No Show Workgroup Survey Results and Recommendations Program Improvement Advisory Committee (PIAC) Susan Dymond, RCCO 7, and Emily Berry, HCPF 4/18/18 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 present recommendations developed by P&CI to PIAC 3
Outline • Potential Limitations • Results • Summary and Key Findings • Alignment Between Surveys • Recommendations and Discussion 4
Potential Limitations • Small sample size for individual questions • Resource limited • Selection bias 5
Member Survey Results • N=51, majority adults • 64% responded they 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
Member Survey Results Other reasons: ➢ Juggling many appointments ➢ Poor memory ➢ Mental health crisis ➢ Appointment rescheduled day before ➢ Exhaustion with newborn ➢ In hospital ➢ Bad weather/traffic In other words, LIFE HAPPENS 7
Member Survey Results • 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
Quotes from Member Survey • “Don't penalize us when we can't make it to an 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
Provider Survey Results • 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
Provider Survey Results • 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
Provider Survey Results • 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
Quotes from Provider Survey • “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: Suggestions Topics Suggestions from Survey Reminders • Ask patients what mode they prefer (call, email, text) • Provide automated opportunity to confirm/reschedule • 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: Suggestions Topics Suggestions from Survey Access/Barriers • More efficient, accessible transportation; skilled with power wheelchairs • Better use of and support from 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 dis -incentivize patients 15
Summary of Provider Survey: Suggestions Topics What Has Been Effective for What Providers Suggested They Providers Can Do Reminders • Confirm appt beforehand • Live person call patient • Contact multiple times • Auto text reminders • 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 shows no show appointments (reminder: this • Cancel appt without confirmation is prohibited by federal law for • Identify frequent no shows Medicaid clients) • Vary no show policy based on appt type • Accountability from payor • Incentive/reward system for patients • Adhere strictly to No Show Policy & • Improve practice work flow Procedures • Promptly identify frequent no shows and call patient to problem solve 16
Summary of Provider Survey: Suggestions 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 • Take time to develop relationship so (transportation, child care) patient values care • Improve customer service • Proactively address barriers; ensure • Support for on-site full time case transportation during scheduling manager • Reduce Medicaid population in practice Education • Inform new patients of no show policy • More outreach to patients who • When scheduling, ask patient to call to habitually no show and place with care cancel if cannot make appt coordinator • Consequences of no show appointments/understand accountability 17
Summary of Provider Survey: Suggestions Topics What Has Been Effective for What Providers Suggested They Providers Can Do Scheduling • Overbook • Increase same day • Timely appointments (not 3-4 appointments, flexibility months out) – depends on appt • Communicate cross-entities type • Account for no shows in scheduling • Develop a wait list • Reschedule within a week or two • Stop overbooking (more time to develop relationship) Technology • Use EHR to send automated • Technical assistance text/email reminders • Make portal more patient/family friendly • Track on reasons why patients no show and develop a plan 18
Alignment Between Member and Provider Surveys • Effective Reminders ➢ Consider member preferences • Timely Scheduling ➢ Depends on appointment type • Access/Barriers ➢ Care coordination support • Relationships/Attitudes ➢ Neither feel respected • Policy ➢ Incentives > Disincentives 19
Recommendations from P&CI to PIAC 1) Collaborate • Practices hold a WCC day coinciding with sports physicals at local schools to Increase Well • The Department, RAEs, and providers collaborate to create Well Check Checks toolkit (P&CI to lead) 2) Research • The Department researches ways to pay for care coordination and report Compensating back (e.g. billing, other incentives) Non-Medical Care 3) Support • RAEs support practices struggling with high no show rates (e.g. TA for Practices with tracking; cultural competency training for office staff) High No Show Rates 4) Share Survey • P&CI shares findings with MEAC Findings and • P&CI shares findings around transportation with the Department’s Best Practices Transportation Benefits Collaborative • Everyone shares best practices to support practices who are struggling with no show rates 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! Workgroup participants represented the following organizations: • CCHN • Mountain Family Medicine CDPHE Mountainland Pediatrics • • Community Care of Central Colorado NW Community Health Partnership • • • Consumer Advocate • River Valley Family Health Center HCPF RMHP • • • ICHP • Salud Family Health Center Kaiser Permanente Value Care • • MCPN • 23
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