Four solutions to an age-old problem
Patient no-shows are a perennial problem for any healthcare facility. According to the American Osteopathic Association, no-show rates in an outpatient setting can range between 23 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 the number of 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. Elmont is a federally qualified health center, and needed to show increased access and outcomes as part of its mission. “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.”
Ashwin Mehra, Ph.D., the lead study author from the Department of Psychiatry and Behavioral Science at Nassau University Medical Center, says they 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 overcome 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:
Guiney says that any one of these strategies on its own probably wouldn’t have made as much difference, but that when combined, they started to produce real results. The clinic saw a 34 percent reduction in no-shows in the fourth quarter of 2015 compared to the same period the year before-and patient visits were up 13 percent during the study period. “There is no question this is a better business model and better for patient care from a medical point of view,” says Guiney. “Many malpractice claims originate with no-shows. If you don’t have as many no-shows, you decrease your exposure to malpractice.”
Guiney says any practice can implement the solutions, because they are low-tech, inexpensive and easy to implement.
The clinic continues to look at reasons for no-shows and ideas for solving them, then examines the data to see if they are working. “We have changed our hours to facilitate people who missed appointments because of work. We may see trends where we have more no-shows in the morning or when it rains or in the winter; we can beef up interventions at those times to compensate.” He adds that even though no-shows are a longstanding problem for physicians, everything is fixable.
“You can’t be overwhelmed by a problem because it’s been that way for 20 years,” he says. “An intervention such as this can change the culture, improve outcomes and make you more effective at your job and make a clinic more effective at its mission.”