How about charging a no-show fee? Charging, let’s say $25 for each no-show, we would have recouped $9725. But that assumes we can collect 100% of the no-show fee. Which I doubt we could collect 100% of the 389 no-shows.
What is the intent?
The no-show fee serves two purposes. The first purpose is to deter people from doing it the first place. And some would argue that the second purpose is to offset the revenue they would have otherwise received had they provided the services.
However, does the no-show fee really deter patients from no-showing? If so, by how much? How do we know that because of the no-show fee, people prefer not to schedule appointments in advance, which may result in delaying care even further because they never end up calling us back?
Does charging for no-shows create an expense because now we have to send out a statement, which some people say it cost upwards of $5 to send? Does the no-show fee really offset the loss?
To charge or not to charge
I consider charging patients for no-shows a hassle. It’s bad enough trying to hunt payments down from patients that actually received services in our office and don’t want to pay. I can only imagine having to hunt down payment from a parent for a service we didn’t actually provide. But I could be missing the boat.
Is the no-show really a loss?
No-shows are considered an opportunity cost. But, when a patient no-shows, does the staff and doctor sit in the practice doing nothing? Or does the unexpected free time give the staff an opportunity to do other important things?
I don’t see a no-show as a loss because there are equally productive task that we all do in the office when a patient missed their appointment. Again, I might be missing the boat here but in our experience, no-shows are almost a good thing because it allows the doctor to spend more time with the families during a visit, make a few extra phone calls to parents, check on labs or simply take a break.
I understand that this notion doesn’t work if a practice sees only 10 patients a day and 2 or 3 people no-show. But if you have a busy office, like I suspect many of you do, the no-shows shouldn’t affect the practice’s bottom line because there is always an equally productive task to be done.
Missing the boat?
I don’t know if I’m missing the boat here. Hence the questions and the analysis.
But it seems to me there is more value in learning to manage missed appointment, than to put so much effort in trying to eliminate them by collecting fees for them when in fact, we are always going to have no-shows.
To me, this sounds like a better idea. What do you think?
I'm a practice administrator at a Pediatric office located in the western suburbs of Chicago. I write mostly about running a small business that happens to be a medical practice.
I don’t think you’re missing the boat at all! I share your philosophy. If the missed appointment is a physical, we follow up to reschedule it, so there’s no significant impact on our bottom line. That’s good clinically, too. At the same time, a missed physical does represent a block of time when someone else might have been fit in, and even in a busy practice it can mean a loss of efficiency. (We only have one provider, so appointment slots are very limited). But instead of no-show fees, we try to remind patients of appointments in as many ways as possible.
We too try to educate patients… and I think the data that I posted, showed that we do a good job of educating patients of the importance of calling us and letting us know if they are going to no-show. As I mentioned, most of the people that no-showed, only no-showed once. Which I think is an acceptable number.
Thank you for your comments, Patrick.
Brandon
Great post. I completely agree. The no shows give me a chance to fill in with last minute appointments or get something else done.
Margaret,
I appreciate your comment.
Brandon
An important, but subtle, lesson here is not what you conclude, but how you got there.
The overwhelming majority of your peers make business and clinical decisions based on how they feel or from a sample of one-bad-day. Here, you’ve actually *done the math*. That makes me happy :-)
That said, I’d personally always want to categorize the REASONS for the no-shows and, perhaps, the day/times to look for patterns. Are Monday mornings bad times for no-shows? Are most no-shows good families with bad luck that day? That would be telling data!
Being able to categorize the reason of the no-show would no doubt be of value. I think knowing which days are more likely to have no-shows than others would also help a lot.
Back in the day, I use to work for the airlines. And I know for a fact they keep track no-show rates for their flights. Why do they keep track? If they know the probability of no-shows based on their history, they know how much to overbook a flight.
Our PM sys doesn’t give me the option to break down no-shows by day of week. It just gives me the no-show number for whatever period I want. Otherwise, I could easily find out what day of the week are the most likely to have no-shows.
As always, thank you for the thoughtful comment.
We now charge $ 30 for a no-show, so we can send those to collections who would not pay it. The second time we ask for $50. The third time they are out! We also ask for payment of this fee before any other appointment can be made. Brutal? No. It takes time to prepare for the visit: verify insurance, reminder call, preparation of chart, collecting data, like labs and Xray results, reviewing EOB and payment status etc. Also it is a lost time slot for those who cannot come in because the “schedule is full” , though they are sick and need to be seen that day. No-shows also harmful for the patient who is loosing another opportunity to get thair illness managed in a timely fassion… No shows therefore are loss for the patient , loss for the parctice, loss for other patients… Asking $3o for damages is not too much ! I know a psychologist who bills his clients for the full visit if you do not show up! I think we pediatricians tend to be too nice…
Thank for your comments Dr. Edenhoffer.
I understand why a practice might want to charge for n0-shows. The question is, however, if the no-show policy is effective in diminishing the behavior one is trying to curb.
Brandon
Is it legal to charge no show fees and collect them from patients who missed their 1st appointment before the signed the patient agreement and became familiar with the practice policies? Thank you.
Don’t see why not. Let’s put it this way. It isn’t illegal.
Brandon