Should patients be charged for no shows?

No shows.  It seems that no matter what we do, we always have them.

Despite the fact that we call every single person on the schedule to remind them of their appointment the day before (the staff personally makes the call. We don’t use an automated system) we found that in 2009, we had 389 no-shows.

Slicing the data

Is 389 a high number of no-shows? I guess it depends on the size of the practice, how many encounters a practice has in a year or how many days the practice is open.

Our practice is open about 310 days a year. If you do that math, that comes out to 1.25 no-shows a day. In 2009, our practice had 10,660 encounters. If you do the math again, you’ll find that the 389 no-shows represent 3.64%.

Further analysis shows:

  • 314 patients accounted for 389 no-shows. This suggests that there were few repeat offenders.
  • 1 no-show     = 261
  • 2 no-shows    = 38
  • 3 no-shows    = 12
  • 4 or more       = 3
  • On average, our patients’ no-show 1.23 times in a single year.

What kind of financial impact did the 389 no shows create?

If one averages, let’s say, $112 a visit, that would mean we lost $43,568. That is assuming none of those 389 no-shows ever came back to the office for their missed appointment. Which wasn’t the case. We often call parents that no-show and ask them to reschedule. The question then is, how many of those no-shows never came back to be seen? Then, we could figure out the loss of revenue. Do you agree?

How about charging a no-show fee? Charging, let’s say $25 for each no-show, we would have recouped $9725. But that assumes we can collect 100% of the no-show fee. Which I doubt we could collect 100% of the 389 no-shows.

What is the intent?

The no-show fee serves two purposes. The first purpose is to deter people from doing it the first place. And some would argue that the second purpose is to offset the revenue they would have otherwise received had they provided the services.

However, does the no-show fee really deter patients from no-showing? If so, by how much? How do we know that because of the no-show fee, people prefer not to schedule appointments in advance, which may result in delaying care even further because they never end up calling us back?

Does charging for no-shows create an expense because now we have to send out a statement, which some people say it cost upwards of $5 to send? Does the no-show fee really offset the loss?

To charge or not to charge

I consider charging patients for no-shows a hassle. It’s bad enough trying to hunt payments down from patients that actually received services in our office and don’t want to pay. I can only imagine having to hunt down payment from a parent for a service we didn’t actually provide. But I could be missing the boat.

Is the no-show really a loss?

No-shows are considered an opportunity cost. But, when a patient no-shows, does the staff and doctor sit in the practice doing nothing? Or does the unexpected free time give the staff an opportunity to do other important things?

I don’t see a no-show as a loss because there are equally productive task that we all do in the office when a patient missed their appointment. Again, I might be missing the boat here but in our experience, no-shows are almost a good thing because it allows the doctor to spend more time with the families during a visit, make a few extra phone calls to parents, check on labs or simply take a break.

I understand that this notion doesn’t work if a practice sees only 10 patients a day and 2 or 3 people no-show. But if you have a busy office, like I suspect many of you do, the no-shows shouldn’t affect the practice’s bottom line because there is always an equally productive task to be done.

Missing the boat?

I don’t know if I’m missing the boat here. Hence the questions and the analysis.

But it seems to me there is more value in learning to manage missed appointment, than to put so much effort in trying to eliminate them by collecting fees for them when in fact, we are always going to have no-shows.

Brandon Betancourt manages a pediatric practice and blogs at Pediatric Inc.

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