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Physician: Ways to Reduce No-Shows Cheat Sheet (DRAFT) by [deleted]

Physiains: Ways to Reduce No-Shows

This is a draft cheat sheet. It is a work in progress and is not finished yet.


No-shows are not just a nuisance for practice manage­ment. They are an opport­unity to turn things around for a poorly understood group of patients: the ones who don’t come in. This is where the action is for conditions like bipolar disorder, where treatment adherence hovers around 60%. Innovative practices have developed patien­t-c­entered approaches to the problem, and they are seeing improv­ements not just in attendance but in the health of their patients and the satisf­action of their employees

Groups at increased risk for no-shows:

1. New patients (the first 3 visits)
2. History of missed appoin­tments
3. Long delay between the act of scheduling and the actual appoin­tment
4. Younger patients (age 20-39)
5. Addictions and multiple comorb­idities
6. Recent hospit­ali­zation
7. Medicare and Medicaid plans
8. Unemployed or low socioe­conomic status
9. Transp­ort­ation problems
10. Treatment by a resident in academic settings

1. Reduce Lg Time fr New Patients

The longer the patient have to wait for that first visit, the more those rates go up. To address this problem, a public mental health center in Los Angeles created a walk-in system that allowed new patients to come in for their visit on the day they called.

2. Person­alize Appoin­tment Reminders

A center in Los Angeles created a walk-in system that allowed new patients to come in for their visit on the day they called. No-shows fell from 52% to 18%, and the need to hospit­alize patients at their first visit dropped—by a remarkable 13-fold.

3. Make it easy to Reschedule

A surprising number of patients know that they can’t make their appoin­tments but neglect to cancel them. Scheduling conflicts are challe­nging for most people, and symptoms such as ambiva­lence, avoidance, and cognitive dysfun­ction don’t make it any easier. The process can be improved with online schedu­ling, person­alized reminder calls, increased scheduling staff, and even the motiva­tional interview

4. Make Reperc­ussions Clear & Humane

Most practices have some reperc­ussions for no-shows, such as charging a small fee ($20-$50) or termin­ating care after 3 missed appoin­tments. There’s evidence supporting both approa­ches, especially when the policies are discussed directly. Both have unique drawbacks as well.

The American Psychi­atric Associ­ation warns that missed appoin­tment fees “should be resorted to infreq­uently and always with the utmost consid­eration for the patient and his or her circum­sta­nces.”

5. Avoid Double Booking

Some practices overbook their schedules to compensate for no-shows, but this can create a vicious cycle. The inevitable appoin­tment conflicts lengthen wait times, and that in turn increases the risk of future no-shows On the other hand, occasional overbo­oking may be approp­riate in a large practice with a high no-show rate and urgent cases that need to be fit in. Dynamic booking is a strategic form of overbo­oking that uses computer modeling to minimize the risks of appoin­tment collis­ions. It can bring that risk down to 5%, but not to zero

6. Reachout When Patients Drop Out

What about patients who don’t reschedule their missed appoin­tment? This is where it gets tricky. To reduce their liability, most psychi­atrists send a termin­ation letter, clearly specifying when their availa­bility will end. On the other hand, these are the patients who most need our availa­bility. Around 20% of psychi­atric patients drop out of treatment premat­urely, and they carry a high suicide risk.[8] The “postcard” studies offer a unique solution to this dilemma.


1. See no more than 6 clients per day.
2. Be clear and firm with your cancel­lation policy.
3. Use a scheduling or practice management software that sends automatic appoin­tment reminders.
4. Offer 2 weekday evenings of appoin­tment times.