Transcript Slide 1

Improving Productivity by Reducing No-Shows
One Community Health Center’s Story
Joe Liszak, MBA
Fremont Community Health Center
Fremont, Ohio
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“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 > $200,000 per
year
• Double/triple bookings = schedule backups
• Patient satisfaction = Poor due to wait times
• Staff overtime issues
• Policy was weak and ineffective
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“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
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“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.
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“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
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“If we get it right, there need not be losers.”
John Anderson
Four years later....the fruits of our labor....
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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
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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.
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Knowing the Facts……
True 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.
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Brief History of CHC
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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
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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.
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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.
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What Keeps People From Getting
To Their Appointment.
What are some reasons patients miss their appointments?
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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??
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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.
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How Do I Schedule an Appointment?
By calling one of our offices from 8:30 am - 5:00 pm
Community Health Services-Medical
Community Health Service-Dental
Fremont Family Practice
Birchard Medical Center
West Side Pediatrics
334-3869
334-8855
355 -8186
334-4428
334-9137
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How Do I Cancel an Appointment?
• You can cancel an appointment with our office 24 hours a
day by calling your doctor’s 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.
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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.
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Transportation Assistance
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TRIPS
Fremont Taxi Service
Care-A-Van
Hart’s Ambulette
Bellevue Four County Wheelchair Van
Veterans Service Office
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Social Services Assistance
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Catholic Charities
WSOS
WIC
Share and Care
Food Pantry
Firelands Counseling and Recovery
Services
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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.
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Financial Assistance
• All CHS offices offer a sliding fee scale
• The local hospitals have Patient Care
Assurance Programs
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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
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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
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Ways the losses are made up.
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Increase in the charges
Overbook patients
Lay people off
All of this causes
1. Longer wait times for patients who keep their
appointments
2. Additional time away from work for those
people seeing the doctor during work hours
3. More ER visits which are costly
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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
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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
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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
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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?
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SUMMARY
Men who do things without being told
draw the most wages.
» Edwin H. Stuart
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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
[email protected]
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