1. Joe Liszak, MBA Fremont Community Health Center Fremont, Ohio
Improving Productivity by Reducing No-Shows One Community Health Center’s Story
Joe Liszak, MBA
Fremont Community Health Center
Fremont, Ohio

2. In the beginning........ No show rate ran between 21-36% daily
“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. Formed an internal committee of eight employee representatives
“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
Statement
Office hours are from 8 a.m. to 5 p.m.
An appointment must be cancelled 24 in advance.
Fremont CHC operates medical and dental offices
CHC was founded over 30 years ago as a migrant clinic
CHC sees patients even if they can not pay.
CHC has four other offices
To cancel an appointment a person can call 24 hours per day
Patients who keep their appointments, prevent health problems
Most ER visits are not emergencies
All patients are required to pay a minimum fee at the time of service.

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
Community Health Service-Dental
Fremont Family Practice
Birchard Medical Center
West Side Pediatrics

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 Doctors Orders….
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 T F