32% of medical groups reported higher patient no-show rates in 2026 than in 2025, according to a Medical Group Management Association (MGMA) poll of 190 practice leaders fielded August 11, 2026. Only 10% reported an improvement, while 58% said no-show rates held about steady.
That 58% is shrinking. Compared with the same MGMA Stat question asked in August 2025, the share reporting higher no-shows grew by 5 percentage points, while the "about the same" group fell 2 points and the "lower" group fell 3 points. For a practice manager watching the schedule fill and then empty out at the last minute, the poll gives a number to a trend that has been visible on the appointment book all year.
Why patients are missing more appointments
MGMA ties the shift to a jump in what patients pay out of pocket. Enhanced premium tax credits for ACA marketplace plans expired at the end of 2025, and marketplace enrollment fell 13% nationally, from 22.1 million people in late 2025 to 19.2 million by February 2026. Average marketplace deductibles rose 37% over the same stretch, from $2,759 to $3,786.
MGMA cites 2024 federal survey data showing 17% of adults delayed or skipped medical care, mental health care, or prescription drugs because of cost, a baseline that 2026's coverage and deductible changes are pushing higher. A missed appointment tied to cost avoidance looks identical on the schedule to one tied to forgetfulness, but the fix for each is different. A patient who skipped a visit to avoid a $3,786 deductible bill needs a payment plan or a benefits check before the next appointment, not a friendlier text message.
What a missed visit costs downstream
MGMA's 2025 DataDive benchmarking data puts numbers on what happens after a no-show. The average practice's appointment cancellation rate runs 19.95%, and only 27.40% of those canceled visits get rescheduled within 30 days.
Collections data from the same MGMA benchmark set shows a related pattern: practices collect 72% of copayments at the time of service, but only 26.83% of patient-due balances after the visit. A missed or delayed appointment pushes the balance into the harder-to-collect category, on top of losing the slot itself.
Read together, the two figures describe a leak with two stages. First a visit is canceled and not rebooked within 30 days for 72.60% of cancellations. Then, if the visit does happen, most of what the patient personally owes goes uncollected. A practice that only tracks the top-line no-show percentage misses both stages of that leak.
Do no-show fees help?
An earlier MGMA Stat poll, fielded January 7, 2025, found 42% of medical groups charge a no-show fee, while 58% do not. Among all respondents, 58% said their no-show rate in 2024 stayed about the same as 2023, 22% said it improved, and 20% said it got worse.
The fee made a measurable difference. Practices that charge a no-show fee were more likely to report improvement, 25%, compared with 16% among practices that don't charge one, a 9-point gap. MGMA's data does not show fees eliminating no-shows, only shifting the odds of improvement. A 9-point gap in reported improvement is not nothing, but it also means most practices with a fee, 75%, did not report improvement either.
What actually moves the needle: reminders
Two peer-reviewed studies indexed in PubMed give a clearer picture of what reduces no-shows than fee policy alone. A randomized trial published in the International Journal of Pediatrics on December 29, 2016, tested text-plus-voice reminders against voice-only reminders in a pediatric resident clinic. Among 169 patients, 84 in the control arm and 85 in the intervention arm, the overall no-show rate was 30.8%. The intervention arm's rate was 23.5%, against 38.1% in the control arm, a 14.6-point difference (p = 0.04) and an adjusted odds ratio of 2.12 for keeping the appointment.
A larger study, published in PLOS ONE on June 23, 2020, tested five reminder message styles against a control across 161,587 health system members. The control group's no-show rate was 21.1%. Every tested message style beat it, and the gap between styles was wide enough to matter for practices choosing reminder wording.
| Reminder message style | No-show rate | Advance cancellation rate |
|---|---|---|
| Control (standard reminder) | 21.1% | n/a |
| Emotional guilt | 14.2% | 26.3% |
| Appointment cost | 15.3% | 27.4% |
| Emotional relatives | 15.6% | 23.4% |
| Social identity | 17.7% | 24.6% |
| Social norm | 17.8% | 21.8% |
Source: PLOS ONE, "It's how you say it: Systematic A/B testing of digital messaging cut hospital no-show rates," June 23, 2020.
What this means for scheduling and billing operations
The MGMA numbers point to two separate problems that need two separate fixes. Cost-driven no-shows, the kind behind 2026's 32% increase, respond to flexible scheduling, payment plans, and upfront cost transparency, not reminder wording. Habit-driven no-shows, the kind the PLOS ONE and pediatric studies measured, respond to reminder design: message content cut no-shows by close to a third in both studies without changing who could book an appointment.
A practice tracking only its aggregate no-show rate, without splitting cost-related cancellations from forgotten ones, cannot tell which fix applies. MGMA's benchmark data shows the size of the gap directly: a 19.95% cancellation rate against a 27.40% rebooking rate within 30 days. Billing companies serving multiple practices are positioned to see this pattern first, since they hold both the scheduling data and the collections data that, put side by side, show whether a given practice's no-shows are a cost problem, a communication problem, or both.
None of the four figures in this piece, the 32% higher no-show rate, the 19.95% cancellation rate, the 42% fee-adoption rate, or the 21.1% baseline no-show rate in the PLOS ONE study, describe the same population of patients. Comparing a single practice's numbers against all four gives a rough map of where that practice sits, and which lever, cost support or reminder redesign, is likely to move its own rate the most.
Sources
- MGMA, "About 1 in 3 medical groups see higher no-shows in 2026 as patients face higher costs," August 11, 2026
- MGMA, "No-show fees in medical practices on the rise to balance bumpy attendance rates," January 7, 2025
- International Journal of Pediatrics, "Text Message Reminders Increase Appointment Adherence in a Pediatric Clinic: A Randomized Controlled Trial," December 29, 2016
- PLOS ONE, "It's how you say it: Systematic A/B testing of digital messaging cut hospital no-show rates," June 23, 2020
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