A good place to start: assertive reminder practices

A randomized, seven-month controlled trial published in 2016 in the International Journal of Pediatrics profiled an urban pediatric ambulatory clinic with an overall no-show rate of 30.8 percent. They were able to reduce that to 23.5 percent among a group of patients by sending text message reminders in addition to the voice message reminders the practice already had in place.

All of the participants had indicated a preference for text messages — and the no-show rate in the group of participants who received only the standard voice reminder was a troublesome 38.1 percent.

Friendly Reminder Practices

A good place to start at reducing no-shows is better scheduling techniques and assertive reminder practices. Medical Offices of Manhattan successfully addressed their no-show problem by focusing on scheduling. “We encourage patients to book follow-ups on the day of their appointment,” says Denise Pate, MD, an internal medicine physician at this multi-provider practice. “Then we send multiple reminders by text message or email starting seven days out, then again at three days, and another reminder at one day if the appointment has not been confirmed. Patients also get a call from a staff member,” she says. Few patients have complained — and the no-show rate has dropped. Tracy Belsan, vice president of performance management at Privia Medical Group, agrees that multiple patient reminders are effective. “I have seen success with that — not just a reminder call [the day before], but starting three and seven days out, using phone, text, and email. You really have to hit patients from multiple avenues to reduce the no-show rate,” she says.

Medical Offices of Manhattan found success with texting both the older and younger members of their patient base, and Pate further notes that virtually all of their older patients are tech savvy and seem to appreciate the text reminders. A 2017 Pew survey found that four in 10 Americans aged 65 or older own smartphones. Furthermore, older Americans generally view smart phones and the internet in a positive light, so encouraging the use of texts and emails in their healthcare might be well received.

Other ways to use technology to cut your no-show rate include letting patients book (and cancel) appointments through a patient portal or website. “Booking online is a good idea,” says Elizabeth Woodcock, president of Woodcock and Associates. “It doesn’t really save staff, since somebody has to manage all this, but it definitely reduces no-shows.” Pate and her patients have found third-party scheduling apps are useful as well.

You may be able to reduce no-shows by eliminating the need to visit the office in the first place. If patients are skipping out on visits because of transportation issues or simply lack of time to get to the office, telemedicine and e-health could be the solution. “If you have the flu, you don’t feel like getting up, getting dressed, and going out to the doctor’s office … a lot of patients prefer [a telehealth visit] when they are sick,” says Tina Colangelo, a New York-area consultant for healthcare services and physicians’ practices. And it’s a plus for the provider, too. “Reimbursement is higher, and you get MACRA credit for it,” she says.


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