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On Time and Ready to Go:

Essentials for Appointment Communication in the COVID World

The pandemic has brought a lot of challenges. On average, revenue across healthcare is down about 40 percent. According to MGMA, 87 percent of patients are afraid to go to the doctor. Now, we are seeing the results of postponing care. People are getting sicker or diagnosed later, causing more severe illness and poor outcomes. You need patients to schedule appointments, and just as important, you need them to show up on time and prepared. When they don’t, it can put your entire schedule behind, result in lost revenue, mean more work for staff, and have a negative impact on patient experience and outcomes.

With the right tools, techniques, and touches, you can create a great digital patient experience that delivers better financial and patient outcomes. In this guide, we’ll look at what the data says about how to:

  • Set up the most effective patient reminders
  • Use pre-visit instructions to prepare patients
  • Utilize text messaging to stay connected with patients
  • Get the most from digital intake
  • Create workflows for new processes like “park and text” waiting or telehealth

The Cost of No-Shows

It’s one thing to get patients to schedule appointments (and we’ll talk about that another day), but it’s quite another to make sure they all show up on time and prepared for their visit. No-shows, late cancellations, and patients showing up unprepared has a big cost. No-show rates in healthcare can range anywhere from 10 to 30 percent. Some specialties face huge struggles with this problem. Here is a sample of no-show rates across a range of specialties:

  • Cardiology –18%
  • Endocrinology – 14%
  • Gastroenterology – 25%
  • OB/GYN – 18%
  • Ophthalmology – 22%
  • Orthopedics – 11.5%
  • Pediatrics – 30%
  • Primary Care – 20%

For a provider who sees 20 patients a day (and that’s low for many specialties), a 10 percent no-show rate means two missed appointments a day. Based on the average revenue per visit across all the specialties listed above, that’s around $400 a day in lost revenue for a single provider. As practices work to recover from the impact of pandemic-related closures, no one can afford to lose that. Add it up. Over the course of a year, that’s nearly $100,000 in lost revenue per provider.

There are many potential stumbling blocks. Luckily, there are also a lot of easy levers you can pull to address those issues.

Automated Appointment Reminders

The top reason for patient no-shows is that they simply forgot about the appointment. That’s why reminders are so important. But how reminders are delivered is just as critical as doing them in the first place.

We’ll just come out and say it—phone calls are out. The latest data shows interest in phone calls has dropped 14 percent just since the COVID pandemic began. Interest in digital communication, however, continues to increase with patients saying that text and email are effective communication methods across the patient journey.

Automated reminders can quickly reduce no-shows to five percent or less while also increasing the number of patient confirmations. The right cadence of automated reminders can actually increase patient confirmations by as much as 156 percent!

Here’s what the data says is the best approach:

  • Start with a message about three weeks ahead. The touchpoint that has the greatest impact on confirmation rate is the weekly message. Appointment reminder strategies that include the weekly reminder message are confirmed at a 126 percent higher rate than when no automated reminders are sent.
  • Add in a message three to five days ahead. The daily message is also important to the confirmation rate. When combined with the weekly message, the touchpoint sent a few days before the appointment provides a lift of an additional 26 percent to the confirmation rate.
  • Finish with a message about three hours ahead. Why should you add this third touchpoint? It doesn’t measurably influence confirmation rates. But remember that this is looking only at confirmations of appointments, not whether those patients show up. It’s not as natural for us to confirm an appointment that’s only a few hours away. Instead, patients are more likely to pass on confirming and just show up. It’s a last step in reducing those no-shows.


The right communication method is also critical, along with other patient preferences. Ask patients how they prefer to get their reminders. Most likely many will say through text. Nearly 80 percent of patients say they’d like to get text messages from their provider. Sending reminders in the patient’s native language also helps improve the effectiveness of those messages.

Integrated Pre-visit Instructions

Automated reminders are great for increasing confirmations and getting more patients to show up, but there is more to it than that. How many times have you had to reschedule an appointment because someone forgot to prepare for their visit? As the healthcare industry moves to a combination of in-person and virtual visits this has become even more critical. You don’t want someone to show up in person when they were supposed to see the provider through telehealth! And for in-person visits, it can throw the schedule off or cost an appointment that it is too late to refill if patients show up without having completed their paperwork or unprepared for tests they need.

Reminders can now contain pre-visit instructions that are based on appointment type. It has always been important to personalize reminders to include:

  • Appointment date and time
  • Reason for visit
  • Doctor they will be seeing
  • Office location
  • Confirmation they can make it

Now, you can also remind them to bring their medications, complete paperwork, or fast before a procedure. You can also send unique information in different reminders like adding a telehealth link and instructions in a reminder 15 minutes before a virtual visit. Pre-visit instructions can also link to more detailed instructions that can include maps and wayfinding or additional details like instructions for “park and text” waiting.

Detailed pre-visit instructions eliminate the guesswork for patients and ensure they show up ready for their appointment. That’s a more efficient and better experience for the practice and the patient.

No-Show Policies

The best no-show policy a practice can have is the policy to avoid them wherever possible. However, there will be times when, no matter how much effort you put in, patients simply won’t show. And they may become repeat offenders. Many practices are trying a variety of no-show policies in order to discourage no-shows and recognize patients who arrive on time to appointments.

Here are a few examples of no-show policies that you can try:

  • Straight fee—This is the most commonly used no-show policy. Each time a patient misses an appointment (or is a certain number of minutes late for that appointment), they are charged a fee. 
  • Fee, erased upon return—When a patient no-shows, a small fee is added to their bill. The fee is removed once the appointment is rescheduled and the patient arrives on time.
  • Reward policy—Other practices are trying to reward patients for keeping their appointments and coming on time. Each week, patients who’ve kept their appointment are entered into a drawing for a gift card or other reward.
  • Detention policy—Several practices have also tried a “detention” policy. Patients who miss an appointment are required to attend a 30-minute session at the practice that focuses on healthcare issues and the importance of keeping their appointments. Only after completing the session are they allowed to reschedule their appointment. While it may seem that extra time or resources devoted to a patient who no-showed is counter-intuitive, many providers see this as a way to improve communication and goodwill with patients.

During times like COVID when patients are truly fearful, it may make sense to stop some of these no-show policies. In other times, they can be effective at targeting that small percentage who can’t be moved to show up by even the best reminder strategies.

Digital Intake Process

No one wants to touch a clipboard anymore. Those days are over. And think about it, when was the last time you filled out paperwork in another industry? It’s probably been a while. Most other industries have moved on to digital paperwork through text and email, kiosks, or both.

Virtually all patients—93 percent to be exact—say that they expect healthcare organizations to use digital tools when interacting with them, and this includes during the intake process. Fortunately, using an online intake process comes with a bevy of benefits for both healthcare organizations and patients, making implementation a lot easier to manage. 

  1. Reducing unnecessary expenses.Did you know that up to three percent of your annual revenue is spent on paper? That doesn’t even include printing costs or postage if you mail forms ahead of time! These small costs really do add up. Using digital forms rather than paper not only saves trees—it saves wasted money for healthcare organizations. 
  2. Improving accuracy.Transferring all of the data written on a paper form into the computer inevitably leads to typos when copying things like social security numbers, addresses, and so on. In fact, experts estimate that 16 percent...oops… 61 percent (see what we did there?)...of claim denials are due to simple demographic or technical errors. These manual errors end up costing healthcare organizations more time and money. 
  3. Protecting patient privacy. Successfully managing protected health information (PHI) is a critical piece of healthcare management. Compliance, reputation, and overall success are at stake. Unfortunately, a large-scale survey recently found that medical-related identity theft accounts for 43 percent of all identity theft reported in the United States―this is more than what is experienced in banking, finance, government, military, or the education sectors. Ouch! Much of this fraud can be attributed to sloppy handling of paper medical files or outright theft of personal data. An online check-in process is a more secure way to manage PHI. 
  4. Saving time. The importance of integrating technology into your check-in process can be an incredible life-saver for their sanity. The check-in process is one of the major bottlenecks within any healthcare organization. Even one or two mishaps can throw off your schedule for the rest of the day. Automating the intake process helps expand that bottleneck to allow for a better patient flow and free up the front desk staff from additional work.  
  5. Improving the patient experience. It is easy to get so busy running our healthcare organizations that many times we don't even notice how unpleasant it is to fill out paper forms for patients. Not only does it take up time in the waiting room (when they may already be feeling a bit anxious), but it also makes the experience that much more difficult for patients. Allowing patients to take care of this task before even leaving home is an incredible benefit for them. 

There are a lot of reasons to switch to digital intake, and it is easier than ever for practices and patients. Click a button and send forms via text or email based on patient preferences. Customize and add and remove forms (i.e., COVID pre-screening). It’s that easy, and the added benefits are that it removes that potential delay at check-in and supports both in-person and virtual visits with a single workflow.

Two-Way Text Messaging

Texting is everywhere. It’s the most widely used feature on a smartphone, and if you look around, you won’t find that hard to believe. Cell phones and texting have become an inherent part of our society. People carry their phone with them wherever they go and are constantly checking and responding to messages. In fact, studies have shown that people see an incoming phone call as an intrusion in their lives. Texting has become the preferred way to communicate.

But people aren’t just texting their friends and family. They text to communicate with their mechanic, pharmacist, and even the grocery store where they shop. And studies have found that patients would prefer to communicate with their healthcare providers through text too. Seventy-nine percent of patients want to get texts from you and seventy-three percent want to be able to send you a text.

Automated text messages are great at combatting the no-show problem. But real-time text takes it one step further by allowing patients to respond with questions or to reschedule at the time they get the reminders. It’s also a fast and easy way to quickly address simple questions in patient-initiated texts like “where do I park” or “do you have an opening today.”

Real-time text is now a critical tool to pre-screen patients for COVID and address their concerns about safety. If a patient hasn’t confirmed, send a text to ask if they are coming and if they have any symptoms of COVID. Offer “park and text” waiting where the patient texts on arrival and you text back when it’s time to come in. Give patients a way to ask questions about your safety procedures and answer them in a real conversation through text.

You can use real-time, two-way text to:

  • Answer common questions
  • Pre-screen patients
  • Verify and update insurance
  • Conduct park and text waiting
  • Follow-up after visits and procedures
  • Reach to patients who aren’t responsive

Finally, you can use text to help address some social determinants of health that may impact patient’s ongoing care and follow-up treatment. Follow up with patients after a visit or procedure to answer questions. This can be especially important if the patient doesn’t have a primary care provider or immediate family to care for them. Reach out to patients you know to be high risk because they are isolated or lack resources to make sure they know they can reach out to you for help. Use text to drive patients to sign up for the portal to engage them more in their ongoing care.

Making sure that patients show up on time and prepared goes far beyond that initial scheduling interaction. It’s an ongoing conversation now that includes reminders, instructions, electronic paperwork, and being available to quell people’s fears and assure them that it’s safe to come in. It’s more than can be done by your staff manually. It requires the technology to support ongoing, personalized messaging combined with the ability to carry on an ongoing conversation through the patient’s preferred method, which is usually text.