The constant problem of not showing up for appointments

The constant problem of not showing up for appointments

  • Fred Belzman is an associate professor of medicine at Weill Cornell University and has been an internist for nearly 30 years. He is the medical director of Weill Cornell Internal Medicine.

If the system we have is so good, why isn’t it working?

No-shows, broken appointments and late arrivals have challenged medical practices over the years. The administration insists that it has a successful system; However, this system constantly gives us the same bad results. In a healthcare environment that is so challenged by limited access for our patients, how can we afford an unacceptably high appointment rate?

All of us medical practitioners say that if I open up our schedule, fill it with good appointments, with patients who need to be seen, we will see them all. Most of us overbook when our appointments are full and patients really need to be seen, such as an acute sick visit, a last-minute pre-op appointment, or some other urgent matter.

I’d be lying if I said that on an incredibly stressful and busy training day, when someone didn’t show up, I didn’t breathe a little sigh of relief and say, “Now I have a moment to catch my breath.” , to follow charts, or to look at my portal messages, or to drink water, or to eat a snack, or just to use the bathroom.” But management insists on optimizing our schedules, overbooking the no-show rate, creating our models at 130% capacity, and trying Everything we can to get patients involved.

Wouldn’t it make sense to operate at 100% capacity? It seems that this should be more than enough.

How do we tolerate a 30%, 40%, or even 50% no-show rate for initial visits in our schedules? Generally, for initial and follow-up visits, the no-show rate ranges between 15% and 40%, depending on the provider and day.

One problem is that patients scheduled to be discharged from the emergency room, or upon discharge from the hospital, often do not want to come to see us a couple of days after they go home when they are still feeling sick. Sometimes, these patients have their own primary care provider, but no one bothers to ask them about it. Adding them to our schedule prevents us from seeing other patients.

A patient who makes an appointment, then cancels it at the last minute and reschedules it for the next week, and then misses that appointment, and does this over and over again, is not only preventing themselves from getting care, but is likely preventing many other patients as well.

Most industries, including some health care settings, take care of this by letting clients know that if they don’t show up for their appointment, they will be charged for that time nonetheless. My dentist’s office makes this very clear. If you cancel less than 24 hours before your appointment or do not show up, they will bill you for the full service. Many of my lawyer friends have told me that if someone doesn’t show up, or even shows up late, they will be billed for those minutes.

One day, as I was reviewing our office schedules, I noticed a line of text written in the “Notes” section of appointments, which included information patients were supposed to receive, such as an explanation of our late arrival policy, a reminder to bring their insurance card, and a list of medications. Updated and note about no-show fees at our clinic. Wait what? Do we have a no show fee?

We do not. Unlike many private practices, due to a range of administrative requirements, we cannot charge a no-show fee to patients who do not attend. So, there’s no real financial skin in the game for people to keep their appointments.

I’m not suggesting setting up this sort of thing, but it seems to reduce the urgency to keep appointments already set. Not showing up has no negative consequences – except for the fact that they don’t get the health care they need, and someone else isn’t given that opportunity either.

So, if appointment organizers are telling patients about a no-show fee, are they scamming them? My suspicion is that they don’t tell them this; It’s just a macro statement that’s put into each specific appointment.

Instead of wasting all this time and energy, wouldn’t we better figure out a way to make sure that everyone who says they’re coming, and everyone who doesn’t definitely get that date scrapped from their schedule to attend is available to someone else who really wants and needs it?

I’m sure there are intelligent systems out there – or we can find a way to build some – that recognize patterns of broken appointments and no-shows, know who we need to reach out to and make sure they come. Our administrators assure us that there are gateway messages and text messages that can be sent to remind patients of their upcoming appointments and give them opportunities to cancel or reschedule. If our no-show rate doesn’t budge, perhaps instead of adding more patients to the schedule, we can put in our effort to make sure they come.

We must insist that we have a way to reach our patients to make sure they understand that this appointment is valuable and that we care about them coming. Patients need to provide a working phone number they want to answer, and we need caller ID on our end that says, “This is your doctor’s office calling,” as well as a gateway message and text message they can answer.

When each day begins, barring some unforeseen emergency, we should be completely confident that everyone we think will come, will actually come. This way we can ask them all the important screening questions and other things needed to have a successful appointment. It’s time to update our systems and insist that our patients also take some responsibility for showing up when they say they will.

I know that some practices, after the first couple of broken appointments, will send warning letters to patients telling them that further broken appointments may result in them being shut out of the practice. Obviously none of us really want to do this, but if you’ve completed your first three visits at our office, it’s time for someone to call you on the phone and say, “I’m sorry, it seems like you’re wasting everyone’s time.” . If you would like to join our clinic, we are ready to see you again in 6 months.”

If you make 10 or 12 follow-up appointments and break them, someone should notice the pattern and spot the barriers that are keeping you from attending. If it’s an issue with insurance, transportation, weather, anxiety, fear of what we’ll find out during the visit, or anything else we might be able to help you with, let us know. We want you here.

It’s all about showing up.

    (tags for translation)administration

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