Dealing with No-Shows

No-shows have always been a revenue kill, especially for practices with tight schedules.

Now, in the era of COVID-19, it’s even worse. Appointments are spaced out and waiting rooms are kept empty on purpose. Double-booking, which was never ideal, is now not much of an option. In short, a no-show poses a serious loss of revenue at the worst possible time.

Of course, no-shows are rarely a systemic problem. It’s usually the same handful of patients. Therefore, blanket solutions are rarely a good fit. Most people skip out on their appointment  for three main reasons:

  1. They forgot (this is the reason, 4 times out of 5)
  2. They’re fearful or anxious
  3. Socio-economic challenges such as cost, language barriers, lack of insurance, etc.

Keep these in mind as we go through the essentials of tackling this problem.

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Track Your No-Shows

We’re digital marketers who solve real business problems for our clients and their practices. So, for us, data is everything! Just as you can’t track return-on-investment without tracking the numbers, you likewise can’t deal with a problem if you don’t quantify it. Your no-show rate indicates lost revenue—if you want to tackle it, start tracking it! 

For accuracy, only count actual no-shows with no prior notice of cancellation. Don’t just track the numbers, but identify which patients are the consistent offenders.


Total Recall

While not quite as cool as the 1990 mind-bending film, it should go without saying. Given that forgetfulness is the leading cause of patient absenteeism, then you need some kind of process for recalls and appointment reminders. Automated systems for this purpose—usually provided by your EHR or Patient Management System—use a multi-touch approach to remind patients about their exams. This can include automated emails, phone calls, and texts, some of which even solicit confirmation. Unless you or your staff have oodles of time on their hands to manually track and confirm each and every appointment, an automated recall system is indispensable to minimize no-shows and make your practice more profitable. 

Pro Tip: Don’t rely on phone messages alone. People don’t trust unknown numbers, especially from automated systems. An SMS is far more likely to be seen.
Above: Arnold attempting to manually handle his recall process.

Should I Charge a No-Show Fee?... Nope!

In our experience...absolutely not! We recently held a webinar on the Best Patient Experience”, in which, to paraphrase, Dr. Shawn Prapta emphatically warned that, 

Nothing turns off patients like being charged a fee for not showing up. These are especially difficult times. You don’t know what’s going on in a person’s life. His car may have simply broken down...just don’t go there!


Especially these days, when we absolutely want unwell patients to stay home and people’s lives are topsy-turvy, it’s not in your best interest to penalize patients for that decision, even if it’s last-minute. And the data supports this. A Medical Group Management Association study showed that nearly half of no-shows didn’t even know their doctor had a no-show policy. Beyond that, you don’t want to be in a situation where you have to listen to reasons and decide which excuse is valid and which not. Either way, you lose. No one likes getting the third degree, and you might very well turn off a patient forever.

Below: This screenshot shows a reminder text that I received for an appointment for my daughters. Had I not replied “C” to confirm, I would expect a diligent practice to be calling me next.

Identify No-Shows and Go From There

Do you already have a solid recall system and you’re still struggling with some frequent flyers going AWOL?  One of our ODSpecialty clients, Dr. Howard Dolman, recommends flagging those who have no-showed 2 or 3 times. The doctor then recommends that you have a “heart-to-heart conversation with the patient about the issue. One of the best ways to help these patients is to ask them to call us for a same-day appointment. In this way, the usual no-show patient can help fill the slots that open up from last-minute cancellations. It's a win-win.”

Once you’ve got a good recall system in place, having a sincere and open discussion will go a long way toward understanding if there’s an underlying anxiety or barrier to care (real or perceived) that is causing the no-show, and allow you to deal with these on a case-by-case basis.

Should I Request a Deposit Upfront?

More and more eye care practices are seeking this solution. Unlike a no-show fee or penalty, a small deposit, usually in the 15-50 dollar range, acts as a financial motivator and discourages no-shows. But… Remember when I said about avoiding blanket solutions to a problem created by a minority of patients? 

To be sure, deposits can and do work for some practices. Yet, we advise caution. If need be as a last resort, consider requiring a deposit from “repeat offenders”, rather than force your entire patient base to now effectively prepay part of their appointment.

Yet, even there, we recommend feeling this out. It really all comes down to your patient demographics. In an affluent urban area, deposits can be par for the course. However, in other areas, they can alienate some patients, particularly in less affluent communities where patients may not always have access to credit cards or digital payment methods. 

The Most Important Metric of Them All

If no-shows are putting a lot of pressure on your practice, it’s likely that your revenue stream is very tight. Beyond a solid automated recall system, your best bet is to forget about no-shows and focus on the overarching problem of low patient volume. When you’re a smaller general care practice, you will see a lot more bang for your buck focusing on new patient acquisition. If a certain smallish percentage of appointments will no-show, the simpler solution is to be booking a lot more appointments.

The best way to increase your bookings is with marketing. Now, everyone and his uncle has their own idea of what marketing means. Yet marketing for 'any kind of new patient' doesn't mean you market to everyone. We advise that you segment your target patients into 12, with a different target segment every month. For example, this month you should target back-to-school patients with a multi-channel campaign that includes website content, social posts, an email blast or two, and in-office materials. (In fact, here’s a FREE back2-school campaign) Next month, switch over to fall allergies or computer vision and run a campaign on that. Then shift to 'use it or lose it'. Trying to market everything to everyone at once basically means you’re marketing to nobody.

Our ODEssentials Package

Our clients averaged 51.06 new patients per month—
on average an ROI of about 4000%—not bad for one month.



But that’s not all! Based on our 15 years of  generating new patients appointments, we’ve learned that what every website absolutely needs really comes down to solid local SEO, fueled by broad fresh content added monthly to your website. 

Does all that SEO and monthly work seem daunting? That’s why we created ODEssentials, a marketing product designed specifically for practices trying to grow their general care appointment bookings.  

And it works! In 2019, our ODEssentials clients averaged 51.06 new patients per month—roughly double what our website-only clients averaged. While there are lots of marketing options out there, ODEssentials is built to solve the challenge of patient growth dynamically—month by month, with the perfect mix of Search Engine Optimization, social media, and campaign strategy. This process is always led by a dedicated optometry Marketing Manager, who strategizes with you on monthly calls in order to bring your growth aspirations to fruition.  

If all that SEO and monthly campaign strategy, design, and implementation sounds like a lot of time and effort we understand, and our team of Marketing Managers stand ready to help. Just fill out the form and book a time for us to talk. You’ll rest easy once you get your growth on.


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