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    Yuriy Kotlyar
    Yuriy Kotlyar

    Patients unexpectedly missing clinic appointments can lead to at least three negative outcomes: Patients may struggle to get another appointment and miss out on needed care. Clinicians may be frustrated at the gap in their schedules. And medical groups that don’t get a handle on the problem will see the impact on their financial results.

    Recent MGMA DataDive benchmarks show median appointment no-show rates of 5% to 7%.1 The cost to healthcare providers from missed appointments is difficult to determine, but one widely cited estimate was a staggering $150 billion annually.2

    Policies and procedures regarding no-shows can make a dent in the problem. Setting and enforcing a fee for missed appointments, requiring deposits and engaging in controlled overbooking are all tactics that can prevent no-shows or mitigate their impact. While they may be needed, these approaches work by delivering negative consequences to patients. Each one is a stick.

    Medical groups also should find some carrots that impact no-shows. These approaches offer patients desired alternatives to ensure they fulfill their appointments or cancel with adequate time for another patient to fill the appointment. Telehealth options, flexible hours and transportation assistance all can reduce no-show appointments while providing a better patient experience.

    Better patient communication offers the greatest opportunities to both reduce no-shows and enhance patient experience. Here are five ways to improve patient communication to prevent no-shows.

    1. Optimize appointment reminders

    To cut the number of no-show appointments, start by optimizing your reminder strategy.

    • Remember that cancellations aren’t the problem: No-shows are the problem. Your automated reminders should make it easy for patients to cancel and release the appointment slot.
    • Ensure your reminders offer personalized messages that include the specific details of their appointment, such as date, time, location and the provider’s name or service (e.g., MRI) being provided. With these details, the patient can determine, at a glance, whether they can come to the appointment or need to cancel and reschedule.
    • Offer personal preference options to patients. These include the choice of channel (email, text message, phone call), language options and the ability to opt out of reminders.

    2. Ensure operations support the reminder strategy

    The next step is to ensure the contact center function has the workflows and capacity to support the patient reminder strategy.

    For example, based on our clients’ experience, about 15% of appointment reminders generate a call to the contact center. Even when there is a frictionless way to cancel the appointment through a text message reminder, some of the patients who cancel might want to speak to someone to reschedule the appointment.

    The operational question is whether these patients will be able to get through to someone to cancel the original appointment and reschedule. If they cannot get through with a reasonable wait time, they are highly likely to become a no-show patient.

    These calls must be accounted for in determining the right level of contact center capacity during evening hours. In weighing the costs of this capacity, consider the high value of preventing no-show appointments.

    As noted above, your automated reminders should make it easy for patients to cancel appointments in advance. Your contact center function can operationalize this in two ways:

    • First, develop a dedicated workflow to contact patients who have canceled appointments through an automated reminder but have not rebooked the appointments.
    • Second, when you rebook these patients, also offer to add them to your waitlist and then actively work that list to fill appointment slots that free up on short notice.

    Patients will be less reluctant to cancel in advance if they feel confident that they will be able to reschedule without too much difficulty. The operational response to achieve that is to have the call center open when your patients are most likely call to cancel or reschedule. Based on the accumulated statistics across our clients, most patients find out that they cannot come to the appointment during the evening hours and weekends.

    If the contact center is closed during those hours and the patient is routed to the voicemail, there is a great chance that the voicemail will not be returned. Even if the voicemail is returned, in most cases, enough time will pass that the appointment would be a no-show.

    Having the contact center function available on weekday evenings and the weekends allows patients to call and reschedule at the most convenient times for them; weekend hours help lower the call volume spike during the Monday peak hours.  

    3. Test, refine, repeat

    Medical groups need a willingness to try a variety of methods, measure the results and choose the right ones for their patient populations to reduce no-shows.

    Consider an A/B testing approach. A medical group can split up a patient population into two groups and then try two different methods for reducing no-shows, for example, by testing different ways to time pre-appointment reminders. In this example, Group A receives reminders 14 days and two days before their appointments, while Group B receives reminders 14 days, seven days and one day before their appointments. Different times of day for reminders also can be tested in this way.

    Artificial intelligence (AI) tools can be used to analyze patient data for performance, as measured on the no-show rate and the rate at which patients who needed to reschedule eventually received needed care.

    4. Follow the data

    The same data analysis tools can surface insights on individual patients who require more effort to ensure they come to appointments. These may be individual patients who have a history of missing appointments or not following up on recommended care, or patients with certain chronic conditions or complex care plans. (This is not, however, a suggestion to base outreach on broad demographic categories, as this may cause legal issues.)

    Asking patients for their communication preferences before or at their first appointment and periodically after that as long as they remain active patients also provides information that helps avoid no-shows.

    5. Return the favor

    Sometimes it’s the clinician who is a no-show. Specialists who perform surgeries may be called away for an emergency procedure and unable to fulfill office appointments at short notice. Sometimes clinicians have family emergencies, feel ill or have other last-minute reasons to cancel appointments.

    Medical groups need to do more than just notify patients that their appointments are canceled. Giving these patients some priority for appointments and actively reaching out to them to rebook builds trust and demonstrates that the provider and the medical group as a whole value the time of patients, too.


    Medical groups need a multi-pronged strategy for reducing no-show appointments that balances sticks, such as no-show fees, with carrots that encourage patients via seamless options for cancelling and rescheduling. Over time, the focus on making patients a partner in avoiding no-show appointments helps patients get the care they need and builds loyalty for a long-term relationship.


    1. MGMA. “Restoring Balance to Patient Access and Medical Practice Operations.” August 2023. Available from:
    2. Jain S., “Missed Appointments, Missed Opportunities: Tackling the Patient No-Show Problem.” Forbes. Oct. 6, 2019. Available from:
    Yuriy Kotlyar

    Written By

    Yuriy Kotlyar

    Yuriy Kotlyar is co-founder and CEO of American Health Connection, Beverly Hills, Calif.

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