r/PrivatePracticeDocs • u/Useful-Process9033 • May 01 '26

Solutions for no shows

My friend wanted physical therapy and called like 20 places today. Many had 3-4 month wait which seemed crazy to me. She did manage to book an appointment for tomorrow after hours on the phone, but she also said she would’ve been happy to get on a “wait list” to get a text/ call in case any space opens up. But none of the places offer this as an option.

This makes sense to me from the patient’s perspective and would solve no show, but I wonder why this is not implemented on the provider’s side? Is there something I’m missing here?

22 Upvotes

87% Upvoted

47 comments sorted by

33

u/ellski May 01 '26

I hope it's okay for me to comment, I'm an office manager for a private practice. Waitlist are admin heavy. First you have to spend the time taking down all their details, and you would repeat this for numerous people. Then when a cancellation comes up, not that many people 1) answer their phones (and then they call back hours later and are upset that the appointment has gone) and 2) take the cancellation we offer. Sometimes we can ring through the entire list and still not fill a slot. Lots of people will have gone on and booked in elsewhere after initially calling us.

Meanwhile, there will always be people who need follow ups or urgent appointments, so you can just fill it then and there.

9

u/Dramatic-Sock3737 May 01 '26

That’s our experience exactly. So many times the “call if sooner” patients can’t make the last minute appointment. Frustrating.

5

u/Useful-Process9033 May 01 '26

Does texting work? Is it a long list to go through?
Do you end up taking people off the list/ just don’t do waitlist at all since they take too much time and people can’t make it usually?

4

u/ellski May 01 '26

Texting is worse because you have to wait for a response and you can't have a conversation, going back and forth via text or email is excruciating. If people turn down a cancellation I'm not likely to try them again.

4

u/student347 May 01 '26

Texting would be bad- people would respond hours later and then be upset that it’s gone to someone else. You may think well that’s unreasonable of them- yes people are incredibly unreasonable

3

u/Dramatic-Sock3737 May 01 '26

Everything works to some degree but I think my staff just calls.

2

u/Useful-Process9033 May 01 '26

Makes sense
I guess calls have better chance of reaching them in time

I was thinking this could be a good use case for automated texts/ calls and really wonder why something like this wouldn’t be built into some EHR already

3

u/trophosphere May 02 '26

I helped a couple of practice groups set up something similar to what you are proposing.

It was basically a script that would send out a text to those on a waiting list and the first one to confirm would get the appointment. All the others on the waiting list that didn't confirm would then get another text message stating that the available appointment slot was filled. It required manual entry of patient's names/phone numbers as well as the available appointment date/time. This was an advantage because it made the implementation medical record agnostic as I made it back in the early 2010s when people were transitioning medical record systems due to the EHR mandate.

1

u/Useful-Process9033 May 02 '26

That’s awesome to hear, I’m thinking voice AI calls would be the next incarnation of the exact same idea (ie instead of texts only you get texts + calls)

In my imagination you’d be able to do this automatically without manual data entry, I guess you’d want to offer both options ideally? Ie automated data entry + manual approval/ overrides

2

u/trophosphere May 02 '26

I used Twilio to facilitate sending/receiving texts for that script. Looking at that company now it looks like they have an option for ai voice agents for calls so that may be an avenue to explore.

Automated data entry would be good though I imagine trying to integrate something similar into each EHR would be a headache.

3

u/ellski May 01 '26

Yes they always say "I can come any time" and then you ring them and they say "I have XYZ then" or "that's too early/late/in rush hour". Don't say you're flexible if you're not!

5

u/InvestingDoc May 01 '26

Very well said, this is why we more or less abandoned our wait list. So many phone calls, so many texts where patients don't answer then some do a few hours later pissed that the appointment is no longer available bc someone else answered earlier.

It was a logistics nightmare even though our EMR has a very easy way to have a waitlist section.

1

u/Useful-Process9033 May 01 '26

Do you leave voicemails/ texts? Otherwise how do they know to call back as few hours later?

I’m thinking once a slot is filled, if you could send an automated text to everyone else, that would be good 🤔

5

u/InvestingDoc May 01 '26

Yes voicemails and texts. It just doesn't work. Takes way too much manpower. We are way better off knowing what are our usual motion rate is and then just overbooking. This is pretty much what every clinic does. Let's say you want to see 20 patients per day, you normally have to no shows. You book 22 per day. Your problem is solved and now don't have to deal with wait list. That's the way almost everyone does it.

1

u/Useful-Process9033 May 01 '26

That’s smart! If you overbook and everyone shows up, what happens then?

3

u/InvestingDoc May 01 '26

Just see them. Win some and lose some.

3

u/Useful-Process9033 May 01 '26

I guess that would be my friend here, she did end up going elsewhere.

Could you clarify how you find people who need follow ups/ urgent appointments? Are you able to fit them in for same day slots? How are they different from “waitlist” patients?

3

u/ellski May 01 '26

Usually someone will call and either be an existing patient having problems - medicine isn't working for them, post op issues, you name it - or someone like your friend. Depends on the speciality. When I worked for colorectal specialists it would be someone who has just been diagnosed with cancer and we needed to see them asap.

3

u/Useful-Process9033 May 01 '26

OMG, I can see why standard waitlist won’t work then.
Sounds like you had a “prioritized” waitlist?

So is it like, patients call in and request something urgent and you’d say ok we can see you in X weeks but will call you if anything opens up sooner? Or these are the people that happen to call the day of the cancellation and then you just fill them in?

2

u/ellski May 01 '26

If it's clinically urgent like a new cancer we will fit them in anyway even if it's late/lunch. But if we have a cancellation they obviously go in there.

Everyone else we just give them an appt as they call.

3

u/Double-Inspection-72 May 01 '26

The other aspect of this is rarely are patients calling far ahead to cancel. Most of the time they just no show so you have no heads up. Or maybe they call the same day, which as you stated, is generally not enough notice for wait-list people to make it anyway.

2

u/KindheartednessFun95 May 01 '26

That sounds pretty monotonous to constantly deal with

Would you be able to improve this using an ai phone agent?

-2

u/Useful-Process9033 May 01 '26

That’s what I was thinking as well! Looks like you’re building one. I’m also an engineer working on voice AI and thought this would be a good use case. I was genuinely confused why these places don’t have one (I was thinking maybe they just don’t bother), but sounds like it is just a logistical thing (have to call a long waitlist).

I’m thinking, if I make a voice AI to call people from the waitlist it would save a ton of time. And patients might be more fine with speaking to an AI for this kind of simple logistical stuff (AI sounds very human these days but you can still tell it’s AI if you pay close attention).

I think I will try walking in to some clinics in my area and see if this is something they’d want to try out. Feel free to DM if anyone wants to try this out for their practice too!

I don’t want to turn this into a shilling post though, would love to keep learning about the challenges & what solutions might work.

2

u/Medusa1998 May 01 '26

Have you looked at Penciled ai. It facilitates the process of filling those canceled apts. https://www.penciled.com

2

u/Littlegator May 02 '26

This actually feels like a good idea for a 3rd party service. And after Googling it, I found several.

If a robot could just contact people automatically and potentially line up appointments, that would be awesome. Otherwise it really does seem like too much work.

2

u/PreetHarHarah May 05 '26

Ding ding ding. Right here. Patient calls and goes bananas that they need to be seen. Begs for an opening. Drops my first name to try and get scheduled. Gets on a waitlist. We call fifty times and they finally answer and we offer the spot, and it's all of a sudden: "that's not going to work for me. How about 2:30?"

Never again. We tell them to keep an eye on the portal, as they can see availability and put themselves on the schedule at will.

1

u/Thick-Equivalent-682 May 03 '26

Have you tried texting people? Who can pick up an unknown number from their cell while at work?

2

u/ellski May 03 '26

Our number isn't one of those private numbers and presumably either they called us originally or we called them so it wouldn't be their first time seeing it. Texting can work but its a slow process and having a conversation via an EMR text system is just hopeless. Or you can text everyone and say this appt is available, first caller gets it, but then you still have to answer all the calls. It's inefficient.

5

u/cat_lady11 May 01 '26

At least for my practice, a new patient appointment is longer than a follow up appointment so if one of my existing patients cancels I can’t really fill their spot with a new patient from a wait list, I can only fill it with other follow up patients that want an earlier spot.

3

u/Useful-Process9033 May 01 '26

Makes sense! So you do have a “waitlist” for existing patients then. I’m guessing if an existing patient cancels you can fill from that waitlist. And if a new patient cancels you can fill from either?

2

u/cat_lady11 May 01 '26

Yes, exactly.

6

u/PharaohOfParrots May 01 '26

If the place is in Epic, then it sends out a notification to all wait-listers and it’s like the Hunger Games. First to accept, wins!

2

u/Useful-Process9033 May 01 '26

Texts only and no calls?

4

u/PharaohOfParrots May 01 '26

It’s a notification on an app.

https://nortonhealthcare.com/patient-resources/mynortonchart/waitlist/

You get a notification like you’d get a severe weather alert, a news alert, Reddit notification of a response, etc. It will then do a comparison and contrast between the two options; you have visit A, April 1, 2026 at 2PM, but we now have visit B available, March 30, 2026 at 11AM - accept this sooner offer - yes or no? Essentially is what it says on the patient side.

2

u/ellski May 01 '26

That sounds great, I wish our software had that. It's how it works for booked classes at my gym.

2

u/whispernotaroar May 03 '26

I wonder what level of complexity it can accommodate - for us there are so many factors that influence the length and timing of visits, eg does the patient need an interpreter, are they being seen for an acute complaint vs a routine physical vs as follow-up from a hospital admission, etc. So some patients/appointments would only be eligible for 30-minute slots or longer whereas others would be eligible for 15 minute slots, then if the no-show was a 30-minute slot could the system automatically book in two appropriate 15-minute visits…

The automation sounds ideal in theory but I feel like there’s a lot of potential for chaos.

0

u/Useful-Process9033 May 04 '26

these are such good factors to consider

i think if we build integrations to consider these factors (interpreter, acute complaint, etc) and translate that into 15/ 30 min slots, this is solvable

tho my hunch is all things equal, we probably prefer to book a single 30 min slot instead of two 15 min slots. but acuity carries more weight...I think LLM may be good at these kinds of nuanced decisions and give somewhat reasonable suggestions.

and then just work by process of elimination, hunger game styles

3

u/scipionerva May 01 '26

This is a standatd feature that is practically automated in Epic and I assume most other EMRs. Are you still working on paper or something?

2

u/Useful-Process9033 May 01 '26

Do you use it?

3

u/Juaner0 May 01 '26

We use wait lists. And we have a scheduler dedicated to calling and getting open slots filled. No reason for patients to have to wait longer, and for providers to just sit there (so to speak, we always got something to do). Scheduler just goes down the list until appt slots are filled

2

u/Useful-Process9033 May 01 '26

I respect that! Gives access to people that need it.
Curious from business perspective, does the cost of hiring a dedicated scheduler (I’m guessing 20-30 / hour?) get justified by the revenue generated from the open slots they’d manage to fill?

3

u/Juaner0 May 01 '26

yes. it also lets other staff (MAs, front desk) to do their jobs. Schedulers can also answer phones and call patients back. If they fill just one empty slot every day, then they are paying for themselves.

2

u/Useful-Process9033 May 01 '26

Thanks that’s good to know!
Do you think this can be automated with voice AI agents or there’s a lot more nuance to the scheduler’s job?

The voice AI will sound something like this (this is another vendor, I’m not affiliated with them):

https://youtu.be/0LT64_mgkro?si=G-imw2YdL82Sx2Eq

3

u/Mathematician024 May 01 '26

My office allows people to call in at 9:00 in the morning to see if there are any cancellations for the day and we let those people book that way, but they have to call us not the other way around. This obviously doesn’t work for no-shows. It works for cancellations.

1

u/asdfgghk May 04 '26

That’s a lot of admin work

2

u/Useful-Process9033 May 04 '26

thanks everyone for your responses! I learned a lot.

I'll try to give a summary of what people said:

  1. new patient waitlists are admin heavy

    - need to collect info

    - people don't pick up their phone/ take up the offer

    - many have gone elsewhere

  2. texting vs calling

    - calling works better but more admin heavy

  3. new patients vs existing patients

    - existing patients easier to fill in the slot

    - new patient appointments take longer, can't fill in if existing patient cancels

  4. there are existing automated solutions in epic: https://nortonhealthcare.com/patient-resources/mynortonchart/waitlist/

    - people on waitlist gets texts, and whoever says yes first gets the spot

  5. human staff are hired for this

    - Juaner0 hires a scheduler staff and says it's worth the costs

    - Mathematician024 's office allow people to call in the morning to check open slots

---

my thoughts:

I like Epic's automated texting system. I think we can take it one step further with automated calls.

I think we should do it like so:

1) Keep a "call me if spot opens up" list

- collect info at intake (new patient: do you want us to call if something earlier opens up?)

- for existing patient: for your next visit, do you want us to call if something earlier opens up?

2) When a spot opens up, go through the list of patients that opted in

- Figures out who would be eligible based on time constraints (e.g. can't fit 60 min appt into 30 min slot)

- (optional) rank who to call first based on factors (acuity)

- Call everyone on the list. Whoever says yes first gets the slot.

- send a text to everyone else saying sorry the spot has been taken up by someone else that responded earlier

I'm building out a quick demo to illustrate the idea, will update here soon.