Why overdue patient care can't wait until January

Most practices are carrying three overdue patient rosters right now. One tracks patients who haven't scheduled a preventive service, such as a mammogram, colonoscopy, vaccine or annual wellness visit. Another holds the patients who a physician sent to a specialist weeks or months ago and never followed through. The third lists dormant patients, those people who haven't been seen in a year or more and have simply stopped showing up on the calendar.

On paper, these look like three different problems. In actuality, they aren't. Each one represents the same failure: Something was supposed to happen and it didn't. What's easy to miss is that all three share a deadline, and that deadline tends to arrive during the exact weeks most practices are consumed with year-end billing and enrollment logistics instead of patient outreach.

Why timing changes the math

Preventive service recalls run on their own cycles, from annual wellness visits, mammograms and flu shots to colonoscopies due every several years. Once a patient falls outside that window, the visit tends to keep slipping, and a recall that's been open for months is often still unresolved heading into the fourth quarter. Wait until January and it resets into a new cycle in which it no longer feels urgent to anyone, including the patient. Many patients have already met their deductible for the year by the fourth quarter, which often means a wellness visit or screening completed in November or December costs them less out of pocket than the identical visit would in February. That math changes on Jan. 1.

Referrals run on an even less forgiving clock. A November 2023 study in JAMA Network Open that tracked "diagnostic loop closure," meaning whether ordered tests and referrals were actually completed, found that only 58% of referrals and tests ordered during in-person primary care visits were completed within the recommended timeframe. The rate was worse for anything ordered during a telehealth visit. A referral still open from summer or early fall is exactly the kind of order least likely to close on its own. Once it ages past the current plan year, it often has to be reissued entirely under a new authorization rather than simply followed up on, turning a phone call into paperwork.

Dormant patients follow a similar logic on a slower timeline. The longer someone goes unseen, the more likely they are to establish care elsewhere, particularly heading into a season when many are already reevaluating their coverage and provider network during open enrollment.

Start with an audit, not a blast

Once practices become more acutely aware of these overdue rosters, the instinct is often to launch outreach across all three rosters simultaneously. But a better use of the next several weeks is to figure out which one still has recoverable value before the year turns, and which is realistically a January or February project. The following questions help determine the order of priority:

• Recall roster: Which overdue services are tied to a hard annual cycle and reimbursable now, versus ones with more flexibility into next year?
• Referral roster: Which open referrals involve a time-sensitive or worsening diagnosis and which are routine enough to wait?
• Dormant patients: Which patients have a plan renewal or open enrollment decision coming, putting them at the highest risk of establishing care elsewhere?

Recall lists that clear that first bar tend to be the fastest-moving, highest-yield target for what's left in the year. On the referral side, it's the time-sensitive cases that warrant a direct outreach effort rather than the full list. Dormant patients are the hardest group to convert quickly, which is exactly why they shouldn't wait for a slower month. A short check-in now, even a lighter touch than a full re-engagement campaign, costs little and can be the difference between catching someone before they decide to seek care elsewhere. The heavier lift of a full reactivation push can reasonably be moved to the early part of the new year.

Use precision under pressure

This is also where outreach itself needs to shift from something practices do casually in bulk to something they execute with precision. Sending the same reminder to a full recall list and hoping enough of it lands is a different exercise than knowing, within minutes, which patients opened a message and took action and which ones need a phone call instead. That distinction matters more in the fourth quarter than at any other point in the year, because staff time for outreach is at its scarcest when the deadline pressure is highest.

Two-way texting has become one of the more practical ways practices are replacing that uncertainty with a clear answer. A patient can confirm a referral, book a recall visit or respond to a simple check-in directly from a reply instead of waiting on a callback that may or may not happen, which frees staff to spend their limited hours on the patients who genuinely need a human conversation.

What this sets up for the new year

Practices that treat outreach to these three patient rosters as a one-time year-end push tend to lose the ground they gained within a few months. What works long-term is a standing process, as follows:

• Recall lists are reviewed on a set cadence.
• Referrals are checked at a defined interval instead of being assumed complete once ordered.
• Dormant patients are flagged before they've moved out of reach.

That kind of ongoing communication and engagement is easier to sustain by pairing the process with technology, such as texting, than with unstructured, manual follow-up alone.

Recall, referrals and dormant patients run on different clocks, but the fourth quarter gives all three the same deadline, with deductibles, referral timelines and patient loyalty coming under pressure at the same calendar turn. Physicians and practice managers who use these weeks to close what's still recoverable and build the habits that keep these rosters from stacking up again will start January working from a schedule that reflects their actual patient base rather than the one that existed back in February.

Sean Roy is co-founder and CEO of Dialog Health, a provider of a privacy law-compliant, conversational two-way texting and rich communication services (RCS) platform that health care organizations, including family practice and internal medicine physicians, use as a communication and engagement channel.