Ken Hertz is a consultant for the Medical Group Management Association and teaches physicians how to reduce the number of patients who don’t show up for appointments—patients like himself.

Hertz has a family history of cardiovascular disease, is a noncompliant diabetic, and typically only exercises on the day or two before his physicals. Two years ago, he missed his annual stress test because he was travelling for work. He has never gone back in for the testing.

He is the typical patient who misses an appointment and falls off of the cliff. This is especially problematic because he is a friend of the physician and knows most of the people in the practice. No one ever called to follow-up and he never thinks to make the call.

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When doctors think of no-show patients, they often understand that it is like having an empty seat on a plane: you still incur overhead costs for the flight, but have lost the chance for potential revenue. Many times, however, these patients don’t return for the visit, checkup or tests needed and it can have a dramatic affect on the quality of their care.

The culprits

The first thing an office needs to know to reduce the number of no-shows is to understand who is doing it and why. Hertz said offices can expect to have, on average, a 5%-6% no-show rate and not have a big problem. Anything much higher needs to be analyzed.

It’s the job of the practice administrator, not the doctor, to figure out what is going on. He said they need to look at the patients and find out if it there are common threads like the financial class of the patients, if they have one particular kind of insurance, if they are mainly patients of a particular doctor, or if they are being seen for a specific type of visit.

“You have to identify what is causing it, what groups they are, if there are key themes that link them together,” Hertz said. “Maybe many have a doctor that constantly runs three hours late and the patients give up.” It also could be that the doctor tells patients they are okay and that they should come back in a month, and the patients just don’t return.

Hertz said it’s worth making a phone call to the patients to ask why they didn’t show up. And any no-show should receive a call to reschedule.