Avoiding the Cost of “No Shows”

When a patient misses their scheduled medical appointment, it affects more than just their health – it affects a physician’s bottom line.

The risk of medical complications from patient no-shows is very real and increases the risk of malpractice claims, especially with obstetric patients and gynecological patients being seen post op or for a recurring problem.  While the costs associated with potential malpractice claims cannot be specifically measured, there are other costs that can and that may actually surprise you.

Numerous attempts to quantify the financial effects of no-shows in medical practices have been undertaken over the years. Some estimates have missed appointments costing a single physician as much as $50,000 to $150,000 annually in lost revenue and additional labor costs.  For a multi-physician office, those numbers become even more staggering. One clinic had 14,000 no-shows in a single year that resulted in an estimated loss of over one million dollars. That’s a huge amount of money that physicians are missing out on.

No Show Characteristics

There are specific trends to look for related to no shows in regard to when they occur and who the likely parties are. In studies conducted across all specialties, the first and last weeks of the month had a higher no-show rate than the middle two weeks.  Some speculate that this could be due to patient cash flow issues related to when the household gets paid.  Short funds at the end of the month make it difficult to pay co-pays or other out of pocket expenses.

Annual exams and/or non-urgent visits are most often the types of visits that result in no shows.  In an ob/gyn practice where well women visits are scheduled out six months or more, this can be especially frustrating to the staff and physicians.

Patients younger than 35 years old have higher no show rates than other age groups.  Another no show patient characteristic is a low socioeconomic status, perhaps compounded by transportation issues.  Finally, patients who have an outstanding account balance with your practice have a higher likelihood of not keeping their appointments.  However, for some patients, simple forgetfulness is the reason cited for missing appointments.


A study conducted in 2007 at the Robert Wood Johnson University Medical Group, an outpatient multispecialty clinic, indicated that approximately 23.1% of patients who received no reminder call missed their appointments. The number went down to 17.3% if patients were contacted by an automated appointment reminder system such as HouseCalls.  But the no-show figure went down further to almost 13.6% if an actual staff member made the call.  The down side to the personal call approach is that it may be labor intensive in a busy ob/gyn practice.

A new trend in patient reminders is through email and text notifications. A study by the Internet Journal of Healthcare Administration found that email reminders provided a 36% decrease in “nonattendance rates”.  Clearly, implementing a practice management system with automated appointment reminders can quickly pay for itself with lower no-show rates and less labor requirements.

Use technology to enhance patient care, improve your practice’s profits, and simplify your office’s workflow. Less “phone tag,” filling out postcards and unruly schedules can be achieved with the right system.

January 2013
L. Michael Fleischman
Stroudwater Associate


Anne Diamond
Senior Director