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No Show Survey Results
Provider & Community Issues (P&CI) Subcommittee
Susan Dymond, CHP, and Emily Berry, HCPF
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3/8/18
Our Mission
Improving health care access and
outcomes for the people we serve
while demonstrating sound
stewardship of financial resources
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Objectives
• To summarize the results of the Provider and
Member No Show surveys
• To discuss findings and look for overlap between
the Provider and Member surveys
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Outline
• Potential Limitations
• Summary
➢ Member Survey
➢ Provider Survey
• Suggestions
➢ Member Survey
➢ Provider Survey
• Alignment
• Discussion
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Potential Limitations
• Small sample size for individual questions
• Resource limited
• Selection bias
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Summary of Member Survey• N=51
• 64% have missed appointment without calling to
cancel first
• Top Reasons:
➢Timing issues (80%): includes forgot, family
emergency/child care, work conflict
➢Transportation (46%)
➢ Staffing and attitudes (30%): includes treatment
by provider or staff
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Summary of Member SurveyOther reasons:
➢ juggling many appointments
➢bad memory
➢mental health crisis
➢appointment rescheduled day before
➢exhaustion with newborn
➢ in hospital
➢bad weather/traffic
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In other words, LIFE HAPPENS
Summary of Member Survey
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• 9.5% responded they got care somewhere else.
➢ Majority went to another primary care provider
• 65% respondents were contacted in advance
➢ Majority by automated or live phone call
Member Survey Quotes• “don't penalize us when we can't make it to
appointment...we are doing our best”
• “I haven't missed but you can get more doctor's who take
Medicaid. You can train the staff, from the first person
you meet at the counter, to the MAs, to the nurses and
the doctors, that they should treat people on Medicaid
better. Don't speak down to them. Don't make
assumptions about them. Not everyone on Medicaid has a
"choice"...many are there because of a disability or just a
rough patch in life.”
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Summary of Provider Survey
• N=110, 81% primary care
• Majority moderately concerned
• 96% track no show appointments
➢ Average percentages ranged from 0.5% to 50% (78% response
rate)
▪ Average = 11.57%
▪ Median = 10%
▪ Max = 50%
▪ Min = 0.5%
➢ 84% have a No Show policy
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Summary of Provider Survey
• 61% track by new/established patients
• 31% track by appointment type
➢ Most common: Well/Visit Preventive and Follow-Up (low acuity)
➢ Less common: Acute/Same Day and Procedure (high acuity)
• Adults no show more often than kids
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New (n=49) Established (n=44)
Average: 23%
Median: 10%
Max: 80%
Min: 0.005%
Average: 32%
Median: 20%
Max: 99%
Min: 0.5%
Summary of Provider Survey• 21% track by payer type
• 24% track reasons for no show appointments
➢ 1) Forgot appointment, 2) transportation, 3) work conflict/family
emergency/child care, 4) inconvenient appointment time
➢ Other: Unknown due to patient not responding to follow-up
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Medicaid Medicare Commercial Self-
Pay
Uninsured
Average 53% 8% 14% 9% 18%
Median 49% 5% 10% 5% 0%
Max 98% 26% 45% 35% 55%
Min 6% 0% 1% 0% 0%
Provider Survey Quotes
• “Spend enough time with patients to develop a
relationship with them so they value their care.
Patients who don't actually want to be here change
doctors; patients who do want to be here show
up.”
• “There is no solution. When your healthcare is
free, you don’t value it.”
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Summary of Member Survey:
What Would Help?
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Topics Suggestions from Survey
Reminders • Ask patients what they prefer (call, email, text)
• Provide automated opportunity to confirm/reschedule
appts
• Contact 2-3 days before; plus day of for habitual no shows
Scheduling • Later hours for patients who work
• Consolidate visits
• Timely (not 3-4 months out)
• After hours number to cancel
• Communicate cross-entities
Summary of Member Survey:
What Would Help?
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Topics Suggestions from Survey
Access/Barriers • Transportation that is skilled with power wheelchairs
• More efficient, accessible transportation
• Support from care manager
• Better use of care managers
• More providers
• Provider on staff for walk-ins
Attitudes • Be flexible
• Better attitude
• More understanding
• Don’t discriminate against Medicaid
Policy • Incentivize providers
• Don’t disincentive patients
Summary of Provider Survey:
What Helps?
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Topics What Has Been Effective for
Providers
What Providers Suggested They
Can Do
Reminders • Confirm by personal phone call (or other
method)
• Use EHR to send automated text/email
reminders
• Multiple contacts (often 1 week prior and
day before)
• Contact in patient language
• Live person call patient
• Auto text reminders
Policy • Discharge after 2-3 no shows
• Same Day/Walk In only after 2-3 no
shows
• Cancel appt without confirmation
• Identify frequent no shows
• No Show Policy (vary based on appt type)
• Incentives/Reward System
• Improve practice work flow
• Allow providers to charge patients for
no show appointments (reminder: this
is prohibited by federal law for
Medicaid clients)
• Accountability from payor
• Adhere strictly to No Show Policy &
Procedure
• Promptly identify frequent no shows
and call to problem solve
Summary of Provider Survey:
What Helps?
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Topics What Has Been Effective for
Providers
What Providers Suggested They
Can Do
Access
Barriers
Relationships
• Emphasize goals/patient needs during
reminder call
• Ensure transportation during scheduling
• Proactively address barriers
• Take time to develop relationship so
patient values care
• Work with care coordinator to find
solutions to barriers of care
• Improved customer service
• Pick up patient directly
• Support for on-site full time case
manager Increase access to care
• Decrease Medicaid population
• Address transportation, child care
Education • Inform new patients of no show policy
• Ask that patient calls if cannot make appt
during scheduling
• More outreach to patients who
habitually no show and place with care
coordinator
• Consequences of no show
appointments/understand
accountability
Summary of Provider Survey:
What Helps?
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Topics What Has Been Effective for
Providers
What Providers Suggested They
Can Do
Scheduling • Don’t schedule more than 2 weeks
out
• Overbook
• Timely appointments (not 3-4
months out)
• More flexibility
• More same day appointments
• Communicate cross-entities
• Account for no shows in
scheduling
• Develop a wait list
• Reschedule within a week or
two
• Stop overbooking (more time to
develop relationship)
Technology • TA assistance
• Make portal more
patient/family friendly
• Track on reasons why patients
no show PDSA and develop plan
Alignment between Member and
Provider Surveys• Effective Reminders
• Timely Scheduling
• Access/Barriers (transportation)
• Relationships/Attitudes
• Policy
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Next Steps
• Provide recommendations to PIAC in April 2018
• Follow up with providers who shared their No Show
policies
• Follow up with members who requested follow up
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Discussion
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Contact Information
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Emily Berry, MPH
ACC Program Performance Specialist
Susan B. Dymond, MBA, CMPE, CPC
Program Manager, Provider Support, RCCO 7
Thank You for all of your valuable input
and participation!
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