Best Practices for Reducing Patient No-Shows Tip Sheet

Medical practices have an average of a five to 55 percent no-show rate, which limits practices in providing efficient care.¹²³ These missed appointments are costly for clinics. Clinics may not be able to eliminate no-shows, but there are ways to reduce them and their negative impact on clinics.

[1] George A, Rubin G. Non-attendance in general practice: a systematic review and its implications for access to primary health care. Fam Pract. 2003;20(2):178-184.
[2] Kheirkhah P, Feng Q, Travis LM, Tavakoli-Tabasi S, Sharafkhaneh A. Prevalence, predictors and economic consequences of no-shows. BMC Health Serv Res. 2016;16:13.
[3] Fiori KP, Heller CG, Rehm CD, et al. Unmet social needs and no-show visits in primary care in a US Northeastern Urban Health System, 2018-2019. Am J Public Health. 2020;110(S2):S242-S250.

The farther out appointments are scheduled, and patients must wait to be seen, the more likely they are to find care from another provider, such as an Emergency Department or Urgent Care Center. In these situations, many patients do not cancel their future appointment, or they no-show because they were seen somewhere else. See the Alliance’s Member Satisfaction Toolkit for more information on timely access to care for routine and urgent appointments.

Blocking time on the calendar each day allows for walk-in availability and urgent/acute appointments (i.e., ear infection or strep throat).

When you discuss no-shows with a patient, emphasize the importance of attending scheduled appointments.

John, I scheduled your appointment for <date> at <time> with <provider name> at our <clinic location>. As a reminder, it is important for you to attend your appointment. If you need to reschedule or cancel your appointment, please call us at <phone number> before your scheduled appointment time.

Send a reminder to your patients before their appointment via phone, email, and/or text. This gives them the opportunity to confirm or reschedule their appointment in a timely manner.

Assign a staff member to remind patients of their appointments 48 hours before, and the same day of, the appointment. Consider using an automated appointment reminder service for your clinic.

If you have unconfirmed appointments, call those patients the day of the appointment to confirm. This allows you to open your schedule for another patient. See the Member Satisfaction Toolkit for additional tips on pre-visit planning.

If a patient has a history of no-shows, double-book their appointment to allow another patient to be seen during this time. If the patient with a history of no-shows arrives for their appointment, they can be seen by another member of the care team, or be triaged by a nurse, if they cannot see their provider.

Moving around appointments as patients arrive to ensure all patients are seen is known as “tetrising.” This allows the scheduling staff to move appointments in real time and catch missed opportunities to increase patient access.

For example, if a patient with a 10:15 a.m. appointment arrives 15 minutes early and the 10:00 a.m. patient arrives late, allow the 10:15 a.m. patient to be seen first. The late patient can be seen during the 10:15 a.m. slot.

Partner with patients to find out why they miss their appointments and help prevent future no-shows. For example:

• Refer patients who have transportation challenges to Transportation Services.
  • For non-emergency medical transportation, call 800-700-3874, ext. 5640.
  • For non-medical transportation, call 800-700-3874, ext. 5577 (TTY: Dial 711).
• Route after-hour calls for Alliance members to the Nurse Advice Line at 844-971-8907 to talk to a nurse.
• Make a note in the schedule if a patient requires an extra reminder call.
• Call the patient before the appointment to ask if they are running late. If they are, reschedule them.

Did you know that you can report when an Alliance member misses an appointment at your practice? You can submit a form via our Provider Portal and one of our Member Services Representatives can follow up with the member.