Reduce the Impact of No-Shows and Cancellations

By Barbara Tauscher, MHA, FACMPE

No-shows and late cancellations can have a greater impact on GI practices than in other medical specialties due to the prep time required for the endoscopic procedures. Unlike other specialties, GI practices may not be able to fill a late cancellation spot within 48 hours. Unfilled appointment slots are especially frustrating for practices with limited capacity; patients who do not show for an appointment deprive other patients the opportunity to be treated.  Patient no-shows cost the healthcare industry $150 billion a year. ¹ In this article, we will focus on no-shows and late cancellations related to procedures.

According to the ASGE GI Operations Benchmarking Survey 2019 Databook, “average cancellation rates have fluctuated between a low of 5.6% to a high of 8.45%. The data over the years has captured an upper  range (8% to 8.45%) and a lower range (6.5% to 5.6%). The cancellation and no-show rates between the upper and lower ranges indicate what is a “normal” range an ASC can expect in terms of holes in the schedule in normal operating conditions from no-shows and cancellations.”²

Cancellation Rates

To improve your practice’s no-show and late cancellation rate, you will need to gather specific data about the reason for the no-show/late cancellation. You can’t improve what you don’t measure.

1. Measuring your no-show vs late cancellation rate. “A patient no-show refers to a missed patient appointment wherein the patient was scheduled, did not appear for the appointment and made no prior contact with the clinic staff.” Late cancellations are those patients who cancel within the time frame when you can fill the appointment slot with another patient (usually 48-72 hours). The solutions for no-show patients may differ than for those who cancel with little notice. If possible, you may want to capture no-show/late cancellation rates by time of day and day of the week.
   
   
2. Track the reasons for the no-show/late cancellations. The #1 reason for no-show/late cancellations is simply that the patient forgot.¹ Other reasons may include time conflicts, cost, fear, and population demographics (language barrier, no driver, etc.).
   
   
3. To estimate the financial impact, multiply the number of unfilled appointments by the average reimbursement rate for the procedure. For example, if your practice averages two no-shows a day multiplied by an average facility fee of $600, the estimated annual lost revenue is $312,000 (2 no-shows/day x 5 days a week x 52 weeks a year).

Best Practices

1. Written Policies: Most GI practices charge a no-show/late cancellation fee as an incentive for patients to keep their appointments. The best practice is to have a signed financial policy that outlines the amount of the no-show/late cancellation fee and what constitutes a late cancellation. You’ll also need to read your insurance contracts carefully to understand whether you can charge a patient for this fee. Medicare and Medicaid patients cannot be charged for no-show/late cancellation fees.
   
   
2. Automated Reminders: Patients often forget their appointment, especially appointments made weeks or months ago.
   • Multiple Reminders: Leverage technology and develop a system of multiple reminders, i.e., seven days before the procedure remind the patient to find their prep instructions, two to three days before remind them to start the prep process, and one day before to remind them of their arrival time.
   • Phone Call or Text? Text messages result in a 209% higher response rate than phone calls, and confirmations via a text message are 295% more successful than a phone call.¹ Check with your vendor to assure that the phone call or text message system can send a bi-directional note back to the EMR system that will indicate whether the patient confirmed the appointment or will need to cancel or re-schedule.
     
     
3. Population Management: As you track the reason for no-show/late cancellations, you may find that some patients require more attention to ensure that they keep their appointments. Patients with language barriers may require an additional phone call or information in their primary language to confirm they understand the instructions. Some patients may have issues securing reliable driver on the day of their appointment. Ensure that your unit has access to a list transportation options for patients if appropriate for unit.
   
   
4. Clear and Concise Prep Instructions: One of the most common reasons for late cancellations is poor bowel preparation. It may take a detailed investigation (possibly including a specific patient questionnaire) to determine if patients find the prep instructions easy to follow. Many GI practices have adopted split preps, which may help reduce late cancellations. Practices may elect to reserve the final appointment of the day for patients who had a poor prep and were scheduled in the afternoon of the prior day or earlier the same day. Having these open slots may keep the practice from losing these patients, who may not reschedule if they have to repeat the entire prep process.
   
    

No practice can completely eliminate no-shows/late cancellations, but there are many steps that can be taken to try to reduce their impact on the practice.

Resources
1. Patient No-Shows- Everything Practice Managers Need to Know

2. ASGE GI Operations Benchmarking Survey (available late October)

Barbara Tauscher is the Director of Operations of The Oregon Clinic Gastroenterology South, part of the largest multi-specialty group in Oregon, and currently serves on the ASGE Practice Operations Committee.