FOLIO 03H · OB-GYN
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18% / MGMA 2024 / OB-GYN median

OB-GYN no-show cost: $594,000 a year for a 3-physician practice.

OB-GYN sits between primary care and surgical specialty on the rate ladder. Gynecology runs 15 percent, prenatal 21 percent. The prenatal sub-cohort carries the highest clinical stakes because the ACOG visit schedule compounds risk if visits are missed.

Sources: MGMA 2024 DataDive, ACOG practice guidelines, Medicaid maternal quality measures.

18%
OB-GYN median, MGMA
$250
Avg per slot
FOLIO 04 · Gyn vs prenatal

Gynecology routine, prenatal, and gyn-onc: three different patterns

OB-GYN is operationally three sub-practices sharing a building. Routine gynecology behaves like primary care for women in established patient panels. Prenatal care runs on a structured ACOG schedule that compounds risk per missed visit. Gynecologic oncology behaves like surgical specialty with consult-to-procedure cascades. The aggregate 18 percent MGMA median masks meaningful differences.

Sub-practiceNo-show rateSlot valueNotes
Routine gynecology (annual exam, contraception, screening)15%$200 to $260Behaves like primary care, lower stakes per missed visit.
Prenatal visits (first trimester)17%$250 to $320High motivation for first visit, drops in second trimester.
Prenatal visits (third trimester)22%$230 to $300Fatigue, physical discomfort, transportation barriers compound.
Post-partum follow-up28%$220 to $290Highest single-visit rate. Newborn care competes with self care.
Gyn-onc consult / surveillance9%$400 to $700High patient motivation, surgical-pipeline dynamics.
New patient general gyn consult14%$300 to $400Referral-anchored, lower no-show than established patients.
FOLIO 05 · Prenatal protocol risk

The prenatal cadence: missing a visit compounds risk

ACOG recommends 13 to 15 prenatal visits across a typical pregnancy. The cadence tightens through pregnancy: monthly through 28 weeks, every 2 weeks 28 to 36 weeks, weekly thereafter. The clinical purpose is graduated: early visits establish baseline and screen for genetic risk, middle visits track growth and screen for gestational diabetes and preeclampsia, late visits monitor fetal positioning, BPM, and signs of imminent labor.

Missing a late-third-trimester visit carries the highest risk because it removes a screening opportunity for preeclampsia or fetal distress at the point when interventions are most time-sensitive. ACOG and HRSA both flag missed late-prenatal as a maternal mortality risk factor. This is not an academic concern: maternal mortality in the US has risen since 2018 to roughly 33 per 100,000 live births per CDC data, with non-Hispanic Black women experiencing rates roughly 2.6x higher, and missed prenatal visits in the at-risk cohort are identified as a contributing factor in a substantial share of cases.

FOLIO 06 · What works

OB-GYN-specific interventions

  • Pregnancy-week-aware SMS reminders. Generic appointment reminders do less work than reminders that reference the pregnancy week (week 24, your visit is to screen for gestational diabetes). Higher patient engagement, roughly 4 to 6 additional points of reduction on prenatal visits.
  • Combined post-partum and newborn visit booking. For practices co-located with pediatrics or with a pediatric referral protocol, booking the 6-week post-partum visit at the same time and place as the newborn's 6-week well-baby visit dramatically improves post-partum attendance. ACOG endorses this as a maternal mortality reduction strategy.
  • Group prenatal care (CenteringPregnancy model). 8 to 10 women at the same gestational stage meet in a 90-minute group session with the midwife or OB-GYN. Multiple studies show no-show rates 30 to 50 percent lower in group prenatal cohorts because the social bond among the group increases attendance commitment. Particularly effective for Medicaid populations.
  • Rideshare integration for prenatal patients. Many state Medicaid programs cover non-emergency medical transportation for prenatal visits as a covered benefit. Programs that integrate Uber Health or Lyft Concierge see 10 to 15 percent no-show reduction on the rideshare-eligible cohort.
  • Same-day OB-GYN waitlist. A separate specialty-specific waitlist (not the general practice waitlist) backfills 40 to 60 percent of cancellations because patients on the list are explicitly opting in for the specialty.
FOLIO 07 · Related

Related folios

Healthcare hubPrimary careSpecialistMedicaidFQHCCancellation waitlistCitation archive
FOLIO 08 · Margin notes

Frequently asked questions

What is the OB-GYN no-show rate?+
MGMA 2024 reports a median OB-GYN no-show rate of 18 percent, with the split running approximately 15 percent on gynecology routine visits and 21 percent on prenatal visits. Top-quartile practices sit at 12 percent. The prenatal sub-cohort runs higher because of the recommended visit cadence (13+ prenatal visits across pregnancy per ACOG guidelines) which compounds the per-visit no-show risk.
How much does an OB-GYN no-show cost the practice?+
Per slot, OB-GYN reimbursement runs $220 to $280 (commercial blend) with new patient consults running $300 to $400. A 3-physician OB-GYN practice running 60 slots a day at $250 average reimbursement, 220 days a year, at an 18 percent no-show rate, loses 2,376 visits and approximately $594,000 in direct annual revenue. Adding unrecovered fixed cost and downstream prenatal-protocol risk, the practice typically exposes $750,000 to $900,000 a year.
Why does prenatal no-show carry extra risk?+
Prenatal care follows a structured ACOG-recommended schedule (initial visit, then every 4 weeks through 28 weeks, every 2 weeks 28 to 36 weeks, weekly after 36 weeks). Missing visits in the third trimester carries the highest clinical risk: late identification of preeclampsia, growth restriction, or fetal distress. Practices serving Medicaid-heavy panels report 28 to 32 percent prenatal no-show rates per HRSA UDS data for FQHC OB-GYN services, materially raising both clinical risk and the practice's exposure on neonatal HEDIS measures.
How should OB-GYN practices handle same-day cancellations?+
Track them separately from true no-shows for benchmarking but treat the operational impact as similar. Same-day cancellations in OB-GYN are typically not late enough to backfill from the cancellation waitlist, especially for prenatal visits where the patient queue is specialty-specific. Top-quartile practices maintain a separate same-day OB-GYN waitlist (patients explicitly willing to come in within a 4-hour window) and an automated SMS notification flow when a same-day cancel happens. Backfill rates of 40 to 60 percent are achievable.

Register entries verified 2026-04-28