Six figures a year is a genuinely large number for something that rarely gets tracked as a single line item. Missed appointments get absorbed into "a slow day" one at a time, which is exactly why the total stays invisible even though every individual instance was noticed.
The direct cost is unfilled chair time — a slot that generates zero revenue but still has staff, rent, and equipment allocated to it. The compounding cost is what happens to the schedule around it: a gap in the morning often can't be filled on short notice, which means the loss isn't just that slot, it's the ripple through the rest of the day's efficiency.
Missed appointments cluster in identifiable ways: certain days of the week, certain times (Monday mornings and the slot right after lunch are common culprits), and certain appointment types (a routine cleaning is missed far more often than a procedure the patient is anxious about, for instance) all carry different real risk levels.
Most practices treat every missed appointment as equally random. The ones with the lowest loss from this problem are usually the ones that have quietly stopped treating it that way — and now confirm differently, or overbook slightly differently, depending on which slot it actually is.
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