Appointment no-shows: a compiled report

Appointment no-show statistics show that a meaningful share of booked visits go unused, that rates moved during and after the pandemic, and that reminders and cancellation policies measurably reduce them. Most of the reliable data comes from health care, where practices track attendance closely. The patterns apply to any business that books time slots: dental offices, physical therapy clinics, med spas, salons, fitness studios and consultation-based firms.

This report compiles two MGMA Stat polls (2025), MGMA DataDive benchmarks, a 2016 systematic review and meta-analysis in BMJ Open, a 2016 randomized controlled trial in the International Journal of Pediatrics, an MGMA poll reported by Becker's ASC Review in 2022, and the 2017 commentary behind the often repeated $150 billion figure.

For single-specialty medical practices, MGMA DataDive Practice Operations data puts the aggregate no-show rate at 6.81% in 2023, up from 5% in 2021 and 2022 and close to the 7% pre-pandemic benchmark for 2019. Rates vary widely by setting and patient population. The pediatric resident clinic in Lin and colleagues' 2016 trial had an overall no-show rate of 30.8%, more than four times the MGMA aggregate.

The lesson for any appointment business: an industry average is a rough reference. Your own rate, broken out by provider, service type, day of week and how far ahead the visit was booked, tells you where the problem is.

To calculate it, divide appointments where the client neither arrived nor cancelled within your notice window by total booked appointments for the same period. Keep late cancellations as a separate count. They cost almost as much as a no-show when the slot cannot be refilled, and they respond to different fixes: a no-show often needs a better reminder, while a late cancellation may point to a notice policy nobody knows about.

For most practices, no-shows are holding steady rather than rising. MGMA's August 12, 2025 poll (265 responses) found 60% of medical groups saw no-shows about the same in 2025 as in 2024, 13% saw a decrease and 27% saw an increase. That is a calmer picture than a few years earlier.

In 2022, Becker's ASC Review reported an MGMA poll in which 49% of medical groups said no-show rates had increased since 2021. An August 2024 MGMA poll found 37% saw an increase, 50% steady rates and 18% a decrease. MGMA's January 2025 poll (622 responses) found 58% said their 2024 rates were consistent with 2023, 22% improved and 20% worsened.

Where rates rose in 2025, practice leaders told MGMA about transportation problems, economic hardship, copays, insurance limits, long waits, scheduling conflicts and illness. MGMA notes that many patients simply do not say why they missed, and that longer lead times between booking and the visit are linked to more no-shows.

Yes. Reminders reduce no-shows, and multiple reminders work better than one. Robotham and colleagues' 2016 systematic review and meta-analysis in BMJ Open pooled 21 randomized studies covering 8,345 patients who got text-based notifications and 7,731 who got none. Patients who received notifications were 23% more likely to attend (67% versus 54%) and 25% less likely to no-show (15% versus 21%).

The same review found multiple notifications were significantly more effective than a single one, and voice notifications appeared more effective than text notifications at improving attendance. That second point argues for a mix of channels rather than text alone.

A randomized trial by Lin and colleagues, published in 2016 in the International Journal of Pediatrics, tested adding a text reminder on top of the standard voice reminder at an urban pediatric clinic. The no-show rate was 23.5% in the text group and 38.1% in the voice-only group, a difference of 14.6 percentage points.

• Patients with reminders: 67% attendance versus 54% without (BMJ Open meta-analysis).
• No-show rate with reminders: 15% versus 21% without (BMJ Open meta-analysis).
• Text plus voice: 23.5% no-show versus 38.1% voice only (International Journal of Pediatrics trial).

No-show fees are associated with better attendance trends in MGMA's polling, though the data shows correlation, not proof. In MGMA's January 7, 2025 poll, 42% of practices said they charge a no-show fee and 58% said they do not. Among practices with a fee, 25% reported their no-show rate improved in 2024. Among practices without one, 16% did.

MGMA's guidance in the same piece describes typical policies: 24 to 48 hours of cancellation notice, fees of $25 to $50 in primary care, and higher fees or deposits in surgical settings. In the August 2025 poll, practices whose rates held steady or fell credited consistent reminders, financial deterrents such as penalty fees or deposits, easy cancellation and rescheduling, online check-in, overbooking and virtual visits.

A limit worth noting: MGMA says practices cannot charge no-show fees to Medicaid patients. Outside health care, salons, med spas and studios have more room to require card-on-file or deposits, and the same principle applies. The policy works best when it is stated at booking and repeated in the reminder.

That number is an estimate from a 2017 commentary, not a study. It appeared in Healthcare Innovation in an article by Jamie Gier, then chief marketing officer of SCI Solutions, a scheduling software company. The article states the $150 billion total and reasons from two inputs: an average cost of $200 and 60 minutes of physician time per open slot, and no-show rates "as high as 30% nationwide." It does not show the full calculation.

The 30% rate is at the high end. MGMA's aggregate for single-specialty practices was 6.81% in 2023. If you need a cost figure for your own business, calculate it: missed appointments in a period, times your average revenue per appointment, minus any fees collected and slots refilled.

The research points to a short list of changes that reliably move attendance. They apply to a dental office, a physical therapy clinic, a med spa or a salon in much the same way.

• Measure your own rate first, by service, provider and booking lead time. MGMA links longer lead times to more no-shows, so check whether visits booked weeks out miss more often.
• Send more than one reminder. The BMJ Open review found multiple notifications beat a single one. A common pattern is a confirmation at booking, a reminder two to three days out and one the day before.
• Use more than one channel. Voice appeared more effective than text in the review, and adding text to voice cut no-shows in the pediatric trial. Let clients choose, and make replies count (confirm, cancel or reschedule from the message).
• Make cancelling easy. MGMA respondents credited easy cancellation and rescheduling. A client who can cancel by reply frees a slot you can refill.
• Set a clear fee or deposit policy where it fits your industry and rules, state it at booking and in reminders, and track whether it changes your rate.
• Keep a short-notice list so cancelled slots get offered to people who want an earlier time.

Most booking platforms and CRMs can send timed reminders, take two-way replies, hold a card on file and fill a waitlist. The work is in configuring timing, wording and the rebooking path so a cancellation turns into a reschedule instead of a lost visit, then reporting on the rate so you know it is working.

Monvell's Automation and Communications teams build this kind of reminder and confirmation flow on the booking tools a business already uses, with reporting on attendance by service.