The Intake

Insights for those starting, managing, and growing independent healthcare practices

The top reasons patients no-show or cancel

Develop simple, actionable solutions to address the no-show and cancellation challenges your practice faces.

Woman on phone scheduling patients for appointments.

At a Glance

  • Patients cancel appointments for many legitimate reasons.
  • Consider implementing telehealth as an alternative when patients feel they need to cancel.
  • Offer patients a wait-list option, so you have accessible possibilities to fill last-minute cancellation slots.

In July 2023, Tebra conducted an online survey of 1,075 patients and 204 healthcare providers to assess the behaviors of both groups when patients cancel, reschedule, or no-show their medical appointments. Of those surveyed, 59% reported canceling or not showing up to their scheduled appointments in the last 12 months for a wide range of reasons. 

On another interesting note, we also found a notable disconnect between providers and patients in terms of a solution. When we asked providers what they typically do to prevent missed appointments and reduce no-show rates, 79% of providers indicated they rely on appointment reminders. 

When we asked the patients what providers could do to help them make their scheduled appointments, 71% said same-day or next-day appointments were the best way to improve no-show rates and curb the number of missed appointments. We should add here that appointment reminders are quite effective — in fact, the study also indicated that 40% of patients said they want more of them. Still, sooner access to appointments wins the day.  

Understand the impact of cancellations and no-shows

For many, the best way forward is to: 

While “life happens,” consistent no-shows and short cancellations can profoundly impact your practice’s productivity and financial stability. ”

And while “life happens,” consistent no-shows and short cancellations can profoundly impact your practice’s productivity and financial stability. One of the survey’s most eye-opening takeaways was that missed appointments due to patient cancellations and no-shows cost medical practices as much as $7,500 per month or $375 per patient. 

Age is a factor in patient no-shows and cancellations

Before we dive in, it might be worth noting that when analyzing the survey’s data, we also saw notable differences between the generations regarding missed appointments due to no-shows and cancellations. We’ll also add that the patients surveyed saw a mix of providers, including primary care physicians, dentists, medical specialists, and mental health providers. 

Result highlights include:

  • Gen Z had the highest appointment cancellation rate, followed closely by Millennials at 47%. 
  • Baby Boomers informed practices about cancellations 98% of the time, while 26% of Gen Z missed appointments without letting the office know.  
  • 82% of Gen Z said they were more likely to show up to an appointment if they could reschedule online, followed by Millennials at 81% and Gen X at 77%.

Top reasons for missed appointments 

Based on personal experience, board-certified ENT physician Drew Sutton says, “Worries over the cost of the appointment, long wait times, and lengthy visits anecdotally top the list of reasons for missed appointments.” 

Tebra’s survey revealed that 59% of patients reported canceling or not showing up in the last 12 months for a range of reasons, including: 

  • Work Conflict – 35%
  • Not Feeling Well Enough – 32%
  • Transportation – 28% 
  • Family emergency – 26%
  • Personal Emergency – 25% 
  • Weather – 22% 
  • Anxiety About Appointment – 16% 
  • Social Engagement – 11%
  • Other – 8%

Work conflicts 

Whether it’s a last-minute meeting or a human resources fire that needs immediate attention, work conflicts happen. To counter their effects on your practice’s no-show rates, consider being more mindful of your patient’s schedule and unpredictable work life. 

In many cases, medical practices can lean in on appointment reminders or even accommodate these folks with appointment windows reserved especially for them. Not only can this help reduce patient cancellations, but it also helps build a solid doctor-patient relationship and should likely improve patient retention

Not feeling well enough

For patients dealing with both chronic or acute illnesses, reasons likely to top the list of why patients miss appointments include:

  • Pain
  • Discomfort
  • Immobility  

To improve patient show rates and reduce cancellations, medical practices might consider offering telehealth appointments to their offerings. If we learned anything from the pandemic, it’s that telehealth can most certainly improve accessibility. In this case, telehealth appointments can meet your patients where they’re at while doing some heavy lifting to improve no-show rates.  

Transportation 

While patients with unfettered access to public transportation may find it easy to keep their scheduled appointments, those in rural areas may not have the same advantage. For medical practices, this loosely translates to no high no-show rates and missed appointments. 

To reduce patient cancellations and improve no-show rates, practices should lean in on automated reminders far enough out for the patient to make necessary arrangements. Whether they need to make ride-share service arrangements or schedule with family and friends, in most cases, automated appointment reminders one or two weeks before the patient’s appointment give them plenty of time to get their ducks in a row.  

Family emergency/personal emergency 

While just about a quarter of survey respondents indicated that family and personal emergencies were one of the top reasons patients miss their appointments, we suspect this is more about specific instances and not indicative of repeat offenders. 

Ultimately, any effort to improve patient show rate should be focused on patient education — show patients the steps they need to take for a proper cancellation. ”

There isn’t much doctors can do for these one-off events to reduce patient no-shows or cancellations. Ultimately, any effort to improve patient show rate should be focused on patient education — show patients the steps they need to take for a proper cancellation. 

By reminding patients to call and cancel when life throws them a curve ball, your staff can fill the slot and improve your appointment show rates. 

Weather 

Weather is one of those things that’s just out of our hands. Providers can, however, make minor adjustments to improve show rates no matter what Mother Nature has in store. For example, if your practice is in an area where snow storms frequently impact transportation options, consider offering telehealth appointments during the winter months or watch the weather and switch in-person appointments to telehealth appointments until old man winter blows through. 

Appointment anxiety

While primary care practices may not see this too much, we suspect some specialties might find that their patients’ fears get the best of them, resulting in missed appointments with or without notice. From scary test results to shame around not listening to prior directions, your patient’s fears can come from anywhere. The only way to counter this is with good communication.

To improve patient show rates, doctors and their staff should consider providing as much information as possible to allay those fears. Moreover, doctors can reduce missed appointments by talking to patients about the next visit and addressing their fears before they even walk out the door. 

Social engagement 

Surprisingly, 11% of respondents said they’ve missed appointments for a social engagement. Again, we suspect this should be a one-off for most patients, and a little education on the cancellation policy could go a long way toward resolving this. 

Other 

Under the “other” category, we’ll also add forgetfulness and a history of lengthy wait times. 

Forgotten appointments

It happens to the best of us. We go about our day and get so entrenched in whatever’s on that day’s schedule that we forget our appointment time. 

As you might have guessed, appointment reminders do much of the heavy lifting here. A simple phone call or text should do the trick. Incidentally, our survey found that appointment reminders are so effective that 40% of patients surveyed said they would like more of them. 

Long wait times

Whether it’s the things still left unchecked on a to-do list or sitting in a room where someone is coughing in your direction, no one likes waiting in a doctor’s office. Long wait times are one of the top reasons patients lose their patience with their medical practice. When asked what providers can do to reduce cancellations or no-shows, 58% said, “see patients on time.” 

Respect for time is a two-way street. If you want patients to keep their scheduled appointments, you have to give them something to show up to — long wait times don’t do anyone any favors.  ”

The takeaway here is that respect for time is a two-way street. If you want patients to keep their scheduled appointments and improve your show rates, you have to give them something to show up to — long wait times don’t do anyone any favors. 

Other ways to improve patient show rate

To put the brakes on repeat offenders, your practice should consider establishing a clear no-show policy, no-show fees, or try up-front payments.  

Institute a no-show policy 

If you show patients that actions have consequences, they might be less inclined to no-show and more inclined to sign in promptly at their appointment time.

According to our survey, 53% of doctors indicated they have a no-show policy in place if a patient misses too many appointments, while 47% said they don’t. 

The top three no-show policies were:

  • Repeat offenders were removed from the patient roster (69%)
  • A warning for first-time offenses (44%)
  • Strikes on their record for repeat offenses (31%) 

Implement no-show fees

According to our survey, 24% of providers charge a fee if patients cancel or no-show. The majority of practices charge $21-$40 per visit.

“We work with well over a dozen medical practices representing diverse specialties, and each one has adopted the no-show fee,” says Jackie Carro, Owner of Marketing Ideals Company. “Communicating the no-show fee at the time of booking the appointment, whether it’s by phone with admin staff or online through a scheduling app, makes it clear verbally and in writing (appointment confirmation emails) that a cancellation less than 24 hours prior to the appointment or a no show will result in a fee. The fee varies by practice, but they’re typically no less than $25. Patients don’t want to pay for an appointment they didn’t make; knowing this upfront makes them a bit more conscientious about keeping the appointment.”  

Taking payments up-front 

Another way medical practices can increase their patient show rate is to consider taking up-front payments or offer discounts for prepayment. As a matter of fact, our survey revealed that upfront payments may have some merit.

  • 64% of patients said they were more likely to show up if they prepaid for their appointment. 
  • More than 50% of patients indicated they were more likely to keep their scheduled appointment if offered a prepayment discount. Gen Z and Millennials top that list at 78% and 74%, respectively. 

“Taking payment up-front is an excellent way to lower patient no-show rates, for obvious reasons,” says Carro. “Patients don’t want to miss appointments they’ve already paid for.”

Require onboarding documents prior to the appointment

Carro says, “This isn’t standard for all specialties, but for our fertility specialists, we require that the patient fill out their onboarding documents prior to the appointment. We can easily determine which patients will actually become patients and keep their appointments by this simple requirement — a person who has not taken the first step to heart most likely won’t become a patient or stick to their scheduled appointments.” Carro notes that by implementing this requirement for her client, no-shows were cut down to zero.

Pre-visit phone calls

According to Sutton, “Pre-visit phones are another way to improve patient no-show rates. This establishes contact with the patient and reviews patient concerns such as transportation. It is not a guarantee, but it helps.” 

Keep a waitlist 

“Keep a wait list to fill in gaps and cancellations, says Sutton. “Call these patients right away to fit them in as needed, and don’t wait to reschedule no-shows.” 

Improve your practice’s patient “show” rate

Overall, we found that Gen Z and Millenials had the highest appointment cancellation rates, frequently citing work conflicts as the reason. And while 98% of Baby Boomers informed practices about cancellations, other generations are often no-shows without informing the providers. 

To reduce patient no-show rates, providers might consider implementing no-show policies and offering discounts for prepayment. Patients have also indicated they want more accessibility and digital tools. To meet patients where they’re at, providers should consider offering more same-day appointments and online scheduling (or rescheduling) options.

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Sharon Brandwein

Sharon Brandwein is a Certified Sleep Science Coach and a freelance writer. She specializes in health, parenting, and, of course, all things sleep. Sharon’s work has also appeared on ABC News, USAToday, Parents, and Forbes. When she’s not busy writing, you’ll probably find her mixing in with her kids or digging through vintage books in local antique shops.

Reviewed by

Drew Sutton

Dr. Drew Sutton is a board-certified ENT physician. He has vast experience in treating all aspects of ENT, with particular interests in disorders of the ear and nasal and sinus disease. During his career, he started and managed an independent, single-specialty medical practice in a large metropolitan area.

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