How to reduce patient no-shows

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.”

Four strategies 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 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:

• 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.

• Staff prioritized accessibility. The staff incorporated strategies to answer every incoming call, such as having a call ring on all front-desk phones, with the entire front-desk staff encouraged to answer any phone regardless of whether it was at their assigned space. The goal was to enable patients to always speak to a person and not voicemail.

• Managers increased their awareness of the problem. Weekly reports illustrating the no-show rate were shared with all healthcare professionals and office staff. This made the issue a priority and showed the strategies were working.

• Specialized, flexible approaches were adopted for each specialty. For example, behavioral health providers have patients with more unplanned, crisis-oriented needs. As a result, providers allowed more direct contact with patients and used existing schedule gaps from no-shows to accommodate patients experiencing a mental health crisis.

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.”