Patient no shows

[braindoc]

I have been seeing a patient no show rate of about 30% in my practice during the last few months. I am not sure how much of this is due to the pandemic, the holidays or just the growing pains of starting a new practice. To make matters worse, the hospital has removed all cancellation fees for outpatient appointments.

For established attendings, my question is what is considered a “normal” or “acceptable” no show rate? Are you seeing similar issues in your practice?

This issue is preventing me from reaching my wRVU threshold and I’m not sure how to solve it. I have spoken to my practice manager and they have assured me that they are calling patents to confirm but they are just not showing up. Some patients eventually call back to reschedule though.

[Random1]

I typically see 30 patients a day , and some days I get one, most days, zero. I live in a small community and people are very respectful. I don’t do cancellation fees, I just won’t reschedule unless they had a good reason. I had some one call the other day to cancel his appointment because he was in the ER having a MI.

[Rando]

From what I've read the usual no-show rate is 10%, but depending where you are there's a wide range. In my well established Family Practice it was more like 5%, and many days I had no no-shows. The PA I had with me seemed to have a higher rate.

Are these appointments the patients are making themselves? I did have more trouble with no-shows on appts that were made by the hospital for follow-ups.

[ENT Doc]

New patient no show 10%.

[SEC Doc]

I was having the same problem a few months ago. Obviously extenuating circumstances recently, but I thought that my no-show rate was too high. I was told that we were calling all patients with reminders. We started requiring documentation in the chart for all reminder calls. That by itself significantly increased my show rate. Additionally, I started doing some double booking which has helped a lot as well. ED referrals and self referrals are common no-shows for me so I typically double book those slots.

[GastroMastro]

I was having the same problem a few months ago. Obviously extenuating circumstances recently, but I thought that my no-show rate was too high. I was told that we were calling all patients with reminders. We started requiring documentation in the chart for all reminder calls. That by itself significantly increased my show rate. Additionally, I started doing some double booking which has helped a lot as well. ED referrals and self referrals are common no-shows for me so I typically double book those slots.

shocking that requiring documentation of phone calls increased show rate. I mean, there was no way the staff weren’t doing their jobs before when they didn’t have to prove it, right?

[Lordosis]

I was about a 25% rate my first 2 years in family practice. Which was maybe a little higher then the established docs at let's say 20%. New patients seem to be troublesome. But now I take far less new patients and I actually let go the people who no show more then 3 times so I am probably under 10% now.

The trick is to get those who no show to reschedule so they can no show again and can be let go. If you never reschedule them then months or years go by before they try to come back and you get the argument that "it was so long ago yadda yadda". Have a fair policy and stick to it.

[Sundance]

5-10%

new patients, especially ER follow ups drive most of it

[braindoc]

From what I've read the usual no-show rate is 10%, but depending where you are there's a wide range. In my well established Family Practice it was more like 5%, and many days I had no no-shows. The PA I had with me seemed to have a higher rate.

Are these appointments the patients are making themselves? I did have more trouble with no-shows on appts that were made by the hospital for follow-ups.

Yes, though there may be a common referral source. I need to check into this so I can double book these.

[braindoc]

shocking that requiring documentation of phone calls increased show rate. I mean, there was no way the staff weren’t doing their jobs before when they didn’t have to prove it, right?

Right now I am working with a skeleton crew because of covid-related hiring freezes. I would not be surprised if some reminder calls were missed or only attempted once

[braindoc]

I was about a 25% rate my first 2 years in family practice. Which was maybe a little higher then the established docs at let's say 20%. New patients seem to be troublesome. But now I take far less new patients and I actually let go the people who no show more then 3 times so I am probably under 10% now.

The trick is to get those who no show to reschedule so they can no show again and can be let go. If you never reschedule them then months or years go by before they try to come back and you get the argument that "it was so long ago yadda yadda". Have a fair policy and stick to it.

haven't yet instated a policy of letting go of repeat no shows yet. Is there a "nice" way to do this?

[jfoxcpacfp]

Why aren’t you using software that sends an automatic text reminder? It is so difficult and such a time suck to call people on the phone to confirm an appointment - even my hairdresser uses this software and it has saved several appts for me (including pretty much all the doctors i visit) that I otherwise would have forgotten/not documented.

[Tim]

+1
Some software actually requires a positive response or a phone call if there are any questions.

[Random1]

While it seems right to blame the patient, I would suspect that is not the issue I would put more emphasis on fixing your internal problems, front end staff and the way your schedule is set up. I do primary care, which may be completely different from what you do, If I can’t get the patient in , then they either go to an Urgent Care or ER or somewhere, IF you have a 30% no show rate, change to more of a same day scheduling. If you can offer the patient the same day and they make an appointment and then don’t show, then you have a problem with you patient population that you can not fix. Or last resort, be open when patients don’t work.

There is a local Cardiology group who makes there monthly rounds to drum up business, but when I call to get a patient in for CP or palpitations , I get the answer , send them to the ER no one is in the office or no appointments are available. I would bet they don’t even know this is happening. After a few times, of go to the ER, we are looking for a new consultant.

[Dont_know_mind]

I found my no show rate reduced when I did my own rebookings and took control of my diary. Not only can you plan treatment better, you get a better idea of how motivated patients are and their schedules. As a bonus, you are also not reliant on your secretarial staff. I find it takes about 10s longer to book someone in myself than to say, please book x in for 1 months time. Just doing this reduced my no-show rate by about 10%.

I have a cancellation policy of 60% of the consultation fee if people cancel with less than 48 hours notice. I accept one excuse but after the second or third time, they have to pay the cancellation fee to rebook. Having a cancellation fee probably reduced my no-show rate by only 5%, but this was usually the 5% that were most annoying.

What really ruins my day are the people who don’t show up repeatedly and when they do arrive are variably 30-60 minutes late, in a compete emergency, take twice as long as scheduled and forget to bring their credit card...

No show rate for new patients depends on your patient selection and what referrals you accept.

In the last few years I’ve cut down my wait list so I’m booked out to only 3 weeks. But I’m more careful about patient selection and 70% of my diary is marked “do not book” so only I can book those slots. This has made my days much more pleasant. I have no idea how people cope with diaries booked out to 3 months. I would find this incredibly stressful. I find if my diary is only 3 weeks booked ahead, I can fit in more complex cases without difficulty. Also I can move people around easily without affecting patient care, if I have an unexpected day off. I work in a particular sub segment of psychiatry so I’m not sure if this would work in other areas.