Missed Visits and Reduction in ED utilization Common reasons for missed visits Missed visits reasons from the patients point of view The benefits of telemedicine Medicare gap coverage Telemedicine Reducing cancellations/missed visits Patient Engagement Ideas for the future

Common reasons patients give for missed visits TELEPHONE DISCHARGE ASSESSMENT Transportation issues I was starting to feel better I was just there a month a go It was only a follow up I forgot It’s easier for me to go to the ED and get a refill I had all of my medications I already knew what they were going to say

Barriers, the patient’s point of view Emotional (65%) Negative anticipation about what will be said Fear of the unknown Self-resolving symptoms Perceived Disrespect of the Patient’s Beliefs' and Time by the Health Care System (44%) Time (next available appointment is in 5 days) Opinions (what I think about my health) M-4 Feelings (not taking my concern seriously) Waiting in the waiting and examination room http://www.annfammed.org/content/2/6/541.full.pdf

Medicare Coverage Gap During this time, patients are paying more for their prescription medications. For patients who can’t afford their medications, they may: -Skip Doctor’s visits (if it is associated with a refill) -Self medicate (allowing their medications to stretch over a longer period of time) -Failure to medicate (saving their diuretic until their feet are swollen) Healthcare providers should be asking patients if there are any barriers to filling their medications today. This allows the provider to offer resources as well as making adjustments in the treatment plan. i.e.- substituting another medication. Ultimately, this can save an unnecessary ED visit.

Your Benefits Now Include Telemedicine What is Telemedicine? A “virtual” doctor visit The next phase of health care Quality care Convenient care Cost effective care Growing trend for millennials 67% of Telemedicine users are ages 21 – 50 65% of Americans have a smart phone A Virtual doctor visit is when medical information is exchanged via electronic communications (video/computer/telephone) for the practice of clinical medicine.

Reducing patients no-shows/cancellations Track the reasons each patient gives for a no-show (trends in excuses can help point to solutions.) Develop a call list for patients who are able to come in for a short- notice appointment. (may be used if there is a cancellation) Schedule accurately so patients don't have long wait times, which may lead them to believe that the practice doesn't value their time, convincing them to not value yours. Compare the number of patients handled by each of your doctors and their clinical staff.  Consider reassigning the load so patients are evenly distributed and seen by the provider they visit with the most. M-8

Reducing patients no-shows/cancellations cont. Explore ways to text appointment reminders to interested patients. Kaiser Permanente recently implemented SMS and its pilot program showed a .73 percent improvement in no-shows, saving $150 per appointment. Schedule appointments within a reasonable time of the patient's call. The longer the lapse, the greater the chance of a no-show and the more likely they are to use the ED. Develop strong relationships with patients to increase their commitment to your practice. Suggestions include sending birthday or holiday cards and assigning nurses to specific patients to work and follow up with. https://www.mgma.com/blog/30-ways-to-reduce-patient-no-shows. The Medical Group Management Association (MGMA), founded in 1926, is the nation's principal voice for medical group practice.

Patient Engagement Discuss the issue of missed visits with your patient advisory board Talk one-on-one to patients who have had missed visits Add a section for missed visits to the patient survey Have you had a missed visit within the last six month? If yes, why? These answers will assist us in better serving our patients.

Idea for the future Build healthcare communities - Multiple Providers in the same building (patient convenience) - All providers document in the same EMR (COC) - Multiple visits on the same day (reduces missed visits) - In-house walk in clinic (ability to treat & triage patients) - Providers build relationships with each other and with the patients