“Since Monday and Tuesday mornings have the most missed appointments, these are the days we are considering overbooking,” says Ms. Boling. “We could add one additional slot in the morning. This fills the needs, but doesn’t put an undo burden on either provider or patients.”
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Explore This IssueNovember 2018
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Because few of its new patients miss an appointment, largely because they don’t want to go to the back of the multi-month waiting list, Ms. Boling’s group doesn’t overbook first visit slots. Also, it doesn’t overbook their nurse practitioners, reserving them for same-day appointments for a sudden flair or other complaint.
Computerization of scheduling has made it easier to start and maintain waiting lists. When last-minute cancelations or no-shows occur, people on the list are contacted until the spot is filled.
Discharge Final Option
The final option is discharging the patient from the practice. Those interviewed all agree this is used only after multiple missed appointments and specific and ongoing follow-up communications.
“This is a very stern measure, but it acknowledges the patient has a shared responsibility,” says Mr. Gans. “Avoiding discharge really starts at the first visit, informing the patient specifically and face to face about these policies.”
The general consensus is that a contact is made after the first no-show, asking the patient to get in touch and reschedule. The second puts them on probation, and they are told three could result in being discharged. If another appointment is missed, then the attending physician is contacted, and they make the termination decision.
“Rheumatologists typically spend a lot of time with each patient to provide the proper quality of care,” says Dr. Grunbaum. “Creating a system that helps reduce missed appointments is a win-win for everyone, especially those who don’t want to wait a long time to see me.”
Kurt Ullman has been a contributing writer to The Rheumatologist for 10 years.
Missed Appointments Viewed as Access Problem
The Sentara Medical Group in Virginia has taken a different tack for its no-show problems.
“We have worked on missed appointment concerns in the setting of access,” says Daniel J. Dickinson, MD, MPH, medical director for clinical integration and clinical chief of internal medicine. “We have learned these two are closely related, and if you provide good access, your no-shows go down. We take some of the blame for missed appointments from the patient and put it on us.”