Patient no-shows still an issue despite more automated reminders

Even with new tools to automate appointment reminders and expanded capabilities of AI coming online in medical group practices, nearly four out of 10 medical groups report their no-show rates were on the rise this year.

An Aug. 27, 2024, MGMA Stat poll found that six medical groups in 10 (63%) have seen their patient no-show rates stay the same (50%) or decrease (13%) in 2024, while no-show rates increased for 37% of responding groups. The poll had 303 applicable responses.

This new poll closely follows no-show trends from a similar poll a year earlier that found more than one-third (37%) of groups reporting an increase in no-show rates last year, while more than half (52%) said they stayed the same and another 11% noted a decrease in no-shows.

Among respondents who saw lower no-show rates in 2024:

• Many moved from an existing patient communication/automated reminder system to a new one, including new text messaging platforms.
• Several respondents had a system that integrated all check-in work along with point-of-service copays, or included a method for filling vacant appointment slots as they occur.
• The few practices using advanced analytics to predict no-shows report higher rates of double-booking around high-risk patients.
• Policies such as credit card on file (CCoF) and no-show fees still were cited as helpful ways to address the issue.

While these are all smart strategies, the biggest remaining question from this week’s poll remains: Many of the practices whose no-show rates increased are also using many of these same strategies without seeing improvement yet.

Best practices in scheduling

While many functions of pre-visit scheduling are intended to start your revenue cycle management process (e.g., eligibility and benefits verification), some have the benefit of engaging your patients and could reduce the chance of a no-show.

Appointment confirmations

Ideally, appointment confirmations should occur 48 business hours before the scheduled visit. This serves one of three key purposes:

1. Confirming the appointment and reminding the patient of their financial responsibilities for the visit
2. Rescheduling the appointment, thereby allowing the slot to be filled by another patient.
3. Canceling the appointment and filling the slot with another patient.

In recent years, many practices have outsourced this process or switched to automated systems. A common approach now is to use an automated call the day before the appointment, as this allows practices to better reach patients on waitlists or those interested in getting an earlier appointment.

Early and complete registration

Aim to register all patients at least 24 hours ahead of their visit, ensuring 100% completion of the patient profile in your practice management (PM) system. For same-day registrations, make sure front desk staff are well-trained in new patient registration processes.

Understand the timeline

Time is a key component in appointment scheduling. This includes the time it takes to answer a patient’s call, the wait between scheduling and the appointment itself and the time spent waiting to check in or go to an exam room.

As noted by Nate Moore, CPA, MBA, FACMPE, time to third next available appointment (TTT) is a key metric for checking a provider’s third next available appointment. The third next available appointment is chosen rather than the next available appointment to reduce variations in provider availability that may be caused by last-minute cancellations or schedule changes. These variations make it seem the provider has more openings than they really do. Consistently looking for the third next available appointment makes the measure comparable to other providers and can better demonstrate trends.

• MGMA DataDive users have access to TTT benchmarks within the Practice Operations data set.

Recent advancements in PM systems and third-party applications using AI or machine learning (ML) have made it easier for practice leaders to predict cancellations or no-shows, facilitating more effective overbooking. But as noted in MGMA polling from February, only 15% of medical groups reported using predictive analytics to improve no-show rates or patient scheduling in general.

• For a closer look at specific challenges and strategies for patient communication and scheduling, read a recap of the MGMA-Relatient patient engagement report, “Optimizing provider staffing, patient scheduling and communication for improved patient access.”

Documentation

Accurate documentation of patients is crucial, particularly those who repeatedly no-show and negatively impact your office productivity.. It’s important for the practice to accurately document patient attendance, especially for missed or canceled appointments.

• Note if a patient tries to reschedule or if there were extenuating circumstances around a missed or canceled appointment.
• As noted earlier, some practices implement no-show policies that include fees. A common approach is to waive a no-show fee once per year for each patient, with  subsequent missed appointments incurring the fee.
• Consider notifying referring providers when their patients fail to show up for their appointments as care management and coordination efforts.

Additional resources

• “Mirror, mirror on the wall, will the patient show at all?” — Sharon V. Nir shows how Ardent Health leveraged predictive analytics to mitigate the loss of access and revenue due to patient no-shows
• “Better patient communication to balance your approach to deterring no-show appointments” — Yuriy Kotlyar details how better communication offers opportunities to reduce no-shows and enhance patient experience.