No-shows prove to be very costly
Based on our research dental practices are confronted with 5 to 10% no-shows. When you look at the problem from the point of view of public health, the no-show rate even amounts to 40%.
No-shows is a broadly known problem in healthcare, though underreported and largely undocumented. As a result, the weight of the problem is of a more latent nature and consequently does not really create a clear sense of urgency.
The fact that the problem is undocumented is due to the simple fact that it’s difficult to prove something that isn’t there. Health insurance funds, national health services and other government bodies do not have supporting data at their disposal. The data is most of the time recorded in the electronic health record system of the practice – at best – and it stays there. In some cases, no-shows are deleted from the electronic health record – and thus the appointment has never existed. Or the data is reported in different formats according to different modi operandi which compromises the quality of the data. And so on.
We are currently investigating this subject matter by gathering no-show data at dental practices in Belgium. The Thomas More University of Applied Sciences has set up an academic research trajectory in this regard as well.
Why exactly no-shows occur is a complex, not-easy-to-fix problem which will not be solved by a simple, one-size-fits-all solution like an online calendar with a standardized reminder feature via text message. Some causes of no-show behaviour, like lead time, even have a reinforcing effect causing a vicious cycle.
In order to be able to solve a problem, one should have a clear understanding of the problem. And the first hurdle to take is: when exactly should we classify an event as a no-show?
Well, it depends from which angle you look at the problem.
From a dentist’s point of view the no-show rate amounts to 5 to 10% in Belgium
Should be categorized as no-show event: the patient who does not show up for the appointment without notifying or without notifying in a timely manner. In other words, no-shows are events which can potentially cause gaps in the schedule of the healthcare provider. Potentially, because even if the gap in the schedule can be filled last-minute by someone on the waiting list or calling in with an emergency, the event is still to be considered a no-show.
When exactly a notification occurs timely depends on among others the type of healthcare provider, the geographical spread and/or degree of urbanization. As a result, what period of time constitutes a timely notification should be determined for each healthcare provider or healthcare practice, based on the metric what amount of time is needed to complete the working schedule in normal circumstances.
For patients this problem is hardly visible. Even for healthcare providers the problem is one of a more latent nature, because healthcare providers simply lack the data. Yet, no-show events do harm the healthcare provider on both an organizational and/or financial level. There is a negative impact on the working schedule of the healthcare provider and people planning, the healthcare provider loses profits and sometimes has made costs which he cannot reclaim.
Although dental practices in Belgium are not fully aware of the impact of no-show, our research shows that they should. Based on our research so far of no-show data gathered and analysed at dental practices in Belgium the no-show rate amounts to 5 to 10%. Taking into account an average hourly rate of 100 to 200 EUR the lost profits can be estimated at between 10 000 EUR to 40 000 EUR each year per full-time working dentist.
Based on numbers from SCI Solutions the no-show rate for appointments with healthcare providers in the US would amount to 5 to 30% even. The lost profits in respect of all healthcare providers across the US are estimated between $25 and $150 billion dollar per year!
From a public health’s point of view the no-show rate in regards to dentistry amounts to 40% in Belgium
When we look at no-shows from a public health perspective, we should extend the concept of no-shows to all events where people do not show up for an appointment with a healthcare provider against evidence-based guidelines, regardless whether one has made an appointment or not.
For instance, scientific evidence shows that in view of good oral hygiene one should visit the dentist at least once per year. As a result, people not visiting their dentist at least once a year can be considered a no-show from a public health point of view.
From a public health perspective the no-show rate is much, much higher than the problem of no-shows experienced by individual dental practices, e.g. for Belgium reportedly about 40% of the entire population.
What does the cost structure of no-shows look like?
On an individual health level, a no-show may cost the patient. The patient had a reason for scheduling a consultation with a healthcare provider. So he/she will see his/her healthcare needs met only later, or perhaps he/she won’t attend to it any longer and thus not get the healthcare he/she actually needs.
On a public health level, no-shows may cost (a) people on the waiting list who may be in an actual need of healthcare and (b) the patient him-/herself who did not show up because, as over time the patient may find him-/herself in poorer health which means on a macroeconomic level people are on average in poorer health.
On an individual financial level, no-shows may cost healthcare providers because they lose profits due to no-shows and incur costs which they may not be able to reclaim from the patient who did not show up for the appointment. And even if the window in the schedule of the healthcare provider caused by a no-show can be filled, it’ll cost both money and time of the care provider to do so.
On a public health expenditure level, no-shows may lead to poorer health on micro- and macrolevel, which in turn may lead to higher healthcare costs and an increased healthcare cost per capita.
Do you have accurate data at your disposal to estimate how much no-shows cost your practice?