Flake, Fluke, or Flying the Coop: Why Your Patients Aren’t Showing for Appointments

Don’t you just hate it when someone RVSPs for a party you’re throwing—but is nowhere to be found on the day of the big shindig? After all, there are a lot of factors that depend on your headcount, from the number of chairs you need to the amount of cake you bake, and when guests bail out of nowhere, it could mean a lot of wasted effort—not to mention wasted cake.

In a physical therapy practice, the negative effects of cancellations and no-shows are even more dire. After all, when patients don’t show up for their appointments, your practice throws away more than uneaten cake; you throw away revenue.

So, why do so many patients fail to attend their appointments—and what can you do to prevent them from flaking on you? Look, there are some factors you just can’t control. Things come up: the alarm clock didn’t go off, the kids are sick, the car broke down—all of these are perfectly valid and uncontrollable barriers that keep patients from making it to their scheduled visits. But, unforeseen circumstances aside, there are actions practices can take to reduce patient cancellations and no-shows.

Remember, this is not simply an inevitable cost of doing business in the healthcare field—and treating it as such can have major financial consequences. After all, time is money, and that’s especially true for PTs, because you don’t make money if you’re not treating patients. To take that several steps further, if you don’t make enough money, you won’t stay in business, which means you won’t be able to continue serving your community.

With that in mind, here are a few ways you can mitigate patient attendance issues:

1. Establish a policy.

If you haven’t already, you absolutely must establish a cancellation and no-show policy. Specifically, that policy should outline rules for scheduling and canceling appointments. Then, present it as part of your initial intake packet and go over it when you’re discussing expectations with patients. It’s not enough to just set rules; your patients need to understand the reasoning behind your policy. Do that, and you’ll immediately increase their compliance.

As for the kind of rules you should set, that’s totally up to you. Some practices opt for a 24-hour cancellation notice requirement and charge a fee for missed appointments. Others request a pre-payment or deposit from patients as soon as they book appointments, although this might make your patients feel like you don’t trust them, and consequently, drive away business. Some practices keep a patient credit card on file, although if you do this, you must have record of a pre-authorization agreement with the bank or patient demographic query (PDQ) supplier. Otherwise, keeping card details on file is a bad—and possibly illegal—idea.

2. Track cancellations and no-shows.

Physical therapy providers should never overlook the power of data—even as it relates to missed appointments. Every practice can benefit from tracking no-shows and cancellations. For one thing, it helps practices identify demographic and logistical trends that help predict the likelihood of missed appointments. By using tracking tools—like those available within your EMR—in conjunction with your billing software, it’s easy to pick out the common characteristics of missed visits. One study conducted at the University of Missouri found that:

  • Medicaid recipients had a higher rate of no-shows than any other insurance beneficiary type. Additionally, Medicaid patients who had appointment times outside of the public transportation schedule never showed.
  • Patients who lived five to 10 miles away from the practice were the most likely to make their appointments, whereas patients who lived 19 to 60 miles away were more likely not to show. Patients who lived more than 60 miles away almost always made their appointments.
  • Young, single men had the highest no-show rates. However, attendance for this group was better for mid-morning appointments on Tuesday, Wednesday, or Thursday.

Now, it’s important to take these findings with a grain of salt, as they’re probably practice-specific. But, that’s exactly why it’s important to track your own no-show and cancellation information. So, start keeping tabs on these trends within your EMR, and look for factors that you can actually control. Once you’ve identified some common missed appointment trends, start implementing ways to change them.

3. Collaborate with patients to schedule appointments.

That same University of Missouri study found that patients were more likely to show up for an appointment at a time of their choosing. The study noted that many traditional schedulers tend to schedule “the first caller for Monday at 8:00 AM, the second for Monday at 8:30,” and so on. But, the schedulers who had fewer cancellations and no-shows asked patients which date and time they preferred. This is a super-easy process change that could help you immediately start turning your no-shows into yes-shows.

There’s also tons of research pointing to a link between long wait times and higher missed appointment rates. This is likely because patients view this as disrespectful of their time. So, practices should avoid intentionally overbooking—which can stymie appointment flow and create a backup in the waiting room.

4. Set up automatic appointment reminders.

Technology can also help you decrease your cancellation and no-show rate by making it easier to remind patients of their upcoming appointments. I’m referring, of course, to automated appointment reminders. The days of appointment reminder cards are drawing to a close. Don’t get me wrong—they’re better than nothing. But, according to a study from the American Journal of Medicine, patients are significantly more likely to keep an appointment when they receive a phone call reminder. There are also several case studies from companies like Walgreens, Hilton, McDonalds, and even Guinness that found phone and text reminders save thousands of labor hours, increase revenue drastically, and decrease no-shows.

Now, you could call your patients one-by-one to remind them of upcoming appointments, but It’s incredibly unlikely that you—or your front office staff—have extra time to do so. That’s where automatic appointment reminders come in. They’re easy to set, and they’re often customizable.

If you use appointment reminders, standardize the checkout process so your staff always offers to send the patient an appointment reminder before his or her next visit. And as the front office person sets up the reminder, he or she should also take a moment to confirm the contact information on file, thus minimizing the risk of missed reminders or follow-up calls.

No-shows are a huge pain point for PTs and party planners alike. And while there’s no magic solution for getting folks to follow through on their commitments, when it comes to patient cancellations and no-shows, the tips discussed above can definitely help you improve your clinic’s appointment attendance rate. For more great advice on keeping your patients engaged in their care—and consistently coming back to your practice—be sure to watch this free recording of a webinar I recently hosted.


About the Author

Heidi Jannenga is co-founder and president of WebPT, the leading physical therapy software platform for enhancing patient care and fueling business growth. She has more than 15 years of experience as a physical therapist and clinic director, and she’s an active member of the sports and private practice sections of the APTA as well as the PT-PAC Board of Trustees.