No Show Rate

Our no show rate is high in primary care and mental health (17-22%) relative to other healthcare systems within VHA. We are not allowed to charge the patient for not showing up to their appointments and are required to re-schedule their appointments within 30 days.

I am looking for strategies to reduce our overall no show rate in our medical center


Institution & Physicians Communication


Speedboat or Tanker? Innovating in or outside the medical university hospital

Participant comments on No Show Rate

  1. Using quite outstanding IT at VHA, I would propose sending text/email several times prior to the appointment -perhaps 72, 48, 24 hrs and the day of. These would ask and require response from the patient. If there is no response, call. If there is no response, I wonder if you could simply assume that patient will be no show and double book there. Or run a pilot to see how many of “nonresponders” are no shows at the end and then decide on double booking policy/timing when the double book will be done etc. In case both patients show up, it should be possible to deal with these unless it is more than 1-2 /day.

  2. Another idea is to be sure some kind of root cause analysis is performed for patients who no-show. A simple follow up phone call questionnaire would suffice: Did they receive a reminder via their preferred method of communication? Did they lack transportation? Did they know how to call us, to cancel or reschedule? Would a specific day or time be better? Do they have trouble attending appointments during our normal hours and days of operation? The responses could reveal a pattern to address.

  3. It would be great to see the VA partner with a start up company to work on the idea that Igor brought up with a patient engagement initiative with text and/or email based reminder system prior to appointments. There is a start up called Medumo out of Boston that has been working with several different groups on helping to decrease no shows prior to procedures, and Medumo has had some great results in the Boston health systems. Medumo’s platform goes straight to text or straight to email so there is no separate app involved . There are other start ups with app based reminders prior to appointments as well (Twistle is an app based patient engagement platform option). These reminders could help with the appointments, ensuring labs are completed prior to the appointments if needed, and also help to drive increased survey response rates if needed.

  4. We have managed to reduce our no show rate for outpatient care with a multi pronged approach
    1. Combination of the telephone reminder calls, text messages and e-mail dependent on the patients preference for communication
    2. Follow up by clinic clerk or social worker (general outpatients) or psychiatrist (this is mandated under the Mental Health Act) if the patient does not show
    3. Identification of root cause of no shows and implementation of a free local patient transport service.
    4. Implementation of a policy that means all patients except mental health are formally discharged after two consecutive no shows. This has been a difficult transition for our very caring staff but does mean our resources are being used to provide care to the greatest number possible.

  5. No show for out patient can also be improved on the following strategies:
    1. Texting/Emailing/ Social Media and maybe even calls 2 to 3 days prior to consult.
    2. Provide a transportation that will shuttle clients to and fro the hospital (if cost efficient)
    3. Do a survey on the reason for not showing and address the problems as soon as possible.
    4. You can issue them a card to track down their attendance to check up, like point system and they can redeemed their points with something valuable to the clients.
    5. You can offer games and other recreational activities that will motivate them to show up or make them look forward to their next check up. It is like offering them an experience rather than check ups alone.
    6. Staff training on quality service, same quality in five or more starts hotel.

  6. In the Netherlands we are allowed to send no show bills but only a few hosptials are doing it. In our hospital we recently debated again on this subject, as part as a “cut costs” project. In the end we decided not to send a bill for no show.
    In our hospital it would bring up 400 k. But we also have to invest in administration and in the end send a summoner.
    Experiences of other hospitals tells us that half of the people who do not show up won’t pay the bill. They probably are people with low income. So the trouble you have to make to get the money it huge.
    And in the end, we are talking about health care and part of our patients our the fragile people who really need care and no bills so think about if it is really worth the trouble.
    What we do is send a text message the day before the appointment as a reminder. Helpt a lot, worth the costs.

    Good luck, Viviane

  7. I agree with other responses that sending text messages is bringing down the no shows, although it’s hard to get some good figures in the net effect.
    But, sending a message should be part of a broader strategy to engage and interact with the patient. In our hospital we started last year with getting a better understanding of all our interactions with the patients. This includes all administrative, scheduling, clinical and non-clinical interactions. We mapped this using concept of patient journey mapping. By this we identify how we can improve our communication with the patient and also understand better how to create an uniform experience for the patient.
    By creating an uniform experience a patient has easier acces to hospital information (simple logistics, like where to park), to disease specific information (guidelines, decision aids, background info on their disease) and their record. With this the patient will be more engaged and I think this will result in better communication from the patient to the hospital also. And thus also result in less no-shows

  8. Our no-show rate it 3-5% for all dental offices. We also do not charge patient for no-show. What we do is:
    1. Text message 2-days prior the visit
    2. Phone call 1-day prior visit
    3. Explaining for those ‘no-show’ that health consequencies for other patient and for them too.

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