Most medical practices have no-show policies in place. They’re generally based on an American Medical Association code that states a doctor may charge for a missed appointment – or for failing to cancel 24 hours in advance – if the patient is fully advised that a charge will be made. Some providers proactively remind their patients of upcoming appointments via text alerts sent out about 1 week in advance. If a patient doesn’t show up, you can wait 15 minutes before calling them.
Four years ago, Lancet Public Health published an article by David Ellis, PhD, and colleagues that looked at the demographics of those patients who routinely miss their appointments. They observed that 19% of patients who missed more than two appointments in the 3-year study period were more likely to be aged 16–30 years, or older than 90 years, and of low socioeconomic status. Overall, women missed more appointments than men and urban practices in affluent areas, where wait times can be longer, were more likely to have patients who serially missed their appointments.
Missed appointments can have both a significant impact on the patient and financial implications for healthcare systems. People with one or more long-term condition who fail to keep appointments may be at risk for premature death. A study in 2019 in BMC Medicine by Ross McQueenie, PhD, and colleagues tackled morbidity, mortality, and missed appointments in healthcare. They concluded that missed appointments represent a significant risk marker for all-cause mortality, particularly in patients with mental health conditions.
So what can you do? Physicians can reach out to the patient to reschedule the care either in-person or through telehealth or they may decide to dismiss them. However, a study by Ann O’Malley, MD, published in JAMA Internal Medicine reported that most practices only dismiss a few patients every couple of years. Most were dismissed for similar reasons: the patient was extremely disruptive or behaved inappropriately toward clinicians or staff, they violated chronic pain and controlled substance policies, or repeatedly missed appointments. An even smaller number of practices dismissed patients for repeatedly not following medical recommendations, violating bill payment policies, not following recommended lifestyle changes, making frequent visits to the emergency department, or self-referring to specialists.