Improving Productivity by Reducing No-Shows O ne Community Health Center’s Story

1. Improving Productivity by Reducing No-ShowsOne Community Health Center’s 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 > $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 Facts……True or False

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 8:30 am - 5:00 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 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.

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 • Hart’s 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 DoctorsOrders…. • 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? • How do you cancel an appointment? When can it be cancelled? • What happens if I arrive late for an appointment? • Can someone assist me with medication costs? • Can someone help me with any other barriers? • How does no showing for an appointment affect me? • How does it affect CHS and other patients? • 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@fremontchs.com