No-Shows in Adult Urology Outpatient Clinics: Economic and Operational Implications

Introduction: We analyzed trends and explored implications of no-show rates in adult urology from provider related characteristics at an academic program. Methods: No-show rates were determined from electronic health records of appointments in adult urology at Duke University Medical Center and affiliated clinics between January 2014 and December 2016. t-Test, Wilcoxon rank sum and ANOVA were employed. Results: Of 72,571 total appointments 13,219 (18.2%) were no-shows. The no-show rates per provider related characteristic were provider type (physician 22.1% vs advanced primary provider 34.0%), visit category (new 26.9% vs return 25.6% vs procedure 17.5%), faculty status (assistant 22.9% vs associate 21.9% vs professor 21.4%) and specialty (oncology 26.7% vs reconstructive 22.9% vs stones 25.4%). Average lead times of advanced primary practitioners and physicians were 47 and 62 days, respectively. There was a statistically significant difference in mean no-show rates by provider type (p <0.01) and new patient by provider type (p <0.01). However, there was no statistical difference in mean rates by specialty, faculty status, provider bump history, provider based visit types and average lead time. The potential loss in revenue from outpatient no-shows is at least $429,810 annually. Conclusions: Provider type and new patient visits by provider type have statistically different no-show rates. Missed appointments are costly and affect clinical efficiency, access to care and potentially patient outcomes. Given the shift toward value based care and future workforce changes, further investigations are needed to determine interventions to help reduce no-show rates. Models to predict and adjust clinics should be developed and deployed.