title: The financial impact of clinic no-show rates in an academic pediatric otolaryngology practice.
abstract: OBJECTIVE
  To investigate determinants of no-show rates in an academic pediatric otolaryngology practice including appointment time, age, sex, new patient status, payer mix, and median household income by zip code.
  
  
  METHODS
  Retrospective chart review of clinic no-show rates and patient demographics in a free standing children's hospital and affiliated outpatient clinics across eight providers in a one-year period.
  
  
  RESULTS
  Analysis shows that the overall no-show rate across all providers was 15% with the highest rate of 19% in the zip code with the lowest median income. Highest no-shows are in June, but overall, seasons did not play a significant role in no-show rates. Male gender, morning appointments, and having public insurance appear to significantly predict no-shows. Lost revenue on no-shows range from $191K to $384K per year. The average percentage of the amount billed paid by insurance range from the lowest by out-of-state Medicaid at 16% to the highest by managed care at 54%.
  
  
  CONCLUSIONS
  No-show rates account for a significant portion of lost revenue in the outpatient setting for an academic practice, and can be predicted by lower median income, male gender, morning appointments, and public insurance. Such patients may need different appointment reminders. Future clinic templates should be optimized for no-shows to increase productivity and access to care.
authors.affiliation: Department of Otorhinolaryngology, University of Texas-Health Science Center at Houston, 6431 Fannin St, MSB 5.036, Houston, TX 77030, United States. Electronic address: zhen.j.huang@uth.tmc.edu.
authors.forename: Zhen
authors.initials: Z
authors.lastname: Huang
authors.affiliation: George Washington University School of Medicine and Health Sciences, Washington, DC 20037, United States.
authors.forename: Mariam
authors.initials: M
authors.lastname: Ashraf
authors.affiliation: George Washington University School of Medicine and Health Sciences, Children's National Health System, Washington, DC 20010, United States.
authors.forename: Heather
authors.initials: H
authors.lastname: Gordish-Dressman
authors.affiliation: George Washington University School of Medicine and Health Sciences, Children's National Health System, Washington, DC 20010, United States.
authors.forename: Pamela
authors.initials: P
authors.lastname: Mudd
mesh_terms: D000328:Adult; D002648:Child; D003710:Demography; D005260:Female; D006776:Hospitals, Pediatric; D006801:Humans; D008297:Male; D000067455:No-Show Patients / Q000191:economics*; D010036:Otolaryngology / Q000191:economics*; D011216:Practice Management, Medical / Q000191:economics*; D012189:Retrospective Studies; D012456:Salaries and Fringe Benefits / Q000191:economics
keywords: Financial; No-show; Nonattendance; Outpatient; Pediatric otolaryngology