Medical Economics: no‑show playbook

Medical Economics reported on March 2, 2018 that reducing patient no-shows in behavioral health requires more than sending another reminder. The article, by Todd Shryock, pointed to workflow changes at Elmont Teaching Health Center in Long Island, New York, where clinicians and staff surveyed patients in 2015 and then changed how the clinic handled reminders, cancellations and access. The piece cited outpatient no-show rates of 23% to 34% and said missed visits can consume 14% of anticipated daily revenue. In behavioral health, the article said, crisis-driven demand and less predictable patient needs make schedule design part of the attendance problem, not just outreach. ### Why did Medical Economics focus on behavioral health instead of generic reminder tactics? Ashwin Mehra, a lead study author from the Department of Psychiatry and Behavioral Science at Nassau University Medical Center, told Medical Economics the clinic began by treating patients as “part of the solution, not the problem.” The article said staff first identified common reasons for missed visits, including forgetting appointments, being called into work and being unable to reach the clinic to cancel. (medicaleconomics.com) Medical Economics said behavioral-health providers faced patients with “more unplanned, crisis-oriented needs.” The article said some providers responded by allowing more direct patient contact and by using schedule gaps created by no-shows to accommodate patients in mental health crisis. That framing shifted the issue from reminder timing alone to a broader question of how clinics preserve access when attendance is volatile. (medicaleconomics.com) ### What exactly did the Elmont clinic change? The Elmont Teaching Health Center implemented a two-phase no-show reduction initiative in 2015, according to the Journal of Osteopathic Medicine abstract and an American Osteopathic Association release. The assessment phase used patient feedback to identify the main causes of missed appointments, and the implementation phase focused on reminder-call verification, patient education, personal responses to patient calls, institutional awareness and coordination across departments. (medicaleconomics.com) Peter Guiney, chair of family medicine at Nassau University Medical Center, said the clinic’s goal was to increase access while reducing the financial hit from missed appointments. Medical Economics said the center used four main strategies, starting with patient education and extending to front-desk and provider involvement in addressing barriers to attendance. ### Where do early intent capture and easy rescheduling fit? (degruyterbrill.com) Medical Economics’ reporting supports a front-office reading of the problem: if patients miss visits because they forget, get pulled into work or cannot reach staff to cancel, then confirming intent earlier and making rescheduling easier addresses the reasons patients disappear. That is an inference from the reported barriers and interventions, rather than a direct quote from the article. (medicaleconomics.com) A March 18, 2026 Medical Economics slideshow made the same operational point with a newer data angle, saying a change in reminder-call timing could reduce no-shows by 28% and describing missed appointments as a persistent financial problem for practices. That later piece did not focus on behavioral health specifically, but it reinforced the publication’s emphasis on reminder design as a measurable operational lever. (medicaleconomics.com) ### Why is this being framed as a front-office ROI issue? The American Osteopathic Association said Elmont achieved a 34% decrease in no-shows in the fourth quarter of 2015 compared with the same quarter in 2014, while patient visits increased 13%. The association also said outpatient no-shows can lower efficiency, increase resource use and lengthen wait times. (medicaleconomics.com) Medical Economics tied those operational losses directly to practice revenue and access. In that framing, modest automation or workflow redesign around reminders, cancellation capture, rescheduling and same-day slot recovery becomes a scheduling and revenue issue as much as a patient-engagement issue. ### What should readers look at next in the source material? Medical Economics has kept publishing no-show coverage, including its March 18, 2026 piece on reminder timing and its earlier March 2, 2018 article on Elmont’s workflow changes. (osteopathic.org) The underlying study is “Reducing Patient No-Shows: An Initiative at an Integrated Care Teaching Health Center,” published in the February 2018 issue of the Journal of Osteopathic Medicine, with Mehra, Guiney and colleagues listed as authors. (medicaleconomics.com 1) (medicaleconomics.com 2)