Lesson 16 – How to increase patient visit volume by reappointing no shows

We all struggle with no-show patients. Here’s how you can re-appoint patients per month simply by mining the data in your EPM. This works well if you are willing to put a little bit of time and effort into it.

We all struggle with no-show patients. Here’s how you can re-appoint patients per month simply by mining the data in your EPM.

In the following steps, I will be using CareCloud as the sample EPM (you can substitute with your EMR/EPM).

Life is a LOT easier if you attach a healthcare focused CRM to your EMR. This works well if you are willing to put a little bit of time and effort into it.

  1. How many return patients do you need for this campaign to break even?

    Make sure that you know how many patients need to show up from this campaign per month before you breakeven. Do not start without defining this. 

  2. Get daily reports for no-show patients

    Try to be diligent about calling your no-show patients in the same week as their appointment. At a minimum, you can start with exported reports of daily no-show patients. If you want to take this initiative seriously, consider using a healthcare focused CRM that helps you with outbound dialing and is always in sync with your EMR. If you do not have a dedicated team to make these calls, hire a BPO team that does the calling and reporting for you.

  3. Identify the people, processes and technologies for your campaign

    Your first step is to identify the right staff, the processes you are going to follow to run the campaign, monitor the campaign, the outcomes you are expecting from this campaign and also the technologies you are going to deploy in the campaign.

    Keep in mind one very important point – the older this data gets (i.e. the longer it has been since your patient was a no-show), the harder it is to get these patients back to your door. So, make plans accordingly and staff your team accordingly.

    A simple math that you can follow is thus:
    – Typically, every day, an agent is going to be able to call about 200 patients once.
    – Out of these 200 patients called, they are able to connect with about 20% (i.e. 40) patients.
    – Out of the patients they talk to, about 70-80% agree to be re-appointed (about 30+)
    – So, effectively, out of 200 patients, you win 30 back, lose 10. This means that you are left with 160 patients to add to the next day’s workload.
    – Do the math accordingly and size your team correctly. The benefits are tremendous if you multiply each patient visit with your revenue per visit.

  4. Define your “no-show patients” campaign

    This means that you need to decide whether you are going to consider all patients that didn’t show up in the last one week or one month or six months as “no-show” patients. Our recommendation is that you define a campaign with patients that did not show up in the last 2 months (max) – No more than that.

    We discovered that after the 2-month period, patients tend to forget that they ever made an appointment with your provider.

    We all have situations where patients did not even show up for their first appointment. In our experience, we noticed that patients like these need to be treated a little differently than the patients who usually do come to see our providers but simply did not turn up for the last appointment. 

    For such patients that never showed up for their first appointment. we recommend that you consider them for a “no encounter” campaign instead. 

    You are also going to need to define the various legends that you are going to use in your campaign. 

    As an example, what are the various outcomes that you are going to accept from your calling team?

    Feel free to use this sample call center log spreadsheet (keep in mind that a healthcare CRM helps makes this easier).

  5. Define at least a few dispositions before you get started

    We use the following (you can have your own):

    DONE – this means that the patient was re-appointed
    NOANS – this means that the patient did not answer the phone. I recommend that your team calls them back next week (i.e. it goes into next week’s backlog)
    LVM – this means that the agent left your patient a voicemail. This is a bit tricky because if the patient calls back and books an appointment, usually another agent answers the call. You need to ensure that this agent also updates the spreadsheet with the fact that the patient now has an appointment hence should be removed from your no-shows campaign.
    WNUM – this means wrong number. Yes, it happens ALL the time.
    CBACK – this means that the patient has asked for a call back at a certain date/time or both. The agent needs to be able to set a reminder for themselves to call the patient back.
    LOST – this means that the patient has either found another doctor or has decided that they do not want to come in for an appointment (i.e their need has been met). Usually, I put these patients in another campaign to try and win them back.
    DCONN – this means that the patient’s phone number is disconnected. The patient population that my clients work with tends to have this happen to them (obamaphones).
    UNAVLBL – this means that for whatever reason the patient is not available, but the phone number is correct (e.g. someone from their family picked up the phone but your agents are not allowed to book appointments unless they speak to the patient directly)
    HUNG UP – this also happens wherein a patient simply hangs up. Don’t call them back immediately but try reaching out to them the week after.
    DNC – this happens (for whatever reason) when the patient does not want to be called any longer. They tell your agent to not call back again – these are a separate category of patients that are lost. DNC is something that I consider as non-recoverable, where as LOST patients is something that I consider as LOST for now, but will try to win back later.
    RECONFIRMED – sometimes due to data errors, the agent runs into situations where the patient has already called in and made an appointment to come back, but the agent’s spreadsheet does not reflect this new appointment. In that case, the agent simply confirms the new appointment date/time.
    DUPLICATE – happens all the time where the patient record is a duplicate in the spreadsheet they are working off of.

  6. Define max attempts to be made

    You also need to make sure you define the maximum number of attempts your team is supposed to give towards reappointing a patient before they mark that patient record as unrecoverable. 

    We have typically defined this as five(5) – ie our BPO team should call the patient at least five times before they give up on that patient.

  7. Prepare campaign data

    Export the patients marked no-shows/cancels in carecloud (reports/analytics section) as a CSV and save it somewhere that you have designated as HIPAA compliant. We include patients that “canceled” in this campaign primarily because most healthcare staff that we work with, did not seem to follow the same process of marking a patient as “no show” versus “canceled”. So we never know for sure whether the patient really wanted to cancel or was simply a no-show. 

  8. Enhance your spreadsheet (if you are not using a healthcare CRM)

    Enhance your combined spreadsheet with some columns to “sort of” make it like a CRM (this allows your staff to be laser focused on working the list). I tend to include columns like these (yours can be different to suit your needs).
    Assigned Date – the date this patient account was assigned to the agent. I want to monitor if they are actively working the accounts given or not.
    Disposition – outcome of the call
    Call date – 1st call date
    2nd call date – self explanatory
    3rd call date – self explanatory
    4th call date – self explanatory
    5th call date – self explanatory
    Notes in carecloud – whatever be the outcome of the call, the agent puts this in carecloud as an after call work.

    The following, you will get from carecloud exported CSVs anyway.. Some (not all) of these are needed for your agent to be able to effectively talk to your patient when they do answer the phone… 
    Appointment Date
    Appointment Time
    Nature of Visit
    Referring Physician
    Policy Type
    Member ID
    Cancellation Reason
    Cancellation Comments
    Referral Source
    Chief Complaint.. 
    Now that you have a defined spreadsheet, schedule a Carecloud report every day (end of day) of all patients that were deemed no-show/cancelled. This data will be added to the sheet you prepared in the step above.

  9. Execute your campaign 🙂

    You can decide to set aside a few hours each day, start dialing, dispose the call with an outcome, notes and follow up if any required. Since our clients work with at least 3-4,000 patient appointments per month, this usually requires multiple full time employees. 
    Keep adding to the list, keep working the list (never ending process). Understand the basic math as mentioned above. In one week, the backlog of calls to be made does add up significantly.
    Do not let patient data get stale.. If you need more agents to add to this team, do so and you will reap the rewards.

  10. Monitor your campaign

    Monitor the performance of your efforts and fine tune calling times if needed. We have noticed that certain kinds of patients tend to pick up the phone early in the morning, around lunch time and then again around 4 PM onwards. Another set of patient demographics seems to pick up the calls throughout the day. 
    We have also experienced that the conversion rate seems to decrease as the total number of calls to the same patient increases (just our observation). This means that if the patient picks up the phone in the first try, the chances of reappointing them are close to 100%, if they pick up at the second try, the chances go down a bit to around 70% or so, if they pick up on the 3rd try, it reduces further etc.. 
    Fine tune the number of calls to be made before you give up on that patient. We have vacillated between 3-5 calls, but we don’t ever truly give up on a patient. We simply move patients from campaign to campaign – if they have not rebooked within 3 calls, then we might move them to a completely different campaign altogether. 
    Play with power dialers (not robocalls) vs dialing manually – you can achieve a lot more calls per day but it does increase your phone bills significantly. 
    Good luck with this – keep at it and you will see HUGE monetary rewards. If you need any help, let me know.
    Next, let’s look a how to increase patient visit volume by recalling patients fallen out of care

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