At a recent medical group practice conference, the topic of patient “no-shows” was being discussed. One of the conference attendees was from a community health clinic and she told the group about a poster they recently hung in their patient waiting room. It featured the number of no-shows in the previous week with messages about how that directly impacted other patients’ ability to see the doctor and get care.
At another conference, an academic practice shared that when scheduling patient appointments they asked the question, “If for any reason you cannot keep this appointment, will you please call us in advance if you can’t make it?” By simply asking the patient to verbally commit to calling if they were unable to keep the appointment, it served to increase their engagement and the practice has seen a decline no-shows.
These two examples – bold to subtle – are great illustrations of the range of strategies to help solve this common challenge for medical groups. However, any strategy aimed at reducing patient no-shows must begin by understanding why a patient didn’t show for their appointment and reviewing current scheduling and reminder processes to ensure they are working appropriately.
Measure the no-show rate for each provider in the practice group.
Contact all no-shows and record details on why they didn’t come to their appointment. Note how far in advance the appointment was scheduled, the type of appointment and patient demographics from the practice’s information management system. Analyze the details and look for insights and trends like:
- Is there a variation among providers and locations?
- Are no-show rates higher on some days versus others?
- Is there a correlation between how far in advance the appointment was made and the no-show rate?
- Does the provider chronically run behind with patients or frequently cancel appointments?
Ensure that the automated reminder system is working properly.
Review the system’s set up as well as procedures for adding new providers or locations. Test the system for both text, voice and email messages. With voice messages, listen to a test message when it’s answered and when left on a device. With emails and texts, consider using the practice phone number as a “test” patient to ensure delivery of the message. Then, review the following:
- Does the system have language options? Besides English, consider other languages commonly used in the community.
- What time of day is contact being made with patients?
- How far in advance are confirmation calls for appointments being made?
- What are the percentages for answered calls, voice mail messages, wrong numbers and undelivered texts or emails? To prevent undelivered information, confirm the preferred method of reminders and scripting for staff during each contact.
Analyze the demographics and payer mixes to determine if there is variation.
- Are no-show rates higher with certain payer mixes?
- Are no-show rates higher with certain demographics such as age, length of relationship with a physician, etc.?
Establish office policies and share them with new patients.
- Do the patient materials emphasize the importance of keeping appointments or cancelling with advance notice?
- Is there a patient termination policy after a specific number of no-shows?
Provide a script for the office staff to reference.
- Emphasize during every contact with patients that this time is being reserved for their care on the provider’s schedule.
- Remind patients of the importance of keeping their appointment or calling in advance if they are not able to make it.
- Consider asking patients when the appointment is made to promise to call if they cannot make it for any reason. Having them verbally promise further engages them in the process.
- Ensure staff members are asking patients for the preferred method to contact them. Don’t rely on the telephone number or email address the practice has on their records. Confirm this information every time.
Finding out the “why” behind no-shows will become even more important as physicians’ pay increasingly gets tied to quality. For payers, the quality measure factors in if the patient has received preventive care such as screenings, lab work and immunizations. If patients can’t get appointments for this type of care, the physician’s level of reimbursement for that patient’s care may be affected.
Fixing the no-show problem begins by understanding it. Take the time to analyze what’s really going on and test different methods to address the problem and improve patient access to care.
Photo: Flickr user Army Medicine
