New York CNN  —  Going to see the doctor soon? Prepare to be hounded with appointment reminders by phone. By text. By robocall. By email. And in your online “patient portal.” Doctors and dentist offices for years left a courtesy voicemail on patients’ home answering machines giving them a heads-up about their appointment. But now, medical practices are flooding patients with reminders of upcoming appointments — and warnings of cancellation penalties. The financial pressure for medical practices to keep patients from ghosting them is a major factor. Practices miss out on revenue when a patient doesn’t show up for an appointment or cancels at the last minute and the slot sits empty. A barber cuts a customer's hair at a barber shop in San Francisco, California, U.S., on Thursday, Jan. 28, 2021. David Paul Morris/Bloomberg/Getty Images/File Related article Here’s why the Fed cares about the cost of your haircut and doctor’s visit But the notifications are getting worse because new software systems enabled medical providers to send automated messages to patients. Health care providers often have multiple notification systems — one for electronic medical records, another for prescription medications, and a different one from the marketing department, for example — that do not coordinate with each other. This can lead to notification overload for patients. “All of these systems were built for the provider and were never patient-focused,” said Oliver Kharraz, the CEO of ZocDoc. “You need to do this in a coordinated way for it to work.” ZocDoc sends three reminders to patients when they schedule a visit on its booking marketplace: the first a week before the visit, the next a day before, and a third and final text three hours before the appointment. Even that may be too many. The more reminders providers send, Kharraz said, the more patients tune them out. “You stop paying attention to all of them,” he said. “The one you need to pay attention to doesn’t stand out.” And not only is the nagging getting worse, but patients hate it because these are private health matters seemingly being shared in a wide network of doctors, databases and even with some total strangers. Missed appointments Americans aren’t missing more appointments than they used to, but they are booking so far in advance that their plans change and they wind up canceling. No-show rates have remained stable across practice types and years, said Ron Holder, the chief operating officer of Medical Group Management Association. Primary care specialties saw a slight increase in appointment cancellation rates from 8.3% in 2020 to 10% in 2022. “Practices already operate on very small margins,” he said. “There isn’t room for a financial miss. LeoPatrizi/E+/Getty Images Related article Blood pressure is best lowered by 2 exercises, study finds The financial hit of a missed appointment varies by specialty, depending on the staff, resources and equipment that were assigned to the patient but were not utilized because of the no-show. According to ZocDoc, patients are an average of 4% more likely to cancel with every day that passes between their booking and the appointment time. Simpler communication Health providers know they’re bugging you, and they have plans to improve their communication. “We’ve recognized that our patients are feeling bombarded,” said Emily Kagan Trenchard, Northwell Health’s chief of consumer digital solutions, a newly-created position overseeing how the health care provider uses technology to interact with patients. Endless notifications are “not the way to keep them engaged.” Previously, Northwell had five different systems that notified patients via text, email and automated phone calls. It’s consolidating these systems and building one synchronized platform. Health care providers say customers will be hounded less as companies consolidate their notification systems. “What we need is a consolidation of all these log-ins,” Kharraz from ZocDoc said. “One to schedule an appointment, one to see clinical information, one to request prescriptions, one to pay your bill.”