Amp Up Patient Access by Slashing No-Show Rates

There is no healthcare without access to healthcare. There are many ways that patients don’t have access to a clinician: lack of health insurance is certainly one of them. But patients face even bigger barriers because of inefficient scheduling and triage systems which effectively prevent them from getting appointments.

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How can this be? Most patient scheduling systems have evolved over time in a never-ending quest to find the perfect system where patient demand equals supply of appointments. But most of the time, this quest is doomed, and the end result is a scheduling system which satisfies no one—neither patient, nor clinician, nor scheduler, nor office manager. One result of these patched-together scheduling systems is that oftentimes patients don’t show up for their appointments—in some clinics, this rate can be as high as fifty percent, or even higher. A fifty percent no show rate means that you’re only seeing fifty percent of the patients you could otherwise accommodate. And that means that patients who need and want care, aren’t getting it.

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This article will be the first in a series to unravel the mysteries of increasing patient access. We’ll start with that familiar clinic nemesis—the broken appointment or BA. A previous article, Reducing Those Darned No-Shows, describes how you can “scrub” the schedule to open up same day appointments by eliminating appointments that patients don’t want or need. (It is well-documented that if you give patients appointments on the day they request them, the no-show rate will decline precipitously.) Having fewer broken appointments means that more appointments are available for patients who will show up for them, which means you’ll be able to see more patients every day.

This article shows how you can tackle the no-show problem by calling patients prior to their appointments. The key to success is NOT “reminder calls.” Rather, the key to success is a reminder call process (that produces the desired result). To construct a great reminder call process, you need to consider the following:

1. Who does the calling? The best callers have daily contact with patients. Different callers will have vastly different results, so experiment in finding the best ones.
2. When do callers call? Each caller is assigned a group of patients from the schedule and begins calling patients two days prior to the appointment. The caller calls repeatedly until every patient is reached.
3. How do the callers find the time to call patients? This is easy. There are plenty of 5 minute downtime periods for every staff member! You don’t need a dedicated hour set aside to do calls. Each caller should use these short bursts of downtime to pull out reminder call lists and call patients.
4. What if the phone numbers are erroneous and patients can’t be reached? If a number is wrong, make a note on the schedule so if the patient shows, the correct info can be gathered. If the patient’s phone is no longer in service, the caller notes this and the clinic should double-book this slot, without removing the patient’s name (in case the patient shows). If you keep track of this, you will see that patients with disconnected numbers rarely show.
5. What do callers say to patients? This is key. Write a script all callers follow. The best script confirms that we have the right person on the phone, reminds the patient of her/his appointment, and makes sure the patient can make the appointment at the appointed time. If not, change the appointment! The caller should ask: “If you cannot make this appointment for any reason, will you call me to cancel so we can use that time for another patient?” And be sure to give the patient a number to call when canceling an appointment—preferably a number dedicated only to that purpose (so it’s as easy as possible for the patient, who can get through right away and either leave a message or talk to a real person and reschedule).
6. In the course of these calls, which are way more than simply “reminder” calls, the caller learns all kinds of things including whose phone is disconnected, which patients seem tentative (“I’m going to try real hard to be there tomorrow.”), which parents are bringing in an extra kid, and which patients have developed a secondary problem (“Yeah, I got that thing on my wrist, but I also have a bad throat I need to ask the doctor about.”) All of this info is of great if unpredictable value to clinic staff. Callers need to find ways to relay all their info to the clinician and/or Patient Care Team.

Try an experiment: Institute a reminder process in your own clinic for four weeks. Before you start, though, figure out your baseline no-show rate for a few days (the number of patients who did not show for their appointment each day divided by the number of patients scheduled that day. For example: Dr. Mendez had five patients who broke their appointments on April 21st, and there were twenty patients scheduled. Dr. Mendez’s no-show rate = 25%, or 5 divided by 20). One caveat: if you have twenty appointment slots in your schedule, but you had only filled fifteen of them for that day, and you had five empty slots, then you would divide 5 by 15, for a no-show rate of 33%). Calculate the no-show rate every day for every provider working in your clinic. We bet you’ll be very surprised at the impact this one technique will have. Try it!

For more ideas on how to reduce BAs and increase patient access to care, see The No-Show Playbook in the Tools section of this website.

Written by Pamela Weisse and Roger Coleman, Coleman Associates