It can happen to any practice. You have a full patient load scheduled for the day, but then a patient — or two — doesn’t show up for a study. Suddenly, not only is your schedule thrown off, but you’re also out the cost of any supplies dedicated to that appointment.
Patient no-shows have long plagued the industry, according to experts, with anywhere from 1 percent to 20 percent of patients either failing to cancel or simply failing to appear for scheduled visits. Anecdotally, radiology leaders estimate most practices have between a 2 percent and 5 percent no-show rate, and these absences can cause significant problems, they said. The Medical Group Management Association puts the national average for all specialties at 5.5 percent.
“I do think patient no-shows can be a tremendous disruption to practices,” said Christine Mayo, vice president of operations for PremierScan, a San Jose-based MRI/CT imaging center. “Some practices consistently see offenders from the same payer source or referring physicians. Regardless of the reason, it’s a great hassle.”
Why Patients Stay Away
A 2004 Annals of Family Medicine study pointed to three main reasons why patients don’t show up to see their providers. Some harbor negative feelings about seeing a doctor; others feel the clinic staff doesn’t respect their time and emotions; and many don’t understand the havoc a missed appointment can wreak on a practice.
But Casey Wheeler, a mobile PET/CT technologist with Idaho-based IsoScan, LLC, chalks a significant portion of patient no-shows up to one factor: human nature.
“People are afraid of bad news, so they operate on ‘If I don’t deal with it, then it’s not there,’” Wheeler said. “Many people don’t show up because they feel like they take back some control over their lives if they don’t get the test done. It doesn’t make sense.”
Others, he said, may view the studies as unnecessary. Those who have undergone repeated scans often contend an additional test won’t show anything new and opt to skip it.
The current economic climate also plays a role in many patients’ healthcare decisions, practice management consultant Elizabeth Woodcock wrote in a column for Medscape News. Lack of insurance or an inability to pay medical bills could push patients to forgo preventive services or delay elective procedures, such as diagnostic imaging tests.
What Happens When Patients Don’t Show
A practice with a daily (and common) average of four no-shows stands to lose nearly $150,000 annually, according to a2009 Physicians Practice article. While all radiology practices feel the financial pinch when patients miss appointments, nuclear medicine practitioners are often at the greatest financial risk, Wheeler said. Unused radiopharmaceuticals, he said, can’t be used for studies at a later date. It’s a medical supply and money down the drain.
“These doses have a two-hour half-life, so if it degrades because a patient doesn’t show up, we can’t use it,” Wheeler said. “And, these doses can cost several hundred dollars. Normally, you can’t bill the patient for it, so the hospital or practice has to eat the cost.”
In the case of cardiac imaging, he said, tracers are often wasted even when patients do show up for appointments. Many times, he said, individuals arrive for functional imaging scans with coffee and breakfast pastry in hand, rendering any test invalid.
Perhaps the more important consequence of missed appointments, though, is the impact on patient care. If patients fail to show up for scheduled tests, it can significantly impede the timely delivery of quality healthcare, Mayo said.
“It’s important that patients understand that by not showing up, they could be actively slowing down their own healthcare,” she said. “As a practice we want to be a partner in patient care. We don’t want them to see us as the bad guys if they don’t get the services they want when they want them.”
What Can Practices Do?
You aren’t without recourse, however. There are tactics you can implement to either recoup lost revenue from missed appointments or reduce your no-show rate.
To avoid losing significant dollars to wasted radiopharmaceuticals, consider having these patients sign a statement, when scheduling their appointments, agreeing to pay for the tracer if they don’t show up for the study and don’t give you adequate cancellation notice, Wheeler said. Although some patients could see it as an aggressive move, they now have a financial impetus to show up.
Also, consider enforcing a charge policy for all missed appointments, Mayo said. Take a patient’s credit card information at scheduling, and apply a no-show fee if he or she fails to appear. You can take it a step further, she said, by declining to schedule patients who miss two or more visits. If you prefer not to refuse patients, however, you can choose to only serve chronic no-show patients on a walk-in-only basis, according to Woodcock.
Instead of punitive measures, there are proactive strategies that can help shrink your no-show population. The most important thing you can do, Mayo said, is to improve communication with your patients and their referring physicians.
“It’s our responsibility as a practice to clearly delineate with referring clinics, payers, and the patients, what our expectations are and what policies exist for cancellations and no-shows,” she said. “Communication is a challenge, and it requires publishing your policies, sending letters to patients, and having discussions during appointment scheduling.”
There are also additional strategies that require a small bit of effort from your staff, but that can be very effective, Woodcock said. For example, give your patients a reminder call or email one to two days before their appointment, create and “last-minute priority list” with the names of patients who can, with short notice, take the spot of a no-show patient, and strategically overbook your slowest hours of the day.
A 2009 American College of Physicians study indicates you can also give more responsibility to the patient by allowing him or her to suggest their own appointment times. Researchers found that out of 11,000 patients, those who were asked for their preferred visit time were far more likely to appear for the appointment.
Finding the solution that works best for your practice can be helpful, Mayo said, but making a significant impact on no-shows nationwide could require a more coordinated effort.
“I’d like to see some sort of industry standard achieved that would apply to all of us,” Mayo said. “And, it’s not enough for us to be concerned about the impact of no-shows on our bottom lines. We also need to consider our relationship with our surrounding communities and how we can serve them better.”
How do you deal with patient no-shows? Tell us about it in the comments below.