Key log and problem solving for health care practices

As a youth, I attended summer camp in Northern Wisconsin. Every Friday evening, a key log ceremony was held for the entire camp. The key log metaphor in the context of a river refers to a log that prevents the free flow of logs in a river to the lumber mill. When one log becomes stuck, a logjam prevents other logs from moving downstream. When the key log is identified and then removed or adjusted, the entire log jam can be released, allowing logs to flow freely once again. In health care, we often encounter blockages and obstructions. Often, we can identify the one element causing the problem. In that case, we can return to a practice that flows smoothly, and the patients are rewarded with a positive health care experience. This blog discusses problems or bottlenecks and how identifying the key log, or the obstruction to solves a bigger problem.

In health care, the key log metaphor highlights critical factors that, once identified and addressed, can significantly enhance the health care system's overall effectiveness, efficiency and patient outcomes.

There isn't a doctor or practice that hasn't experienced a problem or a crisis, either in patient care or in the business aspect of the medical practice. Unfortunately, doctors have few skills in crisis management or non-clinical problem-solving. This task is often left to the practice's office manager or medical director. This blog will discuss finding and releasing the log jam and how it can be applied to nearly every medical practice.

Data exchange between health care systems, providers and patients is crucial for coordinated care. For example, a patient completes demographics and insurance information, as well as an online health questionnaire, in the primary care physician's office. Then, the patient goes to the lab or imaging center within the same institution and must fill out the information entered in the PCP's office. This creates a logjam for the practice, resulting in inefficiency, decreased productivity and decreased staff morale. By addressing the key log of interoperability, health care systems can reduce errors, improve patient safety and work more efficiently.

Another example of finding and releasing the logjam is the problem of frequent delays in patients seeing physicians, which occurs in many practices. The problem to solve is why the practice is one hour delayed in seeing patients by mid-morning when the practice is supposed to start seeing patients at 9:00 AM. Answer: Patients are arriving 30-60 minutes late for their appointments.

Why are patients showing up late for their appointments? Answer: The doctor is usually 30-60 minutes late, and patients become upset waiting to be seen by a chronically late doctor. Therefore, they often arrive and check in 30-60 minutes after their designated appointment times.

Why is the doctor 30-60 minutes late by mid-morning? Answer: The doctor arrives at the clinic 30 minutes late because patients are usually not taken to the exam room until 9:30. Instead, the doctors go to their computers to check emails or return phone calls.

Why does the doctor arrive 30-60 minutes late each morning? Answer: The staff places patients in the rooms from 9:15 to 9:30 and does not prepare them for the doctor until 9:30.

Why are patients put in the rooms 30 minutes after their appointments? This is the key log causing the problem: The staff doesn't arrive until 8:30 and is not ready to place patients in the room until 9:30.

The key log removal solution is to start the day at 8:00 and begin rooming patients at 8:45. Then, inform the doctors that they must arrive in the office by 8:45, allowing them a few minutes to review their computers and that they should start seeing patients promptly at 9:00.

Why look for the key log?

Most medical practices solve problems by identifying the issue and applying a quick fix for prompt resolution. It is better to identify and remove the key log to prevent the problem from occurring again. Seeking the key log rather than using the quick fix process provides practices long-term benefits, including:

• Reduces recurrence of the same problem (by identifying the key log, the symptoms are less likely to happen again)
• Preventing problems before they occur
• Gathering information for identifying other issues that are impacting the practice
• Emphasizing quality and safety over speed

Every practice is unique, and all workplaces have their own set of problems that they need to solve. Implementing the key log concept helps medical practices better understand their issues and gives a clear roadmap to address them permanently.

Bottom Line: One of the best things about finding the key log is that it is easy to implement without added overhead expense. The only cost is the time required to go through the process.

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Onboarding staff in your medical practice

Why does onboarding matter so much if we already hired the right person?

Because even the “right person” can flame out fast if their first days are a blur of missing logins, unclear expectations and mixed messages about how the practice actually works. Physicians Practice makes this point in a very practical way in its rundown of 11 tips for onboarding new practice staff, onboarding isn’t a warm-and-fuzzy extra, it’s how you protect your time, your culture and your patient experience.

What’s the difference between orientation and onboarding?

Orientation is the quick tour: paperwork, passwords and “here’s where things are.” Onboarding is the longer runway to competence; getting someone to the point where they can do the job consistently, handle common curveballs, and know exactly who to pull in when something is off. If you want a simple framework that doesn’t require a consultant, the playbook embedded in 11 tips for onboarding new practice staff basically pushes practices to think in weeks and months, not hours and days.

What should happen before a new hire even walks in the door?

Preboarding is where you earn trust before Day 1. The goal isn’t perfection, it’s avoiding the classic first-day energy drain: “We’re still waiting on your access.”

In real terms, that means sending a clear Day 1 email (where to park, where to go, who to ask for, what time to arrive), and making sure the basics are ready: badge/keys, voicemail instructions, and the process for EHR credentials. The Physicians Practice approach in 11 tips for onboarding new practice staff also leans hard on assigning one point person, so the new hire isn’t forced to interrupt five different people for one answer.

What should Day 1 feel like?

Calm. If Day 1 feels frantic, the new hire doesn’t just learn your workflows, they learn your stress.

Instead of trying to teach everything, use Day 1 to remove uncertainty: how patients move through the practice, what “urgent” means, how communication works (and what not to do), and what success looks like at 30, 60 and 90 days. Even for clinician hires, a checklist helps you avoid assumptions, which is why resources like the Physicians Practice Physician Orientation Checklist can be useful for catching the basics that otherwise get skipped in a busy office.

How do we keep Week 1 from turning into information overload?

A lot of practices accidentally teach the job the way we teach swimming: toss someone in and shout tips from the edge of the pool.

A better approach is sequencing. Week 1 is about being safe and functional — the workflows the person must do correctly right away without creating delays, errors or patient frustration. Then Month 1 is about consistency; the edge cases, the bottlenecks, the “this is how we do it here” nuance. That’s also consistent with the training mindset Physicians Practice lays out in 10 staff training tips to improve efficiency, reduce turnover: repeatable touchpoints and practical learning tend to stick better than a single marathon training day.

What about onboarding clinicians to the EHR; what actually works?

One of the fastest ways to frustrate a new clinician is to teach the EHR like it’s separate from clinical reality. Most clinicians don’t struggle with “where is the button?” as much as “how does this practice want work routed, documented and closed?”

That’s why it’s worth tying EHR onboarding to real patient flow, the same sequence they’ll use in clinic, which is the direction Physicians Practice points practices in with Onboarding new physicians to your practice’s EHR.

What compliance training belongs in onboarding?

This is where you want boring consistency, because boring is what prevents bad surprises.

Start with privacy and security: HHS maintains a practical hub of HIPAA training and resources that practices can use to structure onboarding and refreshers. For occupational exposure risks, OSHA’s Bloodborne Pathogens standard is the core reference point, and OSHA’s own Bloodborne Pathogens fact sheet is a quick way to pressure-test whether your training hits the essentials.

Infection prevention is another area where practices can keep it simple without being sloppy. CDC’s Core Infection Prevention and Control Practices lays out a baseline that’s relevant across care settings, and CDC’s infection control training resources can plug into onboarding without you having to invent content from scratch.

And don’t forget the hiring paperwork side, because onboarding starts the minute someone accepts. USCIS is explicit that employers must complete Section 2 of Form I-9 within three business days of the start date in its guidance on Completing Section 2.

Do we really need an employee handbook and a policy manual?

If you want fewer “it depends who you ask” moments, yes; and the payoff shows up in fewer misunderstandings and cleaner management decisions.

The handbook is where you spell out expectations and reduce legal risk, which is why Physicians Practice puts emphasis on clear language, proper disclaimers and keeping it current in How to write an employee handbook for practice staff. Then the policy manual becomes your “how we run this practice” playbook; patient flow, communication rules, escalation paths, and the operational stuff that gets lost as tribal knowledge. Physicians Practice maps out what belongs there in What should be included in a medical practice policy manual?.

What’s the quickest way to reduce early turnover?

Make onboarding human, not just procedural. New hires rarely quit because they forgot a policy. They quit because they feel unsupported, embarrassed to ask questions, or unsure whether they’re meeting expectations.

That’s why mentorship keeps coming up in retention advice. Physicians Practice frames mentoring as a practical tool, not a feel-good add-on, in 5 mentorship tactics to retain new practice staff, and the underlying message is simple: give new hires a safe person to ask “small” questions before those questions turn into big mistakes.

How do we know our onboarding is working?

You don’t need a fancy dashboard. You need a few honest signals and a predictable cadence.

Track how long it takes someone to work independently, how often work has to be redone (scheduling errors, documentation cleanups, workflow misses), and whether patient complaints cluster around communication or access. Then schedule short check-ins early and often, because onboarding issues show up in daily work long before they show up in a formal review. The training cadence approach in 10 staff training tips to improve efficiency, reduce turnover pairs well here: repeatable, practical touchpoints beat the one-and-done approach.

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5 magic words that make your practice attractive to patients

"We'll take care of that" is a phrase that patients like to hear. Think about what makes certain companies stand out. It is not necessarily the cheapest price or even the product they are selling. The differentiator is the customer experience. The same applies to healthcare, and what stands out and makes most practices successful is the patient experience. For this article, I want to focus on convenience.

Examples of businesses that place an importance on customer convenience include:

• With two clicks, you can buy a product from Amazon and have the package delivered to your doorstep within two days.
• Online grocery delivery services can shop for your food and deliver it to your home. Now you don't have to spend time driving to and from the store, pushing a cart through the store searching for your groceries, or waiting to check out.
• Auto-renewal subscription charges you automatically, so you don't have to remember to re-subscribe. (Spoiler alert: this automatic renewal may be a pain point with charges to subscriptions that you pay for when you no longer use the subscription.)

These five words capture the essence of creating a convenient patient experience. When practices eliminate friction points and other time-consuming tasks, making it easier for patients, they send a message to their patients that they will make every effort to take care of them.

So, how can healthcare provide the "We'll take care of that for you" experience to patients?

Start by identifying the patients' friction points. Leading the list of friction points includes difficulty gaining access to the practice and obtaining prior authorization for appointments, medications, tests, and procedures.

Next, train your staff to identify patients' problems proactively before they complain. You need to examine the reasons for these problems and find ways to eliminate them. An example is the sticker shock when a patient receives a bill for your services. It is better to explain the bill before the patient gets it, or to tell the patient the cost before performing a test or procedure.

Try becoming your patient. Look at your care process as if you were the patient. Mystery-shop your practice and experience what your patients experience. If you call the practice, use the same number patients use to contact the office. Hear first-hand how the receptionist creates that critical first impression when calling the office. Listen to see whether they use the patient's name during the call and whether they remind them to complete their paperwork, including the health questionnaire and demographic information before their appointment.

Role-playing during a staff meeting is another technique for enhancing morale within the practice. For example, one staff member can assume the role of an angry patient calling to complain about a bill, while another staff member attempts to calm the patient and resolve their issue. The rest of the staff can critique the dialogue.

Another example of experiencing what the patient feels is a senior citizen simulation designed for younger staff members to understand the limitations and challenges that older patients face when navigating a medical practice. The senior citizen simulation is accomplished in the following fashion:

A middle-aged team member is converted to a senior citizen by 1) making her hard of hearing by placing a cotton ball in each ear, 2) impairing her vision by giving her glasses that distort the reading material, and 3) making her arthritic by having her wear gloves and immobilizing one leg with a splint. Before the staff meeting, she is asked to go to the bank in the building, make a transaction, enter the office, sign in at the reception desk, take a seat, and review some of our patient education materials.

The team member then returns to the reality of a middle-aged woman. We started the staff meeting, and she explained that she had trouble reading materials at the bank and in our reception area. She also had difficulty getting into and out of the chairs in the reception area. She also had problems using the doorknobs to open doors in the restroom and the exam room. Finally, she had trouble hearing the receptionist in the office and the bank teller.

What did we learn? We learned that the font size, 12-point, on our print material in the reception area was too small. We knew that most of the chairs in our reception area and the exam rooms were not accessible to seniors. We learned that one of the staff members may need help with seniors ' paperwork due to difficulty with fine motor skills, such as writing. We also added rubber door handle grips to assist seniors in opening doors. (Figure 2) Most of all, we increased the sensitivity of the entire staff to the unique concerns of older patients and how we might provide better care for them.

Share your commitment to convenience with "We'll Take Care of That." If your practice is going to make it easy for your patients, let them know. Share that your approach to convenience sets your practice apart from others. If you have a policy of returning phone calls and emails within twenty-four hours, mention that on your website, your practice brochure, and newsletters. However, to truly be different, you must deliver on your promise.

Every time you remove a pain point or eliminate a step in the workflow, you are telegraphing to your patient that you value their time and that their time it is just as important as yours.

Bottom Line: Those five words, whether explicitly stated or implied through your actions, you are saying, "We'll take care of that".

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The true cost curve of preventive care management

Rising healthcare costs are fundamentally reshaping employer and union benefit discussions, forcing more difficult trade-off decisions around coverage, access, and affordability. Employer-sponsored health plans are projected to see cost increases of 9% or more in 2026, placing every benefit investment under heightened scrutiny. In that environment, preventive care management is often met with skepticism, particularly when it drives higher utilization and near-term spending.

That skepticism reflects a misunderstanding of how preventive care actually works. Initial cost increases are not a failure of care management; they are evidence that it is functioning as intended. Preventive care must be evaluated across a multi-year cost curve, not through a single-year snapshot. Its true value appears over time through avoided future costs, stabilized utilization patterns, and improved workforce outcomes.

Why traditional cost metrics fail preventive care

Many employers expect preventive care programs to deliver immediate cost reductions. When early claims increase instead, those programs are often labeled ineffective. That expectation is built on a flawed baseline.

When care is deferred, chronic conditions remain unmanaged, and benefits go unused, making short-term costs appear artificially low. In reality, chronic disease already accounts for the majority of U.S. healthcare spending, largely due to preventable complications. High-risk members frequently avoid preventive care altogether. When engagement improves, previously unaddressed needs surface. Measuring success too early, therefore, leads to false conclusions about program performance.

The preventive care cost curve explained

Preventive care follows a predictable cost curve.

Phase 1: Engagement and discovery

Utilization rises as members begin addressing previously untreated or poorly controlled conditions. Medication adherence improves, and unmet behavioral health needs are identified. Costs increase in the short term because individuals are finally receiving care they have delayed.

Phase 2: Stabilization and behavior change

As conditions are managed more consistently, care becomes less reactive. Emergency department utilization declines, and duplicative or uncoordinated services decrease. Costs plateau as utilization shifts toward more appropriate, lower-acuity settings.

Phase 3: Avoidance and optimization

This is where the financial benefit becomes clear. Prevented hospitalizations, fewer complications, slower disease progression, and reduced catastrophic claims risk begin to influence overall cost trends. Productivity improves, and no-show rates decline. The cost curve bends not because care is restricted, but because risk is addressed earlier and more effectively.

Preventive care management vs. reactive cost control

Restriction-based cost-control models rely on limiting access through prior authorization, narrow networks, or cost shifting. While these approaches may temporarily suppress utilization, they do not change underlying health behaviors. Delayed care inevitably resurfaces as higher-acuity episodes that are more expensive and harder to manage. This short-term “cost control” erodes trust in the healthcare system and discourages individuals from seeking care they need—ultimately driving higher long-term costs.

Preventive care management takes a different approach. It focuses on the root causes of health needs rather than reacting after problems escalate. It reduces unnecessary utilization without cutting off access to care and builds the trust and follow-through required for sustainable behavior change.

Measuring ROI, the right way

Short-term claims reduction alone is an incomplete measure of success. A more accurate view of return on investment includes cost avoidance, risk migration from high- to moderate-risk categories, improved benefit utilization, and reductions in usage of emergency rooms and inpatient settings. Cost avoidance is real, even when it is not immediately visible in year-one claims data.

The role of care management as a benefits quarterback

Employees often struggle to understand which benefits are available or how to use them. At the same time, vendors frequently operate in silos, and HR teams are stretched thin trying to coordinate services. Care management serves as the connective tissue—coordinating care, supporting appointments and referrals, and ensuring benefit investments are utilized.

Human-led care in a tech-enabled world

Advanced analytics and machine learning enhance risk stratification and help identify rising-risk members earlier. Technology strengthens care teams, but it does not replace them. Human relationships remain essential. Trust drives engagement, engagement enables behavior change, and behavior change moderates cost trends. These elements are interconnected and mutually reinforcing.

Special considerations for employers and unions

Unions typically take a longer, generational view of health outcomes, while non-union employers prioritize shorter ROI windows. Preventive care management can work for both, but expectations must be aligned with the appropriate time horizon. The longer the view, the clearer and more durable the return.

What employers should expect in year one

Early success appears as stronger engagement, clearer insight into member risk, and improved care navigation. Members begin answering outreach calls, appointments are scheduled, and conditions move from unmanaged to actively addressed. Financial indicators in the first year may be mixed, but the trajectory becomes increasingly clear.

Reframing cost as an investment

Preventive care management is not designed to reduce costs overnight. When early spending rises, organizations may be tempted to pull back—but doing so simply postpones health needs rather than resolving them. Those needs will reappear later as more complex, higher-cost care. Taking a longer view allows organizations to intervene earlier, when care is more straightforward, outcomes are easier to influence, and costs are more predictable. This is how preventive care ultimately makes healthcare spending easier to manage.

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Combating Patient No-Shows at Your Medical Practice

Like many physicians, chiropractor Jeff Robichaud experiences as many as 12 no-show patients per week. But when new patients don't show up, that's 60 minutes and up to $200 down the drain.

That's why Robichaud, and the other providers at his integrative medicine practice, Concord Clinical Health Center in Concord, Mass., charge fees for those patients who miss - $50 for a new patient appointment and $20 for an existing patient appointment. The practice also has an established 24-hour cancellation policy.

"We have a waiting list of patients who are looking to come into the practice," says Robichaud, who has charged the missed appointment fee for 10 years. "No-shows are a big deal for us. We used to be gracious with patients we'd see for a long time, but found that repeat offenders would be the patients that we didn't charge. Generally what we find is that when they get the first bill, they're very embarrassed."

Charging for missed visits is just one of the tactics Robichaud and other physicians have used to reduce patient no-shows, which are more than just a mere nuisance.

Missed appointments cost your practice money and waste providers' time. They may also invoke legal issues if your practice doesn't have an appropriate strategy in place to address them.

The no-show effect

Patient no-shows plague every medical practice and may be increasing in some parts of the country as the cost of care rises, says Elizabeth Woodcock, an Atlanta-based healthcare consultant, trainer, and author of "Mastering Patient Flow to Improve Efficiency and Earnings."

While some practices experience a small number of patient no-shows, and others see higher rates, the average hovers somewhere between 5 percent to 10 percent, says Woodcock.

"They've certainly risen after the recession," she says. "It varies by specialties, and the bigger factor is payers. We see higher no-show rates if you have a larger self-pay or Medicaid population."

Certain specialists, such as reproductive endocrinologists, tend to have a higher rate of patient no-shows because they aren't patients' regular physicians or they aren't covered by insurance, says Woodcock.

"We've seen a lot more no-shows with the self-pay patients," says Woodcock. "Ten years ago, it was sort of like, 'Well, gosh, our self-pay patients didn't show. It's not that big of a deal.' But today practices really have to pursue payment from everyone."

As Robichaud's experience shows, new patients are some of the biggest offenders at non-primary-care practices (like Woodcock, he suggests that it is due to a lack of a pre-existing physician-patient relationship). Other common no-shows are patients who schedule appointments between routine visits and forget to cancel.

Regardless of why a patient doesn't show up, it always costs practices money - especially if the practice doesn't charge for the entire missed appointment, says Woodcock.

"Some specialists take credit card numbers over the phone because they charge so much and it's not covered by insurance," she adds.

However, such an approach may not be right for your practice, particularly if your patients can't afford it. There are also some payers (such as a state Medicaid plan) that don't allow providers to charge for missed appointments.

"We're well over 30 percent Medicaid [patients], so we can't charge them," says Leann DiDomenico McAllister, administrator for Plymouth, Mass.-based Performance Pediatrics. "We had [another patient], one woman of means, who really liked our practice, and just said, 'Can I just pay if I miss?' because she didn't want to leave the practice, and I couldn't do that. I couldn't have one set of rules for one person, and another set of rules for another."

tactics and technology

At McAllister's practice, the rate of patient no-shows for the last two years is just under 2 percent. But because the practice is small - with one physician and one nurse practitioner - the effects of just one missed appointment have a big impact.

"If they cancel [without adequate] notice, it's too late to fill them; that's revenue we never make back," says McAllister. "When you go for a well exam, it's 45 minutes for the doctor. He has set aside that 45 minutes for you. If you don't show for it, the chances of us filling it with an acute-need [patient] is not high. We work very hard to set aside acute time."

While the practice used to have a 48-hour cancellation policy in place, that wasn't a cure-all solution, as it would be difficult to fill an appointment for a Monday that was cancelled on a Saturday.

The practice, therefore, recently revised its scheduled appointment policy to better explain to patients that no-shows and cancellations with little notice are problematic. For a copy of this policy to customize for your own practice, go to http://bit.ly/ptnoshowpolicy.

"We send a copy of the policy with a letter to the family the first two times they violate the policy, letting them know it's a problem," says McAllister. "[With] the third violation, they get a letter putting them on probation, stating that one more violation will lead to dismissal from the practice. The fourth violation - the patient is dismissed by certified mail, with a copy by first-class mail in case they refuse the certified mail, and with a copy to the insurance provider if the patient is in managed care and needs to have the primary-care physician reassigned."

After most patients see that first letter and appointment policy, the problem does not persist.

"For well more than half [of no-shows], they don't realize it's a problem" says McAllister. "Our patients for the most part appreciate us, and once they realize it's a problem they don't do it again. For another small grouping, there are true emergencies that come up. We've had patients who've gotten in car accidents or their house caught on fire. And we do make exceptions for that. And then there is that very small subset of patients that, for whatever reason, don't believe it's their responsibility to show up on time, to be here when they say they're going to be here."

While Robichaud's practice, which doesn't accept Medicaid, has recently started charging a portion of a visit cost to patients who miss visits, that's not the only tactic the practice uses to make sure patients step through its front door, he says.

Over the last year, Concord Clinical Health Center, in an effort to further decrease missed appointments, has been using eligibility- and benefit-verification software from its EHR and patient portal vendor, Emdeon, to collect copays, insurance information, and patient information in advance. Patients simply click a link on the practice's website that takes them to a questionnaire where they can fill out their demographic and insurance information.

This not only helps the practice figure out coverage and patient copays in advance, but because patients are spending time prior to the appointment filling out information (and subsequently receive both an e-mail appointment confirmation and a text-based reminder), they're more invested in the practice.

"Because the patient has seen we've made an investment in time in them, they see more professionalism and more value in what the practice is," says Robichaud. "So there's a certain level of respect that comes with going the extra mile with patients."

The text-based reminders, which are part of the Emdeon system, only require a patient to confirm "yes" or "no" to a scheduled appointment a few days in advance.

"We're seeing the trend of no-shows significantly reduced with text," he says.

For more on what Robichaud does, please see http://bit.ly/noshow_patientsto come.

Not following up: legal issues

No-show patients don't just have a financial effect on your practice. They can also present legal issues.

Julie Loomis, a registered nurse and attorney for Tennessee-based State Volunteer Mutual Insurance Company's risk-management department, says patients who miss appointments can create serious problems for practices that don't follow up.

"The most common allegations we see would be negligence, delay in diagnosis, or failure to diagnose," says Loomis.

This could put a practice at risk for negligence, for example, if a patient booked an appointment for examination of a skin lesion that turned out to be a melanoma. In such a case, if a practice didn't follow up with the patient who missed her appointment, the patient's health is at risk.

"The courts would look at, 'How much did you know about this patient?' [and] 'Was it a referral from another physician?' Those are all levels that could [be considered]," says Loomis.

Ericka L. Adler, a partner at the law firm Kamensky Rubinstein Hochman & Delott, LLP, and contributor to Practice Notes, Physicians Practice's blog, says a practice should always follow up with a patient who does not show, and document the reason - Are they sick? Was there a work issue? Does the patient not think a visit was needed? - and try to see the patient again, and document those efforts.

"Clearly where it is a true medical issue, if a patient does not get required care it can come back to hurt the physician," says Adler. "This is not entirely fair since the patient was the one that chose not to come to the appointment, but there are many reasons that a patient may miss a meeting, and it is best to follow up no matter the reason. How do we know if the patient is following the doctor's directions? Maybe they did not understand the importance of the follow-up visit? These types of issues … can create a liability for the doctor."

Adler recommends that practices institute pre-visit reminders and follow-up calls to patients.

"They do not need to chase the patient down unless it's a serious issue, just make a reasonable effort," she adds.

Improving patient relationships

Practices that have the best relationships with their patients tend to also be the ones that experience the fewest patient no-shows. But when you have hundreds or even thousands of patients to manage, how can your practice establish a better relationship with patients? Woodcock offers the following suggestions below (see http://bit.ly/late-patients for more tips on dealing with late patients).

1. Give plenty of reminders. Often times, patient appointments are scheduled weeks or months in advance, so patients are inclined to forget about them. Or, even if they're scheduled just days in advance, not every patient remembers to add an appointment to her calendar. To make sure patients show up, Woodcock is a fan of multiple reminders, such as automated phone calls, or personal confirmation calls 24 hours to 48 hours in advance. She also recommends practices use text-messaging reminders. "I generally recommend texting two hours before an appointment," says Woodcock. "It's not the only reminder that you should do but it's a great supplemental tool."

2. Engage patients. "The way we emotionally engage the patient while they're here is important," says Woodcock. "Helping patients understand why they're coming back is very important for the emotional engagement." Woodcock suggests allowing patients to be part of the appointment-scheduling process. "If you call in for an appointment, you [usually] hear, 'You want Thursday at 9:30?'" says Woodcock. "But you really need to start off with, 'What time and date work best for you?' I see good practices and they are capturing the fact that, for example, a Tuesday morning works well for a particular patient, and [the scheduler] says 'I see Tuesdays work well for you.'"

3. Give fair warnings. "I am not a believer in charging [patients] the first time for a missed appointment," says Woodcock. "But I do think charging the second time [is fair]." After the first missed appointment, Woodcock recommends sending patients a warning letter. It should say something to the effect of, "You missed your appointment, and that's a problem, and we want you to know, if you do it again, it's going to be [a certain amount of] money," she says.

4. Dig deeper. Don't just call a patient when they miss an appointment to ask them when they want to reschedule. "Call the patient and say, 'Are you okay? Are you alright?'" says Woodcock. "What you're doing is you are saying, 'We missed you. We are so concerned about you that we're taking the time to call you and make sure you are alright.'"

Most importantly, let patients know that when they miss their visit, it is not just about keeping a one-time appointment, it's about a long-term relationship.

"In order to really take our no-shows up a level, I think we've got to make our patients realize this is a relationship between you and the physician," says Woodcock. "You are not showing up for the doctor and the doctor cares about you."

In Summary

Want to reduce patient no-shows at your medical practice? Consider the following solutions:

• Give plenty of reminders, from automated telephone calls to text-based messages.

• Consider sending patients a warning letter for missed visits; if they miss a third time you may need to dismiss them from your practice.

• Encourage patients to fill out demographic and insurance information in advance.

• Check all your payers' policies to make sure they allow you to charge for missed visits.

• If your patient misses an appointment, always follow up; find out why they missed the appointment.

Marisa Torrieri is an associate editor at Physicians Practice. She can be reached at marisa.torrieri@ubm.com.

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What patients think about direct primary care

A new Hint Health survey using the Person-Centered Primary Care Measure shows DPC patients report easy access, strong relationships and high willingness to recommend their physicians.


Hint Health’s new DPC Patient Experience Benchmark Report offers one of the clearest pictures yet of how patients experience direct primary care (DPC).

To build the benchmark, Hint and its client clinics used the Person-Centered Primary Care Measure (PCPCM) — a patient-reported instrument that assesses access, comprehensiveness, coordination and continuity.

The survey combined 11 PCPCM items, eight demographic questions and a Net Promoter Score (NPS) item into a 20-question questionnaire delivered electronically to patients over a 14-month period ending in August 2025.

1,632 people completed the survey, but after excluding responses that did not meet PCPCM validity standards, the final sample included 1,534 patients from 12 DPC clinics in eight states. The total PCPCM performance score across all items and patients was 89%, with domain scores of 97% for Contact/Access, 90% for Comprehensiveness, 88% for Coordination and 82% for Continuity.

The same survey produced an NPS of 85, which the report describes as world-class in any industry and unusually high for health care compared with typical NPS ranges of 38 to 58.

The report argues that DPC is outperforming the traditional system on both loyalty and overall clinical experience when both are measured with these tools.

Patients who have known their physician longer report higher scores, particularly on items tied to shared history and personal knowledge. Scores are also modestly higher in older and healthier patients, while remaining strong across groups.

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Cardiovascular care is overdue for a preventive reset

Nearly 6.7 million U.S. adults live with heart failure, which accounts for nearly 15% of all deaths each year—and more than $60 billion in annual costs.

And then there’s the issue of capacity. The demand for cardiovascular care continues to outpace the available workforce, with a projected shortage of more than 8,600 cardiologists by 2037. For physicians on the front lines – particularly in primary care – this gap creates an impossible tension: more patients at risk, fewer specialists to refer to, and too little time (and tools) to intervene early.

Today, most cardiac care is still reactive, triggered by symptoms, acute events, or late-stage disease. But prevention requires something different: earlier visibility into cardiac risk, objective physiologic data, and tools that help physicians identify problems before they escalate into emergencies. Patients are already generating unprecedented amounts of health data through wearables and connected devices, yet much of this information fails to become clinically actionable inside the exam room.

If we want to meaningfully reduce cardiovascular disease, control costs, and give physicians back time, we must rethink how early screening, prevention, and diagnostic support fit into everyday care. The future of preventive cardiology will not be built on a single function or siloed technology, but on integrated, end-to-end systems that help clinicians see risk sooner, act with confidence, and intervene before a patient ends up in the emergency room with heart failure.

RPM laid a solid foundation for next gen preventive tools

Remote monitoring made its first big splash more than six decades ago, when Alan Shepard took an EKG, thermometer, and a respirator sensor into space. That original use case and the ones that followed were all designed for a single purpose: to sound the alarm in the event of an emergency. Modern consumer tech is built with the same goal in mind. Watches tell individuals when their heart rate is too high, or when they start to show signs of illness. It is all reactionary data.

As a result, most RPM programs start after a diagnosis, hospitalization, or decompensation. They help reduce readmissions, but the data come too late to truly change outcomes. Clinicians are reacting to alerts, when their expertise might be better used in identifying and understanding patterns to help prevent catastrophic events in the first place.

Despite the drama of a heart attack, cardiovascular disease does not happen suddenly. What if we took this into account and instead of monitoring a patient after an acute incident, we harnessed the incredible tools and technological advances available today to identify risk and patterns long before a serious adverse event?

Data before the visit

If prevention is the goal, what if physicians could have the data before a visit begins?

Imagine the typical annual exam, but as the patient enters the waiting room, they receive an easy-to-use wearable device. As they fill out paperwork, the device collects cardiac function data that is automatically uploaded to their records. In the exam room, the physician begins the appointment by explaining to the patient what the data shows, and asking questions about lifestyle to put the data in context and identify whether further testing or treatment are needed.

In this scenario, the appointment is grounded in clear, accurate data. Instead of asking questions and relying on the patient’s memory or reading from months or years before, we get an instant snapshot that allows clinicians to walk into appointments informed – and armed with actionable insights. The visit is now about explanation and decision making, instead of digging for information that may or may not be reliable.

Where needed, the data can become even broader. A patient could receive and begin wearing the device days or weeks ahead of time and provide information on real-life factors, like sleep, stress, movement and recovery. All of this data gathering, when paired with software that can effectively analyze context (versus just patterns) instead of flooding the provider with too much information, leverages preventive monitoring for prevention rather than a trigger for late-stage response.

Where we go from here

I can almost hear the collective sigh of overworked physicians wondering how they are supposed to integrate one more thing into an appointment. But in this new model, work – especially administrative – is reduced. Automated collection and pattern-based analysis means fewer false alarms, fewer rushed visits, and fewer late-stage crises.

One of the biggest health risks facing patients in the U.S. is not unfixable. In fact, it’s quite the opposite. The demand (and patient appetite) is there. The need to provide more support to cardiologists and physicians is there. And, the technology and innovation are there. What we do need is a mindset shift and a willingness to reject the status quo. If we can overcome those challenges, there are a lot of lives (and money) we can save.

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