Reduce Your Patient No-Show Rate

The patient no-show rate is one of the most substantial factors leading to reduced efficiency and effectiveness of health care facilities.¹ We have all faced situations where a patient confirms their appointment, yet does not show up for that appointment. Many times, these no-shows cause patients to miss important follow-up visits, such as care for uveitis flare-ups or glaucoma work-ups. In addition to less-than-ideal treatment outcomes, patient no-shows result in decreased efficiency from unnecessary use of resources and lost time.¹

According to pre-pandemic research, outpatient no-show rates range between 23.1% and 33.6%.¹ One study found that the no-show rate for telehealth appointments during the COVID-19 pandemic was 7.5%, much lower than the reported no-show rate of 36.1% for in-office appointments or the pre-pandemic, in-office no-show rate of 29.8%.² Although telehealth offers accessible patient care, we as eye care professionals often need patients to be physically present in order to properly examine their eyes and to perform essential imaging and tests.

This article identifies strategies beyond telehealth for reducing no-show rates in your office. To understand these options, we first need to consider the reasons behind high no-show rates.

CAUSES OF APPOINTMENT NO-SHOWS

Behind every action our patients take is some kind of reasoning that we as health care practitioners should try to understand. Patient no-shows are one such issue. To eliminate or reduce no-show rates, we need to understand what causes a patient to not come in for their appointment and consider how to remove or mitigate those barriers. Research has identified different causes of appointment no-shows, including emotional or psychological barriers, lack of understanding of the importance of their appointment or eye condition, transportation issues, financial issues or the cost of an appointment, long wait times, difficulties getting off of work, or finding childcare … the list goes on and on.³

One study found that 41% of patients did not know what happens in the clinic if they do not show up for an appointment.³ Patients initially have a sense of urgency when scheduling the appointment, but after a few days pass and the issue somewhat resolves, they can experience hesitancy with keeping their appointment.³

Patients also often felt disrespected within the health care system, and waiting a long time for an appointment to begin is one way they feel disrespected.³

SOLUTIONS TO REDUCE NO-SHOW RATES

Understanding these potential root causes of patient no-shows can help us help our patients keep their appointments. As we are all aware, one of the best predictors of a patient’s no-show rate is their previous history of no-show appointments. Being aware of this, it’s better to double book those patients with a no-show history.

Emphasize Education

Education is an essential factor in helping patients keep their appointments. The general public often does not understand the importance of eye care appointments, as many ocular conditions, such as glaucoma, do not show signs of vision loss until very late in the disease progression. Hence, patients may believe that if they are seeing fine, there is no urgency to come to the clinic. Being thorough with patient education about examination details and findings is essential, as it will help patients realize why they should not miss their appointments and increase future compliance.

Other action items that could help with patient education include sending out newsletters about eye disease or new research, taking care to follow the anti-spam and patient consent laws for email in your state, and providing patients with information sheets about their ocular conditions.

Increase Accessibility

Ensuring that your clinic is wheelchair accessible, offers translator services, is accessible via public transportation, and has evening and/or weekend hours to accommodate patients who cannot take off of work are all steps that can mitigate patients’ barriers to care and reduce your no-show rate.

Send Reminders

Appointment reminders are vital in reducing no-show rates. Automated or staff-generated voicemail messages and texts or email reminders are also helpful. If a patient did not answer or acknowledge an earlier reminder call to confirm that they are still able to make their appointment, be sure to call them on the day of their appointment. If patients scheduled during the day are unconfirmed, have not picked up previously, and/or have no voicemail available, then calling your evening patients to see if they are able to come in earlier would help improve efficiency in clinic. Another idea is to use automated messaging to try and fill cancelled appointments on a first-come, first-serve basis. Following up with no-show patients, especially those who are new to your practice, allows you to clarify the reason for their absence and reschedule them.

Practice Savvy Scheduling

Scheduling families together in the same time slot (eg, an initial 30-minute appointment plus 15 minutes for each additional family member) can help with clinic efficiency and increase the likelihood that certain patients will show up for the appointment, whether because of encouragement from family members, carpool availability, improved comfort with the health care setting, etc.

Calling patients who schedule their appointment via online booking later that same day to verbally confirm their appointment details helps solidify the visit.

If there is bad weather or a storm on the day of an appointment, calling your patients that morning to confirm their visit or reschedule them if needed also helps maintain clinic efficiency.

Share Reports

We recently started sending eye examination reports to our patients’ primary care providers, which we believe has further improved patient compliance with follow-up visits. This is likely because the family doctors reiterated our findings and educated patients about the importance of following up with us.

Reduce Wait Times

Long wait times experienced during a patient’s first visit can lead to them not showing up at their next appointment. Thus, focusing on reducing wait times and having patients participate in pretesting while waiting would help patients feel more engaged and make them aware that the appointment process has started. High patient satisfaction at the initial visit will help increase compliance with future appointments.

BRIDGE THE GAP

If a patient calls your office to book an appointment and your front office staff needs to look weeks or months into the future for the next available time slot, that can increase the chances of that patient not showing up at their appointment.⁴ Sending appointment reminders and clearly stating your clinic’s strengths (eg, good accessibility, extended hours) can help you bridge this time gap. No one clinic can employ all the strategies discussed in this article, but targeting as many as possible can go a long way in reducing your no-show rate.