You walk through your practice one afternoon only to find three of your therapists chatting in the break room. At first you are frustrated, wondering why they are not with their patients, but you notice the therapy room is also unusually empty. A brief inquiry informs you these therapists have nothing to do for the next 30 minutes because their patients didn’t show up.
One of them is a new patient, one has a habit of missing appointments and will likely be charged the $45 no-show fee, and one is a surprise as they have never missed an appointment before. You follow up with the scheduler and learn that the third patient was scheduled at an atypical time slot due to a scheduling conflict. The reasons seem to fade away at this point. Income has been lost, patients haven’t been treated, and your expenses remain the same. You can’t continue caring for patients with the quality you strive for in this all-too-common scenario.
In this post, we will cover
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The Cost of a Missed Appointment
A therapist rarely enters the field of medicine to earn money, but we all deserve to be paid for our hard work. To be stood up by a patient, intentionally or carelessly, is an insult to a therapist’s time and a frustration to their wallet. A full-time therapist performs 8–12 appointments per day.
So a single missed appointment each day results in roughly a 10% loss of practice income.
That means you can’t give out a Christmas bonus this year. That means your marketing budget has been cut to nearly nothing, causing even more losses next year. Or maybe that new hire or updated piece of equipment you were considering is no longer in budget, preventing your company from growing.
This assumes a single loss alone. However, a first-time evaluation is more likely to be missed than an established patient visit. A missed evaluation is longer than a typical visit, meaning more time and money lost. And a missed evaluation potentially means a missed patient altogether—an entire episode of care (8–20 visits or more) that is never paid out. Worse still, a patient who needs care is never seen at all.
Lost income aside, your patient has not received treatment, and your predicted recovery timeline of 4–6 weeks is now pushed to 6–8 weeks. The patient suffers needlessly, you are forced to call and negotiate with the insurance company, and you may not get paid at all for the last few appointments as insurance authorizations lapse and patients struggle to pay cash for medical visits.
Why Do Patients Miss Appointments?
The Forgetful Patient
Patients rarely miss an appointment on purpose. In our introductory anecdote, the first patient missed out of simple forgetfulness. They had an acute issue that needed treatment. The doctor referred them to your practice, and you dutifully set an evaluation time. While they agreed to it, a week later they went about their normal day and were in the middle of picking up groceries as they usually do at that time.
Maybe their calendar reminder went off at the grocery store and it was too late to make it. They were a little nervous about starting PT anyway, so it was a welcome relief to just avoid the situation and live with the bum knee.
The Carefree Patient
The second patient is a typical case of absentmindedness. They’re a free-spirited artist or an eccentric technologist. They get caught up in “the zone” at work and lose track of time. Maybe they put their phone on silent and miss the calendar reminder, or they’re simply not organized enough to put it in their calendar in the first place. They genuinely want treatment—the bad case of tech-neck causes them daily pain. While you understand their excuses, it’s the third no- show and you have to charge them a fee. You hate it. Nobody benefits from that fee—it just cushions a tiny bit of the loss, often at the cost of alienating the patient and losing the rest of their visits.
The Over-Occupied Patient
The third patient is perhaps the most tragic. They always show up, with a reputation so strong you wouldn’t dare charge the no-show fee. They probably call an hour after the missed appointment, apologize profusely, and beg for a make-up slot later in the day. They usually come Tuesday at 3:00 but scheduled a Monday morning slot this time due to a special event on Tuesday. They forgot to update their calendar and overlooked the change in the chaos of the weekend. Each excuse may sound shallow, but every miss has a story. A story you can empathize with— and one you want to help prevent.
Reminder Calls and Text Messages to the Rescue!
It seems almost silly not to have considered it sooner, but a phone call the day before is often all it takes to curb each of these scenarios. That first-time eval got a call the week before from a friendly receptionist and a follow-up text one day out, so they rearranged their schedule and went to the grocery store after the appointment. That absent-minded artist got a reminder one hour before, and while they were “in the zone,” a phone call interrupted them just in time to close out the task and head to the facility.
The faithful patient got the reminder the previous Friday, set three alarms, and kept their phone close by. Research shows reminder calls and texts of any kind reduce no-shows overall by 20–30% (https://pubmed.ncbi.nlm.nih.gov/26852337/). That means one of those three scenarios was prevented.
More importantly, interaction with a patient before a first-time evaluation reduced no- shows by up to 70% (https://pubmed.ncbi.nlm.nih.gov/35981130/). Altogether, a single reminder text message or phone call could result in significant savings for the practice and greatly improve patient satisfaction.
Reminder Strategy
A receptionist-initiated phone call is the clear winner in reminder effectiveness. Only slightly less effective is the automated text/call system, with little significant difference between text or call. Coming in last, with nearly zero effectiveness, are automated e-mail systems. No clear research shows the “optimal” time to remind a patient via phone or text, but the general agreement is 24–48 hours before the appointment.
From a cost perspective, e-mail marketing is nearly free, but this also makes it heavily abused and the reason consumers have lost trust in e-mail systems in general. E-mail is a great place for a newsletter—not a great place to remind patients of upcoming appointments. Skip this method altogether. That said, if still desired, QuickEMR does allow sending e-mail reminders to subscribed users directly from the appointment book.
Human interaction is slightly more effective than an automated system, but not enough to justify the heavy administrative burden of calling every patient. Here is where a targeted approach works very well. For first-time evaluations and long-absent patients, a human touch will easily pay for itself. Call your evaluation patients one week before the appointment. Introduce yourself, confirm the time and location, answer questions, and start the process of humanizing your practice and making the patient feel comfortable about coming in. Also obtain the patient’s permission for automated text messages and add them to the subscription list on the spot.
Make sure the automated reminder templates include a welcoming message for first-time visitors. Some practices even provide a short video of each provider introducing themselves. With the highest-risk, highest-reward patients covered, use automated text messaging for the remaining 90% who have an established relationship. Set it and forget it, as the schedule sends out a reminder automatically 1–2 days before the appointment.
Schedule reminders to go out in the late morning. This gives you time to review the reminder report in the last hour of the day and call those who have not confirmed and are at risk of being a no-show. If they cancel as a result of this phone call, take the opportunity to go through the waitlist and fill that gap. If desired, send a second reminder 1–2 hours before the appointment on the same day.
At $0.14 per reminder, that costs you $28/month. Your investment in reminder
Ready to integrate an automated reminder system into your clinic?
Assuming 200 visits a month at an average of $100 per visit across all visit types, and a normal no-show rate of 10%, an automated reminder system with 25% effectiveness will reduce losses by $500/month.
At $0.14 per reminder, that costs you $28/month. Your investment in reminder
text messages pays out at least 1500%. That’s a no-brainer!
Interested in exactly how much you can save, stacked against WebPT or PromptEMR? Try our free pricing calculator.
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