Lesson 18 – How to increase patient volumes by calling patients that never showed up

We have all had situations where patients had made appointments with our providers, but never really showed up for their first appointment (where we can bill as a “new patient visit”). Read this guide to bring them back to the practice. Feel free to use the sample CRM spreadsheet to fit your needs

This is a whole lot easier if you use a healthcare CRM and an automated communication solution like ours. We have all had situations where patients had made appointments with our providers, but never really showed up for their first appointment (where we can bill as a “new patient visit”). These were patients that were not really familiar with our client’s practice, nor did they really know about the amazing bedside manners or the skills of our providers.

So, this was almost like a “cold call” with a hope that the patients might remember their first appointment. When we started, we had hoped that patients would recall making the first appointment.. But alas, the older the data was, the more we found our that the patients didn’t even know who the provider was nor who our client’s practice is/was.

The patients didn’t remember when their PCP had referred them to our specialists. When they did pick up the call, they asked the agents “OK, tell me who my PCP is”.. Unfortunately, our client’s staff wasn’t very regimented at capturing the referring PCP information, so more often than not, the agents could not answer this directly – however, choosing the right agents that could handle these questions with a slight change in the script helped iron things out.

  1. Prepare the team

    If you have a call center team that is willing to make “cold calls” or “sort of cold calls” – this campaign can produce very good results. Again, dig into your EMR to find all patients that never showed up for their first appointment, remove the patients that might already be part of a no-shows campaign and get running with this. Your agents will have to have laser focus and not get disheartened at the rates of conversion, but that’s also why you need hard core agents with sales skills and the thick skin to take rejections all day long for this campaign.

  2. Identify and train the team

    You are going to need the right people / staff with the right skill set for this. Most of our call center staff do have decent sales skills, but this was a different breed – we staffed this with folks that have cold calling experience. It worked very well as that’s precisely what was required.

    Your team’s job is going to be to make patients understand that despite the fact that the referring PCP info is not always available with them.. There was a reason why their PCP had referred them to your practice…  and to have the patients agree to coming back in to you see your provider(s).

  3. Use some kind of a CRM

    We started with spreadsheets, but ended up moving to our own healthcare focused CRM (life was hellish before that).

    You are going to need to have a team that knows excel spreadsheets well enough – even then, managing the volume of data is on the hard side.. If you use a healthcare focused CRM, it does get easier (my experience).

  4. Do the return on investment math like this (or something similar)

    – We noticed that 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 30-40% agree to be re-appointed (about 15)
    – So, effectively, out of 200 patients, you win 15 back, lose 25. 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. Keep in mind – what do you have to lose? Anyways, these patients never came in.. at least this was a “sort of” warm call.. Not the coldest of cold calls.

  5. Define your campaign

    When we first started this campaign, we decided that we are going to try and call all patients that we have in our client’s EMR – that never came in for their first appointment. Do keep in mind that every day, more patients keep being added to the list BUT they go into our “no-shows” campaign – this was a one time, huge effort to try and bring those older patients back.

    So, we decided to only include “no encounter” patients older than 2 months (since our no shows campaign takes patients that no-showed in the last 2 months and runs with it.

    Same goes here… Define how many attempts you are going to make. I don’t recommend calling the same patient more than twice a month.. That means, every month, a patient will get exactly two calls from my staff. Keeping in mind that the older the data, the harder it is to reach the patients, you’d arguably want to try the older patients first – BUT a very important point to keep in mind is that your team will not be as motivated when their conversion rates are on the low side (bound to happen with older data).

    Play with a mix of such patient data – mix older data with newer ones so that it keeps everyone happy. Trust me on this – the older the patient data is, the more disheartened your calling team will get.

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

  6. Define reports

    Define reports before you start (fine tune later). As an example, what are the various outcomes / dispositions that you are going to accept from your calling team?
    Here’s a sample spreadsheet to get you started.

  7. Decide on call dispositions

    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 in 2 weeks
    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 2 weeks 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.
    Our agents also started color coding legends to make their lives easier

  8. Prepare your campaign’s data

    We are going to give you an example with Carecloud – just because our latest client uses Carecloud as their EPM (their EMR is on EMA).

    Preparing the baseline data is going to require some work. Export the patients from your CareCloud analytics tab (in your case it could be some other tab of your EMR). Make sure that this spreadsheet gives you the following info:
    – Last Encounter Date
    – Last Appointment Date
    – Next Appointment Date

    Move patients to a new spreadsheet where the following conditions are met:
    – Last encounter date is null or blank
    – Last appointment date is older than 2 months from today. You do not want to take the patients whose last appointment date is within the last 2 months because they might be part of your no-shows campaign (if you are running one). If you are not running a no-shows campaign, then you can include those patients.

    Now, filter out patients that have a next appointment date in the future (as I am sure you will catch those in an appointment reminder campaign)

    Keep in mind that you will have to run this kind of an export / report every week (or every day) and add more patients that have fallen out of care. You can very easily schedule a report every day to get fresh data (in carecloud, you simply schedule a report from the analytics tab).

    Save this somewhere that you have designated as HIPAA compliant.

    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). We tend to include columns like these (yours can be different to suit your needs).

    Disposition – ie. the outcomes we discussed above
    Appointment Date – if and when an appointment is booked, that appointment date.
    Remarks – usually we use this for what the patient said, the insurance details (if updated)
    LAST CALL DATE – so that each agent knows when the patient was called last (this is super important as you don’t want multiple agents calling the patient and ticking them off).
    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… 

    Extra columns
    Patient, Appointment Date, Appointment Time, Provider, Location,Nature of Visit, Phone, Referring Physician, Chart, DOB, Policy Type, Member ID, Co-pay, Balance, Status, Comments, Cancellation Reason, Cancellation Comments, Payer, Referral Source, Eligibility, Resource, Chief Complaint etc.. 

  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 typically hand us more than 8K patient records, this usually requires several FTEs. You can go ahead with lower FTE count but as the data gets older, it is harder to connect with patients.. So, you are better off with a much higher FTE count initially to avoid data getting further more stale.. Once you have “caught up” with the entire backlog (maybe over a year or so), you can reduce the headcount. 
    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.
    We allow agents to call the patient twice a month and have a target of 200 patient calls per agent per day. So, in 2 weeks, they have a target to call 2,000 patients. Let’s say they are able to re-appoint back 10% of the patients. That means they have converted 200 of those patients.. So, they are left with maybe 1800 patients from these 2 weeks. We add these 1,800 odd patients plus get 200 new / fresh new patients from the larger backlog and run the same campaign over the remaining two weeks of the month.
    Our math based on my experience for an 8K database of “no-encounter” patients was that each agent is going to handle 2K patients per month, hence 4 agents were needed to start this correctly.
    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 and improve

    Monitor the performance of your efforts and fine tune calling times if needed. You will see 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. 

    Patients were also not as willing to be re-appointed in this campaign because they didn’t even remember that they were referred to New York Ophthalmology, or they didn’t remember ever making an appointment (made us look like idiots).

    Try power dialers (not robocalls) vs dialing manually – you can achieve a lot more calls per day but it does increase your phone bills significantly. Be careful with extremely high volume of calls. You need to plan for the total number of outbound numbers you will purchase. 

    Good luck with this – keep at it and you will see HUGE rewards. If you need any help, let us know.

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