Sunday, July 28, 2013

Physician No Show Appointments Demoralize Doctors

I’ve had two jobs since I completed a fellowship is gastroenterology over 20 years ago. For the first decade, I was a salaried physician. Afterwards, I promoted myself to private practice. Each model has its advantages and drawbacks, but for me the private practice model wins out. The climate in Cleveland is extremely inhospitable to private practice, because of two mega-medical institutions that incinerate private practices as their boiling lava flows across the region. So far, our practice is still viable, but the prospects for its long term health and welfare are questionable.

One of the advantages of working for a straight salary is that income dies not depend upon productivity. (My employer maintained that we had a productivity bonus, but in reality there wasn’t much the physicians could do to adjust their salaries in either direction.) One of the disadvantages of private practice, particularly where I practice, is the need to hustle aggressively for patients, a task I neither enjoy nor do particularly well. In my present professional world, an empty schedule means empty collections.

So, when a patient decides to miss an appointment, the ramifications are quite different for me now than it was during my first job. At least when I was reading The New York Times during a gap in the schedule while I was on salary, my paycheck didn’t change. Not so these days.

My partners and I are forever lamenting the empty spaces in our schedules when patients do not show up or call in advance to notify us that they will not be coming.

These acts hurt us economically and forfeit an appointment slot that another patient would have happily occupied. Moreover, not showing up is downright inconsiderate. Sorry, if some readers find this latter view to be harsh, but I don’t wish to sanitize it as a venial sin.

Of course, sometimes life happens and an appointment is missed or forgotten. As a member of the human species, I get this. However, many of the patients who are AWOL at appointment times have been contacted a day before by a living, breathing member of our superb staff. Here, the absence is inexcusable.

Should these patients be assessed a fee for failure to appear? If a patient does call to cancel, how much notice is reasonable? 24 hours? 10 minutes? What if their insurance companies prohibit us by contract from charging patients these fees? Then, what leverage do we have?

Should we leave a heartfelt flyer in the waiting room pleading for cooperation on this issue? What good would that do? The ones who really need to read it aren’t there.



8 comments:

Andrew Price said...

As a patient and a patient advocate I agree that it is not acceptable to miss appointments. However, I am not without sin here. In the last three years I have missed one appointment and that was due to an error in adding the diary entry. I don't know if that was my fault or the secretaries but it happened. But when I was younger I missed a few and I admit that was on me. I like to think that all I could do to make up for it is to change my ways moving forward.

But why did I miss these appointments? I think a lot of it was psychological. While all my healthy friends were out playing sports and having fun I had to go to the doctor. Missing the appointment and going and doing what I wanted simply made me feel normal. I did have a chip on my shoulder and I did feel I had been cheated. Going to the doctor means one has to confront their illness and sometimes that can just be too hard.

And you are right Whistleblower, it is not fair on the doctor or other patients and I believe that a penalty fee is acceptable even if the insurance won't cover it. If a person is directly out of pocket it will make them think twice about missing the appointment in the future.

Ironically the person that potentially is hurt the most is the patient. Missing an appointment could mean a delay in diagnosis and or treatment. Small problems could become big problems and this could even be a fatal decision. Maybe this needs to be communicated to patient?

Michael Kirsch, M.D. said...

Andrew, it is refreshing to have a commenter actually sign his name. I appreciate your psychological angle, which I had not considered. Thanks for your view.

Ready Medical Staff said...

Thank you for sharing this perspective. Healthcare is a two-way street (or is it three or four?) Ready Medical Staff

Anonymous said...

I have been asking the same question(s) and have heard several approaches: 1. Send a bill for the agreed upon (in writing) fee;
2. Take charge card billing info and bill for missed appt.s; 3. Call the missing patient and notify fee must be paid at time of next appt.; 4. Decide to absolve the patient and hope "good-will" balances the lost revenue and costs of having the space, staff, and you waiting.
Feedback, please!

Michael Kirsch, M.D. said...

@anonymous above. Don't think this would work in reducing the no-shows. Good will doesn't seem to be enough of an incentive.

Chad said...

This is fantastic!

Maria Santi said...

I think if a procedure is truly necessary there is no reason to miss an appointment. If on the other hand the procedure or appointment is not really necessary there is a higher likelihood that it will be missed. A way to guarantee that appointments do not get canceled is by providing high quality care and an extending office visit that will be of value to the patient. For example, if I have a doctor's appointment, at times I know I would have to wait over an hour to then see the doctor for less than 5-7 minutes. If I have a greater priority that day and the procedure is not truly necessary I may do away with the appointment. On the other hand if I knew my doctor would spend an adequate amount of time with me and thoroughly address my concerns, I would be less likely to cancel should that opportunity present itself.

HenryCampbell said...

In most cases, doctors should know how to treat their patients equally. In my country, the rich will be carefully treated while the poor need to wait for a long time though they're heavily ill. That is not unfair. A good doctor should know his role and work with his conscience. Anyway, I like your post, as it is really authentic. Thanks for sharing with us!

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