Patients Aren’t the Problem: What No-Shows Reveal About Your Health System
Sarah Matt MD, MBA
Chief Strategy Officer | Author | Speaker | Growth Accelerator | Oracle Alumni
The Wrong Problem
Missed appointments cost the U.S. healthcare system an estimated $150 billion per year. A single no-show can mean a $200 revenue loss, a delayed diagnosis, and hours of wasted staff time. So it makes sense that health systems try to fix it.
But here’s the mistake: too many leaders treat patients as the problem, instead of asking why the system fails to meet them where they are.
We have defaulted to financial penalties, aggressive rescheduling rules, and even discharges from care. These tactics may feel like accountability, but they often backfire.
The question is not how do we make patients comply. It is why are we still designing systems they cannot access or trust in the first place.
What the Data Actually Shows
A 2023 study published in JAMA showed that reminder texts and ride-share vouchers significantly reduced no-show rates among Medicaid patients, particularly when paired with simplified scheduling workflows (JAMA Study).
Behavioral health researchers have repeatedly found that non-attendance is not a matter of motivation, but of context: unpredictable work schedules, lack of childcare, transportation challenges, low digital fluency, or previous negative experiences with care (NEJM Catalyst).
And in a review of strategies by the National Association of Community Health Centers, flexible scheduling, walk-in slots, and direct patient outreach consistently outperformed punitive tactics (NACHC Resource).
Three Faulty Assumptions Leaders Still Make
1. “They just forgot.”
Yes, patients forget. But most no-shows happen because something more urgent or overwhelming got in the way. A reminder helps if it reaches them. A rigid system does not.
2. “If it costs them something, they’ll show up.”
Not always. For low-income or uninsured patients, a no-show fee can mean skipping care altogether. For Medicaid patients, it is often illegal to charge no-show fees (DrBicuspid).
3. “We can’t afford flexibility.”
What you really cannot afford is churn. Re-engaging lost patients is expensive. So is downstream disease burden when patients delay care because the front-end system failed them.
What Actually Works
Across both primary care and specialty clinics, no-show rates improve not through punishment, but through redesign. Here are five proven strategies to explore now:
A Shift Is Coming
Several states, including New York, are considering or advancing legislation that limits or bans no-show fees for patients, including those with private insurance. Senate Bill S3188 in New York, for example, would prohibit physicians from charging if the patient cancels at least an hour in advance, arrives on time but is not seen, or waits over an hour (NY Senate Bill S3188).
The shift is not just legal. It is philosophical. The system is slowly acknowledging that access is not just about appointment slots. It is about whether the patient can or will engage at all.
Final Thought
If you are still treating missed appointments as a behavioral flaw in the patient, you’re missing the bigger truth: no-shows are symptoms. They are signals of system mismatch, stress, or mistrust.
We do not fix that with penalties. We fix it with listening, design, and willingness to get uncomfortable with our own defaults.
The best health systems are not the ones with the fewest no-shows. They are the ones that learn the most from them and act accordingly.
-Dr. Matt. #StayCrispy
Ready to Move From Polite to Bold?
If this newsletter stirred something in you--> good. That means you’re the kind of leader who’s ready to stop waiting and start shifting. Looking to bring this kind of thinking to your leadership team? I speak with healthcare organizations across the country, and the globe about bold strategy, digital transformation, and redesigning care with courage.
Explore more at drsarahmatt.com or reach out directly at sarahmattmd@gmail.com to book a session, keynote, or workshop.
Let’s rebuild healthcare leadership where it matters: at the front line.
Co-Founder & CEO at 100ms | Building Agentic AI to Eliminate Healthcare’s Biggest Bottlenecks | Ex-Meta, Disney+
1moTotally agree, Sarah Matt MD, MBA. We’ve spent too long treating no-shows as noncompliance instead of listening for what they reveal. Glad to see legislative action finally catching up to the reality patients have been navigating for years.
Chief Strategy Officer | Author | Speaker | Growth Accelerator | Oracle Alumni
1moEmily Will MHA, RN, ONC Alison Derbenwick Miller at my clinic where we have a completely non insured population, the complexity is huge! We recently moved clinic hours and added in more consistency to walk in hours to see how we could bring more of our patients to the office to get the care they need ⭐️. Hoping to see data soon to see if this was a move that worked!
Senior Technology Executive & Board Member | AI & Cloud Strategy | Innovation Commercialization | Oracle Alum
1moOh yes, Sarah Matt MD, MBA - you are hitting on something important here. No-shows are a key variable in the healthcare equation, and solving for them saves lives and dollars. According to the CDC, chronic illnesses cost the US approximately $3.7 trillion annually. An essential way to reduce chronic illness is through preventative care, and a critical component of preventative care is patients being seen timely during scheduled appointments. Better systems for scheduling (and rescheduling when needed) combined with compassion and understanding will go a long way toward a healthier population.
Nurse Innovator Transforming Access | Nurse & Digital Strategy Executive | Ortho RN | Speaker
1moSarah Matt MD, MBA I believe that you are on to something! There is some fascinating research about no shows. I will find the link to one of my favorite studies that was able to show one of the biggest drivers of No shows was who scheduled it and how they worked with the patient. I believe unlocking digital access can be an effective strategy to no shows. Allowing the patients to see the available options allows them to truly pick the time that works for them, at the venue/location and the provider.
Public-Sector AI Strategy & Governance | AI Audit (15-min briefing) | Policy-aligned, audit-ready delivery for AU government.
1moHello Sarah Matt MD, MBA, Agree with you on "No-shows aren’t a patient problem". They’re a signal the system isn’t designed for real life. At AI Strategy, we help health orgs shift from punitive policies to predictive, patient-centric design, using AI to: 🔹 Detect no-show risk early 🔹 Automate access around real-life barriers 🔹 Build trust into every digital touchpoint The data is clear: flexibility outperforms force. It's time your workflows caught up. — Team AI Strategy Co. - Strategic AI Automation