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    Ani Osborne, MBA

    Motivating patients to schedule care and ensuring they arrive to receive it are essential to managing the health of a medical practice’s population. When patients reschedule multiple times, cancel at the last minute or do not show up, the opportunity to detect disease early when it is most curable is lost.

    Providers lose too. Highly skilled nurses, therapists, physicians, extenders, and other licensed care professionals reserve their valuable time to see a patient, only to be stood up. That time is lost, and so is the revenue that open appointment slot could have generated. Even worse is the likelihood that there may have been patients who were flexible and willing to take that newly opened slot had they known about it. This information could have helped fill the provider’s schedule; the patient who expected to wait much longer could have seen their provider sooner; and the practice could have preserved its revenue.

    The consumer expectation lens

    Amazon, Netflix, and other companies have made tremendous fortunes by providing personalization and convenience. They give consumers control and the ability to take immediate action when they are motivated. Their technology solutions apply psychographic profiling, artificial intelligence and use machine learning to anticipate behavior. They can predict what show you might want to binge watch next, or that it is time to re-order shampoo or any number of items. And their supply chain will deliver everything you order to your door in a few days or less. How does this compare to the scheduling process, durable medical equipment procurement or prescription ordering workflows your patients currently navigate?

    Nobody enjoys navigating automated phone systems or extended hold times. Nor do they want to navigate clunky portals that are only accessible through their computers. Here are some barriers to consider:

    • Is every patient in your practice set up in the portal?
    • Is there a workflow for patients to recover or reset a forgotten user ID and/or password?
    • Your portal may only allow patients to request an appointment, but a scheduler may need to call them to schedule it. 

    These and other workflows take time, adding friction and increasing the likelihood that patients may not schedule an appointment with your practice.


    If your office is only open from 8 a.m. to 4 p.m., it is likely that patients and their caregivers may need to take time off from work and/or school to attend an appointment. However, not everyone can take time off during business hours. Inconvenient appointment times are frequently cited as the reason care is delayed and gaps in routine screening occur.

    Perhaps your practice could set up evening or weekend appointments a few times a week. Maybe a sick child or headache clinic could be scheduled from 11 a.m. to 2 p.m. for those who need immediate attention. It can be difficult for care providers to take time off as well. Your team members may appreciate having a regular morning or two each week to run errands and attend appointments of their own, enabling extended hours for your practice and satisfying the needs of your patient population.

    How long is too long?

    Time to third-next-available appointment is a long-held metric practices have used to gauge when wait times are getting too long and additional staff is required to meet demand. Patients expect to be seen in a reasonable time, usually in terms of days or a few weeks. Longer wait times aren’t tolerable for most people. Patients can source another provider in a few minutes through social media and online ratings right from their phone. With one click, they can reach out to other practices that provide the same services, reducing the wait time for an appointment. Consider if those patients wait until the reminder call for their original appointment with your practice to cancel. By then, it is difficult to find another patient to take that slot, and it is increasingly likely that your utilization will be affected.

    Provider control

    For many years providers have controlled the healthcare ecosystem. Care team collaboration, telehealth, and the trend back to home-based care is causing many to rethink long-standing protocols and workflows that involve more providers than ever before. Shifting control from the provider to the patient can be unsettling. Some may even feel as though they are giving up control of the scheduling process. It might be worth considering how you can see more patients in a timely manner and the impact these changes could make on the health of your patient population and practice utilization.


    Appointments can be cancelled at any point after the slot is reserved. The further in advance cancellations occur, the more likely patients can be found to fill the cancelled appointment. Understanding how your practice cancellation rates compare to peer organizations is a good starting point. Cancellations are often the biggest reason for utilization concerns.

    The financial impact

    What does this cost your practice? Patient no-shows and cancellations that cannot be re-filled average between 6% to 23% of all patient appointments. Assume that your practice has 500 appointment slots each week with an average value of $125 each, for potential weekly billings of $62,500. If 10% of your appointments do not show or cancel too late to re-fill, you miss out on 50 appointments or $6,250 in weekly billings. Over a year, that adds up to $325,000. If you could radically innovate scheduling and dramatically reduce cancellation and no-show rates, the results will profoundly impact your top-line revenue. In this example, a reduction of only 5% adds $162,500 annually.

    Calculate your opportunity

    Here are a few simple calculations that you can perform in less than five minutes to approximate the revenue your practice loses each year due to cancellations and reschedules, late cancels, and no-shows (Figure 1). By lowering these rates by only a percentage or two, your practice could see a significant increase to top-line revenue.

    Honest reflection

    Your practice should ask the following: How frictionless is your current scheduling experience from the patient’s perspective? Do patients still need to contact a phone center, navigate menus, and endure long holds just to make an appointment? Or can patients schedule from their phones 24/7 with a few taps, as they do for airline or movie tickets? Does your current scheduling workstream and technology deliver the utilization you want? Are your patients being reminded a week prior, a day prior, and the morning of their appointments through their smart phones?

    Some rescheduling will always be needed, and you should have a plan for it. Does your current system provide transparency with all available appointment slots, and can the patient select the one that works best for them from their mobile device or laptop? Are all slots available to patients, or do you still hold back a few? If slots cannot be scheduled, utilization will be affected.

    Radical convenience

    By making healthcare radically convenient, decision fatigue can be reduced. If providers understand what motivates patients to seek care, they can create reactivation campaigns with relevant messaging to encourage regular screenings and appointments. For example, your practice can automate a scheduling outreach and appointment setting campaign before screenings are due to ensure the clinically pertinent cadence is maintained. Leverage mobile tools that are “table stakes” in most apps, such as automatic calendaring, reminders, and rescheduling workflows. Many of these apps can bolt onto a well-established scheduling solution to minimize interruption to well-entrenched workflows.

    As new technologies are considered, it is important to remember that you cannot implement them without considering the human element. Earlier phone and portal-based scheduling models treated patients as commodities. Excessive hold times and not always hearing the full range of appointment options from the scheduler were unintended growing pains we all experienced as technology grew up.

    Aisle seats

    Airlines have been asking for passenger preferences for years as they create online profiles. As your practice onboards new patients and updates established patient records annually, consider asking them about scheduling preferences. Perhaps elderly patients would prefer daytime appointments, while working professionals may prefer the first appointment of the day or an evening slot.

    The channel by which the message is delivered is just as important as timing. It also affects the likelihood of keeping an appointment. Text-based communication offers convenience compared to phone trees and portals, and it is an essential technology for practices with younger patients. It is important to streamline text-based workflows to evoke action. Personalization cookies are another tool that can be incorporated into scheduling workflows to further increase the likelihood that an action will be taken.

    Scheduling for all

    Telehealth has tremendous potential to help ensure chronic conditions are well managed, routine screenings happen at regular intervals, and the health of your practice population is tightly managed. With telehealth a mainstream mode of care and the trend toward the medical home gaining momentum, it is important that scheduling solutions accommodate in-person and remote appointments. Getting telehealth appointments onto the patient’s calendar and, in some cases, getting a tech savvy family member to help the patient get connected may be key to some patient populations keeping their appointments.

    Intelligent scheduling and remote appointments also provide a valuable option for those patients who have issues with transportation, are geographically isolated and/or underserved. When scheduling becomes radically convenient and available to all, patients benefit, populations are healthier and utilization rates improve.

    Written By

    Ani Osborne, MBA

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