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Make Patient No-Shows No More

Missed appointments can have a huge impact on your healthcare organization. The wasted staff prep time and unnecessary holes in your schedule can lead to lost revenue. Not to mention the effects your patients will feel from the interruption in care, longer wait times, and decreased accessibility. There is a wide range of reasons for patients to miss their appointments, but most can be combated with improved patient-provider communication. As a dedicated healthcare professional, your goal is to deliver quality care to all of your patients, a task made all the more difficult when they don’t actually walk through your doors. Cancelled appointments and “no-shows,” are unfortunately pretty common. No-show rates have been shown to range from 15-30 percent in general medicine clinics and urban community centers, and as high as 50 percent in primary care facilities.1 No matter how dedicated and organized your organization may be, it’s impossible to guarantee that every patient who makes an appointment will keep it. No-shows cause a ripple effect throughout your organization: You’re not able to provide the treatment the patient needs, valuable staff time is wasted preparing needlessly, the quality of care for other patients takes a hit, and it strikes a serious blow to your bottom line.

The Rate of No-Shows

BioMed Central (BMC) Health Services conducted a 12-year study of no-show rates at 10 regional/community hospitals in Houston, including primary care and various sub-specialty settings (gastrointestinal, audiology, urology, etc.). The goal was to evaluate the prevalence, predictors, and economic consequences of patient no-shows. In the 10 hospitals studied, the average no-show rate was 19 percent. Other studies have placed the rate at 10-30 percent for inner-city clinics, community health centers and academic medical centers, 2-15 percent for private practices3, and over 20 percent at the national level.4 An investigation of large scale no-show patterns within the Veterans Health Administration found men had a higher no-show rate than women (to age 65) and new patients fail to keep appointments at higher rates than established patients.5

No-Shows and Patient Health

Patients who fail to show not only impact their own care, but the care of the patients who keep their appointments too. BMC Health Services Research provided evidence that, among diabetic patients with a prior hospital admission, those who did not show for an appointment were at 60 percent greater risk of being readmitted to the hospital than those who had poorer glycemic control, but kept their appointments.6 “Patients who no-show to primary care appointments interrupt clinicians’ efforts to provide continuity of care,” the report stated.

At the Evans Army Hospital in Fort Carson, Colorado, no-shows have a huge impact on the care available to others. “If we can’t rebook it, access across the board decreases,” said Maj. Jason Anderson, chief administrator of the hospital. “If the next patient is early, the provider can see them. But this doesn’t normally happen. A habitual no-show can take up to five slots with rebooking their appointments. This is denying several of our patients the opportunity to receive the care they need.7

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Strategies for Combating No-Shows

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Reducing the number of no-shows is a major focus in the healthcare industry, and improving patient engagement is an essential part of the strategy. Many practices are recognizing that the processes and procedures that may have worked in the past are ineffective today. New technologies may help them better communicate and connect with patients.

Stay Connected

The most common reason patients give for a missed doctor’s appointment—36 percent in one study17—is simply “I forgot.” But new technologies can play a major role in greatly reducing that number. Communication by email, text, phone call, or even social media has been shown to be effective in reducing no-shows, and can be personalized for each patient’s or patient groups’ preferred method of communication. It’s more than just picking up a fancy new method of communication; using technology to remind patients of appointments actually works. A study by the Robert Wood Johnson University Medical Group found that 23 percent of patients who didn’t get a reminder missed their appointments. The number of no-shows fell to 17 percent when patients were sent an automated appointment reminder.18

Another study showed that the no-show rate among patients who received email reminders decreased by 35 percent.19 Reminders can be combined with what is being termed “automated empathy,” which are emails that check on a patient’s well-being and can be linked to upcoming appointments or procedures. “There’s a limited number of resources in healthcare,” said Cara Waller, CEO of the Newport Orthopedic Institute in Newport Beach. “If you do 500 joint replacements in a year, how do you follow up with all of those patients every day? (This) allows you to direct your energy to people who need the handholding.”20

Confirmation or Cancellation Messages

Encouraging patients to either confirm or cancel their appointment within a specific time frame gives them the opportunity to reschedule their appointment if the current time doesn’t work for them. It also lets healthcare facilities adjust their schedules to avoid gaps in the calendar. Reminders to confirm or cancel can be sent 24 to 48 hours before the appointment and patients can even add the appointment to their calendar on their phone or computer. In addition, encouraging a patient to confirm or cancel their appointment lets them become actively involved in the healthcare process and increases the chances that they will keep their appointment. Personal or automated phone calls, texting, and scheduled emails (whichever their preferred communication method may be) can all be used to send a friendly reminder. Kaiser Permanente, the nation’s largest nonprofit healthcare provider, tested an automated text messaging program at one of its clinics with the goal of reducing appointment no-shows. The experimental program resulted in 1,873 fewer missed appointments at a savings of $150 per patient, leading to a total cost savings of $275,000. The program has since been rolled out nationally.21,22

Automate Wait Lists

Many offices use wait lists to fill vacancies in their appointment schedule due to no-shows and once again, technology is making the process better. Special messaging apps and programs can immediately alert patients on the waitlist of an opening through text or email, rather than requiring a staff member to call each individual patient to fill the slot. The feature improves patient access to care and their relationship with the physician, as well as reducing the amount of revenue lost due to no-shows. In the UK, a survey by the National Health Service found that 91 percent of patients would accept a last minute appointment due to a cancellation if they were offered the slot.2 Effective and timely communication through available technology can be an important tool in reducing the number of no-show patients. By automating tasks like appointment reminders or confirmation/cancellation emails and filling last-minute openings—as well as other notifications to engage patients— healthcare facilities can drastically cut revenue loss as well as reduce their staff’s workload, letting them focus on delivering the best care possible.

Sources

1. http://archinte.jamanetwork.com/article.aspx?articleid=601879;
http://www.ncbi.nlm.nih.gov/pubmed/10554721;
http://www.ncbi.nlm.nih.gov/pubmed/15576538
2. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4714455/
3. http://www.ncbi.nlm.nih.gov/pubmed/7010402
4. http://www.ncbi.nlm.nih.gov/pubmed/10554721
5. M Davies Large-Scale No-Show Patterns and Distributions for Clinic Operational Research 2016
6. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3470968/
7. http://www.fortcarsonmountaineer.com/2015/11/hospital-noshows-affect-all/
8. http://www.jber.af.mil/News/NewsArticles/NewsDisplay/tabid/10180/Article/811099/impact-of-missed-appointments-andno-shows.aspx
9. http://www.beckershospitalreview.com/hospital-physicianrelationships/solving-the-problematic-patient-no-show-equation.html
10. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4153419/
11. http://www.annfammed.org/content/2/6/541.full
12. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1466756/
13. http://link.springer.com/article/10.1057/jors.2013.1#page-1
14. http://www.amednews.com/article/20080204/business/302049997/2/
15. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3096184/
16. http://www.medscape.com/viewarticle/773992/
17. http://jpc.sagepub.com/content/early/2013/07/26/2150131913498513.abstract
18. https://www.studergroup.com/resources/news-media/healthcarepublications-resources/insights/february-2015/reducing-noshows-takes-a-personal-touch
19. http://ispub.com/IJHCA/3/1/6793
20. http://www.healthcareitnews.com/news/hospitals-employ-emailempathy-help-doctors-and-patients-keep-touch
21. http://mobihealthnews.com/298/kaiser-to-rollout-text-messageappointment-reminders/
22. http://mobihealthnews.com/5933/kaiser-permanentes-smsreminders-go-live
23. https://www.theguardian.com/healthcare-network/2014/apr/16/text-messages-eradicate-waiting-times