Eyeworld

OPHTHALMOLOGY BUSINESS 70 August 2016 by Corinne Wohl, MHSA, COE, and John B. Pinto How to evaluate and mitigate your no-show rate 2. Sometimes excess no-shows can be due to lower levels of patient satisfaction. Patient: "Sure, I'll make an appointment (because you are insisting, but I'm not actually going to come in because I don't like it here)." 3. Some of the problem is due to clerical gaps. It is common to see staff insisting that they "really" make reminder calls, but when you audit formally, you find that some or all of the calls are miss- ing. You can't just take staff at their word that they are making the calls—you need to audit di- rectly. 4. If you are booking appointments out for one year, which is rec- ommended, build a system that reminds the patient earlier than the typical 2 days in advance. We commonly advise a reminder via phone call, text, or email set 1–2 weeks in advance and then anoth- er 2 days ahead of the appoint- ment. The more last-minute the reminder is, the higher the chance of a forgotten appointment. 5. Pediatric and higher-volume Medicaid practices tend to have much higher no-show rates. A common workaround for this is to multiply the number of appoint- ment reminders—for example, automated calls 5 days out, live calls 3 days out to non-responders to the auto-calls, then a final auto- mated call 1 day out to everyone. This obviously mildly irritates the diligent patient, but often ac- complishes the desired result of a lower no-show rate. Here are a few common ap- proaches to mitigate an excessively high rate: 1. Keep a call list ready for patients available on short notice to fill empty appointment slots. 2. Schedule repeat offenders at times when it will affect the overall schedule the least. 3. Write a policy to discharge patients who persistently are no- shows. Provide appropriate notice for them to find an alternate doctor. 4. Don't book more than 2 family member visits at a time, unless you purposely make an exception "Lost time is never found again." –Benjamin Franklin F illing 100% of your desired appointment slots daily is a top goal and priority found in the best-run practices. No-show patients must be kept to a minimum for the sake of both your patients and your bottom line. Under-booked appointment templates and excessive no-show rates cost the practice significant revenue and keep patients from needed care. Listed below are the challenges of this multi-faceted problem and success factors to control the rate. First, some facts: • Normal no-show rates for anterior segment practices are 5% in most settings, edging up to 6–8% in coastal/urban settings where folks are simply less courteous about keeping appointments. • In rural America and in retinal practices norms are generally 2–4%. • Pediatric practices average 10– 15%. • ODs average around 8–12%. To calculate your no-show rate, divide the number of daily no-show appointments by the number of scheduled appointments you had when the day began. Be sure your reports are showing only true no- shows and not rescheduled appoint- ments. A patient who was expected in the office this morning but who calls (even at the last minute) to reschedule is not a no-show, by way of convention. Track all no-shows in your EHR system. Many practices use the acronym DNKA for "Did Not Keep Appointment." Be sure to follow-up with a phone call the same day to reschedule the appointment. Note this action in the patient chart. Once the data is collected, analyzing it by doctor, location, day of the week (and even time of day if you are tracking a severe problem) will provide the patterns you need to deduce the cause and reduce the rate. You may also find that the aver- age is different from doctor to doc- tor. For example, surgically oriented and senior docs typically have lower no-show rates. There are many common drivers for excessive no-show rates: 1. Higher no-show rates are most generally due to doctor-mediated gaps: a failure to impress on pa- tients the importance of keeping their next appointment (because of family history, etc.). To the point: Simple practice tune-ups for complex times

• Cover