Tuesday, 16 Oct 2018

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The "No Show" Problem

“Bueller? Bueller? Bueller?”

In my experience, “no show” rates increase twice a year aside from holidays. The first is the lull in January lasting through March when patients haven’t met deductibles and try to put off being seen in specialty clinics. The second is June through August when schedules are interrupted by vacations, school schedules, and generally, life.

If your “no show” rates are climbing just like the soaring Texas summer temperatures, it's important to:

  • Assess the issue – what is the root of a “no show” problem? The top 3 reasons, according to the Texas Medical Association, for “no shows” are: forgetting the appointment, being called in to work/emergencies, and not being able to get through to the office or leave a voicemail for cancellation.
  • Get to work – how do we fix the problem? 

As the healthcare landscape continues to change, “no show” rates will continue to be an important factor for clinical practice. Implementing even one or two of the following proposed changes may help.

  1. I recommend a designated person to call the patients one day ahead of their appointment time to confirm or reschedule. You may even consider confirming by email or text, appointment cards, or investing in an automated system to contact patients.

  2. Use thirty seconds of your visit to discuss the importance of keeping scheduled follow ups in terms of decreasing lag time between medication fills, safety labs, etc.

  3. Encourage patients to notify the office at least 24 hours in advance to cancel or reschedule.

  4. Consider changing work flow to allow the front desk staff to answer every phone call. This helps patients schedule/reschedule right away.

  5. Report “no show” rates at office meetings and get input from all staff regarding next steps.

  6. Consider releasing frequent “no show” patients.

  7. If you have cash pay patients, consider pre-paid visits. It’s easier to work around a schedule when you have already invested in it.

  8. Follow up with all “no show” patients with a phone call in order to reschedule.

  9. Advise patients to update all contact information including phone numbers and addresses, frequently.

  10. Thank patients for spending valuable time with you and try to keep wait times to a minimum.

  11. Keep a waitlist of patients who want to be seen sooner, both new patients and follow ups, this may allow you to fill spots that open up.

  12. Consider charging a patient a “no show” fee. After all, if your hairdresser does it...

  13. Have a plan for “no shows” that are actually just late. Work on a case by case basis.

  14. Consider having “odd hours” such as working through lunch or offering early or late time slots.

What are your ideas for decreasing “no show” rates?

 

Rachel Tate, DO is in clinical practice at Arthritis Care and Research Center and is a member of the Baylor Research Institute in Dallas, TX. Her areas of interest include patient advocacy, musculoskeletal ultrasound, pregnancy in connective tissue disease, and spondyloarthropathies.


Rheumatologists' Comments

It is definitely a big problem, much is from disorganization and patients forgetting, not a simple fix but what you stated definitely helps.