In working closely with FQHC leaders, we know that no-show rates are always top of mind. Lower no-shows translate to improved revenue even as payment models shift away from fee-for-service and toward value-based care. While we believe in the value of engaging your patients holistically, the reality is that no-show rates directly impact the financial health of community health clinics today.
Because of this, it can be tempting to take a tactical approach to improve no-show metrics. But there’s another perspective that can yield better results for both your health center and your patients.
A patient-centered focus will guide the way to improved numbers so you’re not only reducing costs and improving processes but also making real change in the outcomes and lives of the patients and communities you serve. At the core of a patient-centered approach to addressing no-shows is seeing patients as part of the solution and not part of the problem. You and your patients should be working together to improve their health.
We’ve gathered these four patient-centered tips on reducing no-show rates and know they can help you take positive steps forward in the battle against missed appointments.
Create Schedules That Work for Them
Patients miss appointments largely because of schedule conflicts. By rethinking your approach to scheduling in a way that centers patients, FQHCs like yours can make significant changes in no-show rates.
Take the example of Access Community Health Network, an FQHC with 36 centers in the Chicago area. In 2012, they set out on a 3-year initiative to improve patient access. According to the Journal of Ambulatory Care Management, the FQHC saw results including
- A 20% drop in no-show rates
- A 30% decrease in time to third next available appointment (TNAA)
- A 37% decrease in cycle time
- A 13% increase in patient satisfaction
Access Community Health achieved these in part by moving from a first-come, first-served appointment model. This model, while it is often simpler to implement for health centers, has been found to result in higher no show rates. Access’ modified open access approach, which leaves more space for urgent appointments and same-day visits, allows patients to call and schedule an appointment closer to the time of contact.
If you aren’t ready to completely overhaul your scheduling, consider shorter windows (e.g. two weeks instead of six months out) where your patients are more likely to have a clear idea of what their availability looks like.
Educate Your Patients
Scheduling is an everyday occurrence at your organization, but from your patients’ perspective it can be uncomfortable and even disruptive to their lives. In underserved populations that have lower levels of health literacy and linguistic challenges, simple concepts around the scheduling process might be new, or literally a foreign language.
This is why educating your patients on the scheduling process can be such an effective approach to reducing no-show rates.
Elmont Teaching Health Center is a great example of an FQHC that invested in patient education as a way to directly impact no-show rates. Their elevated numbers of missed appointments were resulting in longer wait times for other patients, reduced quality of care, poor outcomes, and lower patient satisfaction — all issues that are exacerbated when patients are managing chronic illness like many underserved patients are. They learned that the main reasons patients were missing appointments were:
- Forgetting the appointment
- Being called into work
- Not being able to reach someone at the center to leave a message or cancel the appointment
Center leaders placed a particular focus on educating their patients on the importance of appointment attendance, teaching them how to properly reschedule and cancel appointments. By implementing this new approach to education along with other changes, Elmont Teaching Health Center reduced no-shows by 14%.
Focus on Accuracy
Addressing your patients in the correct way is critical in the fight to reduce no-shows.
Small mistakes around inaccurate information can quickly balloon into missed appointments and missed opportunities to address pressing health issues. For patient populations with high levels of chronic conditions like diabetes and hypertension, even a few days can make a difference.
That’s why getting contact information correct and sending messages (text, voice, and mail) in the patient’s preferred language or as bilingual messages, is so important. Make sure contact preference is correct in your EMR so that if a patient prefers a phone call instead of a text, you’re honoring that preference. Additionally, in cases like pediatric appointments, include the patient’s first name in case the parent or caretaker has multiple children. This will help minimize confusion and frustration.
Respond to Every Contact
Sometimes, we miss the best opportunities to help our patients schedule and keep appointments. Every missed call or unreturned voicemail is a patient being proactive — and an opportunity for your staff to respond positively to their efforts.
Elmont Teaching Center needed to address an issue of patients reporting that they couldn’t leave a voicemail to cancel or reschedule appointments. In addition to their education program, they made changes to have incoming calls ring on every phone in the front desk area and allowed all front desk staff members to answer any phone.
The main takeaway is to optimize your scheduling communication so it fits your patients’ lives. Through our work with over 200 health centers and healthcare organizations, we’ve developed FQHC-specific best practices on appointment reminder cadences and timing that optimize response rates. If you're interested in learning more about how CareMessage can help reduce no-show rates in your organization, please enter your information below and we'll be in touch.