How to make the most of patient scheduling reminders
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Did the patient get the reminder about an upcoming appointment or the need for some future medical service? The answer might depend on how that reminder was delivered: telephone, email, text, fax, instant message and even mail.
“Some people don’t want to be bothered with phone calls,” said Jane Cho, manager of medical practice affairs with the California Academy of Family Physicians. “Some patients don’t have email. There are so many scenarios.”
Those who develop reminder and recall systems at medical practices say the first step to figuring out what patient reminders will ensure that appointments are kept and medications are taken is to consider how the patient population wants to be reminded, and what the practice wants to remind them about. It might take a few tries to find the right solution, and several solutions may be needed for the various situations.
“Unfortunately, there’s no simple answer, because some strategies that will work in an older population will not work in a younger one,” said John Brewer, president of MedTech-USA, based in Macon, Ga., that helps practices comply with the Health Insurance Portability and Accountability Act. “It depends on the physician’s client base.”
The telephone game
Email and social media tend to be used more for general information about the practice than patient-specific notices, but many practices use the telephone for appointment reminders 24 to 72 hours before a visit. This time period will vary depending on how quickly the practice can fill an empty spot if the call results in a cancellation. Automated services are becoming more popular because in some situations they may be more cost-effective.
For example, CardioVascular Associates of Mesa, Ariz., with nine physicians and three offices, used to have staff call patients for their appointments the next day. It has since switched to automated phone calls. The system notes whether a person answered the phone, the line was busy or a message was left on voice mail. The practice recently added the option for patients to hit a number key that transfers the call to the office if they need to reschedule or have other questions. If they need to cancel, this gives the office enough time to call a patient on the waiting list.
“It’s a critical step — and if patients don’t get a reminder call, they will say something,” said Kyle Matthews, the practice’s CEO. “Most patients appreciate it.”
For this service, the practice paid a setup fee to an outside vendor, and then pays about seven cents per phone call. Matthews describes the automated reminders as “worth every penny.”
However, practices might find success when staff members make calls. A study in the June 2010 American Journal of Medicine analyzing data on a outpatient speciality clinic found that 23.1% of patients who were not called did not show for their appointments. That number declined to 17.3% if called by an automated service and 13.6% when called by a staffer. For this reason, Matthews said, patients who are booked for a nuclear imaging procedure are called by office staff. The expensive radioactive material used in these scans means that a no-show can be particularly costly.
Sending a letter or text
If patients with CardioVascular Associates need another appointment, they generally don’t leave the office until another one is scheduled. But some practices also need to think about the different strategies to recall patients for preventive services and appointments. These are usually sent by snail mail.
For instance, the staff at Rush-Copley Medical Group in Aurora, Ill., identifies what they want to remind patients of by looking at the quality metrics they want to meet. They issue voice-mail blasts as well as mail postcards and letters to alert patients of the availability of flu shots and other preventive services.
“Patients are also consumers,” said Lucy Mayhugh, the group’s director of practice operations. “They have options, and we have to take advantage of the technology that’s available.”
Some companies offer text messages as a means of reminding patients. The staff at Rush-Copley are thinking about this option because they have a broad patient base, many of whom want such reminders. But CardioVascular Associates has decided against text message reminders. Most of its patients are older than 65, and administrators do not believe texts would get much buy-in. Sending text messages to patients would require their permission.
No matter what system a practice chooses, doctors need to keep legal issues in mind, particularly HIPAA. Medical practice experts recommend that when communicating by phone or text message, doctors should balance the need to trigger someone to show up for an appointment or reschedule with the need for patient privacy. The object is ensuring only the intended recipient gets the message.
“The information should be as generic as possible,” Brewer said.
When reminding patients of appointments, experts recommend giving the time it is scheduled and the physician’s name, but not much more. Recall notices can suggest the availability of certain services but should not reveal private medical information.