JRW Book a call (opens in a new tab)

JRW / Tools / No-show cost

What no-shows cost a medical practice.

A 3-provider practice with 10% of booked visits not showing loses about $290,000 a year in slots that stay empty. With reminders, a confirmation request and a waitlist someone works, the rate falls and you recover $138,442 of it.

Jeff Weinberg, JRW · Updated 8 September 2026

Your practice books 14,400 visits a year. With 10% not showing and 20% of those slots refilled, 1,152 slots stay empty, which costs you $291,456 at $253 a visit. With reminders, confirmation requests and a waitlist someone works, no-shows fall to 7% and you recover $138,442 a year.

$291,456 Revenue lost to empty slots, per year
  • No-shows, per year: 1,440
  • No-shows per provider, per week: 10
  • Slots that stay empty, per year: 1,152
  • No-shows with reminders and confirmations, per year: 1,008
  • Revenue still lost with reminders, per year: $153,014
  • Visits recovered, per year: 547
  • Revenue recovered, per year: $138,442

How the number is worked out.

The model counts the slots that stay empty and prices them at what a visit brings in. It leaves out the staff minutes spent on each no-show and the care the patient did not get.

  1. 01Visits a year. Providers times booked visits per provider per day times clinic days. The defaults are ours; count yours from the schedule.
  2. 02No-shows. Visits times the no-show rate. MGMA’s member practices ran 6.81% in 2023 as a single-specialty aggregate; ten VA clinics averaged 18.8% over twelve years; a review of 105 studies worldwide pooled to 23%. The default sits at 10%.
  3. 03Slots that stay empty. No-shows minus the share the front desk refills the same day with a walk-in or a waitlist call. The default refills 20%.
  4. 04What a slot is worth. The federal survey of what office visits cost, all payers, 2021: $253 in primary care, $368 across all specialties. A no-show costs the full visit, because you pay for the staff and the room either way.
  5. 05With reminders and a waitlist. In a randomized trial of 9,835 patients, a staff phone call three days ahead cut no-shows from 23.1% to 13.6% and an automated reminder to 17.3%. A Cochrane review of eight trials found text reminders raise attendance by 14%. The default moves the rate from 10% to 7% and the refill rate to 40%, because a confirmation request turns a no-show into a cancellation, and a cancellation can be refilled.

The defaults.

Dials you change are marked in colour. The last column says where each default comes from and what kind of source it is.

DialYoursDefaultWhere the default comes from
Providers33JRW, 2026 Our default
Booked visits per provider per day2020JRW, 2026 Our default
Clinic days per year240240JRW, 2026 Our default
Visits that no-show10%10%JRW, anchored on MGMA and Kheirkhah, 2026 Our default
Empty slots refilled the same day20%20%JRW, 2026 Our default
Revenue per visit$253$253AHRQ, Medical Expenditure Panel Survey, participant publications page, 2021 Official
Visits that no-show, after7%7%JRW, anchored on Parikh et al., 2026 Our default
Empty slots refilled, after40%40%JRW, 2026 Our default

Sources.

One randomized trial, one Cochrane review, one twelve-year clinic study and MGMA’s member data carry the defaults. The visit value is federal survey data.

Our defaults. The no-show rate default of 10% sits between MGMA’s member aggregate and the VA clinics; most independent primary care offices we talk to are in that range, and specialty, behavioral health and pediatrics run higher. We set the refill rate low because most front desks have no time to work a waitlist. The after figures assume every patient gets a reminder and a confirmation request, the agent writes the answers to the schedule and offers released slots to a waitlist by text, with a person only called in when nobody takes the slot. How a voice agent handled it at a mental health practice. How we set defaults.

  1. JRW default. JRW, 2026. No public benchmark we trust. The number is a round figure in the range we see in engagements, chosen so the headline errs low. Replace it with your own. Source
  2. No-show rate, set between the MGMA aggregate and the VA clinics. JRW, anchored on MGMA and Kheirkhah, 2026. MGMA's member practices ran 5% to 6.81% from 2021 to 2023; ten VA clinics averaged 18.8%. We start at 10% for primary care and 12% for specialty. Replace it with your own. Source
  3. Mean expense per office-based physician visit, by specialty. AHRQ, Medical Expenditure Panel Survey, participant publications page, 2021. 2021 mean expense per visit: $253 for primary care, $368 across all specialties, $433 OB/GYN, $436 cardiology, $627 orthopedics. The federal survey of what visits cost, all payers combined. Source
  4. No-show rate with an agent confirming every appointment. JRW, anchored on Parikh et al., 2026. In the trial, a staff call cut no-shows by about 41% and an automated reminder by about 25%. An agent that calls and asks for a reply should sit between, so the default cuts the rate by about 30%. Source

Also consulted

  1. No-shows in appointment scheduling: a systematic literature review. Dantas et al., Health Policy, 2018. 105 studies, 1980 to 2016, pooled: average no-show rate about 23%, from 13.2% in Oceania to 43% in Africa; study rates from 4% to 79%. Lead time and prior no-shows were the strongest predictors. A global pooled average, not a US benchmark. Source
  2. No-show fees in medical practices on the rise. MGMA Stat, 2025. Poll of 622 medical group leaders, January 2025: 42% charge a no-show fee, and MGMA suggests $25 to $50 in primary care; 58% saw 2024 no-show rates hold steady, 22% improve, 20% worsen. MGMA DataDive single-specialty aggregate no-show rates: 7% in 2019, 5.55% in 2020, 5% in 2021 and 2022, 6.81% in 2023. Member practices, which skew larger and better run than the average office. Source
  3. Patient no-shows in 2025. MGMA Stat, 2025. Poll of 265 practices, August 2025: no-show rates higher than 2024 for 27%, about the same for 60%, lower for 13%. Reminders were the tactic most often credited; fees and deposits, easy rescheduling, limits on chronic no-shows, overbooking and telehealth followed. Source
  4. Mobile phone messaging reminders for attendance at healthcare appointments. Gurol-Urganci et al., Cochrane Database of Systematic Reviews, 2013. Eight randomized trials, 6,615 participants: text reminders raised attendance by a risk ratio of 1.14 against no reminder, moderate-quality evidence, and matched phone-call reminders at lower cost per attendance. Source

Where the slots go.

  • Reminders and confirmations

    A text three days ahead and a call the day before, asking for a yes or a no. The agent writes the answer to the schedule. Patients who say no, or say nothing, get a call from the agent. How we do it.

  • Released slots

    When a patient cancels, the agent offers the slot to the waitlist by text, gives it to the first patient who accepts, and updates the chart and the schedule. The front desk hears about it afterwards.

  • Chronic no-shows

    Prior no-shows are the strongest predictor. The agent flags patients with a history so the practice can call them personally, double-book, or ask for a deposit, whichever its policy says.

The voice intake case covers new-patient calls, not reminders: booking rate up from 33% to 58% at a practice with over 100 providers.

Questions.

Is 10% the right no-show rate for us?
Count a month of your own schedule: visits booked, visits arrived, cancellations. MGMA’s members ran under 7% in 2023; VA clinics ran 19%; the global average in the research is 23%. Primary care with long lead times, behavioral health and pediatrics run high. Put in your own.
Do text reminders work?
Yes, modestly and reliably. The Cochrane review of eight trials found a 14% rise in attendance. A randomized trial of 9,835 patients found a staff phone call beat an automated reminder, 13.6% against 17.3% no-shows. An agent that calls and asks for a confirmation sits between the two.
Does this include staff time?
No. It prices the empty slot only. Each no-show also costs the front desk a call and a note, and a slot filled by a waitlist call costs the minutes to make it. Those are small next to the visit.
Should we charge a no-show fee?
42% of practices in MGMA’s January 2025 poll do, and MGMA suggests $25 to $50 in primary care. Fees also bring complaints and the work of collecting them. Reminders and confirmations do more for less friction; a fee is a second step for chronic no-shows.

“Copy a link” puts your dials in the address, and we store nothing. A browser agent that supports WebMCP can run this calculator as estimate_no_show_cost. How the calculators work.

Fill the slots your no-shows leave empty.

Tell us your EHR and your no-show rate, and we’ll show you how an agent would confirm visits and work your waitlist. Fixed price per automation. If the first one misses the scope we agreed, you don’t pay.

Book a call (opens in a new tab)

Related: How to reduce patient no-shows · Missed calls, medical practice · Voice agents for medical practices · Voice intake case study