February 17, 2017
Patient no-shows continue to cost hospitals millions of dollars a year. At many hospitals and medical centers around the country, no-show rates are alarmingly high, increasing wait time for appointments, lowering staff morale and adding $150B in waste to the health care system at large.
Mytonomy recently partnered with a major integrated health system (20+ hospitals) to conduct an information intervention pilot at one of their hospitals. While hospitals attack no-shows through various means as we discuss below, this pilot focused solely on pre-procedure patient education coupled with a nurse navigator phone call, as the driver towards a rate reduction. No transportation component was included — all patients made their own arrangements to get to their appointments.
By focusing on reducing patient anxiety and building an emotional connection with the patient, Mytonomy was able to reduce the no-show rate for routine-stress tests at this hospital from 50% to 7%.
This no-show reduction has the potential to save the hospital $328,000 a year for the stress test alone. When applied across most or all procedures, the savings for care providers would be enormous.
This large amount of missed appointments leads some health providers to occasionally overbook time slots. However, overbooking is an imperfect solution, as it can lead to decreased patient satisfaction. Health care providers need to tackle no-shows at their source.
A 2012 article on Medscape.com attributes no-shows to four causes:
- A lack of rapport between patient and doctor/practice staff.
- A patient’s lack of appreciation for, and education about the purpose of visits, tests, and procedures.
- Long waits. Both to get an appointment and in the waiting room.
- Logistical and personal issues such as transportation troubles or scheduling conflicts.
Healthcare providers strive to address these causes, often focusing on the obvious tactical fixes. For example, “reminders” can be a great way to help patients keep their appointments. Many healthcare providers send out text or phone messages as both a reminder and an opportunity for the patient to cancel.
When certain hospitals in the VA Health system implemented a centralized phone reminder system in between 2008 and 2009, they saw a reduction in no-shows from 16.3% to 15.2%. By opportunistically catching the patient on the phone, these calls double as an opportunity for the healthcare providers to build trust with the patient.
But if patients are given reminders, why do so many miss their appointment? A 2004 study cites patients’ feeling disrespected by the healthcare system.
The study illustrated the importance of educating patients about what is going to happen to them and why it’s important, especially when patients know they will endure an uncomfortable procedure, such as a blood test, pelvic examinations, or surgery.
One driver of no-shows is a lack of transportation. Recent hospital partnerships with well known companies like Uber allow hospitals to reduce transportation cost and offer greater flexibility to patients. While transportation issues certainly contribute to no-shows, they may not the principal cause of missed appointments in all cases.
It’s important not to oversimplify the no-show rate problem, as being solely a “lack of transportation” problem. A substantial amount of missed appointments result from patient confusion and anxiety, which can lead to forgetfulness or avoidance.
To offer a comprehensive solution to no-shows, hospitals should offer pre-procedure patient education, appointment reminders, and in cases of need, transportation assistance. Like peanut butter and chocolate, these ingredients go well together!