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The Annals of Family Medicine (AFM) recently published a study on the problem of no-shows. Here is a look at the major findings of the study and some suggestions on how you can reduce your no-shows with the scheduling, appointment reminder and patient tracking functions found in AppointmentsPRO.

Educate the Patient
65% of participants in the AFM study mentioned that negative emotions about going to the doctor were greater than the perceived benefit of keeping the appointment. Likewise, self-resolving symptoms resulted in missed appointments. One patient explained, "When my feet were swollen it was on my mind, but as soon as the swelling went down, then I forgot about it." The AFM study also cites previous research which suggests that people with a history of failed appointments are less likely to understand the purpose of the appointment.

All of these factors suggest that it is very important to help your patients understand why it is important to keep the appointment: how the treatment may hurt for a while, but the benefits will last for a lifetime...and that even if the symptoms go away for a while, the underlying problem must still be treated. Incorporate this language into the appointment reminder letter you give the patient when the next visit is scheduled (Data > Patient Reminder). You should also add this language to the script of your phone reminders and to the text of your email reminders. And if your patient has a history of no-shows due to fear of pain, add a pop-up note in AppointmentsPRO (Data > Patient > Notes) reminding the practitioner to address these fears during the visit.

Show Respect by Limiting Wait Times
Issues of respect were a factor in no-shows among 44% of the AFM study participants. Waiting was one way disrespect was communicated: not only the time in the waiting room, but also in the exam room. Wait times have a great impact on patient satisfaction, and in turn on physician referrals and other sources of new business.

It is essential that you track average patient wait times in AppointmentsPRO (Reports > Statistical Reports > Arrived vs Seen Comparison) and work with your staff to limit the average wait to no more than five minutes.

Sometimes patients also felt the health care staff did not respect their history. A practice-wide, standardized documentation system allows one practitioner to step in for another when necessary and get up to speed on the patient's condition very quickly. For more more information on electronic documentation, click here.

Availability
Both the AFM study and previous research found that no-show rates increase as the time grows between the scheduling date and the actual appointment. AppointmentsPRO allows you to hold times throughout your week specifically for new patients, so that you can get them in right away. It's always difficult to leave open slots that may never be filled, but if new patients cannot get in to see you for several days, consider the negative impact this will have not only on your no-show rate, but also on your ability to get and keep new patients.

Put the Needs of the Patient First
Logistical issues such as trouble getting off work, child care, transportation, and cost were also cited as factors in the study. There are several things you can do to reduce these types of cancellations. First, use open-ended questions when scheduling patients. Many people are simply too shy or distracted to adequately think through their personal schedule, especially when they may be dealing with a major health concern. Instead of giving them a time, involve them in the scheduling process with an open-ended question:

Wrong: “How is Monday morning at 10?”
Right: “What day is good for you?

Of course you will also need to consider the practitioner’s requested timeframe for seeing the patient when making an appointment. AppointmentsPRO can be a big help in this area. The Find Appointment function (Appointment > Find Appointment) lets you enter multiple criteria for the appointment, then uses computer logic to display a series of options that meet everyone’s needs.

A second way to negate the impact of logistical issues is to track them in AppointmentsPRO (Reports > Statistical Reports > Cancellation Summary and Reports > Statistical Reports > No-Show Summary) so that your scheduler can be aware of the most common logistical problems. For instance, if an appointment is made at roughly time the school lets out, the scheduler can ask, "Do you have children you need to pick up?"

Enhancing Your Reminder Program
Simply forgetting the appointment was another one cause of no-shows. That’s why a “multi-touch” reminder system is important. Many practices simply print a reminder letter at the time the appointment is scheduled. By adding “multiple touches” such as phone, email and mail reminders, fewer people will forget. (Make sure your reminders arrive far enough in advance of the appointment, so that if the patient did forget, they have time to cancel any other plans they may have made!) SpectraSoft has an email reminder module, an in-house phone reminder system and an outsourced phone reminder option that all help you achieve higher contact rates and fewer no-shows.

Communicate the Negative Consequences
Forty-one percent of the participants indicated they did not know what happens in a clinic if there is a failed appointment. Many believed that canceled appointments occur regularly and allow the practitioners to catch up or take a break.

Your reminder letter should stress the importance of the appointment. You may want to point out that practitioner time is limited, or that missed appointments may be a subject to "missed appointment fee." Make it clear that your practice has set aside this time specifically for the patient, and that you in turn expect the patient to make it a priority to keep the appointment.

Let us know if this article was helpful -- write us at newsletter@ssoft.com.

Links

You can read the entire study from the The Annals of Family Medicine here: http://annfammed.org/cgi/content/full/2/6/541.

These previous articles from Practice Management News may also be of interest:
7 Ways to Reduce No-Shows and Cancellations
8 Steps to a Better Reminder Program