What Your No-Show Rate Isn’t Telling You About Virtual Access
What Your No-Show Rate Isn’t Telling You About Virtual Access
No-show dashboards tend to focus on patient behavior. But in virtual care, no-shows are often telling you something about your workflows.
Most teams monitor no-show rates by provider or service line. Fewer teams break them down by modality, payer, or visit setup process—and that’s where virtual access issues are quietly hiding.
This article offers a 20-minute starter audit you can run with your scheduler, access lead, or virtual care coordinator to surface early warnings that your current workflows may be blocking care—and revenue.
1. Segment No-Shows by Modality (Phone, Video, In-Person)
If you’re lumping all missed appointments into one line on your dashboard, you’re flying blind.
Why it matters:
Video visit no-shows are often driven by workflow issues, not patient forgetfulness:
- Patient didn’t know how to connect
- Link wasn’t sent (or wasn’t opened)
- No platform was confirmed
- Tech failed and no one followed up
What to try:
- Segment your last 4 weeks of no-shows into phone / video / in-person
- Flag if video no-shows are 2–3x higher than in-person
- Ask: Was this really a patient issue—or a missed confirmation step?
2. Overlay Payer + Patient Type for Hidden Gaps
Not all patients engage with virtual care the same way. And not all payers support it the same way either.
Example patterns we’ve seen:
- Medicaid patients no-showing for video, but attending phone visits reliably
- Behavioral health visits booked via video but completed via phone—with no workflow to track the switch
- Interpreter-supported visits where no-show rates spike because the virtual workflow for language access wasn’t designed
What to do this week:
- Pull a list of virtual no-shows and segment by payer + visit type + interpreter need
- Flag any populations with 30%+ no-show rates
- Consider adjusting modality defaults for those groups
3. Audit the Confirmation, Not Just the Appointment
You held a slot. The provider showed up. But did the patient ever confirm the visit method?
This is the most common silent miss: assuming the patient understood how the virtual visit would work.
Try this:
- Review 5 no-show video visits from last week.
- For each one, answer:
- Was there a documented confirmation from the patient (not just a reminder sent)?
- Was the platform confirmed and link delivered?
- Was any tech test run for first-time users?
If the answer is “probably” or “not sure,” you’re not measuring patient behavior—you’re measuring staff assumptions.
4. Track Modality Shifts Within 24 Hours
Your no-show problem might actually be a modality confusion problem.
We’ve seen clinics where 15–30% of virtual visits change modality (e.g. video → phone) the day of the visit. The shift gets documented late—or not at all. It breaks the workflow, the billing, and the patient experience.
Action:
- Pull visits from last week where the scheduled modality ≠ the documented one
- Flag same-day or day-before changes
- Identify the root: Was it patient preference, lack of tech access, or unclear scheduling?
Fixes might include:
- Scripting schedulers to confirm and reconfirm visit modality
- Flagging high-drift visit types for pre-visit outreach
- Auto-defaulting certain visits (e.g. behavioral health) to phone when modality drift is >30%
5. Run a Payer-Specific No-Show Heat Map
This is the one most teams haven’t done—and it’s where the signal lives.
Why it matters:
Certain payers create more barriers to virtual care (unclear reimbursement, low patient education, tech mismatch). That shows up in your no-show rate—if you segment it.
Try this:
- Break down no-shows by payer + modality over the last quarter
- Sort by highest video no-show %
- Highlight where switching to phone—or increasing live confirmation—could lift attendance
This turns your no-show report into a modality fit tool, not just a dashboard.
Final Thought
No-shows are easy to blame on patients.
But in virtual care, most no-shows aren’t patient errors. They’re workflow failures that create unconfirmed, unsupported, or inaccessible visits.
The best teams treat them like revenue flags, not attendance stats.
Want Help Visualizing This?
BettyWell helps clinics reframe no-shows into workflow insights—so you can see where virtual access is actually breaking, and what to change.
Book a 20-minute Ops & Revenue Review and we’ll walk through your recent no-show trends and surface the real gaps in your current setup.