No Show Survey Results Provider & Community Issues (P&CI) - - PowerPoint PPT Presentation

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

• utcomes 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 Survey

Other 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

11 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 12 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
• ut
• 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 Emily.Berry@state.co.us Susan B. Dymond, MBA, CMPE, CPC Program Manager, Provider Support, RCCO 7 Susan.Dymond@ppchp.org

Thank You

for all of your valuable input and participation!

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