5 ways to reduce no-shows in orthopedic practices

How digital tools can help practices reduce no-shows

In the fast-paced world of orthopedics and pain management, few things are more frustrating to a practice manager than patient no-shows and late cancellations. The staff inefficiency, the unused clinical capacity, the impact on patient care and practice revenue — a suddenly empty appointment schedule is a workflow nightmare with potentially significant operational consequences.

By one estimate, patient no-shows cost the medical industry around $150 billion per year, with individual physicians losing as much as $150,000 annually due to missed appointments.¹ It’s a complicated and persistent problem in practically every healthcare setting, but it’s especially common in outpatient orthopedics, where no-show rates can be as high as 39 percent.²

The reasons for no-shows in orthopedics, and pain management in particular, are well known to most practice managers. Reasons include everything from last-minute fluctuations in a patient’s symptoms that make it too painful to get to their appointment to setbacks like pre-authorization delays or issues around imaging coordination. Patients also skip appointments because they feel better and think that seeing a doctor is unnecessary. For some, when a procedure is scheduled far in advance, they disengage and simply forget.

Historically, practices have fought against no-shows with phone call reminders and paper waitlists, or strategies like overbooking. But these manual workarounds aren’t always practical when staff are already stretched thin. Similarly, given the revenue challenges in the industry, many clinics can’t afford to depend on ad hoc solutions that may not be effective. Every missed appointment means additional financial strain, and additional pressure on practice operations.

Today, a better approach is to leverage technology to try to reduce missed appointments automatically while freeing up staff to focus on other tasks. Here are five ways practices can use digital workflow solutions to attempt to close their no-show and late-cancellation gaps.

1. Use predictive analytics to identify high-risk patients

The first step in the no-show-reduction process: Establish a system for identifying those patients most likely to skip or late-cancel their appointments. Those include patients who are new to the practice, or those with months-long wait times between visits. The key to moving from reactive to proactive scheduling is identifying who these “high-risk” patients likely are.

At one time, this meant staff making educated guesses or parsing the schedule patient by patient, but practices can now do the work faster and more effectively with predictive tools embedded within the electronic health record (EHR). These AI-driven solutions can analyze data on scheduling trends, patient demographics, and referring providers. Practices can then use that information to identify patterns for use in their own forecasting of peak visit times, or to predict the spots in clinicians’ schedule that are most susceptible to developing holes.

For front desk staff, this kind of predictive power gives them the upper hand in scheduling. They can use schedule adjustments and selective overbooking, and, for high-risk patients, targeted text reminders and calls. They’ll spend less time worrying about gaps in the schedule and more on constructive efforts like preventing those gaps from opening in the first place.

2. Automate patient outreach and streamline pre-visit workflows

While identifying high-risk patients is critical, it’s equally important that practices develop strategies for connecting and communicating with those patients. For those with significant pain, especially, reminders received at a regular cadence will provide reassurance, as their appointment date approaches, that relief is on the way. Or consider the patient scheduled for a knee replacement who may decide to cancel if she’s concerned about finding transportation to her next visit. A campaign of clear and consistent communication — through automated text, email, and voice-call reminders — could help her stay focused on the reasons for her appointment: pain relief, better mobility, and better quality of life.

Practices can begin before the patient’s first appointment with digital solutions like automated insurance-eligibility checks designed to speed up and streamline pre-visit workflows. They can leverage AI-powered tools (via “AI triage”) to keep the lines of communication open round the clock, for example. They can also provide two-way functionality on automated calls and texts to encourage patients to confirm their appointments.

Digital solutions like patient portals and mobile apps also allow patients to message clinicians, check their health information, and complete pre-visit tasks online from anywhere. Make fulfilling pre-visit requirements easy and convenient for patients, and chances are they’ll decide to follow through when the time comes to actually show up for the appointment.

3. Reduce scheduling friction with digital self-service tools

Last-minute conflicts that keep patients from their appointments can sink even the best-planned orthopedic schedule. When one patient doesn’t show up, a little shuffling will probably fill the gap. But two or three with absolutely no warning, back to back on the same morning? Unless a practice is very nimble or overbooked, that’s a difficult and potentially expensive problem.

The fact is, a patient experiencing a pain flare the night before their appointment may not prioritize calling the practice first thing in the morning to explain that they’re unable to come in. Patients are more likely to no-show when rebooking is inconvenient. And for many, if they can’t do it quickly and easily, they may not reschedule at all.

The solution, again, is for practices to offer online and mobile-friendly tools designed to reduce scheduling friction. If a patient can move their appointment on their own, and pick a new time that works better for them, that could make the difference between a straightforward rebook and the patient simply not showing up. And these online tools can allow patients to make those changes at all hours, including when the practice isn’t open. For front desk staff, that could be just what they need to fill the open appointment slot with a different patient.

4. Shorten lead times with smarter scheduling and capacity management

Because longer lead times (days to appointment) are strongly associated with increased no-show rates³, practices looking to keep schedules full have to find ways to shorten patient waits. One proven way to do so is by leveraging technology that allows patients to see and book available appointment slots as they become available.

With AI-enabled waitlist scheduling, for example, practices can automatically identify appointment openings in real time due to cancellations, and immediately send text messages to already-scheduled patients who may wish to move their appointments up. In a high-volume orthopedic practice with relatively long appointment blocks where every empty slot has an outsized financial impact, it’s a solution that can keep schedules full with minimal staff involvement. It’s also a path to better patient satisfaction as they enjoy the benefits of faster access to care.

5. Expand access with telehealth as a same-day alternative to cancellations

Another way to deal with the no-shows and cancellations that tend to wreak havoc on orthopedic practices is to offer same-day virtual visits as an alternative to patients’ regularly scheduled appointments. For visits like chronic pain follow-ups, or for imaging reviews or post-procedure check-ins, telehealth can help make sure the encounter stays on the books.

Especially if the telehealth solution is integrated with the practice’s EHR, it’s a simple solution to a potentially schedule-busting problem like a patient calling in sick at the last minute. Patients should be able to meet with their provider from any browser on their phone, tablet, or computer. And the visit shouldn’t require any downloads or new logins — just access to their personal patient portal.

An added benefit for practices is that telehealth is a technology that patients of all stripes want as an option. By offering telehealth, orthopedic clinics can meet high-risk patients where they are, but they can also drive more revenue by increasing the number of appointment slots available to patients overall.

athenaOne®: an integrated platform that solves the no-show problem

While a certain number of patient no-shows are probably inevitable in orthopedics and pain management, it's likely they can be significantly reduced with some easy-to-implement technology-driven strategies. The key is for practices to recognize that no-shows are manageable workflow problems. They don’t typically happen because patients don’t want to come in. They happen for reasons out of their control, or because rescheduling is too difficult.

athenahealth’s solution to the patient no-show problem is a comprehensive communications suite available to users of athenaOne, which includes features like real-time eligibility verification, referral tracking, and patient engagement and telehealth capabilities. It also includes a solution called “Patient Conversations,” an AI-native, automated outreach tool that delivers appointment reminders, offers scheduling support, and provides answers to routine patient questions.

Ready to reduce no-shows and late cancellations at your practice? Learn how athenaOne can help while optimizing scheduling efficiency.