Wiki How can we reduce Surgery No Shows?

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jenndeshon

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Hey guys!

I work for oral & maxillofacial surgeons and we have a problem with our Medicaid patients simply not showing up for their surgery appointments. I have spoken with our Medicaid rep (we're in KY, by the way) about the possibility of charging surgery deposit fees to them that we would refund whenever they come to their appointment. Of course, Medicaid says we can't do that. Can anyone offer suggestions on how to reduce the number of Medicaid no shows we have? We try to fill spots with other patients from our short call list but that is not often possible on such quick notice. This problem leaves big holes in our surgery schedule that, especially in this economy, we cannot afford to have. We would welcome any and all suggestions you can offer so let me hear your best ideas!!!!;)

Thanks,

Jennifer, CPC
 
This is always a tough one. If a patient shows or doesn't show, the expenses for that time slot have been allocated already....Both fixed and variable expenses. If the patient does not show, unfortunately the physician's practice eats the expense. A no-show to the doctor is like a shoplifter in retail.

However, if a patient fails to follow up with abnormal labs or diagnostic studies, or fails to come in after repeated phone calls from a provider's office, the provider should prepare a letter to the patient, outline the reason the visit is needed, or why the follow up was important, clearly spell out the potential consequences for the patient's health/longivitity, advise the patient to contact the office to schedule/reschedule an appointment (specify the urgency needed), and that failure to do so will result in dismissal from the provider's practice. Send the letter by certified mail, return receipt requested (even though US mail is presumed delivered if not returned). File a copy of the letter and certified mail receipt in the patients record. This will show the provider and staff took appropriate measures to inform the patient of the concern and consequences. If the patient still fails to follow up, dismissal at that point would be appropriate as the patient would then be a liability/significant risk for the provider. Send a dismissal letter to the patient (certified, as indicated above), offering to provide urgent care for the next 30 days (for continuity purposes), and offer to send the patient's medical record to a provider of his/her choosing (include release of information request along with the letter), and provide the effective dismissal date (after the 30 day offer to provide urgent care). Should a law suit ever result becsuse of claim of delayed diagnosis, etc. the above actions will clearly favor the provider.
 
Pre surgery contact

Are you calling your patients 48 hours prior to surgery with a reminder of both surgery time and required prep (nothing by mouth, etc)?

During that call are you offering to reschedule the patient in case something has come up?

This clearly takes up valuable staff time. But your surgeon's down time for a no show patient is even more valuable. I really like AR's suggestions, and they will protect your practice, but many of our Medicaid patients just don't respond to written communication. Sometimes the "personal" touch helps.

I wish there were some way to make the government payors realize that not holding patients accountable actually further reduces the quality of the care they receive.

S I G H

F Tessa Bartels, CPC, CEMC
 
Thanks for the responses. AR's suggestions are good and we did have some success with that when I worked in family practice. The problem I have with that here is that at an oral surgeon's office, most of the time you see a patient 2 or 3 times (a consultation then the surgery and maybe a follow-up, depending on the surgery), so we've probably only seen this patient once before their surgery appointment and we have no way to be sure how well they keep their appointments based on that.

We do call to remind of the appointment & reiterate instructions, but especially with the Medicaid patients, we find they don't have a phone number or the person at the number listed won't see the patient for a few days or the number has been disconnected. We have recently begun to leave messages at viable numbers that if they do not confirm their appointment by noon the day before surgery then we will put someone else in their surgery spot. Not much success with this one yet but we will give it some time.

Please keep the suggestions coming! One of my doctors is very demanding and cannot understand why Medicaid won't allow him to charge a deposit fee, even though we have explained it many times. HELP!!

Jennifer, CPC
 
This is a difficult population segment to handle. The goverment doesn't make the individuals take responsibility by allowing a no show fee, etc. Times are even tougher for them then for us as prices keep rising and fixed income doesn't.

Maybe they have a transportation issue to get to and from the surgery, family to take care of, etc. Maybe a proactive approach in working with the caseworker or the patient to make sure their other needs are met for the surgery as well would increase the shows.

Confirming appointments is a good idea. Maybe you could institute a clinic policy that if a patient does not cancel a surgery 48 hours in advance, they will need to find another surgeon. (Medicaid probably won't let you do that either). If the no show problem is only with this population segment, maybe your provider needs to consider disenrolling as a medicaid provider (I know, there are many many factors involved in this one).

There aren't really any good solutions to this one.
 
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