Hitting a Nerve

No-shows: Trying to predict and reduce the unpredictable


Why do patients no-show?

The reasons are, obviously, widely variable among patients and circumstances. Some are more understandable than others, but all of them add up to an empty chair across the desk and loss of income for that time slot.

A doctor holds an alarm clock. CherriesJD/Thinkstock

A recent study in Neurology: Clinical Practice looked into this question. Interestingly, it found that people with certain chronic diseases, such as medication-overuse headaches, chronic daily headaches, and seizures, were among those with the highest no-show rates.

These are all conditions that require medication fine tuning, but this can be difficult without the patient coming in. There’s only so much that can be done on the phone, and in this business a direct face-to-face conversation is often needed.

On the opposite side, they noted that people with degenerative disorders that have more limited treatments, such as Alzheimer’s and Parkinson’s diseases, had the highest rate of making it to the appointment, though this may be due more to caretakers than the patients themselves.

Financial issues come into play. Younger patients with chronic diseases may have more difficulty taking time off work, or may just simply not have the money for a copay. They could also be too depressed from their situation to come in. Granted, it would be nice if they’d call to let us know they weren’t coming (at my office we don’t ask questions), but many don’t bother.

All of us are affected by this problem. Seeing patients is what drives the economics of every medical practice. An empty exam room is a financial hit, and it denies another patient who needs help a chance to be seen.

Fifteen years ago, my billing company ran some numbers and found that patients on one specific insurance plan had two to three times the rate of no-shows of any of my other contracts. With a number like that, I couldn’t see a reason to stay with them, and I dropped that plan. I felt bad for the reliable patients affected, but the hard truth is that if I can’t keep my practice open, I can’t help anyone. Why this plan had so many no-shows could be from a number of factors, but the end result was the same. Regardless of the reason, it was having a negative impact on my bottom line.

Dr. Allan M. Block, a neurologist is Scottsdale, Ariz.

Dr. Allan M. Block

We try all kinds of different ways to remind people of their appointments. My secretary makes reminder calls. Other offices send texts or emails, or have a robocall system. These can only help to a certain degree. At some point, this becomes the “you can lead a horse to water ...” adage.

There’s no real easy answer, either. At my office, we don’t overbook. It seems to be an unwritten rule that every time we gamble that someone won’t come in and then put someone else in the slot, they both show up.

Research like this is interesting, and maybe helpful at making a predictive model about no-shows. But I’m not convinced it will eventually have everyday use in a real-world practice.

Dr. Block has a solo neurology practice in Scottsdale, Ariz.

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