Physician Lesson # 3-“Reducing Patient No-Shows”

You will always have patients that simply don’t show up for appointments for a variety of reasons.  What I hope to do is show you how to calculate the cost of no-shows and give you suggestions to reduce them. No-shows include same day cancellations, as they both result in no revenue.

A no-show is a no-show, regardless of the reason.  Tracking why patients miss their appointments is useless UNLESS the reason is your fault.  So spending time asking patients why they missed their last appointment is only beneficial if they are honest and you can determine if it’s something your office, staff or providers are doing that causes this.

No show reasons that could be prevented by your office include the following:

  1. Rude front office or clinical staff. Sincere smiling faces when a patient arrives ultimately reduces patient no-show rates. I work in many office and go to the doctor myself.  Sincere smiles go a long way.
  2. Long appointments. Physicians consistently keep long appointment times. Not purposefully, but their schedule set-up simply does not allow enough time to take care of each patient.
  3. Long gaps between scheduling appointment to an actual appointment. Time from scheduling an appointment to the actual appointment day is sometimes too long. If your specialty or location is one that significantly increases patient demand and causes long wait times for appointments it can contribute to patient no-shows.  Patient may get better or find an alternative to you.

Again, only fix the “why” if it is your fault.  Don’t dwell on the many other patient related reasons.  You can’t fix them.

Now let’s talk about the financial aspects of no-shows.  First, you need to determine what a no-show is costing your practice on average.  You can calculate the value of a no-show by determining how much you are reimbursed on average/patient. There are two types of patients, a new patient and an established patients, so you will need to calculate the cost of a no-show new patient and a no-show established patient.

Below is a model you can use to calculate the cost of a no-show. For this examples we are going to assume a new patient brings in $125.00/visit and an existing patient brings in $75.00/visit:


Let’s be conservative and say a physician is seeing 200 patients per month.

  • 2 new patient no-shows/week would cost him $250.00
  • 6 existing patient no-shows/ week would cost him $450.00
  • New Patient no-show ($250) and Existing Patient no-show($450) would cost this office $700/week
  • Assuming the practice is open 50 weeks/year you could calculate this rate of no-shows would cost $35,000/year.

Now this example is for one provider and we are being very conservative here.  You can argue that this loss is pure profit or more importantly cash that could be paid directly to the physician.  You see, because your office is open and running at full staff, a no show does not decrease your costs, it only decreases your profit.

There have been studies performed substantiating that 1 no-show is actually 2 patient appointments.  One for the patient that no-showed and one when the patient reschedules because that appointment takes a slot that could have been used by another patient.  So, theoretically you could multiply my numbers by two.  Again, these are simple, conservative numbers to prove a point.

Hopefully by now you are excited to find solutions to reduce your no-show rate.  There are many and I will list the ones I feel work the best.  The best solutions, however will be the one(s) that work for your particular practice.


  1. Develop a “short” call list. This is a list of patients that need to get in quickly, but can’t because you are booked for the foreseeable future.  This works especially well for those specialties that are limited in numbers and can’t keep up with the demand.
  2. Reduce your time from the day the patient is scheduled for an appointment to the actual appointment date. This is easy to recommend, but takes a lot of creativity to accomplish.
  3. Make sure your patient demographics are accurate. This includes the patients home & cell phone number as well as address.
  4. Discharge patients from the practice after a determined number of no-shows. Regardless of excuse these patient are costing you money.
  5. Begin handing every patient a small business card size “No-Show Policy” at each visit. The patients will be reminded that your office expects every patient to show up for their appointment and will know there are consequences if they do not.
  6. Utilize patient reminders. There are many ways to do this.  Phone calls, text, post cards, etc.  The key is to find what works for you.
  7. Charge a no-show fee. I am not a fan of this one.  It typically increases your accounts receivable, makes patients mad and many providers have staff write-off when the patient complains. However this is an option that your office may like to try.
  8. Call patient on the day they no-showed to determine if the practice contributed to why they no-showed. But more importantly to reschedule.
  9. Probably my favorite and very effective, yet extremely hard to get physicians to try. Develop a separate schedule with no doctor attached.  ONLY schedule habitual no-show patients and limit to a few per day.  If the patient shows up for the appointment then one of the providers will have to see them.  You can explain to them exactly why they are not seeing their normal provider.  You can alternate which provider sees them or more than likely one of the providers will have a no-show and be available to see that patient with ease.

In closing, I hope you found this information useful. Knowing and understanding your current no-show rate and the dollars it is costing your practice annually is very helpful in understanding your cash flow. Be methodical in finding solutions that work for your practice and implement those solutions. Once you implement solutions you will hopefully see a drop in no show rates and an increase in cash.

If your practice is struggling with financial solutions, call us today! PSUSA is located in the US and keeps all of the billing here in the US. We strive to have A+ customer service, A+ specialist and complete transparency. Let PSUSA handle your medical billing needs so you can do what you do best – provide quality patient care!

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