Patient no-shows pose concern amid medical practice staffing challenges, consumer price hikes

After two and a half years of pandemic disruption and staffing challenges in healthcare, it’s hard to assess what conventional wisdom there is regarding trends in patients showing up for their scheduled appointments.

On one hand, several practices have seen productivity gains in the past year as COVID-19 cases have been kept at bay and patients are more willing to travel for in-office visits. On the other hand, critical shortages of staff have impacted hours of operation and wait times for appointments, which can prompt some patients to shop around for other providers in hopes of being seen sooner.

An Aug. 2, 2022, MGMA Stat poll found that about half (49%) of medical groups reported that their patient no-show rates increased since 2021, compared to about 4 in 10 (39%) that said the rate stayed about the same, and 12% that reported a decrease in the no-show rate.

For medical groups that have seen no-show rates increase or stay the same, the top drivers cited were:

• Patients hesitant to seek care due to cost
• Patients going elsewhere due to long wait times after scheduling an available appointment
• Lack of transportation to appointments
• Patient forgetfulness or apathy.

Among respondents with no-show rates on the decline, the top four reasons given were:

• Implementation of online patient check-in options
• Additional text, email and/or phone reminders ahead of appointments
• Improvement in COVID-19 case numbers and improved willingness for patients to visit the office
• Limiting patients with a history of no-shows to same-day-only appointments.

A closer look at 2022 data

Previous MGMA Stat polls helped detail some key issues with visit volumes and scheduling throughout the first half of the year:

1. More than 8 medical groups in 10 (85%) reported that 2022 visit volumes were above or about the same as 2021 levels, according to a May 10, 2022, poll.
   1. The top challenges cited among practices with lower visit volumes included:
      1. Patient reluctance to come in after the Omicron COVID-19 surge
      2. Visits taking longer for patients who deferred care earlier in the pandemic
      3. Lack of appropriate staffing to handle higher volumes
      4. Patients opting against visiting due to financial concerns amid rising inflation and consumer costs.
2. Appointment availability and wait times (46%) were the top challenge with appointments, according to a March 15, 2022, poll, with no-shows (38%), cancellations (11%) and “other” (5%) making up the remaining results.
   1. Responses from practice leaders who reported “other” matched many of the responses of the May 10 poll. They reported challenges such as:
      1. Having appropriate staffing levels to handle rising patient demand for care
      2. Patients who deferred care during the pandemic presenting large lists of concerns that cannot be addressed in the allotted time or during a well visit
      3. Providers being unwilling to open blocks on their schedule
      4. Limited waiting room space due to COVID-19 guidelines
      5. Lack of accurate clinic grids for scheduling
      6. Higher rates of last-minute cancellations, even in practices that charge fees for them.

Patient appointments throughout the COVID-19 pandemic

Tracking patient appointment benchmarks throughout the COVID-19 pandemic has shown some surprising results:

• From 2019 to 2020, no-show rates decreased across all practice types (primary care, surgical and nonsurgical specialties), according to 2020 and 2021 MGMA DataDive Practice Operations benchmarking data.
• Similarly, appointment cancellation rates fell by 68.1% for primary care and nonsurgical specialties from 2019 to 2020, while surgical specialty cancellation rates decreased by 73%.

In these instances, the severe and sudden closure of practices and restrictions on elective procedures in the early months of the pandemic in 2020 likely hampered the total number of appointments throughout the year and limited appointments to high-acuity care cases.

Prior to the pandemic, the median patient no-show rate for medical practices jumped by 40%, from 5% in 2018 to 7% in 2019. Around this same time, it was unlikely for many practices to charge a no-show fee to patients: Less than 20% of single-specialty practices charged a no-show fee in 2019, according to 2020 MGMA DataDive Practice Operations benchmarking data.

Did you know?

When it comes to ensuring optimal patient access and minimizing no-shows, MGMA Better Performer practices report being open a few more hours per week (excluding weekends) compared to all practices, according to the 2021 MGMA DataDive Better Performers Practice Operations data set:

• Primary care Better Performers were open three hours more per week compared to the median for all practices.
• Nonsurgical specialty Better Performers were open 4.5 hours more per week than the median.
• Surgical specialty Better Performers were open five hours more per week than the median.

Learn more: MGMA data reports

• For a deeper look into these benchmarks, access the 2020 data report (Benchmarking for Patient Access in a Post-COVID-19 World) and the 2021 data report (COVID-19 Recovery and the Evolution of Medical Practice Operations), as well as the 2021 MGMA Better Performers data report.
• Sign up for the MGMA Insights newsletter to be among the first to know when the 2022 MGMA Practice Operations data report is released, featuring key data findings on patient access and wait times, patient portal use, value-based care and more.

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