Area medical centers struggle with no-shows
By Michael Iorfino, The Times-Tribune, Scranton, Pa. | |
McClatchy-Tribune Information Services |
Twenty-nine patients had appointments to see an internal medicine physician at the
Four canceled last-minute. Twelve never showed.
"In June, 30.9 percent of the patients who had an appointment in our internal medicine practice either no-showed or canceled last-minute," said
A decades-long problem, the high rate of patient no-shows is now magnified by rising medical care costs and a wave of newly-insured Americans seeking access to health care in crammed physician offices, rather than emergency departments. Not only do missed appointments affect the patient, but they also cut provider revenue and prevent some patients who need treatment from access to care -- the underlying premise of the Affordable Care Act.
While health care providers who serve a low-income population are more prone to see a higher volume of missed appointments, medical practices nationwide in 2012 averaged a 5 to 7 percent no-show rate, a
"As (patient) volume increases, we need to make sure that we have the capacity to handle patients, including same-day patients," said
Since January, when coverage purchased through the health insurance marketplace began, the Wright Center's primary care practices in
Though the no-show rates haven't climbed -- they still occasionally reach about 30 percent -- Wright Center officials know they have to reduce it in order to efficiently meet the growing demand. In June, the center implemented a policy that calls for officials to warn patients who miss an appointment that they will be charged
"We will first give you a warning to say, 'you are taking time away from a patient that potentially needed a visit, please be respectful of others,'" said Ms. Lacey, who added that the Wright Center also does reminder phone calls one day before appointments. "We are trying to get people to think about it so that if they can't make it for whatever reason, they call and cancel."
Low-income patients represent the bulk of the missed appointments, experts say.
Barriers, such as transportation or fear of medical costs, often deter them from making appointments. Some don't have a landline or cellphone contract, instead relying on prepaid phones that they dump for another one instead of buying more minutes.
"We accepted
He said various methods exist to reduce the no-show rates. Some medical practices do reminder calls or bill patients who missed an appointment. Others implement wave scheduling, where two patients are scheduled for appointments on the hour and at the half-hour instead of one every 15 minutes -- potentially inconveniencing patients, but also reducing physician downtime.
A popular practice is overbooking, similar to airlines, he said. For example, he said, if on average 30 percent of patients no-show, the provider could overbook by 30 percent "and hope it evens out."
"Obviously, the danger with that is there are going to be days when everyone shows up, and people are going to be left waiting," Dr. Geraci said. "On the flip side, there are going to be days when you underestimate ... and you are still going to have open slots."
The latter scenario represents lost revenue at a time when medical costs rise.
Dr. Geraci said it cost about
"Twenty years ago, if you had two no-shows a day that was fine, because you know you still were comfortably making money," he said. "Unfortunately, with everything else going on and the economy in general, it's no longer that way. Now, especially in primary care, you have to watch every penny."
After sliding the document back onto a stack of papers on his desk,
Despite the high no-show rate, he said officials do not plan to charge patients who miss appointments. Instead, they will use an automated service that sends appointment reminders via calls, texts or emails as early as a week ahead of time.
"Bottom line is we ... recognize the obligation we have to the community and the clientele, and nobody benefits by charging them an additional fee if they don't show," he said. "That could make them feel embarrassed or want to avoid coming for service, and then sooner or later they are going to end up in emergency room. And then the whole community pays the price."
Contact the writer:
[email protected], @miorfinoTT on
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