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Providers aim to cut missed appointments


By Timothy Magaw, Crain's Cleveland Business
Posted: November 12, 2012 - 11:15 am ET
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Cleveland-area healthcare providers are taking a crack at reducing the number of patients who are no-shows for appointments, as an absent patient often means absent revenue.

Though it might seem like a minor inconvenience, missed appointments can cost hospitals and doctors' offices big bucks — and in an era of tightening budgets and declining reimbursements from government and commercial payers, every dollar counts.

Officials at Akron General Health System say missed appointments accounted for roughly $18,000 in lost revenue each month for just its cancer program.

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“Our drugs are so expensive and the volume of patients is increasing so much that it was really putting a crunch on us,” said Connie Bollin, executive director of oncology services at Akron General.

Ms. Bollin said the cancer center's no-show rate hovered between 15% and 20% before hospital volunteers in September started calling patients to remind them of their appointments. The gentle reminder, she said, accounted for a 25% decline that month in the number patients bailing on appointments.

From reminder phone calls, emails and text messages to sending vans to pick up patients, Northeast Ohio's healthcare providers are looking for new ways to ensure their patients stick to their schedules. Healthcare officials say while it's good for their bottom lines, it's also good for their patients' health.

“We try everything we can to mitigate no-shows in order to maintain the continuity of care for our patients,” said Bryan Fredericks, chief operating officer for Summa Physicians Inc., a multispecialty group of more than 270 physicians associated with Summa Health System in Akron.

Such efforts include a mailed reminder and a phone call—not an automated message but rather a conversation between a Summa staffer and the patient about the pending visit and whether he or she needs to bring any additional information.

Wallop to the wallet

By their nature, Northeast Ohio's health care organizations have a high amount of fixed costs given the rate at which they've acquired hospitals and physician practices over the last 20 years, according to David Dumpe, an associate professor of finance at Kent State University. As such, hospital administrators are aware of what they must earn in order to break even and, in a best case scenario, turn a profit.

“When somebody misses an appointment, those dollars are not going to show,” Dr. Dumpe said. “Then you've got an awful lot of expertise and infrastructure just sitting on the shelf not being paid for.”

Giving medical providers further incentive to reduce no-show levels is the federal government's decision to siphon Medicare dollars starting this fall from health care institutions with high readmission rates. Regulators plan to withhold a portion of Medi-care payments — starting at 1% and rising each year — for hospitals with 30-day readmission rates that are above the national average for patients with certain chronic conditions.

Some health care providers say readmissions are due in large part to patients who skip out on their follow-up appointments.

Touching base

The Cleveland Clinic and University Hospitals for years have dispatched automated appointment reminders, including letters and phone calls, to patients. But as Northeast Ohio's two largest health care enterprises upgrade their information technology infrastructure, they're introducing tools that could trigger fewer patients to brush off their health care.

University Hospitals is installing a new billing and scheduling system throughout its regional network of 1,500 physicians that will include new ways to communicate with patients that should help mitigate no-shows, according to Dr. Michael Nochomovitz, president of University Hospitals Physician Services. The new system has a secure online interface where physicians can send patients reminders. Inversely, patients will be able to send their physicians messages with any questions they might have about their care.

The Clinic, which boasts a system-wide no-show rate of about 12.5%, is launching a pilot initiative to remind patients via text message of their appointments at its Stephanie Tubbs Jones Health Center in East Cleveland, which sits near the site of the now-shuttered Huron Hospital. The health center's patrons — who to a large extent are low-income people, often without landlines — will be able to confirm or cancel their appointment via text message, according to Mary Curran, executive director of special projects at the Clinic.

Also, Ms. Curran said the Clinic's same-day appointment campaign, which launched earlier this year with an ad that aired during the Super Bowl, is designed to fill empty slots created by those patients who make last-minute cancellations.

“It would put pressure on any health care system when you have any blank slots,” Ms. Curran said. “That's just a given. There's always somebody behind (someone who cancels) that needs access.”

Urban challenges

Hospitals and physician groups that mainly serve low-income patients often struggle with the highest no-show rates. The MetroHealth System, which is subsidized by Cuyahoga County, sees a no-show rate of as high as 25% in some of its service lines, according to Dr. Alice Stollenwerk Petrulis, its medical director of managed care.

MetroHealth has tried to steer many of its patients away from using its emergency department as a one-stop shop for routine care and instead guides them toward primary care physicians. Often, however, those patients don't show up for scheduled appointments.

To combat that problem, MetroHealth is employing care coordinators to act as concierges of sorts in setting up patients' care. MetroHealth also has a van service that transports patients to its main campus — a service it hopes to expand to its community health centers in the coming months.

“It's a matter of meeting a patient at their current state and finding out their barriers and helping them surmount those barriers,” Dr. Petrulis said.

St. Vincent Charity Medical Center in downtown Cleveland faces similar troubles, according to Nan Woldin, its director of revenue cycle. The hospital, for one, is looking to cut down on the number of patients who cancel pre-admission testing appointments — the important step before a patient is cleared for surgery.

Ms. Woldin said surgeries are a revenue driver, and canceled pre-admission tests often set back surgeries. She said it's harder to fill an empty surgery slot than a diagnostic procedure such as an X-ray because a surgical procedure often requires specialized staffing.


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