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    Chris Harrop
    Chris Harrop

    Across ambulatory and outpatient settings, patient no-show patterns in 2025 look less like a single trend line and more like a set of overlapping waves. Economic pressure and coverage churn are pushing some patients away from care, while smarter scheduling and digital tools are pulling others back in.  

    MGMA Stat poll, August 12, 2025: 60% of medical groups report patient no-shows about the same in 2025 vs. 2024.


    An Aug. 12, 2025, MGMA Stat poll found 73% of medical practices report patient no-show rates have stayed the same (60%) or decreased (13%) in 2025 relative to last year, while 27% say no-shows have increased. The poll had 265 applicable responses. 

    What’s driving patient behavior 

    Where no-show rates are increasing 

    Medical practice leaders who reported higher no-show rates in 2025 cited a mix of patient attitudes, logistical barriers, and systemic factors.  

    • Many observed a growing sense of indifference toward keeping appointments, with some patients appearing uncommitted, unconcerned about their health, or quick to seek care elsewhere without canceling.  
    • Transportation challenges were frequently mentioned, alongside economic hardship, copay costs, and insurance limitations, particularly for Medicaid patient visits where no-show fees are prohibited.  
    • Access issues — including long wait times, clinic location, and poor patient throughput — were noted, as were the impacts of environmental disruptions such as flooding.  
    • Other factors included fear of government enforcement actions, personal scheduling conflicts, illness, and a general lack of time management.  
    • Several leaders emphasized that patients often do not provide clear reasons, making it difficult to pinpoint the primary drivers. 

    Where no-show rates are stable or decreasing 

    Medical practice leaders who maintained or improved no-show rates in 2025 most often credited consistent patient communication, particularly frequent digital reminders, automated calls, and occasional live outreach. Many paired these with financial disincentives such as penalty fees or security deposits, though some noted these could increase patient dissatisfaction or administrative burden. 

    • Easy cancellation and rescheduling options, patient portal access, and online check-in systems were also seen as helpful, while some practices limited scheduling privileges or discharged chronic no-shows.  
    • Additional tactics included overbooking to offset expected absences, aligning appointment availability with patient needs, and leveraging virtual visits.  
    • Transportation barriers, patient financial strain, and personal constraints still contributed to missed visits, but leaders emphasized that persistent reminder systems combined with clear policies were the most common factors in stabilizing or reducing no-show rates. 

    A broader view of the issues 

    • Coverage churn and cost sensitivity. The unwinding of pandemic-era continuous Medicaid coverage has left millions cycling on and off insurance, creating confusion about eligibility, cost exposure, and where to seek care. In reporting states, about 31% of people with a completed renewal were disenrolled during the unwinding, with tens of millions ultimately affected — conditions ripe for missed and delayed care. 
    • Lead time matters. The longer patients wait between scheduling and the appointment date, the more likely they are to miss it. Recent evaluations of open-access models show that reducing days-out (“third next available”) and lead time lowers no-show rates, especially for primary care and routine follow-ups. 
    • Transportation remains a top barrier. Even with ride benefits expanding in some plans, access to a car or reliable transit still predicts whether people show up. A Robert Wood Johnson Foundation brief found 21% of adults without access to a vehicle or public transportation skipped needed care — a stark reminder that no amount of reminder tech overcomes a missing ride. 
    • Telehealth helps (on average) but not always. Post-pandemic evidence leans toward lower non-attendance for virtual visits overall, though results vary by setting and population. The net takeaway: telehealth is useful, but it should be deployed where fit is strong (behavioral health, med management, short follow-ups) and carefully measured. 
    • Digital friction and communication gaps. Appointment reminders that can’t be replied to, portals that lock people out, and language/access barriers all compound risk. Two-way channels and simple self-reschedule paths remain underused


    For leaders reading the tea leaves, the opportunity is to tighten fundamentals — access, communication, and readiness — then layer on targeted tactics by specialty and visit type. 

    Moves that reliably reduce no-shows 

    1. Shrink the wait. Treat access as a clinical quality metric. Measure and manage third-next-available; convert more templates to same-/next-day capacity; and run weekly “backlog scrubs” to pull forward those scheduled far out. Expect fewer no-shows simply by shortening lead time. 
    2. Make reminders conversational. Use two-way texting that lets patients confirm, ask questions, or “tap to reschedule.” Escalate unanswered texts with a live call for high-risk visits (new patients, procedures, imaging with prep). Keep messages ultra-plain (what, when, where, prep) and in the patient’s preferred language. 
    3. Offer the right virtual/in-person mix. Default to virtual for medication checks, results reviews, behavioral health, and brief follow-ups; set clear criteria for when video is acceptable versus when in-person is required. Track no-show and completion rates by modality and visit type so you can tune the mix rather than argue it on gut feel. 
    4. Close practical gaps before they become no-shows. Proactively verify coverage seven days before the visit, price out expected cost-share, and message options if benefits have lapsed (e.g., sliding fee, reschedule to open-access slot). Offer transportation help up front — bus passes, ride-hail codes, or NEMT (non-emergency medical transportation) scheduling — rather than waiting for patients to ask. 
    5. Target effort with risk signals. Use simple rules (prior no-shows, long lead time, morning of Monday slots, distance, prep-heavy visits) or a predictive model to flag high-risk appointments. Direct your scarce human outreach to that list; consider controlled overbooking only where you have room to absorb variance. 
    6. Institutionalize the “missed-visit play.” Within 24 hours of a no-show, send a friendly, blame-free rebooking link; within 72 hours, make a live call for clinically important follow-ups. Track reclaimed slots as a KPI. 

    Specialty insights 

    • Primary care and multispecialty: Adopt a hybrid open-access model: reserve blocks for same/next-day, protect continuity slots for chronic care, and push routine checkups into predictable, high-attendance times. Use rolling template optimization: shift capacity each month toward time blocks and visit types with the strongest completion rates.
    • Procedural/surgical: Put a navigator on high-prep cases to confirm bowel prep, driver availability, and coverage; these calls pay for themselves in reclaimed capacity. Offer preop telehealth for questions, plus cost transparency to prevent day-of drop-offs. Keep a “rapid fill” list of eligible patients and empower schedulers to pull them forward on day-before cancellations.
    • Behavioral health: Lean into virtual first; it consistently boosts completion for therapy and med-management. Offer short-cycle scheduling (1–2 weeks) and recurring time blocks so attendance becomes habitual. Use “friction-free” rescheduling and rapid reengagement after a miss; the goal is continuity, not punishment. 
    • Pediatrics: Bundle siblings on the same day, and bias toward after-school, early-evening, and Saturday clinic sessions — the times caregivers can make. Add pre-visit SMS checklists (“bring forms/ID, fasting?”) and one-tap reschedule links; send reminders to multiple caregivers when consented. Connect families to transportation resources or school-based telehealth when appropriate. 
    • Imaging and diagnostics: Failures here are often about readiness: missing labs, fasting confusion, or contrast anxiety. Do a day-before SMS/phone “readiness check” and attach a one-page prep visual. For modalities with chronic no-show risk (e.g., MRI scheduled far in advance), use risk-based micro-overbooking and a same-day waitlist to backfill. 

    How to tell if it’s working 

    Stand up a simple scorecard by site and specialty: 

    1. No-show and late-cancel rates by visit type/modality 
    2. Third-next-available 
    3. Days-out at scheduling 
    4. Reclaimed-slot rate after misses 
    5. Completion rates for high-risk cohorts you’ve targeted.  

    Share it with frontline teams and celebrate reclaimed capacity like new revenue — because it is

    Bottom line 

    In 2025, the practices winning back capacity are the ones doing basic access brilliantly, removing practical friction before it becomes failure, and matching visit modality to the work at hand — then using data to steer effort where it has the biggest payoff. 

    Additional resources

    Join MGMA Stat 

    Our ability at MGMA to provide great resources, education and advocacy depends on a strong feedback loop with healthcare leaders. To be part of this effort, sign up for MGMA Stat and make your voice heard in our weekly polls. Sign up by texting “STAT” to 33550 or visit mgma.com/mgma-stat. Polls will be sent to your phone via text message. 

     

    Chris Harrop

    Written By

    Chris Harrop

    Chris Harrop serves as Senior Editor on MGMA's Training and Development team, overseeing the Strategy, Growth and Governance vertical. Previous to this, he spent eight years as MGMA's Senior Editorial Manager, leading MGMA's publications team. In that role, he was editor of the quarterly MGMA Connection magazine, weekly MGMA Insights newsletter, and MGMA Stat, a weekly, nationwide polling initiative focus on real-time responses to industry topics. Since 2020, he also has been lead editor on MGMA's data summary reports, giving context to the benchmarks and trends in the MGMA DataDive survey datasets. He also regularly directs and serves as lead author or editor on a variety of industry whitepapers and research reports commissioned by MGMA's solution partners. Prior to MGMA, Chris was a journalist and community newsroom leader in multiple Denver-area news organizations.


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