You know the feeling: you’re cruising along through your work day, seamlessly transitioning from one patient to the next, keeping a close eye on the clock to make sure that each patient receives the care they need in the time allotted. Then suddenly, your 11:00 patient no-shows and your 11:30 calls and cancels their appointment due to car trouble. There’s nothing like an hour-long gap in the middle of your morning to completely throw off your flow.
While no-shows and cancellations are annoying for providers, these missed appointments also have larger impacts on the clinic’s bottom line and the healthcare system as a whole. In this article, we’ll discuss:
  1. The cost of cancels and no-shows to providers, patients, and the healthcare system
  2. Common reasons why patients miss their appointments
  3. How to address these barriers to improve patient attendance

The Real Cost of Missed Appointments

In addition to sending your schedule for a loop, no-shows and late cancellations have a detrimental effect on your clinic’s income and the healthcare system as a whole. Patient engagement platform SCI Solutions calculated that each missed appointment costs physicians an average of $200 in lost revenue.[i] In 2017, they estimated that this amounted to a total loss of $150 billion for the U.S. healthcare system.1

In the rehabilitation field, the numbers are equally grim. In 2015, a national survey of more than 800 U.S. physical therapists found an average no-show rate of just over 10%.[ii] A recent Canadian case study found a combined no-show and 24-hour cancellation rate of >20%, which cost the outpatient clinic in question more than $114,000 CAD in 2017.[iii]

In addition to assessing the cost to providers and the healthcare system as a whole, it is important to also consider the impact that missed appointments have on patients. A missed appointment often leads to a delay in the patient’s treatment, which can contribute to a longer and slower recovery.3 Over the long term, missed appointments can also lead to greater patient morbidity, as an undertreated condition becomes chronic and more debilitating, and this may result in an increased cost to the healthcare system.3

4 Reasons Patients No-Show to Appointments

Countless studies have been performed across a variety of specialties in medicine, and this research describes a whole host of reasons that patients miss their appointments.[iv] While we can’t analyze all the possibilities here, let’s consider four common causes of no-shows in the rehab realm.

  1. Cost and transportation concerns
    • Studies on no-show rates in physical therapy often report that patients of lower socioeconomic status are more likely to no-show.3 If a patient becomes overwhelmed by the growing cost of repeated, frequent appointments, they are more likely to attempt to avoid further financial burden by no-showing.
    • Transportation barriers are another commonly cited concern among patients attempting to come to outpatient clinics.[v] When a patient is already strapped for cash, the added cost—not to mention the inconvenience—of a bus ticket or ride-share to the clinic may put them over the edge.
  1. Long wait times in the office
    • For the average patient, there’s nothing quite as frustrating as setting aside valuable time and money to come to the clinic, only to discover that their therapist is running 20 minutes behind schedule and will now have to triple-book them with the patients before and after to treat everyone. Patients commonly cite extended wait times in the clinic as a source of dissatisfaction and frustration with the healthcare system.[vi] If patients feel disrespected by their providers, they are more likely to miss future appointments. 4
  1. Discouragement
    • This reason is harder to quantify, but every therapist has had this discussion with patients: “I just don’t feel like I’m getting any better. I don’t think therapy is working”. It’s only natural for patients to question the value of the time and money they are spending on their rehab, particularly if they feel they aren’t seeing results. While some patients may voice these concerns to their therapist, others may find it easier to avoid an awkward conversation by not coming to their next scheduled appointment.
  1. Fear of pain
    • A recent study of no-shows for outpatient medical procedures found that a key cause of missed mammography appointments was due to patients’ anxiety about the procedure and their anticipation of discomfort.5 The rehabilitation professions are equally notorious for the pain patients associate with visits. For many patients, previous negative experiences in therapy may significantly impact their willingness to show up for subsequent visits.

4 Ways to Combat Cancellations & No-Shows

While you can’t control every cause that may lead your patients to cancel their appointments, you can help mitigate the impact of many of the aforementioned reasons:

  1. Cost and transportation barriers
    • Be transparent as possible about the cost of care from the beginning. If the patient knows exactly what to expect in terms of fees per visit, they are less likely to fall victim to sticker-shock.
    • While it’s not easy to define exact expenses for patients with cost-sharing health plans, you may at least be able to provide an estimated average cost per visit based on commonly billed codes. Additionally, if you can define an approximate time frame to recovery, including expected frequency of visits, this allows patients to budget over time.
    • If transportation is an issue, telehealth follow-ups become more appealing, assuming your clinic’s procedures and the patient’s insurance coverage allow for this option.
  1. Long wait times
    • While you can’t always control every aspect of your day, managing the ones you can will significantly cut down on the time patients spend waiting for you, and thereby improve their experience and satisfaction. By streamlining your home program prescription with the AC Health app, for example, you can decrease the time you spend on paperwork, giving you more time to provide each patient the treatment they deserve while still staying on schedule.
  1. Discouragement
    • This is where motivational tools and patient-friendly outcome measures can be so valuable. The AC Health app allows therapists to set patient-centered goals at the start of care, and even take photos or video to demonstrate the patient’s initial status. You can then document progress in the Patient Goal section to show improvement over time. When your patient inevitably forgets how far they have come a few weeks into therapy, what better way is there to encourage them to stay the course?
  2. Reduce Cancellations due to Fear of PainFear of pain
    • Education is key here. Ensuring a positive and minimally provocative initial evaluation is one valuable first step in improving patient trust and decreasing fear. In addition, setting expectations regarding typical post-visit discomfort and exercise-related soreness can help prevent the patient from feeling blindsided by symptoms between visit 1 and 2. The AC Health app includes a variety of additional resources you can share with patients to help them learn more about pain throughout their rehab journey.