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Are last minute no-shows killing your practice?

January 23, 2018

    Nate Comstock

    As a former medical group executive, one of the most common complaints I received from our physicians was "these no-shows are killing my practice!" The no-show dilemma is not a new phenomenon, and there are numerous strategies—both new and longstanding—to mitigate their negative financial and operational impact.

    However, an increasing abundance of data now allow physicians and leaders to evaluate their practice patterns in ways that were not possible before.

    Take a second look at your no-show rate

    While recently working with a 190+ bed hospital in the Northeast, we learned that the organization's primary care group was operating at near-best practice levels with an outpatient no-show rate around 5%. However, upon further investigation, we found something interesting: There were a large number of appointments that had been cancelled or rescheduled—more than offsetting the benefit of their best-in-class no-show rate.

    For example, when we examined the group's data for all cancelled appointments, we found that almost half (a 12-month average of 49%) were rescheduled fewer than 24 hours from the appointment date and time. More troubling yet, we found that 60% of these cancellations were "last-minute"—within three hours of the appointment. But from the patient's perspective, this scenario isn't necessarily an unfamiliar one—life happens sometimes despite our best intentions! Work, meetings, and unexpected deadlines can pile up at the last minute, making it hard to escape the office and go to the doctor. Child care conflicts or transportation issues can come up unexpectedly. Or sometimes, confusion simply gets the best of us and we remember just then that we had a preexisting conflict to begin with.

    For physician practices, this tight window of time makes it incredibly difficult and laborious to successfully contact, schedule, and confirm a backfill patient seeking a sooner appointment. Moreover, it begs the question of how to avert last minute cancelations among patients who would otherwise have every intention of making their appointments.

    Reduce and respond to last-minute cancellations

    Ultimately, we helped this organization assemble reporting capabilities that allowed them to monitor last-minute cancellations, just like they do for no-shows. This type of infrastructure is critical in order to implement advanced analytics such as a predictive no-show tool, which would allow for the proactive management of all appointments with a high risk of rescheduling or not arriving at all. Additionally, we developed front-end processes in order to respond rapidly to last-minute cancellations.

    For example, we developed policies and workflows to standardize appointment reminder operations alongside a new, automated process for waitlist management. The appointment waitlist allowed front line and clinical staff to create an electronic queue of patients, by priority level, who requested a sooner appointment, which was previously documented on paper and available only to select practice staff for review. The organization now had in place the components of an effective no-show mitigation strategy, including:

    1. No-show definition and identification
    2. Reporting and analytic dashboards
    3. Processes and clarity of roles for rapid response to last-minute cancellations
    4. Electronic, prioritized patient waitlist available to all staff and providers

    Impact your patient experience—and finances

    These changes, in addition to a host of other access interventions, resulted in $3.6 million in projected impact for this organization, and an estimated annual increase of about 580 wRVUs per clinical FTE for primary care. More importantly, metrics that impact the patient experience such as days to new patient appointment improved from 18 to 13 days!


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