The age-old problem of patients not keeping appointments was getting out of hand at the Fallon Clinic in Worcester, Mass., so its staff decided to do something about it.
With one in five patients at some of the clinic sites failing to show up, the staff decided to examine the issue through the formation of a risk management committee.
"Coming in for the appointment is the first part of compliance with someone's medical care," said William Primack, M.D., chairman of Fallon's risk management committee. "Follow-up is key."
Staff at the 300-physician multispecialty medical group also had been made aware of a case elsewhere in the state that led to a $750,000 malpractice ruling against a physician. The case, which had nothing to do with Fallon, focused on a patient's failure to come in for a follow-up visit: A man who had broken his leg took his own cast off rather than showing up for follow-up care.
With about $100 million in annual revenues, Fallon Clinic is part of Fallon Health Care System, which also includes Fallon Community Health Plan, a 160,000-enrollee HMO based in Worcester, and 400-bed St. Vincent's Hospital in Worcester.
The risk management committee included representatives from the hospital, the clinic and the health plan. Administrators were able to create a program to reduce the number of no-shows through efforts coordinated between the clinic and the health plan.
Both organizations realized the failure of patients to keep appointments with providers could impact the quality of care. No-shows also increase costs and create a potential for malpractice liability by interrupting care, the committee's studies showed.
Patient visits total about 950,000 at Fallon's 30 clinic sites in central Massachusetts each year.
The average no-show costs Fallon about $32, based on a typical 15-minute appointment with a primary-care physician. Since all physicians are salaried at Fallon, overhead and staff costs remain the same whether or not the patient is seen.
"We started with hiring telemarketers to call our patients two days before the appointment, and the evening before," Dr. Primack said.
The telemarketing program costs 25 cents per call. Each telemarketer makes about 66 calls an hour. Two-thirds of the patients are contacted.
Before the telephone reminder program began in 1990, the no-show rate averaged 9.2%, ranging from 5.1% at some clinic sites to 20.6% at others.
The average no-show rate dropped to 6.7% last year, ranging from 1.9% at one clinic site to 9.7% at another.
"If the patient tells the telemarketer they will be unable to keep the appointment, this is noted as a late cancellation," Dr. Primack said.
A list of these patients is then faxed to the physician's office at the end of the evening so the patient can be contacted the next day to reschedule. The canceled time can then be used for another patient.
In addition, all patients with appointments made more than five working days in advance get a telephone call to remind them.