Nearly one in five practices loses more than $5,000 a month to no-shows, and another 31% loses between $ 2,500 and $ 5,000, according to a 2026 Tebra survey of independent practice owners.

Yet many practices still treat no-shows as inevitable — in fact, 38% have taken no steps to address the problem. 

Tebra’s latest research finds that missed appointments aren’t random. They’re the result of unclear expectations, workflow friction, and inconsistent follow-through. 

In a recent webinar, independent practice owner Kristin Trick and nurse practitioner Leanna Coy joined Tebra’s Miriam Datskovsky to explore what top-performing practices do differently. Their conclusion: reducing no-shows isn’t about sending more reminders. The practices with the lowest no-show rates design systems and workflows that make attendance the default. 

76% of practices send automated reminders, which do help. But reminders don’t solve the root causes of no-shows.

As Kristin explained, “It’s not that they just forgot. Something comes up — work runs late, they’re not feeling well, there’s inclement weather, or they just can’t get through to reschedule easily.”

When life happens, patients need two things:

That’s where cancellation and no-show policies matter. Even though many patients say the fees feel unfair, 30% have shown up just to avoid one. Fees and policies do work — when they’re clear and consistently enforced.  

Leanna put it simply: “Even if patients don’t love the idea of a fee, when it’s explained clearly, most people understand that it’s about respecting everyone’s time.”

Yet practices struggle to enforce policies consistently, especially in larger practices. Enforcement can come down to on-the-fly decisions, where a single exception leads to more.

There's a gap between policy, enforcement, and patient understanding. The data reveals a few key issues:

The practices with the lowest no-show rates close that gap. They communicate expectations clearly — and follow through. Clear, consistent policies drive better patient behavior.

Kristin’s approach: set expectations during intake, then reinforce them conversationally over time. 

Across the data and discussion, patterns emerged. Practices with the strongest attendance design around no-shows, rather than reacting to them.  

Patients are more likely to show up or reschedule when they know exactly what to expect. That starts with clear policies, but ongoing communication matters just as much:

Taken together, these small details reduce uncertainty and prompt earlier action, giving practices time to fill open slots rather than lose them.

Kristin also advises reinforcing the cancellation policy directly in reminders. Patients are more likely to attend or reschedule when reminders include:

Most patients don’t want to miss appointments, but they lack a convenient way to adjust them. 

77% say they have to call to reschedule, but only half can get through quickly. By the time they connect, it’s often too late to fill the missing appointment slot. 

By contrast, 69% of patients say they would be more likely to show up if they could easily reschedule online, especially after hours.  

Ideally, practices send reminders with a one-tap reschedule/cancel option 7 days ahead of time, and again 48 hours ahead. 

Kristin’s approach: if a patient reaches out, she offers to reschedule for later in the week while pulling another patient from her waitlist into the slot. 

When a patient can’t physically make it to the office due to work, childcare, or transportation, telehealth increasingly offers a fallback that keeps the visit on the schedule.

The latest data reflects that shift:

As Leanna noted, telehealth works well for follow-ups, minor illnesses, and reviewing results. More patients are comfortable with the option: 57% of patients say they receive the same level of care virtually, up from 47% a year ago. 

Telehealth is more than just convenient. It’s a way to save appointments and revenue that might otherwise be missed entirely.  

Even the best policies fail without consistent enforcement. Most webinar attendees described themselves as “mostly consistent” — but that still leaves room for exceptions.  

When enforcement varies:

Consistency removes that ambiguity and builds predictability for patients and staff, while easing the front desk burden. 

The practices seeing the biggest improvements don’t rely on a single tactic. They build systems and workflows that combine:

As Miriam noted, “At the end of the day, you’re running a business. You have to make policies that support both your practice and your patients.”

No-shows will always exist, but they don’t have to drain revenue or operations. 

The most effective practices shift from reacting to missed appointments to designing systems that reduce them, with clarity that drives behavior and flexibility that saves appointments. 

The result is fewer schedule gaps, less day-to-day chaos, and more predictable revenue. And when schedules stabilize, provider and staff burnout improve.  

Watch the full discussion with Leanna Coy, Kristin Trick, and Miriam Datskovsky to learn how to fix the gaps that cause no-shows — and watch for the upcoming full report on no-shows and cancellations. 

Ready to take action? Schedule a free demo to see how Tebra’s connected scheduling, communication, and telehealth tools support workflows that cut no-shows.