How to Reduce Therapy No-Shows

The best-studied fix is simple: remind people. A Cochrane review of text-message reminders found attendance of 78.6% with reminders versus 67.8% without. Pair reminders with a waitlist for open slots and a clear, fair cancellation policy, and you protect both your patients’ progress and your schedule.

By the Best Therapy Productivity Calculator team · Last updated October 2026

What does the evidence say about reminders?

Finding
ReviewCochrane Database of Systematic Reviews, December 2013
Studies8 randomized trials, 6,615 participants
Text vs no reminder78.6% vs 67.8% attendance (moderate-quality evidence)
Text vs phone callAbout the same attendance (80.3% for phone calls)
Overall qualityLow to moderate

The review is older and not therapy-specific, but it’s the strongest summary we found. Text reminders are cheaper than calls, so they’re a sensible default.

Bar chart from a Cochrane review: 67.8 percent attendance with no reminder, 78.6 percent with text reminders and 80.3 percent with phone call reminders
Appointment reminders and attendance

What does a no-show cost your productivity?

On an 8-hour paid day, one missed 45-minute session takes 45 billable minutes off the top.

Billable beforeAfter one no-showProductivity
408 (85%)36375.6%
384 (80%)33970.6%

See the scheduling side with the utilization calculator.

What else helps?

  • Book the next visit before the patient leaves, at a time they choose
  • Send a reminder the day before with an easy way to reschedule
  • Keep a waitlist of patients who can come in at short notice
  • Ask about barriers like transport, work hours or childcare, and offer earlier or later slots where you can
  • Explain why each visit matters in plain words tied to the patient’s goal
  • Have a written cancellation policy that’s applied fairly. Check payer contracts and state rules before charging fees. Medicare has specific rules on missed-appointment charges.

Frequently asked questions

Do text reminders work for therapy appointments?

The Cochrane review covered healthcare appointments in general and found text reminders raised attendance. We haven’t found a large therapy-specific trial.

Is a text or a phone call better?

In the review, attendance was about the same. Texts cost less.

Can I charge Medicare patients for no-shows?

CMS allows missed-appointment charges in some cases if the policy applies to all patients equally. Medicare doesn’t pay the charge. Check current CMS guidance and your MAC before charging.

Related: Therapy utilization calculator · Productivity vs utilization · 70% productivity

Sources