Compared to other service industries, the prevalence of no-show fee policies in healthcare is difficult to gauge. But one thing is clear: No-show rates are a challenge affecting resource utilization, costs and patient access.
On average, missed appointments can cost physicians $200, though this varies by specialty. The average no-show rate across primary care and various subspecialties was roughly 20% over a 12-year period ending in 2008, according to a 2016 study. It has since likely become a larger issue, with up to 50% of medical groups reporting an increase in no-show rates in recent years.
Across industries, no-show fee policies have emerged as a way for businesses to make up for lost revenue when there is an unexpected opening on the books and deter inconvenient behavior. From 2019 to 2024, the number of restaurants on the reservation platform Resy that charged at least one cancellation fee more than quadrupled, according to data cited by The Wall Street Journal.
It is more difficult to gauge just how common no-show fee policies are in healthcare, given there is no one overarching platform to track such fees and they are largely discretionary policies that vary by organization.
"It's more common than it used to be," Arthur Caplan, PhD, founder of the division of medical ethics at NYU Grossman School of Medicine, part of New York City-based NYU Langone Health, told Becker's. "But this is an area you're always operating by anecdote."
Lowering no-show rates is critical, especially when the average wait time for the next available medical appointment across 11 specialties is nearing 40 days, but how to best go about doing so is complicated in healthcare, experts told Becker's. Healthcare leaders have high-stakes factors to consider before imposing monetary penalties on patients, such as whether their policy may widen healthcare disparities.
"You want to make sure that you are not so punitive" that patients do not come back, said Rick Gundling, senior vice president of professional practice at the Healthcare Financial Management Association.
What to consider
Comprehensive data on common reasons for missed appointments is hard to come by, though one study from 2020 showed financial issues were often at play. Some portion of missed appointments is beyond a person's control: an illness, bad weather, transportation issues, etc. For some, a $100-plus fee to reschedule may be enough to prevent them from coming back. Instead, they may avoid the fee and not return as a patient. Such scenarios represent a loss for both the patient and the practice, as the business is not recovering any potential lost income from the appointment, and a patient's health may suffer from missed or delayed care, Dr. Caplan said.
"I don't think the penalty system captures that, nor is it solving the problem," he said.
In other cases, fees may stand to make no-shows even more prevalent. Patients who are not as burdened by the fee may rather pay out of convenience to skip their appointment last minute instead of missing another commitment. Putting a price on late cancellations may make the practice more acceptable, as demonstrated by a study in 2000 that found late pickups significantly increased at a daycare center after a fee policy was imposed, which was cited by The Wall Street Journal in a May report.
The experts Becker's spoke to encouraged leaders to think outside the box on ways to deter no-shows that do not involve fees. At Peoria, Ill.-based OSF HealthCare, leaders are constantly considering new ways to address the issue among patients who consistently do not show up for primary and specialty appointments, said Amanda Mishler, senior vice president of clinical operations at the health system's medical group.
OSF Healthcare does not charge patients for missed medical appointments and is instead experimenting with a patient agreement in certain high-demand specialties, including behavioral health.
"The agreement highlights the patient's commitment to showing up to appointments," Ms. Mishler said. "If they repeatedly no-show, we will remove them as an established patient. In order to re-establish with the practice, they would need to go through the new patient process again, however, there is not a monetary impact to the patient."
No-shows will always be a challenge in some capacity, but addressing the underlying factors behind why it is a habit for some patients is the only long-term and reliable way to mitigate the issue, leaders said. Missed appointments should increasingly be used as an opportunity to initiate conversations with patients about the potential barriers they face in accessing healthcare and address social determinants of health.
"Social determinants of health is something that needs to be understood as it may be a key driver for continual no-shows," Ms. Mishler said. "Taking the time to have a conversation with patients about barriers to showing up for appointments is important as they may not understand the importance of their appointment, or the impact not showing up has on access for others."
Knowing what factors are at play also allows the organization to offer potential alternatives when appropriate, such as a virtual visit. If access to reliable transportation is a barrier, a fee will not prevent the same problem down the line, and organizations should instead determine what resources they can offer patients.
"Maybe it's getting an Uber voucher" or sharing other options, Mr. Gundling said.
"It's about great customer service and getting a better understanding of the patient," he said. "Don't make it punitive. Make it a way to engage."