REDUCING PATIENT

NO-SHOW RATES
A COMPREHENSIVE GUIDE
Reducing Patient No-Show Rates: A Comprehensive Guide

CONTENTS
INTRODUCTION 3

THE COST OF PATIENT NO-SHOW RATES 4

BREAKING DOWN PATIENT NO-SHOW COSTS 5

POOR PROVIDER-PATIENT COMMUNICATION DRIVES NO-SHOWS 6

PATIENTS WANT REMINDERS & RESCHEDULING – BY TEXT 7

8 STRATEGIES TO REDUCE PATIENT NO-SHOW RATES 8

HOW WELL HEALTH IMPROVES PATIENT-PROVIDER COMMUNICATION 12

THE WELL HEALTH IMPACT: CASE STUDIES 13

ABOUT WELL HEALTH INC. 14

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Reducing Patient No-Show Rates: A Comprehensive Guide

INTRODUCTION
High patient no-show rates have a
negative impact on healthcare. They
damage provider revenue, and they
prevent patients from receiving optimal
care – a serious lose-lose.

Patient no-show rates vary greatly across the U.S. healthcare

system, ranging from 5.5% to 50%. The COVID-19 pandemic
significantly contributed to this rate and even as hospitals
and practices embraced telehealth to provide care during the
pandemic, patients still missed telehealth appointments due
to a number of challenges, including technical issues or not
acknowledging telehealth as a “real” doctor’s appointment.

According to a study published by the National Center for

Biotechnology Information (NCBI), patient no-show rates
can reach as high as 80% in problematic areas where
multiple factors that drive patients to miss appointments are
present. Patient no-show rates soar for a variety of reasons
— logistics, emotional barriers, or sometimes simply just
forgetting.

A central cause of no-shows is patients lacking a convenient

and easy way to communicate with their doctors. Many
providers still force patients to pick up the phone, or use
clunky portals. They fail to offer them a digital medium that is
easy, convenient, and multilingual. However, it’s been proven
that when providers improve their patient communication
methods, no-show rates do decrease.

How can providers implement the right strategies to reduce no-show rates?

And what results can they expect?

Read on to find out.

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 Reducing Patient No-Show Rates: A Comprehensive Guide

THE COST
of Patient No-Shows
Here’s an all too familiar scenario:
A medical staff member calls out a
name in a packed waiting room. Visibly
impatient people look up, but no-one
answers. The staff member calls out the
name again. Silence again. The name is
BAD FOR PATIENTS
crossed out. • Interrupted continuity of care
• Poorer clinical outcomes

This is a no-show. • Unmonitored medication use

• Delayed preventive screenings

A patient has failed to show up for an appointment

and didn’t cancel that appointment ahead of time. This
happens thousands of times every single day. No-show BAD FOR PROVIDERS
patients have been a headache for many healthcare • Unspent labor is still paid labor, typically
practices, large or small, and it’s been a longstanding, ranging from 50% to 60% of total operating
ongoing problem. revenue.

• A shortage of doctors and other medical

Whenever a patient doesn’t appear for a check-up,
personnel forces healthcare practices to
surgery, or consultation, it leads to wasted capacity.
overstaff. Their ever-increasing salaries,
Personnel, resources, and expertise that have been
combined with high no-show rates, further
scheduled for that particular appointment are
drive down revenue.
underutilized, and the slot goes empty. Unlike a
cancellation, where staff could backfill the appointment, • Overstaffing contributes to employee
a no-show is lost revenue. disengagement and turnover. Several
healthcare organizations have seen an 18%
dive in productivity and as much as 16%
loss in profitability.

For providers, these ill effects translate • No-shows add more administrative burden
directly to a damaged bottom line. to staff who are tasked with scheduling
and appointments. As the list of patients
to call grows, the operational expenses
required for calling patients and making
follow-ups also increase.

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Reducing Patient No-Show Rates: A Comprehensive Guide

BREAKING
DOWN
Patient No-Show Costs
Patient no-show rates vary greatly across the
U.S. healthcare system, ranging from 5.5% to
50%. (The global average for patient no-show
rate is 23%, according to the National Library
of Medicine).

Data from the Physicians Foundation revealed that U.S. doctors see
20 patients daily. However, when many patients fail to show up, the
result is significant revenue leakage.
HOW TO
CALCULATE
One missed appointment can cost a provider $200 to $265. Across the
YOUR PATIENT
U.S. healthcare system, an average loss of $200 per appointment
translates to $150 billion every year. In a $3.5 trillion industry, every NO-SHOW RATE
missed appointment represents a significant amount of lost revenue
for healthcare systems. And despite what some patients think, To calculate your no-show rate,
skipping an appointment doesn’t free up time in a provider’s schedule divide the number of no-shows
— it creates more administrative work for staff and prevents other by the total number of weekly
appointments. For example, if
patients from getting the care they need.
your practice typically sees 100
patients each week, and you
For managed care and services that receive monthly fixed fees from
have 20 no-shows, your no-
their clients, they can’t pass along the additional costs of services and
show rate is 20 divided by 100,
administration. When clients don’t show up, due to multiple personal
or 20 percent.
reasons including financial issues, lack of transportation, and lack of
time off from work, the impact of the loss of revenue is intensified No-show rate calculation
because of the extra expenses. results will differ for everyone,
but the national average no-
It’s critical for healthcare providers to empower patients to show up show rate is roughly 18 percent.
to their appointments. Not only will it stop financial bleeding, more During the COVID-19 pandemic,
patients appearing for their check-ups and procedures can generate patient no-show rates soared
millions of revenue. The NCBU study shows that reducing the no-show across the U.S. healthcare
rate to 5% would increase revenue by nearly $51.8 million annually network, and in some clinics,
the figure rose to 36.1%.
across the U.S. healthcare system.

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Reducing Patient No-Show Rates: A Comprehensive Guide

Poor Provider-Patient

COMMUNICATIONS
79% ​​
Some of the causes of no-shows are
hard to mitigate:

People are busy and forgetful; public transportation and ​​of healthcare consumers
the weather also play a role. However, there is one big area expect providers to
where providers can actively slash patient no-show rates. communicate with them via
U.S. research has shown that up to 31.5% of no-shows are channels they prefer.
due to poor provider communications.

80%
Fragmented communication between patients and
providers, as well as outdated practices for managing
patient preferences for appointment reminders, are among
the leading drivers of high no-show rates among providers.
of patients now put a
premium on convenience
To fix this, healthcare practices need to start making the
factors and would have
whole appointment scheduling journey as seamless and
no difficulty switching to
friendly as possible. Modern patients want communication
another provider if it’s more
with their providers to deliver the same things they expect convenient.
from the consumer products they use in their everyday
lives: convenience, value, and innovation.

Strategies to reduce no-show rates must also consider

language barriers and how to address them. According to
the National Library of Medicine, among non-proficient
English speaking patients who received professional
medical treatment, 50% said their inability to understand
the local language contributed to errors, 30% struggled to
understand medical instructions, and 20% did not pursue
healthcare services if they were not readily available.

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Reducing Patient No-Show Rates: A Comprehensive Guide

Patients Want Reminders

& Rescheduling

BY TEXT
There are two major things that can
immediately cut patient no-show rates:
• Texting appointment reminders to patients
• Offering patients the option of self-rescheduling by text

Notice the common denominator? Texting.

Texting, while not a new communication platform, is the most widely

used messaging medium in the U.S. Currently, there are approximately
294 million smartphone users in the U.S.

Texting also enables providers to quickly fill in canceled slots, ensuring

revenue is still generated, and patients are serviced.

98% 91% 55%

is the open rate for want to be informed about of respondents in one
texting. the status of their ill loved consumer survey said they
ones via text. would reply to text reminders
to confirm or cancel their

70% 83%
appointments as well as ask
for additional details from
their physicians.

of American healthcare like to receive reminders

consumers prefer from physicians for
texting to schedule their prescriptions, schedule
appointments. confirmations, follow-up
appointments, and more.

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Reducing Patient No-Show Rates: A Comprehensive Guide

STRATEGIES
to Reduce Patient No-Show Rates
Understanding why your patients are missing
their appointments is essential to finding solutions
to reduce no-shows. As discussed, poor patient
communications are a key cause of missed
appointments that can be remedied through digital
communications such as texting. Providing patients
with multiple, convenient communication options
that are automated, bidirectional, conversational,
and in a language of their choosing are all other
effective ways of addressing no-show problems.

Here are 8 strategies that offer both immediate and

long-term solutions you can implement to reduce
your health system’s no-show rate.

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Reducing Patient No-Show Rates: A Comprehensive Guide

1
Use the patient’s preferred
2
Help patients understand the
method of contact need for the appointment

Patients of all ages now use technology in One reason patient no-show rates remain high
every facet of their lives and expect more is that patients don’t understand the purpose
than robo-dialers, or one-way email and text of the visit. Only 12 percent of U.S. adults have
systems from their providers. They want proficient health literacy, and a staggering 77
the convenience of choosing their preferred million adults have basic or below basic health
channel to communicate whether it be literacy. This results in patients not adhering
text messaging, phone, or email. Ask your to treatment plans — including attending their
patients their preferred method of contact for scheduled visits. One of the effective strategies
appointment reminders and other types of to reduce no-show rates is to make information
patient outreach. and health education accessible to patients,
particularly in complex medical situations.
In addition, providers can also communicate
instructions and information via texting prior
to a visit or procedure to help patients prepare
and empower them to show up to their doctor’s
office. Research published in the journal,
Medscape General Medicine recommend five
steps for changing patient beliefs and behavior
as they relate to following treatment plans and
attending appointments.

Educate your patients so they:

• Recognize the risk of not adopting a healthy
behavior
• Perceive their condition as serious
• Believe in the positive effects of the
suggested treatment
• Can address their fears and concerns
• Believe they can complete the treatment plan

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Reducing Patient No-Show Rates: A Comprehensive Guide

3
Use automated patient
4
Calm patient fears
appointment reminders
Another way to reduce no-show appointments
Perhaps the most effective strategy, and is to calm your patients and address their
arguably the simplest for reducing patient fears. Fear fuels patient no-show rates since
no-show rates, is to send appointment patients may fear bad test results, getting
reminders. Automated appointment on the scale, or uncomfortable procedures.
reminders help bring down patient no-show Whatever the reason, fear keeps patients
rates and boost appointment confirmations. from following through with their scheduled
Leveraging automated text reminders will appointments. “Many people feel anxious
ultimately increase patient attendance via because they fear the unknown, and they let
better scheduling and slot utilization. their imagination run wild,” said psychologist
Dr. Barbara Cox in an interview with NBC’s
Conducting outreach through text and health site, Better. “They may imagine a
email has huge potential to reduce missed worst-case scenario, when in fact going for an
appointments. Text appointment reminders annual check-up is the best prevention.”
that are bidirectional — meaning patients
can text you back — give patients a chance to Addressing the fear factor is a big step
confirm their appointment, get directions, ask in reducing no-show appointments. Cox
questions, and adequately prepare for their recommends providers help patients to
appointment. acknowledge their anxiety before a visit.
Providers can initiate this conversation
by asking patients how they feel about an
upcoming test or visit and reinforcing their
role as not only a provider but also, an
advocate and an ally.

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Reducing Patient No-Show Rates: A Comprehensive Guide

5
Reduce the time between
6
Offer digital check-in and
scheduling an appointment updates on scheduling issues
and the actual appointment
Healthcare consumers are busy people, so
asking them to repeatedly wait long periods of
Cut down the waiting time for your patients to
time before an appointment may turn them into
get an appointment. Whether it’s reducing no-
no-shows. Eventually, they may also become a
show rates in primary care or in specialized
lost patient if they find another provider who
practice, patients want faster access to
they perceive values their time.
doctors, information, and medical services.
Spending a significant amount of time in
To save administrative time, many providers
between appointments waiting to see their
are continuing virtual waiting rooms practices
doctor can be a frustrating experience. The
created during the COVID pandemic or
longer the time in between scheduling an
operating a hybrid version. Offering a touchless
appointment and the actual appointment,
or digital check-in process will allow patients
the more likely the patient is a no-show.
to pre-register and complete any screenings
Unfortunately, the problem is a bit of a
or paperwork before their appointments. For
chicken-and-egg scenario. Long wait times
up-to-date information, bidirectional texting
to see a provider increases no-shows, and
allows patients and the medical staff to quickly
no-shows contribute to longer wait times for
communicate if there are any scheduling or time
other patients.
issues.

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Reducing Patient No-Show Rates: A Comprehensive Guide

7
Text patients to reschedule
8
Send follow-up messages

Proactively reach out to patients after they Automating thank you messages to show
missed an appointment with an invitation to your patients appreciation for keeping their
reschedule. Encourage them to text back or appointments acknowledges their time is
contact the office staff. valuable and helps build patient loyalty. You
can also include additional information in the
post-appointment thank-you message for
referrals, medication, and any other types of
follow-up.

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Reducing Patient No-Show Rates: A Comprehensive Guide

How WELL Health® Improves Patient-Provider

COMMUNICATIONS
WELL® reliably cuts patient no-show rates by equipping healthcare providers with a sophisticated and
centralized communication hub that simplifies patient-provider communication. From a unified platform,
providers can engage patients in one-on-one, back-and-forth text conversations at scale.

The WELL platform eliminates communication issues stemming from outdated, rigid phone systems and
other one-way communication tools. Providers can tailor their messages based on their patient’s profile,
previous interactions, and current treatment plan. Personalized messaging empowers patients to become
more engaged and involved with their health, thus contributing to the reduction of patient no-show rates.

Two-Way Patient-Provider Multilingual Support

Texting Functionality A key cause of no-show patients are
Patients can get in touch and language issues, which WELL can easily
exchange text messages with their resolve. The hub is designed to support
providers through the device that is over 19 different languages, including
central to their life: their cellphone. Spanish, German, Japanese, and
Bidirectional text messaging also Chinese. WELL automatically translates
allows healthcare providers to see messages to patients’ preferred
incoming messages from patients. languages, helping providers build
(WELL also supports email, patient rapport and strengthen relationships.
portals, and voice calls.)

Secure Messaging
Broadcast Messaging The WELL Health system is also
To help fill slots when patients do designed to protect patient
cancel, WELL empowers healthcare information through secure messaging
providers to send customized protocols. All messages are secure and
messages to up to 1,000 patients, require patients to verify their identity
informing them of available slots to prior to viewing the content of their
ensure all slots are utilized. messages.

Appointment Reminders Pre-Appointment Instructions

Patients are automatically reminded Patients receive a set of instructions
of their upcoming appointments, and prior to their appointments,
invited to confirm, reschedule, or empowering them to come to their
cancel. appointment fully prepared.

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Reducing Patient No-Show Rates: A Comprehensive Guide

The WELL Health Impact

Case Studies

Community Memorial Health Located in Coachella Valley, The Tiburcio Vasquez Health
System (CMHS) is a large CA, health system Eisenhower Center (TVHC) caters to 115,000
healthcare system that had a Health grappled with high call patients, a large proportion
legacy appointment reminder volume. Staff spent as much as of which are Hispanic. The
system that didn’t allow two hours on the phone each language barrier was making
patients to respond. Every day dealing with appointment it difficult for TVHC physicians
day, CMHS staff had to call reminders yet patients were to connect with such a large
patients to remind them of their still frequently no-shows. volume of patients, resulting in
appointments. But after using Eisenhower Health had to find high patient no-show rates and
WELL for two months, CMHS a way to decrease no-shows to lost revenue. By implementing
saw immediate results. maintain revenue. After using WELL Health, TVHC overcame
WELL, the staff saw the time the language barrier issue.
CMHS’s no-show rate dropped they spent on the phone drop
by 29 percent, resulting in an from as much as two hours to as TVHC saw its no-show rate
estimated $1,169,600 increase low as 15 minutes. drop by 20%. Confirmed
in annual revenue. bookings skyrocketed from
With WELL, Eisenhower Health 25% to 80%.
“It became obvious to us very saw a 40% reduction in no-
early that (WELL) was going to shows and a 23% growth in WELL “has given us a better way
eliminate a lot of work... and it appointment confirmations. to talk to our patients, an easier,
did.” - Lori Hooks, Director of more efficient way to reach
Quality and Practice Systems. With all the extra time, Mark out to patients, and a better
Steffen Chief Administrative way to handle scheduling,” said
Officer, Primary and Specialty Caleb Sandford, TVHC Chief
Care Clinics said, “We can focus Operations Officer.
our care team on more patient-
focused activities and follow-up.”

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Reducing Patient No-Show Rates: A Comprehensive Guide

ABOUT WELL HEALTH INC.

WELL Health® is a SaaS digital health leader in patient
communications and the 2021 and 2022 Best in KLAS winner in
Patient Outreach. The WELL Health intelligent communications
hub is the only two-way digital health solution engaging patients
throughout their entire care experience. WELL Health enables
conversations between patients and their providers through
secure, multilingual (19 different languages) messaging in the
patient’s preferred communications channel: texting, email,
and telephone. WELL Health helps 200,000+ providers facilitate
more than 1.1 billion messages for 37 million patients annually.
By unifying and automating disjointed communications across
healthcare organizations, WELL Health reduces unnecessary
provider stress and potential errors, while increasing patient visits
and loyalty.

Founded in 2015, WELL Health is based in Santa Barbara, California.

WELL Health has been named No. 10 on the 2021 Forbes America’s
Best Startup Employers list, No.133 fastest-growing company in
North America on the 2021 Deloitte Technology Fast 500, and
ranked on the Inc. 5000 list of fastest-growing private companies
for two consecutive years.

Learn more at wellapp.com

WEBSITE: wellapp.com
SALES INQUIRIES: sales@wellapp.com
GENERAL INFO: Email us at well@wellapp.com

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