The $150 billion cost of poor patient communication

The gap between what patients expect from their healthcare providers and what they experience is widening, and the consequences have moved beyond satisfaction scores and into emergency rooms.

A 2025 survey released by digital health company Artera, conducted with independent research firm PureSpectrum, polled more than 1,000 U.S. patients who had interacted with the healthcare system in the past year. Patients reported that broken communication was contributing to missed appointments, unpaid bills, and in some cases serious medical emergencies they believed could have been prevented.

The tension is familiar to anyone who has tried to call a doctor’s office and ended up on hold for 20 minutes before being transferred twice. Fifty-eight percent of patients in the survey said they have been frustrated trying to reach their providers by phone. More than a third said they have no-showed for an appointment specifically to avoid the hassle of calling, and nearly half reported skipping scheduling altogether because connecting by phone felt like too much of a burden.

Among patients who chose not to schedule because of phone frustrations, 61 percent reported negative health consequences, and forty percent described those consequences as life-threatening.

For health systems, the financial impact is sobering. The average missed appointment costs a provider roughly $200, and across the U.S. healthcare system, no-shows drain an estimated $150 billion annually, a figure supported by data from the Medical Group Management Association. National no-show rates vary widely by setting and population but routinely reach double digits.

The expectation gap

Patients are not comparing their doctor’s office to other medical practices. They are comparing it to their bank, their airline, and their favorite retailer. Eighty-two percent of respondents said they expect healthcare communication to meet the same standard as those other industries, and more than half said at least one of their current providers is not doing enough to improve the experience.

This dissatisfaction has consequences, with 63 percent of patients claiming they would switch doctors based solely on a poor customer experience. Among younger, working-age adults between 17 and 54, that number rises to 73 percent. Those findings align with an Accenture study of 8,000 U.S. adults, which found that about one in five consumers had switched providers in the prior year, with nearly 90 percent citing that the organization was too hard to do business with. Patients reporting negative front desk or digital experiences were twice as likely to leave their provider as those with poor clinical experiences.

Perhaps recognizing this shift, about 72 percent of health system executives listed improving consumer experience, engagement, and trust as a priority, according to Deloitte’s 2025 global outlook survey.

Equity concerns amplify the urgency

Non-white patients were 53 percent more likely than white patients to no-show for appointments due to communication frustrations. Among those who missed or skipped care, non-white patients were 64 percent more likely to report that the decision led to life-threatening consequences requiring emergency treatment.

A Press Ganey analysis of 6.5 million encounters found that underrepresented populations reported lower perceptions of empathy, care personalization, and responsiveness in both inpatient and ambulatory settings. Research published in npj Digital Medicine has also documented utilization gaps in digital health tools among racial minorities, driven by differences in broadband access, health literacy, and cultural preferences.

The Artera survey found that non-white patients were more likely to say a simple text reminder could have prevented a missed wellness visit. Sixty-nine percent of non-white patients who forgot to schedule such an appointment said a reminder would have helped, compared to 56 percent of white patients.

Spam and fraud are undermining trust

Seventy-one percent of patients said they have noticed an increase in messages from unfamiliar numbers that resemble scams, and 87 percent of that group said they are less likely to read messages from numbers they do not recognize.

Short-code messaging plays a role. About three-quarters of patients reported that five- or six-digit automated messages have increased over the past five years. Among those who noticed the rise, 89 percent said the messages are disruptive and 65 percent said they pay less attention to them, with more than half reporting that they have missed important information as a result.

The survey suggests a shift toward recognizable communication could help patients engage. Eighty-nine percent of patients said they would be more likely to engage with texts sent from a consistent 10-digit phone number. Patients said that approach would make them more likely to schedule appointments, complete instructions, follow care plans, and pay bills on time.

Conversational texting, not robotic replies

Patients are not just asking for more texts, they want more flexible ones. Eighty-two percent said messaging with providers is valuable, but 55 percent reported frustration when replies are limited to rigid responses such as “yes” or “1.” Nearly three-quarters of that group said they ended up calling the office anyway.

Three-quarters of patients said the ability to start an open-ended text conversation with their provider would improve their experience. The financial case for improving those interactions is clear. A Deloitte analysis of HCAHPS data found that hospitals with excellent patient experience scores carried average net margins of 4.7 percent, compared to just 1.8 percent at lower-rated facilities. Even after controlling for hospital characteristics, a 10-percentage-point increase in top-box ratings was associated with a 1.4 percent boost in net margin.

Where AI fits in

As communication demands grow, many organizations are struggling to scale front-office operations with traditional staffing models. The report positions AI-powered virtual agents as a response to that pressure. Nearly 90 percent of healthcare executives rank digital and AI-driven transformation as a top priority, and more than 40 percent of C-suite leaders told Deloitte they have already seen moderate to significant returns on AI investments. According to Accenture, 83 percent of healthcare executives cite employee efficiency as a top goal, and the firm estimates that integrating generative AI into call centers could increase worker capacity by as much as 30 percent.

Patients want communication that feels human, arrives from a trusted source, and supports the full care journey from scheduling through follow-up. Providers that continue to rely primarily on phone trees and one-way text blasts risk losing patients to competitors that increasingly treat communication as core infrastructure rather than an afterthought.