Appointment no-shows could cost an average radiology practice $1M a year

Radiology loses more uncaptured revenue per patient visit than primary care or other practices due to patients not keeping appointments, according to new research published in Current Problems in Diagnostic Radiology.

“Each no-show appointment represents a missed opportunity to deliver appropriate care as well as to receive payment for that patient visit,” wrote first author Rebecca J. Mieloszyk, PhD, of the University of Washington in Seattle. “In modalities that have fixed costs like radiotracers or specialty technologists, there is an added fixed component to the already substantial opportunity cost. Even in cases where an appointment is filled with an inpatient or stand-by patient, there are sometimes lost costs due to staff preparatory work such as insurance authorization, scheduling time and protocoling.”

To better understand the impact of missed appointments and the financial burden placed on institutions, Mieloszyk and colleagues reported the no-show levels seen at Lahey Hospital & Medical Center in Burlington, Massachusetts. They specifically assessed uncaptured revenue as the post-charge payment that could have been received had the patient arrived for the exam.

Mieloszyk and colleagues presumed that Lahey had a volume of roughly 200,000 exams per year, using a variety of imaging modalities. The researchers utilized Medicare data to determine cost of the imaging exams.

The researchers found radiography has the highest exam volume and mammography has the highest no-show rates. The exams that led to the greatest uncaptured revenue include: mammography screening bilateral, MRI brain with contrast, CT chest without contrast, abdomen ultrasound, CT head without contrast and ultrasound breast bilateral. They found:

  • The researchers noted that uncaptured revenue ranges up to $15,000 per year for breast ultrasound and up to $350,000 per year for mammogram screening.
  • Brain MRI, abdomen ultrasound, and mammogram screening each exceeded $100,000 of uncaptured revenue per year.
  • Annual uncaptured revenue due to brain MRI, abdomen ultrasound, and mammogram screening was estimated at $700,000.

“When all exams are incorporated in the analysis, uncaptured revenue due to no-shows in radiology likely reaches $1 million per year at a typical academic medical center in the United States,” Mieloszyk et al. wrote.

The researchers noted quality improvement projects could examine the effect of modified scheduling and patient reminder systems to reduce no-shows and obtain revenue.