Scheduling for “No Shows”
Grant Diggles February 10, 2025
No-shows are one of the biggest inefficiencies in a dental practice, leading to lost revenue, underutilized provider time, and disruption to the schedule. Depending on the regulatory environment and patient demographics, different models can be applied to minimize no-shows, improve patient accountability, and protect the practice’s schedule.
1. Understanding the No-Show Problem
📌 Industry Average No-Show Rates:
- •Private, fee-for-service practices: ~5-10%
- Insurance-based practices: ~10-20%
- Medicaid-heavy environments: ~30%+
📌 Common Reasons Patients No-Show:
- Forgetfulness / lack of reminders
- Financial concerns / unexpected costs
- Fear / anxiety about treatment
- Perceived lack of urgency for preventive care
By understanding why no-shows happen, a practice can take a proactive approach to reducing them.
2. No-Show Management Models & Strategies
“The Overbooking Model (For High No-Show Practices)”
Best for: Medicaid-heavy practices or environments where no-show charges are not permitted
How It Works:
✅ Overbook the schedule by 20-30% based on historical no-show rates.
✅ Use ghost columns to accommodate potential no-show replacements.
✅ Warn chronic no-show patients that they may have to wait if they arrive late due to overbooking.
✅ Have a walk-in policy for certain services (i.e., hygiene checks, quick fillings).
Pros:
✔️ Keeps the schedule full despite expected no-shows.
✔️ Reduces lost revenue.
✔️ Ensures providers stay productive.
Cons:
❌ May create longer wait times if all patients actually show up.
❌ Requires careful scheduling and patient communication.
📌 Pro Tip: Be transparent with patients. Let them know that due to past missed appointments, they may have to wait if they arrive late. This encourages them to show up on time.
“The No-Show Fee Model (For Practices That Can Charge)”
Best for: Fee-for-service, PPO, or practices allowed to charge for no-shows
How It Works:
✅ Set a no-show policy requiring 24-48 hours’ notice for cancellations.
✅ Charge a $25-$75 fee for no-shows or last-minute cancellations.
✅ Clearly communicate this policy in new patient paperwork, appointment reminders, and website.
✅ Be flexible for first-time offenders – waive the fee once as a courtesy.
Pros:
✔️ Creates a strong financial incentive for patients to show up.
✔️ Significantly reduces casual no-shows.
✔️ Encourages early cancellations, giving staff time to rebook the slot.
Cons:
❌ May upset some patients, especially those with financial difficulties.
❌ Can be difficult to enforce in some patient populations.
📌 Pro Tip: If a patient complains about the fee, offer to apply it as a credit toward their next visit instead of waiving it.
“The Prepayment Model (For High-Value & High-Risk Appointments)”
Best for: Practices with high-ticket procedures (implants, Invisalign, sedation, etc.)
How It Works:
✅ Require a deposit or full prepayment for certain procedures.
✅ Use credit card holds for appointments over a certain value.
✅ Allow deposits to be refunded only with 48+ hours’ notice.
Pros:
✔️ Works extremely well for high-value procedures.
✔️ Reduces financial risk for the practice.
✔️ Ensures serious commitment from the patient.
Cons:
❌ May deter some patients who can’t afford upfront costs.
❌ Requires clear communication to avoid misunderstandings.
📌 Pro Tip: Let patients know that prepayments lock in their preferred appointment slot.
3. Proactive Strategies to Minimize No-Shows
A. Implement a Robust Appointment Reminder System
✅ Send text/email reminders at 7 days, 3 days, and 24 hours before an appointment.
✅ Use AI-driven tools like Weave, NexHealth, or RevenueWell to identify patients most likely to no-show.
✅ Allow easy rescheduling through online scheduling portals.
📌 Pro Tip: Make sure your reminder messages include an easy-to-click confirmation link.
B. Create a VIP Patient List (Short-Call List)
✅ Maintain a list of patients willing to come in on short notice.
✅ Call these patients immediately if a slot opens due to a no-show.
✅ Offer a small discount or priority scheduling for patients who participate.
📌 Pro Tip: Advertise your “Sooner Possible List” so patients know they can get in faster.
C. Enforce a Three-Strike Rule for Chronic No-Show Patients
✅ 1st No-Show → Friendly warning, reminder of policy.
✅ 2nd No-Show → Require deposit for future appointments.
✅ 3rd No-Show → Possible dismissal from the practice.
📌 Pro Tip: Chronic no-show patients cost the practice money—it’s okay to let them go if needed.
D. Educate Patients on the Importance of Keeping Appointments
✅ Explain that missed appointments delay their treatment progress.
✅ Use scripts at checkout to reinforce the importance of showing up.
📌 Example Script for Front Desk:
“Mrs. Smith, we’ve reserved this time just for you. If you need to reschedule, please give us at least 24 hours’ notice so we can accommodate other patients in need of care.”
4. How to Handle Patients Who Don’t Show Up
✅ Same-Day Follow-Up Call:
•“Hi [Patient Name], we missed you at your appointment today! We’d love to get you rescheduled. Please call us as soon as possible so we can find a time that works for you.”
✅ Automated Follow-Up (Text or Email):
• A simple text like “We missed you today! Call us at [number] to reschedule.”
✅ Enforce the No-Show Policy (If Applicable):
•If charging a fee, send a formal notification with an online payment link.
📌 Pro Tip: The key is immediate follow-up—patients are more likely to rebook within the first 24 hours after a missed appointment.
Final Thoughts: A Balanced Approach to No-Shows
Managing no-shows requires a combination of overbooking, financial policies, proactive reminders, and patient education. A one-size-fits-all approach doesn’t work—practices must tailor their no-show strategy based on their demographics, regulations, and financial goals.
✅ For Medicaid-heavy practices: Overbooking is key.
✅ For fee-for-service & PPO practices: No-show fees & prepayments work well.
✅ For high-ticket procedures: Require deposits to protect revenue.