Patient No-show for Outpatient Physical Therapy: A National Survey

Introduction: Patients who fail to show for scheduled medical appointments (no-show) create a cascade of issues for the health care system, the provider, and themselves. No-show can affect clinical productivity, cost and quality of care, and treatment outcomes. There is an overwhelming lack of research on no-show as it relates to outpatient physical therapy in the United States. The purposes of this study were to report national no-show rates, describe the presence and characteristics of no-show policies, determine the relationship of these policies and other demographic information to no-show rates, and describe the most commonly perceived reasons for no-show. Methods: An online survey was developed and made available to an estimated 7,128 outpatient physical therapists currently practicing in the United States. Participants received the survey link through one of four methods: in person at the 2014 American Physical Therapy Association (APTA) Combined Sections Meeting, through direct mail to APTA members registered as outpatient practitioners, through social media postings, and through an online newsletter available to members of the International Spine and Pain Institute. The survey requested information regarding demographics, clinical setting, reasons for no-show, no-show rates, and no-show policies. T-tests, one-way ANOVAs, and Kruskal-Wallis tests were used to compare clinic no-show rates among locations, settings, and different no-show policies, and to ultimately make future no-show policy recommendations based upon significant findings. Results: Of the 802 surveys that were completed, 634 reported a no-show rate. Nationwide the mean no-show rate was 10.4% (±7.43). About half (52.5%) of respondents were from private outpatient clinics and 77.4% of respondents reported their clinic has a written no-show policy. The #1 most commonly reported reason for no-show was that the patient “forgot”. Private clinics reported significantly lower no-show rates (7.81%±5.92) than hospital-campus clinics (14.53%±8.17; p \u3c 0.001) and pediatric clinics (12.86%±9.50; p = 0.049). Employing a multi-method reminder system along with requiring a 24 hour cancellation notice was associated with a significantly lower no-show rate when compared to only using phone call reminders (multi-method and 24 hour notice = 6.07%±4.59, phone call only = 13.80%±9.66; p = 0.019). In addition, no-show consequences that included a fee were associated with a significantly lower no-show rate than those that included the possibility of discharge (“charge a fee” = 8.85%±6.13, “discharge” = 13.22%±8.67; p = 0.049). Discussion: The majority of outpatient physical therapy clinics (77.4%) have written no-show policies, and although no-show policy characteristics and the rates associated with them are diverse, it appears that a proactive policy may limit no-show frequency. No-show policies are needed and useful when considering a nationwide mean no-show rate of 10.4%, “forgot” as the #1 perceived reason for no-show, and significant findings regarding specific strategies and consequences that limit no-show. The impact of no-show on productivity, revenue, cost and quality of care, and patient outcomes are all areas for future research. Conclusions: Based on the data, the authors recommend a policy including multiple methods of reminders (emails, phone calls, and text messages) and requiring that the patient give 24-hour notice of cancellation or face a financial penalty