According to the 340B Drug Pricing Program, your Federally Qualified Health Center (FQHC) is entitled to 100% of the reimbursement rate on any 340B outpatient drug prescription your patient fills — even when you’ve referred that patient to a specialist who writes the script.
As we have outlined in a previous post about the 340B prescriptions, a major challenge for FQHCs is proving they own the patient’s care. As a result, these covered entities fail to capture 98% of prescriptions written by an outside provider. That’s why documenting that you own the patient journey is critical to generating revenue to sustain and grow your FQHC.
Technology offers many ways to improve 340B prescription capture — from directing more patients to contract pharmacies to getting specialists to close the loop with patient data sent back to the referring PCP — and one not-so-obvious but effective strategy: improving patient show rate.
What is the Average Patient No-Show Rate at Specialist Appointments?
A 2016 study found that the average patient no-show rate for both primary care and specialist appointments combined was about 20 percent.
When you look at specialist appointments exclusively, however, the data is more concerning. Patients miss 50% of all specialty referral appointments.
Narrow it down even further to patients insured by Medicaid — as about 41% of the FQHC’s patients are — and you find that only 34% of Medicaid patients go to their specialists when referred by the FQHC provider. In other words, nearly half of the FQHC patient population has a no-show rate at specialty referrals of 66 percent!
Even when these patients don’t miss their referral appointments, only 20% of specialists close the loop and send notes back to the FQHC. That means, best case, you’re only capturing 340B prescription savings for less than 7% of your patient population!
Decreasing No-Shows to Increase 340B Prescription Capture
If you could give your patient show-rate a quick boost, your FQHC could quickly capture more 340 savings. But many 340B software solutions do not focus on appointment scheduling and reminders, which can easily increase the show rate at specialty referrals.
When you schedule specialist appointments right at the point of care and track that they happened FQHCs immediately bump up patient show rate for specialty care to 73% for Medicaid patients. Of course, this benefit extends beyond just Medicaid patients. Health Centers using ReferWell’s 340 Program solution have seen a 110% increase in patients showing up to their specialist appointments. That means greater 340B savings for you, more access and better care management for patients.
Closing the Loop for 340B Compliance
And, once these additional patients show up, the same technology encourages more specialists to close the loop. You receive audit-proof evidence that the appointment happened so you can improve 340B program compliance without disrupting or adding to your workflows.
If you’d like to move the needle on 340B prescription capture closer to 100%, increasing patient show rate at specialist appointments is a quick and easy way to get there.
ReferWell makes it easy to direct patients to the right specialists, track that they showed up and get specialists to close the loop — making your care transitions more effective and efficient and improving health outcomes for your patients!
Written by Tom Mackintire
Tom is a trusted advisor helping Medicare Advantage, Medicaid and ACA plan executives meet their quality and member outcome goals. Tom has 20+ years of sales and leadership experience within the healthcare market. He is also an expert on the 340B Program and helps health centers maximize 340B savings through better referral management.