Many companies that sell scheduling software claim to lower the rate at which patients miss appointments. To do this those vendors suggest that more reminders and automated messages will eliminate empty slots in the schedule – but data shows that results are inconsistent. There is research for some methods, while other methods only create a feeling of progress. For a patient who lacks a way to travel to the clinic, a third message does not change the outcome.
In a medical practice with 2 – 50 clinicians, missed appointments result in financial loss and a lack of medical treatment for patients – but it is useful to distinguish between actions that change the data and actions that only provide a sense of activity before you buy new software – this text identifies the factors and provides a method to determine which missed appointments are preventable.
Is telehealth a factor in reducing missed appointments?
It is effective in some cases but the results are not universal. In a large study of a safety net population in the United States, telehealth is linked to a decrease in missed appointments of about 30 %. Because of this result, “telehealth reduces no-shows” is a common belief.
But the same study shows that the impact depends on the income, health conditions and demographic details of the patients. Telehealth is effective when it removes the need for transit or time away from a job. If patients already possess the means to travel to the clinic, video appointments have a smaller effect on the data. By looking at those results, the conclusion is not “telehealth fixes no-shows” but rather “telehealth fixes the specific no-shows that come from access friction”. It is necessary to identify which patients experience the specific difficulties.
What is a significant but ignored factor?
The time between the booking of an appointment and the date of the visit is a strong indicator of patient attendance. Many practices create their own missed appointments by not managing this duration. According to MGMA, longer wait times raise the probability of a missed appointment. If a patient has an appointment in three days, they are likely to attend. If an appointment is six weeks away, the circumstances of the patient can change.
On a daily basis the settings of the scheduling system determine this wait time. If the first open slot is always multiple weeks in the future, missed appointments are likely to occur regardless of reminders. To improve attendance, a practice can offer appointments in the same week for urgent needs or use a list of patients who can fill sudden openings – this is a matter of how a practice designs access rather than how it sends notifications.
How many reminders are useful?
The number of useful messages is lower than what software sellers suggest. For standard visits, evidence supports two points of contact – a confirmation at the time of booking and one message shortly before the visit. For patients with complicated needs, more messages through a chosen method of communication are helpful – but more than two messages for standard care lead to lower returns. And if a practice sends four or five messages, patients may stop paying attention to them.
By focusing on the method of communication instead of the quantity, a practice can be more effective. A message that allows the patient to send a reply is better than multiple messages that do not allow a response. If a patient is unable to say “I need to move this” or “I no longer have a ride”, the message is only a one way notification. Such notifications do not resolve the logistical problems of the patient.
Which missed appointments are not solvable by reminders?
There are certain obstacles that reminders cannot change – the following barriers are well-documented:
- Transportation – Fullscript cites data showing that approximately 21 % of adults who do not have a car or public transit options miss their medical care. A text message cannot provide a ride.
- Language – if a patient reads Spanish and the reminder is in English, the message is not useful.
- Digital barriers – if a patient must use a password they do not remember to change an appointment, they may stop trying.
- One way communication – when a patient is unable to cancel through a message, they simply do not attend and the appointment slot remains empty.
As those examples show, these are problems with how a practice designs its communication and access – those issues are resolved by removing obstacles rather than by increasing the number of alerts.
How to evaluate missed appointments in 20 minutes
It is not possible to improve a process that you have not first divided into categories. By collecting data from the previous 50 – 100 missed appointments, you can organize each instance into one of three specific groups:
- Addressable by access design. The causes relate to the design of service access – long periods between scheduling and the visit, a lack of transport, an absence of digital options or appointments that do not require physical presence.
- Addressable by reminders or communication. Patients in this category are reachable and possess the means to attend but they forget the time or find the process to change the appointment difficult.
- Neither. The causes relate to external factors, which include urgent personal crises, patients who stop using the service entirely or rare events in a person’s life.
As you analyze those proportions, you can determine where to allocate financial resources. If the data shows that most missed appointments are in the first group then buying more reminder services is an ineffective use of funds. If the data shows they are in the second group then the tools for messaging and automated rescheduling are the primary areas for improvement. Because many medical offices rely on estimates rather than data, they often select the wrong solutions and spend money on ineffective actions.
Which specific tools are necessary for measurement?
When the distribution of causes is clear, you can build capabilities that are precise and easy to quantify:
- Two-way messaging, so a patient is able to send a response to change an appointment or report an obstacle before the time slot is empty.
- Easy self-rescheduling, so the act of changing a visit time takes very little time and does not require a telephone conversation during the workday.
- Dynamic waitlist backfill, so the system offers a canceled opening to another patient who desires an earlier time, which also reduces wait times for the entire population.
- Telehealth as an option, not a requirement, available for patients who miss appointments because of physical access problems.
And because the features often exist in different software programs within a standard office, they frequently remain unmonitored. On that account many organizations are reviewing unified white label telehealth platforms with two way patient communication so that the functions for scheduling, messaging and waitlists are in one environment where the impact on attendance is visible. To provide a solution, Healee offers a platform that is built on technology used for more than 5 million appointments and 1 million patients across 200 clinics. On this platform organizations can manage those functions under their own brand name. The central idea is not the specific software but the fact that you can only monitor data that one system can observe from start to finish.
In a neutral assessment, much of the technology for reducing missed appointments is promoted with exaggerated claims but certain actions are supported by data. To improve results, you should lower the time between scheduling and visits, send two reminders on a communication channel that patients use and offer telehealth to the patients with access barriers. By focusing on those areas, you can ignore less effective methods. If you wish to see how a unified platform manages two way messaging, self rescheduling and waitlist backfill under your brand, you may request a demo.
Sources: