Patient no-shows are a perennial problem for any medical practice or healthcare facility. According to the American Osteopathic Association, no-show rates in an outpatient setting can range between 23 percent and 34 percent, resulting in a loss of 14 percent of anticipated daily revenue.
The Elmont Teaching Health Center, a community-based health center in Elmont, New York, implemented a program to reduce its no-shows in late 2015, achieving a 34 percent decrease compared to the same quarter the year prior. The results of the program were recently published in The Journal of The American Osteopathic Association.
Peter Guiney, DO, a primary care physician and chair of the Department of Family Medicine at Nassau University Medical Center, says the impetus for the program came from a need to increase access while reducing the financial impact of no-shows.
“From a medical point of view, this effort was just as much of a concern as educating patients about diabetes and hypertension,” Guiney says. “If they don’t make it to appointments and take their meds, it’s obviously going to impact their health.”
Four ways to reduce no-shows
Ashwin Mehra, Ph.D., the lead study author from the Department of Psychiatry and Behavioral Science at Nassau University Medical Center, says the researchers started by looking at the patients as part of the solution, not the problem.
By working to understand what was contributing to patients missing appointments, the clinic’s team would be able to formulate ideas on how to overcome the barriers to care. “It was an interdisciplinary approach,” Mehra says. “How can the front desk help? How can the providers help?”
Once a list of challenges was created, the team brainstormed ideas to address the most common reasons why patients missed appointments: forgetting the appointment, unexpectedly being called into work, or not being able to reach someone at the clinic to leave a voicemail or cancel. Elmont used four main strategies to reduce patient no-shows:
Patients were educated.
They were informed about the importance of complying with appointments as well as how to properly cancel or reschedule an appointment at virtually every touch-point. This information was included in reminder phone calls one day prior to the appointment, in multi-lingual signage at the clinic, in one-on-one conversations during appointments, and in phone calls following a no-show. Staff members were given scripts to follow so they knew what to say and how to say it. Doctors reinforced the message during visits, which made a difference, says Mehra.