Most practices do not address the problem of no-shows adequately. Many physicians and practice managers consider it a cost of doing business. And office staffers do not mind because no-shows mean less work. But what if you could reduce your no-shows by two patients a day, per physician, for four days a week for the 45 weeks he works each year?

Four days a week x 45 weeks = 180 physician days a year

Two no-shows a day @ $70 (an average payment) = $140 lost per physician day

$140 a day x 180 days = $25,200

That $25,200 can't go in the bank unless you address the no-show problem.

Step 1--Keep Track of No-Shows
At the end of each day, have the front desk receptionist complete something like the grid-like No-Show Daily Report at right. It shows the number of no-shows and the names and notes any important weather patterns that could affect no-shows. If a patient calls and reschedules the appointment, do not include him as a no-show.

Step 2--Study No-Shows
There may be variations, including higher no-show rates on certain days of the week or during certain seasons. Is there a group of patients more likely to miss appointments? Is it your Medi-Cal patients? Individuals from certain neighborhoods? Younger patients? If you see a pattern, schedule those patients at the end of the morning and/or late afternoon, so they don't affect the rest of the schedule.

Step 3--Take Actions to Reduce No-Shows
Reminder calls: The No. 1 way to reduce no-shows is to make reminder calls. An employee can make 25 to 40 reminder calls an hour. Other advantages of such calls include being able to reschedule patients right away; discuss co-pays, deductibles or outstanding balances; and remind them to bring authorization forms.

Automated systems: Many physicians like to use an automated reminder system, rather than dedicate staff time. Here are two companies: Teltrax Med Voice at 800/720-1151 or Phone Tree at 800/951-8733.

Scheduling strategies: If your no-show rate among new patients is high, take special concern. First, new patients provide better reimbursement for each level of code. Second, there is a higher probability of Level 4 and 5 visits with new patients. Third, there are more potential ancillary service revenues with new patients. Fourth, there is also a higher probability that new patients need procedures. Many practices give new patients higher priority in the schedule to get them in faster and reduce the no-show phenomenon. Not surprisingly, if new patients are scheduled too far in the future, they go elsewhere.

Step 4--Deal With No-Show Patients
Phone calls and messages: Within one to two hours of the appointment time and at least within 24 hours, telephone the no-show patient. If you reach the patient, remind the patient about the appointment and ask what the problem was. If the patient is reasonable and requests another appointment, make one. If you get an answering machine, leave a message of concern and ask for a call back.

Letters: In all cases, follow your phone call or message with a letter confirming the appointment no-show. State your policy for these patients when they want to schedule a new appointment. This letter could establish a dollar value for the next no-show.

Chart notes: Record the missed appointment, indicating date and time. Note any follow-up phone call, message and letter.

For a second no-show, repeat the phone call and send a letter indicating that another no-show will be cause for termination. Attach a bill for a no-show fee. Make notes of all actions in the patient's chart. If the patient makes another appointment, you could collect the fee as a condition of the visit or forgive it.

For a third no-show, do not bother to call the patient. Send a letter of termination, based upon the patient not meeting the conditions of the second letter.

There is leeway in all of these strategies. For example, some doctors do not believe in charging for no-shows, but will terminate the patient upon the second no-show. However, it's best to establish consistent policies and then determine who has authority to make exceptions.

The no-show phenomenon must be studied and addressed. From a business point of view, no-shows are essentially lost income. Every effort should be made to curb these losses.

George Conomikes is president of Los Angeles-based Conomikes Associates, a practice-management consulting firm. He can be reached at 800/421-6512 or conomikesg@conomikes.com.