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    About one-third of medical groups have seen an uptick in their patient no-show rates thus far in 2023, with most practice leaders reporting they’ve kept this metric mostly unchanged despite staffing and financial challenges.

    An Aug. 8, 2023, MGMA Stat poll found that 52% of medical groups reported their patient no-show rates had stayed the same so far this year compared to 2022, while 37% reported an increase and 11% told MGMA they saw a decrease in their no-show rates. The poll had 380 applicable responses.

    The latest poll finds improvement in managing patient appointments versus an Aug. 2, 2022, poll that found nearly half (49%) of medical groups had experienced a jump in no-show rates through the same period in 2022.

    What’s working today

    Patient access has been at the forefront of many administrative leaders’ minds, either as a public safety consideration during the COVID-19 pandemic or a matter of practicality during the Great Resignation and a shortage of available staff for check-ins, checkouts and all the patient flow in between.

    For the poll respondents whose no-show rates decreased, there were several common factors that drove their improved performance:

    • Several medical groups credited the implementation of robust, automated appointment reminder and confirmation text messages, emails and/or phone calls at a certain cadence leading up to the appointment (e.g., five days, three days and/or one day prior to the visit).
    • One practice leader told MGMA that the organization is implementing a new reminder system beyond the patient portal reminders
    • Several respondents noted they have new patients sign a no-show policy to be assessed a fee (often $25 for an office visit or $100 for a surgical appointment) or charge for a missed appointment without appropriate notice. Multiple respondents noted that they instituted new no-show fees just in the past year for non-Medicaid patients.

    Several medical practice leaders who responded to the poll noted that they were reluctant to institute a no-show fee at this time due to the degree of manual work to implement within their existing practice management (PM) system. In instances where continued no-shows occur despite the automated reminders, some respondents noted that they have added more direct calls to patients before reaching a point of potentially dismissing a patient after a certain number of no-shows.

    However, one approach that often does not lead to improvement is the habit of overbooking appointments to avoid empty spots on providers’ schedules. As Fred Pelzman of Weill Cornell Internal Medicine Associates recently wrote for MedPage Today: “Instead of trying to overbook schedules … maybe we could just do everything humanly possible to ensure that everybody gets there for the appointments that are already scheduled.”

    Pelzman’s solution? More communication with new patients — typically, a pre-visit phone call — to ensure the clinic has accurate phone numbers, emails, emergency contact information and patient portal enrollment.

    Pelzman isn’t alone in thinking there’s a better way: A group of operations administrators and desk coordination leaders from the Mayo Clinic recently shared their experience in using a pre-appointment intake (PAI) process to call patients one to three business days prior to a patient’s arrival, with the goal of collecting or confirming important elements for their care, including date of birth, current medications, medical devices/implants and more. The use of the PAI process resulted in improved patient rooming times, as well as increases in medication reconciliation completion. While there ultimately were mixed results in some specialties, the pilot program did reveal opportunities to create remote work opportunities for on-site clinical support team members in a competitive labor market.

    Learn more via MGMA DataDive

    Managing noncompliant patients

    While most medical groups have held no-show rates steady thus far in 2023, it’s important for practice leaders to track this rate and be prepared to enact changes if things go awry.

    In a recent MGMA podcast episode, MGMA senior industry advisor Cristy Good, MPH, MBA, CPC, CMPE, offered some best practices on managing no-show patients who do not follow up with their care.

    “Ensure that patients receive clear information about the importance of their follow-up explained to them — the risks that are possible, and the consequences of not following up as well as the benefits of timely treatment,” Good said. “The key is to have various ways to communicate with those patients. Some patients might like phone calls, some people might like emails or text messages and mailed letters. Knowing what your patient population responds to, as well as individualizing it … increases your chance of getting them to respond.”

    Another key part is to maintain a record of all communication attempts made with that patient. “Note the dates, the times, the method of communication for each attempt — that should be documented,” Good said, who added that noting these attempts in an EHR is standard for many practices. This is especially important for compliance purposes and to avoid potential claims of patient abandonment. Good also noted that systems that can automate outreach and provide appointment reminders to patients without a staff member taking the time to make a phone call is highly recommended in an era of high turnover among front desk support staff and competition for workers.

    When it comes to high-risk patients or high-risk test results, it’s best to designate a patient navigator or coordinator to speak with patients and/or designated caregivers and family members to answer questions and ensure they understand what they need for follow-up care.

    For patients who repeatedly miss appointments or refuse suggested treatment, Good said it’s still important for the practice to handle the situation with sensitivity and respect for that patient’s decision by listening and, when possible, formulating alternative treatment options or offering education materials to educate the patient with information from another source. “If they continue to refuse treatment, you need to understand the implications for the decision and document it” — the discussion, educational materials provided and the patient’s stated reason for refusal — “in the medical record,” Good said. “It's crucial to make sure you also obtain an informed refusal so that the patient and you acknowledge that you're both understanding where both are coming from, and the risks and consequences of their decision.”


    Your contributions are vital to MGMA’s ongoing work to provide great resources, education and advocacy for medical group leaders. Sign up for MGMA Stat to make your voice heard in our weekly polls. Simply text “STAT” to 33550 or visit Polls will be sent to your phone via text message.

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