Reducing no-shows

MGMA Connexion, Apr 2006

"Can you give some examples of effective strategies to reduce appointment no-shows? We've used reminder calls and postcards with limited success, mostly due to inconsistent efforts by clinic staff."

Stephen J. Rapatz-Harr, PA-C, MHA, CMPE, MGMA member and vice president. Clinic/Provider Services, Mille Lacs Health System, Onamia, Minn., stever@millelacshealth.com, from the MGMA Primary Care Assembly e-mail forum

Responses

"Our practice management system calls everyone on the schedule two days in advance. If the appointment is made the day before, the person should remember it. We can have the message say anything we want. Works well for us and has decreased no-shows. I have 6.6 full-time employees, and we have from zero to five (no-shows) a day but usually around two."

"We try to identify patients who are routinely no-shows. We try to double-book those slots with an acute-care visit. In that way, even if the historically no-show patient shows up, the physician can normally handle both in the same time frame."

"We are trying a few things:

* "An automated call reminder system. In the rural-community-clinic portion of our organization it decreased no-shows by 25 percent.

* "We have a progressive response policy that starts with a 'we missed you, how are you doing?' letter. The second letter is stronger, informing the patient that further no-shows could get them discharged from our clinic. The third letter is 'good bye.' The letters have to be initiated by the physician; nothing goes out without the physician's OK.

* "We have worked on improving access in primary care to see if our no-show rates also improve, but with mixed results."

"We implemented an automated phone tree system. It worked along with our present practice management system and has reduced no-shows tremendously."

"Two words: open access. People don't show for appointments because they aren't convenient or they forget. Set your practice up so they can come in when it is convenient.

"We tell our employees to follow up in two weeks and to call on a day that is convenient for them. If you can do sameday appointments with a modified open-access [approach], you will see a significant reduction in no-shows."

"We've implemented a no-show fee. We confirm appointments for physical exams three days prior and then all appointments the night before. We tell parents that if they don't give 24 hours' notice to cancel an appointment, they are responsible for a no-show fee. We have reduced our no-shows by 25 percent this year with the new policy. Patient education and a financial 'punishment' have led to better compliance."

"No-shows are generally a multifaceted problem that doesn't have a one-size-fits-all solution. Analyze your situation to find out the causes of your problems, then create the necessary solution(s). Phone calls two days in advance are a great idea, but they only catch the people who forgot they had an appointment and those who call to tell you that they had forgotten to cancel. That will certainly decrease some of the no-shows, but you'll probably have a greater reduction if you look for the hidden causes, as well."

@ www.mgma.com

* In the MGMA Knowledge Center in the member area, choose Article Archive and search under "appointments - no-shows"

* In the Store, enter 6211 in the Search box for the CD of the audio conference "Improving Patient Flow - A Patient Encounter Toolkit," or 6210 for the tape; 6072 for the book Mastering Patient Flow: More Ideas to Increase Efficiency and Earnings, 2nd ed.

* In the Education/Events area, choose Seminars to register for "Achieving Efficient Practice Operations," May 5 in Tampa, Fla.

e-mail us

How does your practice try to reduce no-shows? Tell us at connexion@mgma.com

The views expressed are those of the participants in MGMA's e-mail forums only and are not endorsed by MGMA. The views do not constitute legal advice.