Hint: It’s Not About Show Rate
Reducing no-shows and missed appointments is an area where many health care organizations continue to struggle. While there are a variety of factors at play, recent studies find that only 50% of referrals result in appointments.
But measuring the data on patient no-shows for scheduled appointments ignores an important point — many care transitions (including referrals) are missed not because the patient fails to show, but because the appointment is never scheduled.
If we look at the number of total recommended care transitions in the US, we learn that patients getting referrals only show up 50% of the time when organizations lack a solution for efficient care transitions. In most cases, the appointment is never scheduled because the way that health care generally functions puts the burden on the patient to follow through with making their referral appointments. So, measuring a “no show” rate, and focusing on trying to fix that, ignores the true impact of missed transitions of care that never had a chance – because they were never booked.
Why do Missed Care Transitions Matter?
Getting patients to follow through with their recommended care transitions is the key to transitioning to value-based care. Value-based care is concerned with the triple aim of improving health outcomes, improving quality of care and lowering cost. When patients schedule and show up for appointments more often, health care moves the needle on all three of these objectives:
Outcomes: When patients follow through with recommended care transitions, specialists can diagnose conditions, establish comprehensive care plans and monitor patients to intervene faster.
Care Quality: When payers and providers take an active role in the referral decision and scheduling process, patients follow through on recommended care more often and enjoy a satisfying care experience with the best options in the network (from a quality and total cost of care perspective).
Cost of Care: Identifying health concerns sooner and engaging patients with specialists in a care program avoids costly ED visits and readmissions. When they are engaged more often with the providers in the payer network who have traditionally delivered the best outcomes, the overall cost of care is further reduced.
Three Steps to Increase Show Rate
1. Take charge of the provider search process.
Many doctors are still printing a sheet of local specialists from the EMR, handing it to the patient and leaving them to book the appointment. That’s a poor experience for the patient and doesn’t motivate them.
While the patient may leave the PCP’s office with the best intentions to call a specialist’s office and schedule a visit, all too often “life intervenes” and the patient becomes preoccupied. Unless in acute distress, the patient mentally files the appointment into the “nice to do, when I have the time” category. And it doesn’t happen.
Providers can lean on technology for referral decision support that makes it easy for both them and patients to follow through with specialist care. They can use software solutions to find specialists based on criteria personalized to the patient, including location, insurance accepted, subspecialty, schedule availability (which should be visible to the provider) and language spoken. Making it easy for the patient to see viable options that are pre-qualified for them both improves their care experience with the PCP and it makes it more likely they’ll follow through with the referral recommendation.
2. Schedule follow-up appointments at the point of care.
Booking appointments at the point of care — while the patient is still at the practice — has resulted in a 60+% increase in show rate among payers, ACOs, FQHCs and health systems using ReferWell, based on internal studies across several patient populations. By taking the “to do” off the patient’s plate and coupling the recommendation with an easy-to-accept action, the PCP can ensure the patient will follow through much more often – and with the provider the PCP recommended, based on the criteria entered into the decision support technology.
Make sure the patient leaves with a confirmation printout with key information such as directions to the specialist’s practice, and that they convey how they prefer to be communicated with for further information (i.e. by phone/text or by email) about their appointment.
3. Send appointment reminders.
Forgetfulness is among the top reasons patients miss appointments. Help them remember with timely reminders at the time of booking and before the appointment. It helps even more to send these reminders the same way that patients communicate in their daily lives—email and text message (not phone or snail mail).
What Does the Data Show?
When appointments are not booked at the point of care, the average follow through rate among all commercial patients in 2020 is just above 50%. Among Medicaid and uninsured patients, the follow through rate drops below 35%.
With the addition of a solution to optimize and manage care transitions, the average follow through rate increases to 86% for commercial patients and 73% for Medicaid members. That’s because in both cases, 100% of the patients receive a booked appointment at the point of care (i.e. before leaving their primary provider’s office). They still have some “no shows” (more for Medicaid than commercial insureds) but the resulting follow through rates are much higher than when the onus is left on the patient.
|Before Solution||After Solution|
|Commercial||~50% follow through||86% follow through|
|Medicaid||35% follow through||73% follow through|
That’s because this technology makes referral workflows and care gap closure efficient for payers and providers by:
- Taking the burden of following through with care off the patient;
- Securing their commitment to following the PCPs’ recommendation while at the PCP; and
- Communicating reminders in an effective manner that makes it easy for patients to reschedule if their appointment is no longer convenient.