QD91 - No Show Nancy Save

This is QD clinic brought to you by RheumNow's expanded coverage of twenty twenty virtual ACR meeting. It's gonna be exciting. Today's case oh, by the way, I'm doctor Jack Cush. I work for RheumNow. Today's case, Nancy no show.

Nancy no show didn't show this morning, and I had a free hour to begin my day. That was kinda nice because I got a lot of work in, answered some emails, you know, took a walk around the block, and and didn't make any money and didn't do any good. So Nancy no show has done this before. Maybe Nancy no show is a first time consult like my new patient today that didn't show. The question is, how do you handle no shows and how do I handle them?

I struggle with these just as much as anyone else. The no show rate that most rheumatologists experience varies quite a bit. It can be as low as single digits, but most of you have a no show rate of somewhere between twelve and twenty percent. Most business models in rheumatology would say that you need to keep your no show rate down less than ten percent. If you had a static number that in fact was predictable, you could work against that and do what the airlines do and just overbook.

And then when everybody shows up, just throw it into high gear so that you can meet your workload for that day. On the other hand, most of us don't do that. Most of us wanna have our time accounted for, knowing that at 02:00 I'm seeing this patient, at 03:00 I'm seeing that patient, and at 04:30 I'm checking out. But, unpredictability is bad for business. Again, it's frustrating.

It's frustrating for you. It's frustrating for the patients. No shows often have lots of good excuses. And by no show, I mean people who don't call ahead of time and say, my car broke down, my child is sick, I can't make it tomorrow, can I reschedule? You know, there you have the opportunity to fill in.

So let me give you some perspective on this. Number one, there is research out there about no shows that it is higher in non whites, meaning whites are more likely to be on time and actually make the visit. It's about 10% lower for non whites compared to whites in a few studies. Is people are more likely to keep their appointments when they're over the age of 65. I don't think that has to do with whether not they're working or retired.

I think it just is that medicine becomes more important as one gets older. Younger people are less likely to make those appointments. You could also predict no shows based on patients who have psychosocial problems and certainly people who have a prior history of prior no shows. They're likely to be recidivists and make that mistake. There is, again, there are studies showing that you can actually predict no shows based on those four factors of age, race, whether it's psychosocial factors or prior no shows.

What can you do about this? Well, the number one, way of of reducing no shows is reminders. There are lot of reminder system sis systems out there. You can be as simple as snail mail and sending someone a reminder in the mail, having automated systems where patients can choose how they're gonna get their receive their notice by text, by email, by phone call, Pony Express, whatever they want. It's tailored to them.

Those are fee or services one pays for. Many of you just have your staff as part of today's duties to call tomorrow's patients to remind them. The data shows that no show rates drop by, as much as 50%. So one study showed it went from 10 to 5%. Another study showed it went from eight to four percent.

I think when you've got like a 20% no show rate, I don't think it's gonna go to 10, but it certainly gets better. So, reminders make sense. The other thing that is often not done and should be done is setting expectations. Meaning, you as the clinician need to at the end of your visit say, next time when I see you in three months, we're going to discuss x, y, and z. It's very important that I see you then so we know whether this drug is working, whether your labs have gotten better, whether we can show that this medicine has continued to be safe.

You know, again, we next next time we could talk about pregnancy because we didn't have time to talk about it this time. You know, set an expectation, make it like a soap opera, tune in tomorrow, days of our rheumatologic lives. And, again, it makes sort of sense to set an expectation. Likewise, your staff, when they check patients out, can set an expectation. There's an interesting model in one of the family practice journals that talked about setting up a virtual doctor visit, meaning the patients who are criminals, the no showers, they now go into a bin and they are notified that you're now in an alternative schedule.

Meaning you don't really have an appointment, but you have an appointment with our virtual doctor. And then if and when you show up, you get slotted in in sort of a chronological order beside someone who has a scheduled appointment, and the doctor will try to squeeze you in. I kinda do a version of this on my own right now. Although I kinda tell patients, you're last in line. I've got three people waiting.

You're the fourth person I'm gonna see, and that's the price you're gonna have to pay to be when you're been called a repeat no show. And that's usually people who've had, more than three no show events in a one or two year period. And lastly, you could go with what you're now becoming expert at, and that is virtual medical visits. Meaning it's no, it's less skin, off of your shoulder that when a patient doesn't show for a virtual visit because there are other virtual consults that you could slot in in very short notice. So the idea is use your virtual medicine days as a way of seeing those no show patients.

Now that's a bit problematic because sometimes the virtual no shows are are the are the real no shows are people who really do need to be seen face to face for an accurate joint exam for better instruction for things that one can only do in a face to face visit. But, again, we're trying to salvage one, the patient care and two, the the finances, and three, the workflow by having a strategy for no shows. Think about it. Let me know what you think. That's it for this edition of QD Clinic.

You can, again, follow us, on RheumNow, see what we're going to do for ACR twenty twenty. We'll see you there.