No Show Survey Results Provider & Community Issues (P&CI) Subcommittee Susan Dymond, CHP, and Emily Berry, HCPF 3/8/18 1
Our Mission Improving health care access and outcomes for the people we serve while demonstrating sound stewardship of financial resources 2
Objectives • To summarize the results of the Provider and Member No Show surveys • To discuss findings and look for overlap between the Provider and Member surveys 3
Outline • Potential Limitations • Summary ➢ Member Survey ➢ Provider Survey • Suggestions ➢ Member Survey ➢ Provider Survey • Alignment • Discussion 4
Potential Limitations • Small sample size for individual questions • Resource limited • Selection bias 5
Summary of Member Survey • N=51 • 64% have missed appointment without calling to cancel first • Top Reasons: ➢ Timing issues (80%): includes forgot, family emergency/child care, work conflict ➢ Transportation (46%) ➢ Staffing and attitudes (30%): includes treatment by provider or staff 6
Summary of Member Survey Other reasons: ➢ juggling many appointments ➢ bad memory ➢ mental health crisis ➢ appointment rescheduled day before ➢ exhaustion with newborn ➢ in hospital ➢ bad weather/traffic In other words, LIFE HAPPENS 7
Summary of Member Survey • 9.5% responded they got care somewhere else. ➢ Majority went to another primary care provider • 65% respondents were contacted in advance ➢ Majority by automated or live phone call 8
Member Survey Quotes • “don't penalize us when we can't make it to appointment...we are doing our best” • “I haven't missed but you can get more doctor's who take Medicaid. You can train the staff, from the first person you meet at the counter, to the MAs, to the nurses and the doctors, that they should treat people on Medicaid better. Don't speak down to them. Don't make assumptions about them. Not everyone on Medicaid has a "choice"...many are there because of a disability or just a rough patch in life.” 9
Summary of Provider Survey • N=110, 81% primary care • Majority moderately concerned • 96% track no show appointments ➢ Average percentages ranged from 0.5% to 50% (78% response rate) ▪ Average = 11.57% ▪ Median = 10% ▪ Max = 50% ▪ Min = 0.5% ➢ 84% have a No Show policy 10
Summary of Provider Survey • 61% track by new/established patients New (n=49) Established (n=44) Average: 23% Average: 32% Median: 10% Median: 20% Max: 80% Max: 99% Min: 0.005% Min: 0.5% • 31% track by appointment type ➢ Most common: Well/Visit Preventive and Follow-Up (low acuity) ➢ Less common: Acute/Same Day and Procedure (high acuity) • Adults no show more often than kids 11
Summary of Provider Survey • 21% track by payer type Medicaid Medicare Commercial Self- Uninsured Pay Average 53% 8% 14% 9% 18% Median 49% 5% 10% 5% 0% Max 98% 26% 45% 35% 55% Min 6% 0% 1% 0% 0% • 24% track reasons for no show appointments ➢ 1) Forgot appointment, 2) transportation, 3) work conflict/family emergency/child care, 4) inconvenient appointment time ➢ Other: Unknown due to patient not responding to follow-up 12
Provider Survey Quotes • “Spend enough time with patients to develop a relationship with them so they value their care. Patients who don't actually want to be here change doctors; patients who do want to be here show up.” • “There is no solution. When your healthcare is free, you don’t value it.” 13
Summary of Member Survey: What Would Help? Topics Suggestions from Survey Reminders • Ask patients what they prefer (call, email, text) • Provide automated opportunity to confirm/reschedule appts • Contact 2-3 days before; plus day of for habitual no shows Scheduling • Later hours for patients who work • Consolidate visits • Timely (not 3-4 months out) • After hours number to cancel • Communicate cross-entities 14
Summary of Member Survey: What Would Help? Topics Suggestions from Survey Access/Barriers • Transportation that is skilled with power wheelchairs • More efficient, accessible transportation • Support from care manager • Better use of care managers • More providers • Provider on staff for walk-ins Attitudes • Be flexible • Better attitude • More understanding • Don’t discriminate against Medicaid Policy • Incentivize providers • Don’t disincentive patients 15
Summary of Provider Survey: What Helps? Topics What Has Been Effective for What Providers Suggested They Providers Can Do Reminders • Confirm by personal phone call (or other • Live person call patient method) • Auto text reminders • Use EHR to send automated text/email reminders • Multiple contacts (often 1 week prior and day before) • Contact in patient language Policy • Discharge after 2-3 no shows • Allow providers to charge patients for • Same Day/Walk In only after 2-3 no no show appointments (reminder: this shows is prohibited by federal law for • Cancel appt without confirmation Medicaid clients) • Identify frequent no shows • Accountability from payor • No Show Policy (vary based on appt type) • Adhere strictly to No Show Policy & • Incentives/Reward System Procedure • Improve practice work flow • Promptly identify frequent no shows and call to problem solve 16
Summary of Provider Survey: What Helps? Topics What Has Been Effective for What Providers Suggested They Providers Can Do Access • Emphasize goals/patient needs during • Work with care coordinator to find Barriers reminder call solutions to barriers of care Relationships • Ensure transportation during scheduling • Improved customer service • Proactively address barriers • Pick up patient directly • Take time to develop relationship so • Support for on-site full time case patient values care manager Increase access to care • Decrease Medicaid population • Address transportation, child care Education • Inform new patients of no show policy • More outreach to patients who • Ask that patient calls if cannot make appt habitually no show and place with care during scheduling coordinator • Consequences of no show appointments/understand accountability 17
Summary of Provider Survey: What Helps? Topics What Has Been Effective for What Providers Suggested They Providers Can Do Scheduling • Don’t schedule more than 2 weeks • More flexibility out • More same day appointments • Overbook • Communicate cross-entities • Timely appointments (not 3-4 • Account for no shows in months out) scheduling • Develop a wait list • Reschedule within a week or two • Stop overbooking (more time to develop relationship) Technology • TA assistance • Make portal more patient/family friendly • Track on reasons why patients no show PDSA and develop plan 18
Alignment between Member and Provider Surveys • Effective Reminders • Timely Scheduling • Access/Barriers (transportation) • Relationships/Attitudes • Policy 19
Next Steps • Provide recommendations to PIAC in April 2018 • Follow up with providers who shared their No Show policies • Follow up with members who requested follow up 20
Discussion 21
Contact Information Emily Berry, MPH ACC Program Performance Specialist Emily.Berry@state.co.us Susan B. Dymond, MBA, CMPE, CPC Program Manager, Provider Support, RCCO 7 Susan.Dymond@ppchp.org 22
Thank You for all of your valuable input and participation! 23
Recommend
More recommend
