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The Cost of Missed Medical Appointments

By Rod Moser, PA, PhD


My schedule is often booked up months in advance for routine physicals or elective surgical procedures. Our computer system automatically calls patients to remind them of upcoming appointments, assuming the patient still has the same phone number and an answering machine in case they are not home. Many times, I will have my medical assistant call them on the same day to see if they are still planning to come in. With all of those safeguards, I still have two or three “no shows” on any given day, including some that we have called as reminders.

When a patient does not show up for a routine office visit, there is not sufficient time to fill in that appointment slot unless someone has just walked through the door. If I have nine or ten missed appointments every week for fifty weeks, it will add up to 500 office visits that go unused. Because I am on salary, I don’t really see an immediate economic impact, but my employer sure notices it when they multiply that number by several hundred medical providers.

Very few medical providers charge for no-show appointments. Why? They don’t charge because patients would be ticked off, not pay, and change medical providers. I have heard that some specialists charge for no-show appointments, but their office visits are longer and they charge upwards of 0 for an initial visit.

We do have a policy in place to send out a letter. The first no-show gets a letter to say how disappointed we are. The next letter mentions they have done this twice and we don’t like it. The third letter is a warning that they could be dismissed from the practice, and the fourth letter is a dismissal letter. Do we send them out? Sometimes.

Since most of my patients are children now, and children do not drive, I see no reason to punish a sick child because a parent has issues with time management. When a “no-show” turns into a “just late,” I tend to see them anyway. I do see the on-time patients first. It is amazing how a patient will arrive thirty minutes late, expect to be seen, and still try to add in another sibling or have extra agenda items.

When I analyze my no-show appointments, I find that low-income people (those on Medicaid) tend to miss the most appointments. One of the families in my practice has six children. One day, I allowed three visits in a row to accommodate three sick children. She didn’t show up, but did call later in the day and booked three more appointments. She missed those as well. That is six missed appointments spanning two hours of my 12-hour day. I didn’t send her a dismissal letter, but I did transfer her care to someone in my practice who is more tolerant of this stuff.

What causes people to miss medical appointments?

  • Something important came up and they simply forgot
  • They got better and did not bother to call
  • They were going to be late, so they decided at the last minute not to come.
  • They had insurance problems or financial difficulties
  • They lie and claim they cancelled the appointment
  • Car trouble, flat tires, speeding tickets
  • Diarrhea
  • They don’t really care

I have to say that sometimes, I don’t care either. I often get so busy that having a no-show gives me a chance to catch up on my charting, make phone calls, get something to eat/drink, or pee – things that I consider luxuries on some days. One or two no-shows, I can handle. If I have more than that in a day, I get miffed.

Making a medical appointment is a commitment. If you make an appointment, please try and show up on time and keep it. If you have to cancel, call as soon as you can so this precious opening can be used by someone else. We all forget an occasional appointment. Emergencies can happen. We occasionally have to cancel their appointments, so we know that.

My phone rings. It is the sweet computer voice reminding me of my MRI scheduled for this weekend. I’ll make sure to be there.


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