How to Reduce Eye Care Practice Cancellations, Reschedules and No-Shows

By Eleni Karayeva March 19, 2021

No-shows come at a price. While no eye care practice can be fully immune to them, there are ways to minimize the impact of no-shows on your practice. Start by reviewing your current no-show policy and see what strategies are best for your practice.

Overbooking and no-show fees:

Sometimes we can borrow tactics outside our industry. Think airlines and upscale restaurants. Overbooking is common in busy urban practices, especially those with high percentages of patients with managed care plans, while no-show fees are a staple of practices with commercial and private pay patients. The idea behind it is the assumption that there will always be no-shows on the schedule, and the overbooking is meant to compensate for that. If all of the patients do show up, the doctor would simply rush through the exams. There are several issues with this approach, however. One, it compromises the level of care, reducing patients to numbers. Increased wait times would cause some to walk out, or at the least, walk out without making a purchase after their exam. But more importantly, overbooking is impractical in today's context of Covid protocols.

Will You See the Doctor Now? - Big Ideas - MediumStill, a no-show in a schedule spaced out by thirty minutes to an hour for each appointment can leave a significant revenue gap for the practice. This explains the trend why we see practices charging no-show fees for missed appointments. While the fees themselves are no higher than an average exam copay, what you want to consider here is ease of implementation as well as what kind of message you are sending by charging a no-show fee. Would you actually bill the patient if they don't show up for their appointment? And if you do, how likely are they to come back to your office in the future? Especially in the age of Covid, penalizing patients for missing their appointments can come across as downright insensitive. The last thing you want is to adopt policies that drive patients away from your practice. Retaining your patients over time clearly holds far greater value than collecting a single $20-25 fee. Now if you still want to incorporate the concept of no-show fees, there is a more discreet way to do so: mention on pre-registration forms and appointment cards that there is a fee for missed appointments. It communicates the notion that your time is valuable and that it would simply be polite to call ahead in case the patient can't make it, even if you don’t enforce the policy.

Prevent no-shows from happening. Is your recall strategy up to the task?

There are several reasons why patients don't show up for their appointments. Let's figure out why it happens and what role you can play in preventing it.

Some reasons behind missed appointments are unavoidable: a change of schedule, a child to pick up from school, an emergency. But the most common reason is that they simply forgot. And that's hardly surprising, especially if the appointment was made weeks or even months before. Effective communication is key, so take the time to reevaluate your recall system. Many technologically-advanced practices have implemented automated recall systems such as SolutionReach. While such systems are great and allow for much customization, there are a few things to keep in mind. Keeping patient information up to date is one of them. The best recall systems won't be of any use on an out-of-service number! When registering the patient for an appointment always note their preferred method of contact. Do they prefer to be called, or do they want you to send them a reminder text or email? Most EHRs allow you to notate which is the preferred method of contact. The patient experience should always be tailored to each patient individually.  While recall and reminder software can indeed do wonders for improving no-show rates, don't become 100% reliant on them. Consider what happens if the phone number on file is a landline number; the patient will receive an automated call. Such calls can easily be mistaken for telemarketing, and result in the patient hanging up or ignoring the call. Text message reminders get a lot of positive feedback from patients, but not across all age groups. For example, neither automated calling or texting is an efficient way to reach out to seniors. For this reason, don't completely give up on traditional phone calling!
No Show Policies that Won't Scare Off Patients
The best strategy lies in an automated recall system augmented by the staff. Always have a staff member go through the appointment confirmations.  Calling only those that did not confirm both saves your staff time and avoids redundancy by calling those patients that already confirmed via email or text. 

And lastly, don't forget about following up with the patient. Too often, missed appointments are just that - no-shows marked in red on the office scheduler. Your patients might have forgotten about their appointment, but you shouldn't forget to reach out to them to reschedule. Don't wait for the patient to call you! This way, not only will you gain valuable insight into why your patients did not show up, but you'll also turn losses into revenue. Ultimately, your patients will appreciate your flexibility and understanding.

Final thoughts…

Here’s another tip on how to help reduce no-shows. When scheduling and rescheduling, always ask the patient what times work best for them; even if you cannot accommodate the exact request. You should offer several options. When patients are given one specific time slot, though they might initially accept it, they are less likely to keep their appointment. This also holds for recurring follow-up appointments. 

Handling no-shows, especially in today's chaotic practice environment, is like any other aspect of your practice. The best outcomes often come from careful examination (and reexamination!) of existing protocols and an understanding that adaptation is the key to a thriving practice. 


Eleni Karayeva

Eleni Karayeva has been in the eye care business since 2013, having done everything from sales and marketing to provider relations and general management of multiple opticals across NYC. Eleni is also an expert in provider credentialing and medical optometry billing. She enjoys the challenge of helping eye care practices reach and exceed their full potential and is always looking to incorporate innovative strategies to optimize the patient experience and drive up revenue. Her success in the industry led Eleni to found LK Project Management & Consulting, a management consulting firm that works exclusively with optometry practices. Besides the regular billing and credentialing clients in her portfolio, Eleni's most recent projects include setting up a new optical store in Brooklyn, NY and launching several successful marketing campaigns. Eleni loves fashion, photography and traveling, often turning to her hobbies for more inspiration.

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