Medicaid beneficiaries may provide revenue, but no-shows cost
Does this sound familiar? Physician Dr. Smith practices in a low-income area, where most of her patients are Medicaid beneficiaries. Most days, Dr. Smith arrives at work with a fully-booked schedule awaiting her. After seeing her first patient, she learns that her next appointment hadn’t yet arrived and wasn’t answering his phone.
The next three patients also failed to arrive. By day’s end, eight of Dr. Smith’s twenty Medicaid-insured patients scheduled for the day were no-shows.
If this has happened in your practice, or you’re thinking of accepting Medicaid in your practice, read on.
High no-show rates pose serious financial and healthcare concerns for providers. In a survey of family medicine, cardiology, dermatology, obstetrics, gynecology, and orthopedic surgery, providers’ Medicaid acceptance rate was 55.4% in 2009, but just 45.7% in 2014. (1) In fact, “the provider that accepts a large number of Medicaid patients and makes it work for his or her practice is much like the fabled unicorn: there are rumors that they exist, but no one has actually seen them.” (1)
Since the Affordable Care Act (ACA) became law, many states have expanded their Medicaid programs, meaning that more patients are now Medicaid beneficiaries than ever before. A study by the Illinois College of Optometry found that the average overall no-show rate in their clinic was almost 25% -- but among their Medicaid patients, the number jumped to over 41%. (2)
Because Medicaid patients typically have lower incomes (as compared to privately-insured patients), they face more hurdles to obtaining care. Transportation costs to get to-and-from medical appointments, unpaid time off of work, and childcare can be cost-prohibitive and make it impossible to make their appointment.
These issues are intransient such that an individual provider is unlikely to be able to remedy them in the daily operation of their practice. But that doesn’t mean that you shouldn’t take Medicaid. In fact, addressing this issue means that you should.
Inexpensive measures -- such as better provider-patient communication and ensuring that appointments are compatible with mass transit schedules -- can alleviate no-shows considerably.
One study found that poor appointment scheduling procedures are responsible for a third of missed appointments – that is, the patients weren’t asked about their preferred appointment times. (2) Evening appointments, when public transportation is less available, saw the highest no-show rates. (2) Both of these practices have easy fixes: Ask patients for preferred appointment times and be mindful of transportation schedules, especially for evening appointments.
Another way to avoid no-shows to ensure that you have current contact information for your patients. Most practices attempt to confirm appointments, but due to a failure to keep updated records, many are unsuccessful in reaching patients with the reminder. (2) Practice staff should identify the best way to reach patients at the time of scheduling, which could potentially reduce no-shows by 30%. (2)
Education is also key to improving patient compliance with scheduled visits. Listening to your patients’ fears about the appointment and ensuring that patients understand your advice and answers is crucial. Whether they be language, educational, or societal barriers interfering with your provider-patient communication, they’re likely responsible for some of your no-shows. Often, “noncompliant” patients simply don’t understand the importance of follow-up visits or are avoiding them because of fears that you can compassionately address with them. (2)
Because of the frequency of no-show patients, many practices have begun double- or triple-booking appointment slots. This practice (while understandable) is counter-productive and disrespectful to patients. Those patients who do come to their appointments, only to learn that the provider is double-booked, will be the ones who suffer with rushed visits and long waits in the waiting room. After that experience, they become more likely to no-show for subsequent appointments.
Successfully managing a high Medicaid-population practice means striking a balance between business realities and providing dignified and quality care to this vulnerable populations. If you’re struggling to do this, please reach out! We have some ideas.
(1) Tammy Worth, Treating Medicaid Patients, Medical Economics, (Feb. 18, 2015).
(2) Robert W. Moses, Approaches for Medicaid Patient No-Shows, American Optometric Association.