Patients that do not show up for their appointments are a major problem in healthcare. Not only do these no-shows prevent other patients from scheduling appointments, but they put their own health at risk. Frustratingly, they also cost medical practices money, as an absent patient also represents a lost opportunity for revenue – up to $300 per missed appointment. There are many factors that affect no-show rates, including travel time to the doctor’s office. Here, the solution to the all too common problem will be discussed.
Impact of Time and Travel Distance on Patient Compliance
Numerous studies1 have been performed on the issue of no-shows in the medical field. Indeed, transportation barriers are routinely cited as one of the top impediments to healthcare access, primarily in rural areas. In addition to no-shows, increased travel times and distances result in rescheduled or delayed appointments, as well as missed medication or its delayed use. For many patients, these transportation barriers can cause worsening health and inability to manage chronic conditions.
Overall, patients that are part of low-income brackets that rely on public transportation, as well as those who are underinsured or uninsured, are most likely to be no-shows for their medical appointments. In one study, vehicle access2 was a primary indicator of whether patients in the rural Appalachian mountains were able to receive routine health care. Public transportation in rural areas can be nonexistent or unreliable, and central healthcare facilities in these regions may be located 60 – 90 miles away.
For numerous patients, lack of reliable transportation and / or travel time and distance were the top factors for missed clinic appointments. In a study that looked at 200 children with a history of being no-shows for their clinical appointments, 51% of parents3 identified transportation barriers as the primary reason for being unable to attend appointments. A second study of 183 caregivers of urban children found that 50% of no-shows4 were due to transportation barriers.
Overcoming Patient No-Shows
Reducing the no-show rate is one of the most effective ways to battle decreasing revenues in the medical community due to reduced reimbursements. One solution is to charge no-show patients a fee, which is intended to discourage them from not showing up for future appointments. The downside to this practice is that it can discourage these patients from making additional appointments, while also penalizing them for factors that may be outside of their control. A similar solution is to charge patients with a no-show history a fee for holding their appointments. Again, this practice has advantages and disadvantages, with the main disadvantage being that it could completely prevent a patient from booking a necessary appointment.
Some medical facilities have found that appointment reminders and warm confirmations also decrease the rate of no-shows. For instance, when follow up appointments are made more than 150 days after a previous appointment, patients are less likely to show up. In these instances, confirmation phone calls within the week of the appointment, as well as appointment reminder post cards, can both be used with success. However, these solutions cost the clinic time and money, and do not adequately address the problems that arise as a result of transportation barriers.
An additional – and perhaps more practical – solution is for medical practices to set up satellite locations that offer basic diagnostic services. When satellite clinics are strategically located in regions around the central clinic, a satellite location can make access to healthcare easier for patients that are likely to no show due to long travel times and distances. This solution is especially useful in rural areas where lack of public transportation is a problem, or where the nearest clinic is more than hour away. BHN currently provides urodynamic testing services for many practices'/hospitals' satellite locations all over the U.S.. This has the dual impact of a) decreasing no-show rates by making the appointment logistics easier for the patient and b) reducing the load on the central location. Since BHN provides the equipment, staff, supplies, and software required for urodynamics testing there are no additional up-front capital costs for the practice, which makes it easy to justify economically.
Indeed, many of the above studies referenced showed that reduced distance to a clinic could reduce no-show rates. Setting up satellite clinics for diagnostic testing is also simple. Physicians can outsource testing, which is a feasible option when faced with the decision to purchase new equipment or hire ambulatory nurses. When cost is a concern, such as the cost associated with setting up a brick-and-mortar satellite clinic, physicians can utilize the resources of rural communities, such as school gymnasiums or other meeting areas in which a large underserved population can be seen.
Conclusion
Ultimately, the no-show problem will never go away, no matter how well this issue is managed. Doctors must find creative ways to mitigate lost revenue due to no-shows, and understand the aggravating factors in order to create better opportunities for both patients and staff.
References
- Syed ST, Gerber BS, Sharp LK. Traveling Towards Disease: Transportation Barriers to Health Care Access. Journal of community health. 2013;38(5):976-993. doi:10.1007/s10900-013-9681-1.
- Arcury TA, Preisser JS, Gesler WM, Powers JM. Access to transportation and health care utilization in a rural region. J Rural Health. 2005;21(1):31-8.
- Silver D, Blustein J, Weitzman BC. Transportation to clinic: findings from a pilot clinic-based survey of low-income suburbanites. J Immigr Minor Health. 2012;14(2):350-5.
- Yang S, Zarr RL, Kass-hout TA, Kourosh A, Kelly NR. Transportation barriers to accessing health care for urban children. J Health Care Poor Underserved. 2006;17(4):928-43.