Reduce Missed Appointments: Best Practices

March 30, 2017
7 min read
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Reduce Missed Appointments: Best Practices
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The dreaded missed appointment. Missed appointments cost the U.S. healthcare system more than $150 billion a year.

Everyone wants to reduce missed appointments and boost efficiency in the workplace - medical practices are no exception. If anything, medical practices are especially impacted by the 'time is money' adage. As we know, individual appointments carry a hefty price tag and normally drive the main revenue for the practice.

So, we've collected the best practices to reduce missed appointments for your medical practice.

First, what doesn't work.

Charging a No-Show Fee

Well, we're not saying this is the worst way to deal with no-shows. It's certainly better to recover some lost revenue than none at all. However, we don't think it's the clear winner. Wouldn't it be better to decrease your no-show rate than to put a quick fix over the issue?

As a technology-first company, we work to constantly refine our 'conversion rates.' In healthcare, your show-rate is your conversion rate. You should constantly be mindful of your appointment show-rate conversion, and work towards optimizing. The goal is 100%.

While things inevitably get in the way, your goal should always be to strive towards 100% of appointments booked to appointments held.

Reprimanding Patients may have an impact on retention

Patients may flag an experience as negative if they are charged for a last-minute or same-day cancellation.

Market research has found that it can take up to 12 positive experiences to overcome the damage of a single negative one, AND poor experiences are shared almost twice as much as good ones.

Although it may be no fault of your own, this form of reinforcement may isolate people from scheduling a new appointment for fear of being charged a fee for cancellation based off of previous negative experience. Ouch.


While overbooking can save your practice the headache of dealing with gaps during the day due to missed appointments, the situation can often be unpredictable. The patients who show up then are more likely to experience long wait times and frustrating administrative experience.

Think about your latest online reviews. Were they about the quality of care or the quality of your patient experience inside and outside office?

Similar to the negative association that may occur with charging a fee for no-shows, overbooking can contribute to the 'negative' mindset. This association will dissuade patients from rebooking at your practice.

Customer Service Woes

A 2016 Vanguard study found that your practice 'customer service' has a significant impact on patient experience.

Summary of findings

  • 96 percent of patient complaints are customer service related
  • 4 percent are healthcare related


Of the customer service complaints:

  • 53 percent of complaints are related to communication
  • 35 percent of complaints are related to long wait times/waiting rooms
  • 12 percent of complaints are related to practice staff
  • 2 percent of complaints are related to billing

You can run a patient no-show rate analysis to calculate your approximate no-show rate for a given week. From there, you can overbook to anticipate the predicted no-show volume. This method is the best way to overbook your practice. Easy data-driven decisions, easy wins.

No-Show Rate Calculation

To give you perspective: If a pediatric practice sees 100 patients a day at an average cost of $125, with a 13% no-show rate, the practice would lose $32,500 each month.

The Medical Group Management Association (MGMA) report shows no-show rates range on average from 1% to 28% (with that 13% in our example well within the range). This range varies little from specialty-to-specialty.

Finally: Tips to Reduce Missed Appointments (For Real)

As we know, even a small no-show percentage can have a tremendous impact on operations.

Appointment Reminders - Of The Future

How do you reach out to your patients before an appointment? Do you calculate your no-show rate? Do you A/B test methods? It's GREAT if you do these things, BUT we don't expect you too.

With the burnout rate and overtime hours the way that they are, no one working in a medical practice environment has extra time to do business analytics. So we've figured out the best way for you.

Calling Works, Until It Doesnโ€™t

An article on American Medical News shows that patients are significantly more likely to keep an appointment with a phone call reminder. Well, of course.

But, we don't have time for that.

This study goes on to say that despite the effectiveness, staff โ€œfrequently have a hard time fitting in these calls, which means that sometimes they don't happen at all.โ€

It also addresses the of cost-effectiveness of these phone calls (or rather, lack-thereof).We highly suggest taking a look.

The Take-Away: Mobile Messages

A Kaiser Permanente study found solid evidence of mobile messages having a high impact on the reduction of missed appointments.

The study involved a clinic conducting an experimental mobile messaging pilot program. The results? The clinic experienced experienced 1,873 fewer no-shows; with a $150 savings per appointment, this then translated to a total cost savings of $275,000 (source)

You might be thinking...

We do fine sending postcards to our patients.

Let's break it down: you spend approximately 1.5 minutes to fill in the specific appointment date and time, address it, and then send it. If that location sends out 50 appointment reminders per day, itโ€™s using up 75 minutes of time each day that could be used more productively.

You may think that your patients are too old, not tech-savvy or won't like their doctor office sending them mobile messages; however, we've found that overall patients are adopting messaging more than ever before.

For example, our messaging platform Klara is activated quickly and easily by patients.

The majority of our users are actually 45+.

It's not just a Millennial game, only 12.5% are below 25. (That's not to say that's a small number, either)

Reminder Messages: Human-Powered Works Best

While there are plenty of automated reminder systems out there that push messages to your patients, they fall short of addressing the context around the appointment.

A 2016 study concludes, To optimize appointment and reminder systems, health care services need supportive administrative processes to enhance attendance, cancellation, rescheduling, and re-allocation of appointments to other patients. (source)

Klara is a messaging platform that allows for staff to save time sending appointment reminders in the form of messages or saved templates. It has a two-way chat function, that enhances the administrative processes.

The study goes on to state unless otherwise indicated, all patients should receive a reminder to facilitate attendance at their health care appointment. The choice of reminder system should be tailored to the individual service. (source)

Klara enables individualized messages, rather than an automated, standardized reminder-bot. Patients receive custom, personal care and staff save time โ€” all while reducing your missed appointment rate.

More Tips for Reducing Missed Appointments (MGMA Tried and True)

  • Have patients repeat the date and time of their next appointments, whether they're in your office or on the phone.
  • Discharge patients who accumulate a set amount (your choice) of no-shows in a year.
  • Charge for same-day cancellations (which can be just as bad as no-shows), unless it's an emergency. You can also alternatively charge after a grace period that you identified earlier. For example after one no-show you get charged.
  • Schedule appointments within a reasonable time of the patient's call of appointment. The longer the lapse, the greater the chance of a no-show.
  • Develop a call list of patients who are able to come in for short-notice appointments. When a no-show happens, these patients may be able to fill the empty spot.
  • Allow patients to prepay for their next appointment, giving them an incentive to return.
  • Schedule repeat offenders during a time that has less of an effect to the overall schedule.
  • Track the reasons each patient gives for a no-show. Trends in excuses can help point to solutions. For example, are they covered by a certain insurance carrier, seen by the same physician or on a certain day of the week?
  • (source)

Simon Bolz, Co-Founder, Klara

A serial entrepreneur, Simon founded two technology companies in Berlin. He then found his true passion in healthcare helping build Germanyโ€™s most innovative implantology clinic group. Simon studied at the London School of Economics, Humboldt Universitรคt Berlin, and got a Masters at the New School for Social Research in New York. In 2013, he and Simon Lorenz, Ph.D. founded Klara with the mission to transform communication in healthcare, so every patient can receive great care.

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