Improving ‘No Show’ Rates

Many clinics struggle with patients missing appointments without notification, also known as ‘no-shows’.

Why no-shows are problematic:

• the patient who ‘no-shows’ does not receive potentially important care
• another patient who could have been seen in that appointment slot may not receive care from their own physician or care team that day
• lost revenue

Principles to address no-show rates: 

• The further out appointments are booked, the greater the likelihood that patients will forget, seek care elsewhere, or the problem will resolve before the appointment.
  • Working on reducing TNA (third next available) appointment rates can help alleviate booking challenges.
• Reminders can make a big difference – phone, text or email. o Patient permission is required for text and email reminders.
• A small number of patients may need extra reminders or an alternative appointment approach.
  • Example: create an EMR reminder or have a specific process for this small subset of patients.
  • Consider booking these patients when it will be least disruptive to the flow of the day (e.g., late afternoon).
• It’s important to have a no-show policy and ensure that patients and clinic team members are aware of it.
• No show fees can be a deterrent; however, they can also create challenges, so views on them are mixed.
• If the clinic policy includes a no-show fee, some recommendations include:
  • Ensure that the fee is reasonable, especially for patients with socio-economic challenges.
  • Be clear with staff about how to enforce – e.g., warn twice, then charge after 3 missed appointments.
  • If there are exceptions or exemptions (e.g., influenza-like symptoms), be clear and consistent.
  • If short notice cancellations are made (i.e., influenza-like symptoms), consider having a process for providing alternative care (e.g., virtual appointment).
  • Determine and communicate what will happen if fine payments are not made. 
• When booking, remind patients about the clinic’s cancellation policy.
• Research has shown that patients are more likely to comply if they are asked to confirm that they will contact the clinic if they need to cancel an appointment.