For decades, no-shows have proven to be a costly problem for doctors. In fact, missed appointments generate a staggering $150 billion. impact on the American healthcare system each year.

The reasons patients decline appointments are as individual as the patient and include concerns about health care costs, long wait times and lack of transportation, said Michael Nilsson, a software developer and founder of AddEvent, a calendar technology platform used by healthcare professionals. to reduce missed appointment rates.

“Perhaps the most frustrating or confusing reason patients skip appointments is forgetfulness or apathy,” Nilsson said. Medscape Medical News.

And while sending multiple reminder emails, text messages, and phone calls can sometimes alleviate missed appointments, no one method of communication is entirely effective.

Just ask Bernadette Anderson, MD, MPH, a family physician in Columbus, Ohio, who says juggling schedules when patients don’t show up is a common occurrence, a financial drain, and a significant stressor for her and its staff.

“Every time a patient doesn’t show up, it costs $200,” she said. “We are unable to reschedule this person, which creates a significant burden on us. »

Anderson regularly treats multiple members of a family, which leads to even more complications.

“We have reserved several consecutive slots for these families,” Anderson said. “If this family has been consistently skipping appointments, I will double-book them with other patients. This means that all patients in that time slot sit even longer in the waiting room – if everyone shows up.

Reintegrating patients who fail to show up on schedule can also be difficult.

“That means I have to use my limited staff resources to try to reschedule appointments and get those patients back into the office,” she said.

Anderson added that this back-and-forth is not only detrimental to the patient’s health, but can also begin to strain the patient-doctor relationship.

“You start to wonder if a patient takes their health seriously,” she says. “It makes me wonder, ‘Do you want my advice and/or is this a good solution for both of us?’ » »

Collect relevant data

If no-shows are a challenge in your office, quantify the scope of the problem. One way to do this is to collect revenue per visit (RPV) data, suggested Peter A. Wishnie, DPM, who ran a private podiatry practice in Piscataway, New Jersey, for 34 years before retire.

“The percentage of appointments kept each week is an important statistic,” said Wishnie, who coaches healthcare professionals to become better business owners. “On the other hand, if your average RRP is $160 and 20 of your patients don’t show up, you lose $3,200 for that day alone.”

Additionally, if your LTV stays the same for 5 days of the work week, you stand to lose $64,000 per month or $768,000 per year, Wishnie added.

“Doctors tend to go with the flow,” he said. “Patients come and go, but most doctors have no idea what their RPV is. » However, having statistics can help you identify the problem and begin to adapt.

Don’t lose patients during follow-ups

Let’s say your attendance rate is okay, but you notice that after a preliminary appointment, your patients are not complying with your suggestion to return to your office for a follow-up appointment, whether in 2 weeks or 2 weeks. month.

“Your patient may not be very happy to come back, especially if they have high copays or deductibles,” Wishnie said. “That’s where it’s very important for doctors to explain to patients why they need to come back and what happens if they don’t.”

For example, use phrases like: “I know you might feel better, but I need to see you again to make sure we take care of XYZ so this doesn’t happen again,” -he added.

“By explaining health reasons — and quantifying those reasons — you can potentially avoid a no-show,” Wishnie said.

Integrate your reception on board

When a new patient calls to make an appointment, Paul Rosenberg, MD, a board-certified plastic surgeon in private practice in Fort Lee, New Jersey, and plastic surgeon-in-chief at the New Jersey Gynecomastia Center, trains his staff to get to know them. a little bit – to try to reach them on a human level.

“We don’t ask what kind of insurance do you have,” he said. We try to ease the pain and find connection.

Then, after that first meeting, it can be helpful to have your front desk staff ready with a script to discuss next steps.

“It’s the front desk’s job to ask, ‘How did everything go today’ and help the patient understand why they might need a follow-up appointment,” Wishnie said. “If the patient still doesn’t understand, that’s when the nurse or doctor needs to step in and explain. »

Then, if a patient cancels that appointment, train your staff to say “let’s reschedule this” rather than “would you like to reschedule this,” Wishnie added.

“Make sure your front desk team reinforces the new appointment day three times so the patient is clear when they need to return. »

Try different forms of reminder messages

Although text message reminders sent by your practice may annoy some patients, text messages have proven to be particularly effective in keeping patients on schedule. An older study found that text message reminders reduced no-show rates by 38%.

Additionally, Nilsson said integrating add-to-calendar links into patient confirmation and reminder emails resulted in a 7% increase. increase in patients attending their appointments.

“The reality is that patients are inundated with digital messages, and while confirmation emails and reminders are great, getting the appointment on a patient’s iPhone or digital calendar is even better.

When All Else Fails, Consider a Missed Appointment Fee Policy

It may not be ideal, but the only way to deal with repeat missed appointment violators might be to charge them for those missed appointments. These fees can cost patients up to $100 or more.

“Many health care providers have started charging no-show fees to discourage missed appointments and compensate for lost revenue,” Nilsson said.

Anderson says it’s critical to communicate with patients and, first, allow for a missed appointment before billing them for wasted time.

“I don’t tell a patient the first time,” she said. “The second time I send an invoice with a charge for their no-show. After the third time we discuss it and that’s when my patients realize I’m serious. I say – nicely – that if this continues to happen, I may have to fire them from my practice.

Ultimately, one thing that makes a difference in scheduling an appointment is the relationship a patient has with a doctor and where they are in their treatment, Rosenberg said.

“When an established patient comes in for a pre-op or follow-up appointment, the rate of missed appointments is zero,” Rosenberg said.

Lambeth Hochwald is a New York-based journalist who covers health, relationships, trends and issues important to women. She is also a longtime professor at NYU’s Arthur L. Carter Journalism Institute.