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How did Eisenhower Health cut no-show rates by more than 66%? (Hint: Text messages).

January 14, 2020

    Similar to providers across the nation, cutting no-shows has been a priority for Eisenhower due to the loss in revenue from missed appointments. Providers implement a number of tactics for reducing their no-show rate, but text-based appointment reminder systems have grown in popularity. While the best reminder strategy may vary according to an organization's needs and resources, a recent study from the Advisory Board's Medical Group Strategy Council found that text message reminders are more effective at preventing patient no-shows, compared to phone and email reminders (see chart below). The success of text messages may be attributed to several factors, including its less invasive and disruptive nature relative to phone calls.

    No-show rates by form of patient appointment reminder

    By implementing bi-directional, automated text messages, Eisenhower Health, a health system in Rancho Mirage, California consisting of a 463-bed hospital and several outpatient facilities, reduced its no-show rate from 8% to 2.3%, increased its staff's productivity, and enhanced its digital front door.

    The problem: Relying on manual phone calls proved to be ineffective and inefficient.

    Eisenhower Health observed a no-show rate of 8% across their outpatient services. As a precaution, staff manually called patients to remind them of upcoming appointments, which yielded little improvement due to its time-consuming nature and lack of standardization. Consequently, Eisenhower Health partnered with WELL Health, an IT vendor that provides a single platform to govern communications, to implement.

    The solution: Sending automated text message reminders.

    Following advice from a consulting firm, Eisenhower heeded WELL Health's advice and interfaced its platform with Epic EHR. The California-based health system replaced its manual patient reminder approach with this new communication system. The solution augmented workforce efficiency by enabling front desk staff to shift its time from dialing patients to prioritizing other higher-value tasks. Across a span of the first eight months, the no-show rate for patients decreased from 8% to 2.3%.

    Here are the top 3 takeaways for IT leaders.

    1. The upfront cost can lead to revenue gain.

    2. Before any further consideration, your initial thought is likely, “This sounds great, but what will it cost me?” You'd certainly want to gauge whether incorporating an automated appointment reminder system is financially feasible for your organization, but don't let the sticker shock discourage you from moving forward.

      Eisenhower paid an undisclosed one-time integration fee for Well Health to collaborate with Eisenhower's IT team during the implementation effort. However, the expense paid off. According to an article, Chief Administrative Officer Mark Steffen revealed that "Eisenhower Health is projecting an annualized net income of more than $75,000. This revenue enhancement is projected to increase to more than $260,000 if the organization can increase utilization of billed appointments to more than 75%"—a feat Steffen correlates to its newly implemented reminder platform. The graphic below shows additional assessment notes:

      Overall assessment: Text reminders are a smart investment medical groups should be making

    3. Prioritize the timing of text messages.

    4. The timing and way in which text reminders are delivered matter. Accordingly, part of Eisenhower's success can be traced to the calculated way its platform sends reminders. Initial reminder are sent 72 hours before the actual appointment, excluding those that occur on a Monday or Tuesday, for which patients receive reminders on the Friday prior to avoid communications during the weekend. If there's no response, a second reminder is sent the day before the appointment. Furthermore, anyone who responds to cancel or reschedule receives a call from the front desk staff.

    5. Use automated text message reminders to enhance your digital front door, but recognize its limitations.

    6. Similar to virtually any technology, a text-based appointment reminder system has its limitations. Roadblocks include patients choosing whether  to opt-in as well as text message reminders not appealing to all demographics, such as many seniors. Ultimately, text message reminders should only serve as one of the many components comprising your organization's "digital front door," and patients should have alternative methods of receiving communication from their providers.

      Eisenhower Health, for instance, also incorporates automated phone call reminders as an option. Furthermore, to optimize its digital front door and create a more seamless patient journey, Eisenhower leverages its automated text message system to issue alerts to those who opt-in, ranging from notifications about ongoing construction to provider-issued instructions ahead of their visit. However, providers should also be wary of overloading patients with such broadcasts.


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