A Population Health Perspective

No-shows can be bad for your bottom line, but they can be just as bad, if not worse, for the health of your patients. “You don’t want to have patients going to the emergency room or urgent care when their disease reaches a pinnacle because they didn’t come in regularly so you could keep them healthier and on an even keel,” says Tracy Belsan, vice president of performance management at Privia Medical Group. “The more you can get the patients to come in to see their regular primary care provider, the more education they will receive. It’s also important for the family to get that education so they can be a part of disease management as well.”

“Looking at your no-show problem from a population health perspective can help tackle the problem from a patient’s perspective.

The way to zero in on the effects of no-shows from a population perspective is by gathering data. “Measure it,” says Woodcock. “Data is always a good idea. You need to know your demographics, determine the rate of no-shows, and understand who is missing appointments and why,” she says. Woodcock recommends sorting patterns by payer (e.g. uninsured, Medicaid, Medicare) to see if child care, transportation, or financial issues are driving your no-show rate. Certain types of appointments are more likely to result in no-shows. Corralling this data is a great project for a medical student or intern to work on, says Woodcock.

Once you have the data at hand — you’ve tracked your no-shows and know the most common reasons your patients are missing appointments — you’ll have a better idea of what corrections to make. If your patients miss appointments mostly because of transportation issues, don’t waste time fiddling around with your reminder schedule. If your patients aren’t listening to their voicemails, then maybe you should try sending texts or calling at different times of day. “Choose ten or so approaches based on the data you’ve collected,” says Woodcock, “and then play around with them until you find something that works.”

Addressing the problem of no-shows requires careful attention to your patient population and creating better processes for scheduling and reminding them of their appointments. By investing in the latest technology, such as patient portals and systems that send automated reminders, you have the tools to find solutions that work for your practice. In order for any of the methods discussed here to work, you must understand your patient population and develop solid relationships with the individual members of that population. That combination of the 10,000-foot view and the one-on-one, a mix of data and relationships, can not only reduce your no-show rate, but make your practice and your patients healthier on many levels.

“You have to be creative if you want to reduce no-shows,” says Tina Colangelo, a New York-area consultant for healthcare services and physicians’ practices. “But you care for [your patients], so you want to get them in, whatever it takes.”