As one client’s exponentially increasing no-show rate climbed to an all-time high, it was time to take steps to curb this growing problem.

In a location where the no-show rate was historically 17%, this practice was experiencing an increase in the number of patients not showing up for appointments to an office record of 52%. Something had to be done.

Defined as the number of patients who fail to arrive for their scheduled eye exam appointment, the no-show rate must first be tracked, calculated and measured. You must know your practice’s no-show rate before you can address it.

If you’re using a computerized practice management system to book your patients’ appointments there is normally an electronic workflow in the system for your staff to document if patients show up, cancel, reschedule or don’t show up for their appointments. Practice management systems typically have a “Reports” area where there would be a Cancellation and No-Show report. This report may segment the cancellations and no-shows by patient, appointment type, provider, date or time. It can run the no-show rate by week or by month.

Additionally, you may need to run a Provider Production report that tracks the number of exams seen by the optometrist for the week and/or month. An example of a Provider Production report is shown below. To calculate your office no-show rate, divide the aggregate number of no-shows for the time frame you’re measuring divided by the total patient exam visits by the same time frame, as follows: no shows ÷ patient visits x 100 = no-show rate.

No-shows negatively impact the office performance and financials with lower generated revenue/income. You and your staff will be underutilized as you’re not seeing patients and generating revenue, which will ultimately increase your office overhead costs. No-shows decrease the efficiencies of your office, costing you revenue of up to $250,000 per year!

With your no-shows tracked and calculated, how do you measure and compare to your colleagues and the industry? Per Sendhub, the optometric industry average patient no-show rate is 12%. How does your office compare to the industry?

In the case of my client, we knew the office’s historical no-show rate of 15% based on the practice location demographics that we measure monthly in order to observe trends to determine whether they are increasing or decreasing. We saw no-shows for this particular office at 14%, then spike to 43% the next month, and the following month spike again to 52%! Here is the measurement and the calculated lost revenue:

They were on a declining path that was affecting their gross revenue by $40,000 per month, so we conducted a forensic investigation to determine the cause; we already knew the effect.

First, I reviewed the practice’s revenue streams for any anomalies and discovered the office had applied to more Medicaid plans. In my own practice management in which I acquired optometric offices, I observed a trend that Medicaid plans resulted in high no-shows, around 30%, so offices would double and triple book to offset them. My gut feeling was that this office may have been experiencing the same trend.

My recommendation to the office administrator was to pull historical daily schedules with patient names and insurance plans, run the Cancellation and No-Show reports for the same period, and document the no-shows by the insurance carrier. After about two weeks we analyzed the data and had our answer. The exponential increase in no-shows was directly from the Medicaid plans, costing the office over $84,000 in lost revenue over two months!

The administrator and I also reviewed the current no-show process, because it had been working well prior to the spike. The current no-show process was:

• a dedicated electronic patient notification system is used
• scheduled patients are tagged with an electronic reminder notification
• the first automated appointment reminder call is scheduled for four days before the appointment
• patients have the option via the electronic reminder call to reschedule their appointment if needed
• the second appointment reminder call is scheduled two days before the appointment
• the system provides the office with an electronic version of the confirmed and non-confirmed appointments
• staff manually calls patients who do not confirm via the electronic notification system
• the third notification call is scheduled for the day before the appointment

The administrator and I composed the executive summary with the action plan and presented it to the practice’s physician owner. Upon reading the summary the physician made the executive decision to stop seeing the high no-show Medicaid plans.

With the directive of the physician/owner, the administrator communicated with the staff regarding future appointment requests from those Medicaid plans.

The no-show rate for the fourth month came in at a year low of 5%!

No Show Rate
Operational Days
Variance From Average
No Show Revenue Loss/Gain

The remainder of the year no-show trend was in the mid to high teens, nowhere near what could have been a major financial issue. As of today, the office is maintaining its historical no-show rate, the best we can expect from the patient demographics and acceptable to the physician/owner and practice administrator.

The office no-show procedure has proven to be effective and is re-evaluated quarterly or when we encounter another anomaly.

Steven Sunder is the president of Sunder Vision Solutions, providing eyecare business consulting since 1998. He has held senior executive positions in eyecare practice management with budgets higher than $10 million, and he is president of an optometric merger and acquisition company in a tri-state region. Contact him at Steve@SunderVisionSolutions.com, or visit SunderVisionSolutions.com.

Recommendations for a No-Show Procedure
You should have a no-show procedure in place.
a. Create a no-show policy
b. Include patient requirements such as:
i. Follow-up to be made by patient one month before appointment due date
ii. Create a patient appointment pop-up in practice management system if the patient does not call to make an appointment
iii. Staff to call the patient to schedule
c. Automated call to be done four days, two days and one day before appointment
d. Text can follow the same schedule
e. If patients don’t confirm, staff call x days before or call patients on the wait list to fill the schedule

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