As medical practice management consultants, we’re naturally always looking for ‘best practices’ we can share with all of our clients.  There is often a rub, though: what’s ‘best’ for one practice (or one practice type) may not be right for everyone.  When it comes to the best way to solve practice management problems, sometimes the only correct answer, as economists like to say, is ‘it depends.’

No-shows — how to deal with them, how to minimize them — are a great example of this sort of problem.  I’ve been participating in a lively discussion on the subject on LinkedIn in the medical office managers group.  The discussion was kicked off via a link to an article that seemed to have the definitive list of to-dos (and not-to-dos) to maximize show-rate — except that the comments from participants in the group suggested it wasn’t so simple.

Example: “don’t use postcards as reminders — they’re a waste of money and don’t improve show rates.”  But, the data cited in the article pertained only to a residency-based  family practice, and the study didn’t provide any information about the wording of the reminders.  But, other studies that weren’t restricted to academic family practices showed otherwise, although the relative benefits of postcards versus other reminder methods were less clear.  And other data show that multiple reminder types used together — a combination of postal and SMS text, for example — might deliver still better results.

Given the lack of clear data on an issue like no-shows, you may need to try different approaches and aim to continuously improve your practice’s performance.  The answer to the problem of the right mix of reminders for your practice is likely to be “it depends” … but, on what?  The good news is, you can think through some of the possible factors that will influence reminder success pretty readily, since you already know a lot about your patient base.

For example, you know something about the age of your patients.  A practice with mostly older patients — say, cardiology — might find that postcards are still among the best ways to remind patients (and may work best with a phone follow-up).  Busy moms, on the other hand, might be better reached for pediatric appointment reminders via text.

You might also know something about why some patients aren’t showing up (if you don’t, you should ask them!).  Are they afraid of bothering their physician because they’re feeling better?  Or just trying to avoid “unnecessary” co-pays for follow-up care when they’re feeling fine?  (Reminders need to focus on the importance of follow up care — even when a crisis is over.)

Response to reminders of different types will also depend on patient preferences, so it’s helpful to be patient-led and ask patients the best way to reach them.  (Are you collecting multiple contact data on your facesheets? And securing permission for email or text reminders?)

Marketers know that response to both medium and language in any kind of message needs to be tested — small wording changes can make a surprisingly big difference.  This could matter in your reminders, too.  For example, have you tested ways of informing people of the harm that skipping an appointment causes your practice?  (Some patients may not realize there’s any negative impact at all — they may even believe you’ll appreciate having less work.  Unfortunately, given how some practices overbook, the idea that a no-show is a bit of a relief may even be something they’ve even overheard at a previous visit.)

If no-shows are a problem at your practice, it’s best to start the process of improvement without buying into ideas that are too definitive, broad or dogmatic, and start trying different approaches that are tailored to what you already know (and are learning) about your own practice’s patients.

by Laurie Morgan

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