Understanding, Predicting, & Reducing Appointment No …

1 Running head: GRADUATE MANAGEMENT PROJECTU nderstanding, predicting , & Reducing Appointment No-Shows in aMilitary Medical Treatment FacilityAndrew H. Army-Baylor University Master of Health Care AdministrationGraduate ProgramAppointment No-ShowsTable of ContentsABS T7 CT ..o .o ..ooo. I .o OF FIGURES .. vLIST OF FIGURES .. o o .@ ..e@@@ee@@@@@@ o@*@*ee VLIST OF TABLES .. viChapter1. INTRODUCTION ..ee * 1 Conditions which prompted the study .. 1 Statement of the problem ..0 ..*..5 Literature review .. 6 Definition .. 7No-show rates .. 7 Characteristics of Appointment non-compliance.

2 8 Interventions .. 10 Mail/phone reminders .. 10 Over-scheduling .. 10 Education ..O .. 11 Single provider .. 12 Price .. 13 Location .. 14 Time interval .. 14 Patient profile ..14 Marketing .. 15 Purpose .. 182 .METHOD ..s..**. and reliability ..213. RESULTS .2..224. DISCUSSION .. 28iiAppointment No-Shows5. CONCLUSIONS AND RECOMMENDATIONS .. 31A. DESCRIPTION OF THE NAVAL HOSPITAL .. 35B. SPSS & OTHER RAW DATA .. 37 REFERENCES ..e a a .. a *e 4 6iiiAppointment No-ShowsABSTRACTA ppointment non-compliance can disrupt the efficientoperation of a medical facility. At Naval Hospital, CampLejeune, the Appointment non-compliance rate for 1999 was not markedly high, Naval Hospital leaders believed morecould be done to increase Appointment compliance.

3 The goal ofthis study was to identify potential predictors of appointmentno-shows at the Naval Hospital and suggest methods toeffectively address the interval, age, and gender were selected aspotential predictors of Appointment non-compliance following acomprehensive review of the literature. Chi-square tests wereperformed on each predictor against the dependent variableoutcome. Outcome defined as whether a patient kept or no-showedfor an Appointment . Clinic type and branch of service were alsoanalyzed as variables, but only for their descriptive differences between the dependent variable and allthe predictors were identified (p <.)

4 0001)o A CHAID analysis wasthen performed on each predictor to detect interactions and rankpredictor to the results of this study, Naval Hospital, CampLejeune should implement a computer-generated appointmentreminder system as an effective measure against Appointment non-compliance. The system would not only counter the problem offorgetfulness; it would also offer patients an easy way tocancel appointments at the touch of a button, circumventing anoften difficult and cumbersome centralized Appointment No-ShowsLIST OF FIGURESF igure Page1. Chaid analysis .. 27 VAppointment No-ShowsLIST OF TABLEST able Page1.

5 Appointment Non-Compliance Data by Interval .. 222. Appointment Non-Compliance Data by Age .. 233. Appointment Non-Compliance Data by Gender ..244. Appointment Non-Compliance Data by Branch of Service .. 245. Appointment Non-Compliance Data by Clinic ..256. Appointment Non-Compliance Data by Quarter .. 26viAppointment No-Shows 1 understanding , predicting , and Reducing Appointment No-shows ina Military Medical Treatment FacilityINTRODUCTIONC onditions which prompted the studyDespite years of extensive research on the issue, thenumber of Appointment no-shows continues to rise in most healthcare settings (Garuda, Javalgi, and Talluri, 1998).

6 Recent changes in the financing and delivery of health carein the United States have compounded the problem. The evolutionfrom fee-for-service to managed care has led to a focus onoperational efficiency to curb the perpetually rising costs ofproviding health services (Feldstein, 1996). This new mandatefor better efficiency means health care leaders must developmethods to reduce Appointment transition to managed care in the United States did notexclude the military health care system. Concerns about theeffect of Appointment no-shows in military health care were notas prevalent prior to TRICARE.

7 During this time, militaryhospitals and clinics did not incur the costs of sendingpatients to civilian providers. The majority of these costs werepaid at higher levels while patients made up the differencethrough deductibles, co-pays and supplemental No-Shows 2 Appointment no-shows can jeopardize the operationalefficiency of a medical facility (Smith and Yawn, 1994).Providers for example, are unable to effectively treat andmonitor those who miss appointments. Vital resources are wastedwhile untreated conditions become worse, (Mirotznik, Ginzler,Zagon, and Baptiste, 1998; Koren, Bartel, and Corliss, 1994).

8 Patients with chronic conditions who miss appointments risk themost (Deyo and Inui, 1980). Appointment no-shows disrupt the patient-providerrelationship; denying others access and diminishing the level ofquality (Koren et al., 1994; Barron, 1980). In the military'smanaged care system ( TRICARE), Appointment no-shows couldresult in unnecessary patient referrals to a provider no appointments are available at the primary treatmentfacility, then patients are referred to the network. This isarguably the most substantial cost issue the military healthsystem will face as a consequence of Appointment Appointment no-shows would ideally open moreappointment slots, thereby decreasing the number of military's deliberate transition toward capitatedfinancing effectively terminated the old way of doing business -a way which provided hospital commanders additional dollars tosupport higher utilization without valid justification (OfficeAppointment No-Shows 3of the Deputy Assistant Secretary of Defense (TRICARE ManagementActivity), 1998)

9 The modified capitation model ( revised financing),the principal reason Appointment no-shows now concern leaderswithin the military health system, is now the primary financingcomponent of the TRICARE program. With revised financing, thecosts of network services are paid by the individual militaryhospitals and clinics. Revised financing is the precursor toenrollment based capitation (EBC). Under EBC, the militaryhealth care system will operate like a Health MaintenanceOrganization (HMO). Military hospitals and clinics will receivefunding based on the number of enrolled beneficiaries(capitation).

10 Operating under a fixed amount of annual fundswill force facilities to reevaluate how they do the first time in its history, the military healthsystem is being exposed to the same financial risks thatcivilian health care systems now face. Hospital commanders mustnow increase member enrollment to maximize per-member-per-month(PMPM) revenue, which will eventually be distributed byDoD/Health Affairs (TRICARE Management Activity, 1998). Appointment no-shows became an issue at Naval Hospital,Camp Lejeune North Carolina (Naval Hospital) for three primaryreasons (See Appendix A for a brief description of the NavalHospital).