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3 Tips to Reduce No-Shows

July 24, 2017 • Practice Leadership • Paul Potter


Did you have several patients not show up for their appointments this week?

Join the club.

Patient no-shows can be one of the most frustrating aspects of a therapist’s job, with good reason.

We put all time and effort into the initial evaluation, entering information into the EMR, calculating functional limitations, outlining the plan of care, designing a home exercise program (with handouts no less) only to have the patient be a no-show for their next appointment.

You’re confident they need your services and you’re more than capable of helping them reach their goals.

Despite how sincere and convincing you are, for one reason or another, you seem to have more no-shows than you’d expect.

Not only are no-shows exasperating they are a real time and money suck. No one gets paid for a no-show. Unfortunately, all the expenses related to missed appointments-staff salaries, rent, utilities, etc. still must be paid.

While you can’t eliminate no-shows totally from your practice, busting common no-show myths can go a long way in reducing their prevalence. By slightly shifting your mindset and making a couple of changes you can create a patient experience patients will hate to miss.



The Negative Impact of No-Shows

Any manager or staff whose income tied to productivity is familiar with the headaches of no-shows. Last minute cancellations or no-shows are lost revenue that can never be regained.

The insidious nature of missed appointments can strangle the life out of the best-run practices.

The median income for physical therapists, according to salary.com is $81,615, or about $40 per hour. If you have 2 no-shows per day, that’s equivalent to $400 per week, $1,600 per month and nearly $20,000 per year. Take that times 3 therapists and you’re flushing $60,000/yr. down the drain.

And that’s just therapists’ salaries. This figure doesn’t take into account the average per-visit cost of $120. The lost revenue can total a whopping $180,000/yr.

Not what you or I would call chump change!

Clearly, not having a plan to manage no-shows can have a huge negative impact your profitability. No-shows are something no practice can afford to neglect- it’s like a hole in the bottom of your boat, you’ve got to paddle faster and faster just to keep your boat afloat.

Another hidden consequence of no-shows is the pessimistic effect it can have on the staff morale. I have seen the annoyance of missed appointments directed towards patients and the front office staff.

Scheduling mismanagement can lead to blaming and shaming patients to keep their commitments. Certain patients are labeled as ‘chronic offenders’ and put on ‘probation’-creating an adversarial relationship between the staff and the person being served.

If you want to open up a can of worms bring up the issue of no-shows in the next staff meeting, talk about whose responsibility no-shows are. Topics such as charging for missed appointments, who collects the cancellation fee etc., will quickly reveal how well you are managing no-shows.

Most of us have experienced the negative effects of no-shows and don’t like it. The question is how do we go about positively managing them. Here are three tips for decreasing patient no-shows and doing it with a smile on your face.


Remarkable Patient Experience

Have you ever made a reservation at a restaurant that you could hardly wait for?

The restaurant has a great reputation and is hard to get into. You need to call weeks ahead to make a dinner reservation. You’ve always had a pleasurable experience every time you’ve gone there.

As expected the food is divine, the ambiance is perfect and the service is out of this world. The staff acts like it’s their privilege to serve you. The whole experience from start to finish is simply remarkable. It’s one of those pleasurable experiences that you tell all your friends about and you can hardly wait to go again.

Now think about the patient experience at your clinic in the same way. Instead of thinking, ‘How do we make these patients keep their commitments?’

Try changing your mindset and ask, ‘How do we create a patient experience so remarkable people won’t want to miss it?’

Let’s face it, most of us are living very busy, distracted lives. Patients’ attention is under a constant bombardment from advertising messages both offline and online. We check our messages while on the go and scan our email while waiting at a stoplight.

Patients’ attention is captured by easy solutions for their health problems from online product popups to paid ads from massage therapists, chiropractors, and acupuncturists etc. to give their services a try.

I say in my article 3 Ways To Make Your Patient Experience Remarkable, most therapists are too busy telling people how qualified they are, promoting their average services and hustling to get ahead.

As a result, therapists lose sight of their most powerful strategy…creating a patient experience so remarkable that people can’t help but want to return.

Something’s remarkable when it’s worthy of being noticed, especially as being uncommon or extraordinary. Regardless if it’s a massage therapist or a physical therapist whoever provides a remarkable patient experience will be remembered and talked about.

If you are going to capture and keep your patients’ attention you need to build in a little bit of ‘wow’ into your patient experience. Your patients will pay attention to their appointments when the experience at your clinic is worthy of being called remarkable.

Now doesn’t that sound like a more positive approach to solving your patient no-show problem? Don’t you think that’s something your staff can get behind?

Instead of thinking of ways you can get people to do something you want or handling ‘chronic offenders’. How about brainstorming ways that you can WOW your patients?

I know you’re probably saying. All this talk about remarkable care makes you tired. You’re doing your best to keep up on evidence-based practice and get your notes done. Deep down you might be saying:

‘Isn’t getting patients better enough?’

The answer is yes, for some patients but not for most. Nowadays most consumers are looking for the total package. Of course achieving successful outcomes is necessary just like an outstanding restaurant must have great tasting food.

But a remarkable patient experience also includes delivering other kinds of value. Convenience in scheduling, personalized onboarding, and frictionless payment are all types of value that people have come to expect from service providers.

Consumers are looking for exceptional value for their healthcare dollar. The different elements of value can range from functional improvements to emotional rewards to life-changing experiences. Therapists that deliver exceptional value in a variety of ways will be the providers that see their practices flourish.

Knowing what patients really value doesn’t have to be mysterious. The 30 Elements of Value identified by researchers at Bain & Company make it much easier to emphasize the emotional and psychological needs of your patients. The Elements of Value Pyramid could help you creatively enhance the value you already provide.



Appointment Reminders

One practical way of creating a remarkable experience for some patients is to connect with them in their preferred method of communication.

Study after study has shown that appointment reminders are an effective tool in helping people keep their appointments. Automatic text, email, and call reminders are commonly used to communicate appointment reminders to patients. Large healthcare organizations like Kaiser Permanente have shown how phone and text message reminders save thousands of labor hours and dollars. Kaiser experienced 1,873 fewer no-shows that translated into a total cost savings of $275,000.

Automated email, phone and text message reminders can reduce no-shows dramatically and increase clinic revenues-all without adding extra staff. Depending on which service you chose they’re easy to use and fairly customizable. The WebPT EMR system includes an appointment reminder feature in its Front Office Suite. Patients can be notified of upcoming appointments via email, phone or text messages automatically in WebPT.

Statistics from the Pew Foundation show that 83 % of text messages are opened and read within the 1st hour of receipt. Additionally, a study conducted by Morgan Stanley shows that 91 percent of Americans have their mobile phone within arm’s reach 24 hours a day.

The secret to appointment reminders is to spend a couple of minutes asking each patient how they want to be reminded of appointments. Simply show respect by asking and using their preferred method of communication; by text, email or phone.


Remarkable Patient Relationships

Let me ask you an honest question,

Are you more apt to blow off an appointment with a friend or with someone you hardly know?

Most of us will give our attention to people and events that we are emotionally connected to.

Building strong patient relationships will reduce the number of no-shows because strong relational connections increase patients’ commitment to their treatment.

One of the major reasons for no-shows is that the patient’s expectations weren’t met on the last visit. Instead, wanting to avoid conflict by discussing the situation they simply don’t show for the next appointment.

Exceptional patient engagement is just as important as exceptional care. Matter of fact, a large part of treatment outcomes is dependent on patient engagement.

We must make sure we are taking the time to listen to our patient’s needs and wants. By really getting to know them you can pick up on preferences and simple things that add value for each patient.


Practical Steps

Despite your best efforts, we all know certain patients whose life skills just don’t seem to include self-organization. What do you do with patients that habitually seem to miss appointments?

The first step is to do your due diligence to stop creating no-shows. Do you or other therapists in your practice often rearrange their schedules at the last minute for vacations or unplanned events?

Demonstrate leadership by being respecting your patients’ and staff’s time. They are typically busy too.

Rescheduling takes a lot of staff time. Patients get frustrated with your staff and you when they are called to reschedule or when you’re chronically late for appointments. If you or your partners don’t take your schedule seriously then your patients won’t either.

Secondly, choose to manage patients who are chronically late or fail to show up for appointments versus playing the blame game. Track your no-shows to find patterns.

You may find a certain referral source or payor that has a higher incidence of no-shows. It may make sense to stop participating with a payor or physician who might be sending a lot of patients but is costing you income.

It is the entire staff’s responsibility to make sure that patients receive the care they need. This includes a written missed appointment policy that is gracefully explained to every patient, signed and consistently applied.

Whatever the case, it makes sense to dig out the causes of your no-show problem early and deal with them.

If you’ve done your best to engage with every patient then you’ve built the foundation to expect mutual accountability for each other’s schedules. Consider personally reminding patients how important it is to stay on track with the treatment plan and you want to see them back.



There’s simply no magic wand to completely eliminate patient no-shows. You and your front office may be very organized and responsible but that doesn’t mean that patients are going to reciprocate.

You can only focus on those factors that you can influence. You can’t make your patients keep their appointments any more than you can make them do their home exercises.

There are scheduling programs that send phone and text reminders at minimal cost that have clearly shown to decrease no-shows that you should implement right away.

We all appreciate clear explanations of what’s expected of us. Your missed appointment policy is another way to clearly communicate what you expect from your patients and staff.

Building strong patient relationships and a remarkable patient experience will go a long way in reducing the number of no-shows. Exceptional engagement with every patient is a vital part of providing exceptional care that almost all patients will show up for.

Paul Potter is a physical therapist and mentor who lives in Lincoln, Nebraska, with his wife, who is also a therapist. They have four daughters. For more than 35 years, he successfully managed his own private practice. He now shares his knowledge and experience through teaching and mentoring therapists who want to have their own practices. His website PaulPotterpt.com helps therapists achieve professional and financial freedom. Connect with Paul on his website or on LinkedIn.

Paul Potter

For over 30 years Paul Potter has owned and managed a private physical therapy practice specializing in manual orthopedic rehabilitation and medical fitness programs for special populations. He hosts the Functional Freedom Podcast where he interviews current thought leaders on practice issues and strategies to facilitate the professional effectiveness of therapists. A few factoids about...

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Randy Crosby

Commented • July 25, 2017

yes.this is a really good article I am read full post.it's amazing 3 reduce tips. thank for share there tips.

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