While we have expectations of easy access to quality healthcare, the frequency with which we miss scheduled appointments is a significant issue within the system.
While we have expectations of easy access to quality healthcare, the frequency with which we miss scheduled appointments is a significant issue within the system. Missed appointments hamper our healthcare system. A 2017 study found that the U.S. healthcare industry loses $150 billion to missed appointments annually, with each lost appointment costing physicians an average of $200. Healthcare providers plan their days meticulously, making sure they have exactly the right number of staff members for the number of patients expected that day, coming in and leaving at the appropriate times to keep the day flowing smoothly.
Rent and equipment costs are often tuned to the anticipated patient volume as well. A missed appointment throws off this delicate balance, damaging the efficiency of the care provided and impacting revenue. But having highly qualified, well-paid employees sitting idle due to a no-show doesn't just hurt the provider's bottom line; it also hurts the patients themselves.
Two hundred dollars per appointment is quite a bit of money, but what does that mean for a practice over the course of a year? A recent study published by the National Library of Medicine reported that 760 appointments (21.2%) were missed out of the 3,583 scheduled over the course of a year. That's $152,000 in a single year. But the money lost on the appointments themselves is only the beginning.
A string of missed appointments can turn an adequately staffed day into an overstaffed day, lowering employee engagement and increasing turnover. Employees are there to work, and idle time — in any profession — decreases engagement and increases attrition. Disengaged employees are 18% less profitable than their more enthusiastic peers.
Another way to imagine this number is as a percentage of employees’ salaries; money spent paying disengaged employees is only 82% as effective as money spent on an engaged employee. If patients are missing appointments, leading to a widespread decline in staff engagement throughout a practice, a full 18% of the labor budget (itself often being about half of the overall budget) is going to waste. That's as much as 10% of the total overhead on top of the $200 per appointment in direct losses.
In recognition of the problem, and in an attempt to recover lost revenue, some practices have started penalizing patients with no-show fees for missed appointments. However, such fees can have the opposite effect. A potential patient may become reluctant to book an appointment at all, since there's always a chance that they'll miss it and lose money to the no-show fee.
Ultimately, no-show fees and other solutions that shift responsibility onto the patient for missed appointments fail for two reasons. First, they do not acknowledge that missed appointments already have significant negative consequences for patients. A patient who misses an appointment will likely have to book a makeup appointment weeks or months out, or they may not book an appointment at all, worsening their projected health outcomes. Second, no-show fees fail to address the direct cause of a missed appointment (such as an unintended scheduling conflict). Patients already don't want to miss appointments. They need help making it to their provider, not negative incentives that may dissuade them from booking an appointment in the first place.
Delaying even routine checkups for too long can turn acute issues into chronic issues or lead to a lapse in care altogether. Patients who miss appointments, then, don't just facilitate the loss of immediate medical resources and time but also increase the amount of care they're likely to need over the course of their lifetime. Older patients, who are the most likely to develop chronic conditions, are also the most likely to stop seeking care altogether after a single missed appointment. In one study, those with chronic conditions like diabetes, asthma, arthritis, and cancer doubled their attrition rate after just a single missed appointment.
The combined weight of many thousands of steadily worsening, unchecked medical problems, over time, will increasingly tax the medical system for as long as missed appointments remain commonplace. In addition to expenses, both personal and public health writ large are at stake. A missed appointment doesn't just need to be replaced with a single new appointment; it may take several additional visits to successfully treat whatever conditions develop between the missed appointment and the moment when medical personnel finally do have an opportunity to continue treating the patient.
The time and expertise of medical professionals are the most important resources in the healthcare system. If patients are not seen when they need to be seen, these resources go to waste. So if the consequences are so dire, for patients and providers alike, why do patients miss appointments? Another study published by the National Library of Medicine found four main causes for missed appointments:
Family and employer obligations
Personal health issues
Industry-wide awareness of these issues has led to the development of a wide array of strategies to improve patient attendance and retention. Personal obligations and health issues are major externalities that healthcare providers and organizations have little ability to intervene in. Transportation and forgetfulness, however, are easier problems for institutions and providers to help with.
The best way to keep patients from missing appointments due to health issues is to foster positive relationships through effective and personable care. Positive outcomes are not enough; patient satisfaction is a vital element of retention, and it’s the only way providers can continue improving the health of their patients and, with it, their dependability and retention. While the solutions below can certainly help with retention, they are not substitutes for strong patient relationships.
Transportation poses a more tangible challenge, and healthcare professionals have developed innovative solutions for the problem. For instance, some providers and organizations have started working with rideshare services to provide transportation to and from appointments for patients who may otherwise have trouble getting there on their own.
The recent shift to telemedicine has also helped mitigate personal health issues, transportation challenges, and scheduling conflicts as major causes of missed appointments. Sick patients have an easier time getting on the phone to talk with a medical professional than they do making their way to a physical location. In the case of communicable illnesses (like viruses), sick patients don't need to worry about the potential for getting anyone else sick.
Similarly, it's much easier (and cheaper) for patients who lack reliable transportation to make a video call than it is for them to navigate to a clinic, doctor's office, or hospital. The convenience of telemedicine has also reduced scheduling conflicts by eliminating travel time and reducing the overall time commitment of an appointment. Rather than abandoning another commitment entirely to make an appointment, patients can simply step into another room for 30 minutes or an hour to speak with their healthcare provider. Of course, telemedicine appointments are just as easy to forget as traditional appointments — and that's where strategically deployed patient reminders can help.
Patient reminders are a common practice, but forgetfulness remains a major cause of missed appointments. How might providers rethink their reminders to make them more effective? Rather than making a single reminder call or text the day before an appointment, Forbes contributor Sachin H. Jain suggests that providers start sending reminders a few days in advance and continue sending them until the patient responds.
It's also helpful to automate patient reminders and schedule them to go out earlier in the day. By the afternoon, patients have often already made plans that conflict with their appointments and are unlikely to change them. A reminder sent just a few hours earlier in the day may catch patients before they've had a chance to double-book themselves, decreasing the likelihood of a missed appointment.
In some ways, patient forgetfulness is the most difficult and unpredictable barrier to overcome, but there are proven solutions available at a reasonable price. Aizan Technologies Inc. offers MessageKite, their SMS marketing solution for small and medium businesses. Utilizing MessageKite, medical offices can reduce the revenue losses and operational disruptions caused by costly appointment cancellations and no-shows. Providers can set a schedule of appointment reminders to go out to patients in the days leading up to their appointments, schedule follow-up messages, and receive automatic notifications if a patient is likely to miss their appointment.
MessageKite is also great for supporting the practice’s efforts to increase compliance. Administrative staff appreciate the simplicity of communicating with patients over texts rather than by phone. Since all messages are managed from a centralized dashboard, the staff can access, organize, and respond to messages from any computer connected to the internet. Flexible automated messaging saves providers and employees alike significant amounts of time and money. In addition to reducing no-shows, automating the tedious task of sending patient reminders will boost engagement and free up valuable time for the staff to focus on solving other problems.
MessageKite gives staff members the intuitive tools they need to streamline communication, automate ineffective workflows, and improve the patient experience. Reach out today to learn more about protecting revenue, improving patient retention, maximizing employee engagement, and dramatically reducing administrative workloads.