Improving Productivity by Reducing No-Shows One Community Health Center

1
Improving Productivity by Reducing No-ShowsOne
Community Health Centers Story

• Joe Liszak, MBA
• Fremont Community Health Center
• Fremont, Ohio

2
We are not saints, but we have kept our
appointment. How many people can boast as much?
Samuel Beckett

• In the beginning........
• No show rate ran between 21-36 daily
• Revenue and expenses loss gt 200,000 per year
• Double/triple bookings schedule backups
• Patient satisfaction Poor due to wait times
• Staff overtime issues
• Policy was weak and ineffective

3
If you can find a path with no obstacles, it
probably doesn't lead anywhere.
Frank A. Clark

• Problem Identification......
• Formed an internal committee of eight employee
  representatives
• Monthly brainstorming meetings
• Worked through many emotions and feelings,
  especially regarding children and parent
  responsibility

4
You can have data without information, but you
cannot have information without data. Daniel K.
Moran

• Scope of the problem...
• Health center patients opted to use ER at a very
  high rate.
• Our health center was the only health care
  resource accepting Medicaid or self-pay in a 3
  county area
• Dental program was the only program in a 5 county
  area accepting Medicaid
• Dismissal of patient from health center left no
  other health care option.

5
I have found that the greatest help in meeting
any problem is to know where you yourself stand.
That is, to have in words what you believe and
are acting from.
William Faulkner

• Developing the policy....
• No patient dismissal suspension after three no
  show appointments in one year
• Written notification of each no-show third
  notification- Certified letter of suspension
• No-show algorithm
• No-show Appeals Process
• Required education class for patients to be
  reinstated

6
If we get it right, there need not be losers.
John Anderson

• Four years later....the fruits of our labor....
• 9 overall no show rate
• Increased revenue
• Much better patient flow
• Better patient outcomes due to compliance
• High patient satisfaction
• Much higher educated patient base

7
Our Education Approach

• Education is an ornament in prosperity
• and a refuge in adversity. Aristotle
• The next slides present an overview of
• the reinstatement class given to patients
• who no-show three times in one year.

8
Knowing the FactsTrue or False
T F Statement
Office hours are from 8 a.m. to 5 p.m.
An appointment must be cancelled 24 in advance.
Fremont CHC operates medical and dental offices
CHC was founded over 30 years ago as a migrant clinic
CHC sees patients even if they can not pay.
CHC has four other offices
To cancel an appointment a person can call 24 hours per day
Patients who keep their appointments, prevent health problems
Most ER visits are not emergencies
All patients are required to pay a minimum fee at the time of service.
9
Brief History of CHC

• Started in 1972 in Tiffin
• Moved to Fremont in 1978
• Started dental office in 1981
• Built a large addition in 1992 in order to have
  more doctors
• Added 3 other offices in the 1990s
• Became JCAHO accredited in 2000
• Added Pediatric office in 2005

10
Health Professional Shortage Area (HPSA)
Designation

• What is this?
• A HPSA area is an area that does not have
  enough doctors to serve the population. Sandusky
  County has a special populations HPSA which means
  not enough doctors to take care of the migrant
  population.
• What does this mean?
• This federal designation allows CHS to offer
  doctors and dentists positions with our
  organization and in turn, they can receive school
  loan repayment.

11
Other Service Providers

• Question
• Other than CHS, where else can I go for
  medical and dental services if I have a Medicaid
  card, or I am paying the bill myself?
• Answer
• Very few other providers accept Medicaid or
  patients who are self-pay, this is why it is so
  important that you remain a part of our system,
  so that you will always have a place for you and
  your family to receive care.

12
What Keeps People From Getting To Their
Appointment.

• What are some reasons patients miss their
  appointments?
• Cannot get off work
• Cannot find transportation
• Forget appointment
• No babysitter
• An emergency came up
• The weather was bad
• No phone to be able to contact the office
• Others??

13
How Can We Help You?

• Community Health Services employs a full-time
  Patient Care Coordinator to assist you. We have
  put together a list for you to take with you so
  that you can use one of these services in the
  future to help you keep your appointments. Here
  are some of those programs that may help.

14
How Do I Schedule an Appointment?

• By calling one of our offices from 830 am - 500
  pm
• Community Health Services-Medical 334-3869
• Community Health Service-Dental 334-8855
• Fremont Family Practice 355 -8186
• Birchard Medical Center 334-4428
• West Side Pediatrics 334-9137

15
How Do I Cancel an Appointment?

• You can cancel an appointment with our office 24
  hours a day by calling your doctors office
  number. The Memorial Hospital answering service
  will take a message and pass it along to your
  office.
• With our new computer system, you will have an
  option to cancel your appointment when you
  receive your courtesy reminder call.

16
Late for an Appointment?

• CHS policy states that all patients who arrive to
  an office more than 10 minutes late may be
  rescheduled. After that time, each office can
  determine if you can still be seen or not,
  depending upon appointment availability in that
  office.
• Please try to arrive at least 10 minutes early
  for your appointment.

17
Transportation Assistance

• TRIPS
• Fremont Taxi Service
• Care-A-Van
• Harts Ambulette
• Bellevue Four County Wheelchair Van
• Veterans Service Office

18
Social Services Assistance

• Catholic Charities
• WSOS
• WIC
• Share and Care
• Food Pantry
• Firelands Counseling and Recovery Services

19
Medication Access Assistance

• Patient Assistance Programs
• Some drug companies have programs for those
  in need. The Patient Care Coordinator at CHS can
  assist you with the paperwork.
• Samples given by CHS doctors when available.
• Share the Care Program
• Free medications for people who qualify.
  Distributed by CHS doctors when available.

20
Financial Assistance

• All CHS offices offer a sliding fee scale
• The local hospitals have Patient Care Assurance
  Programs

21
Cost of No Show THEN. . .

• In 2004 there were 28 no shows in the
• CHS medical and dental offices resulting
• in
• Medical office losses - 79,534 annually Dental
  office losses - 134,241 annually

22
Cost of No Show NOW!!

• Everyday there are 9 patients who no show in the
  CHS medical offices
• Everyday there are 4 patients who no show in the
  CHS dental office
• CHS medical areas lose 54,288 annually due to no
  show appointments
• CHS dental office loses 53,244 annually due to
  no show appointments

23
Ways the losses are made up.

• Increase in the charges
• Overbook patients
• Lay people off
• All of this causes
• 1. Longer wait times for patients who keep their
  appointments
• Additional time away from work for those people
  seeing the doctor during work hours
• More ER visits which are costly

24
Following the Doctors Orders.

• Keeps you and your children healthy
• Cuts down on the time you spend in our office
• Saves you money
• Creates more appointment time for others
• Reduces emergency situations

25
What You Can Do To Help?

• Call ahead to cancel an appointment
• This allows us to give your appointment to
• someone else
• Creates more appointment availability
• Frees our schedule so people can get appointments
  sooner
• Emergency patients can be seen quicker

26
Keep Us Up-to-Date

• Your current phone number and address will help
  us remind you of your appointment
• Helps us contact a family member in case of an
  emergency
• Current insurance helps us bill you correctly

27
What Have I Learned?

1. How do you cancel an appointment? When can it
   be cancelled?
2. What happens if I arrive late for an appointment?
3. Can someone assist me with medication costs?
4. Can someone help me with any other barriers?
5. How does no showing for an appointment affect me?
   
6. How does it affect CHS and other patients?
7. Are there other Medicaid/self pay providers that
   I can go to?

28
SUMMARY

• Men who do things without being told
• draw the most wages.
• Edwin H. Stuart

29
THANK YOU FOR COMING!

• ANY QUESTIONS?
• For More Information contact
• Joseph Liszak, MBA
• Chief Executive Officer
• Community Health Services
• 410 Birchard Avenue
• Fremont, Ohio 43420
• 419-334-8943 T
• 419-334-8619 F
• jliszak_at_fremontchs.com