Estimating the Cost of No-Shows and Evaluating the Effects of Mitigation Strategies

Abstract

Objective To measure the cost of non-attendance (“no-shows”) and benefit of overbooking and interventions to reduce no-shows for an outpatient endoscopy suite. Methods We used a discrete event simulation model to determine improved overbooking scheduling policies and examine the effect of no-shows on procedure utilization and expected net gain, defined as the difference in expected revenue based on CMS reimbursement rates and variable costs based on the sum of patient waiting time and provider and staff overtime. No-show rates were estimated from historical attendance (18% on average, with a sensitivity range of 12 to 24%). We then evaluated the effectiveness of scheduling additional patients and the effect of no-show reduction interventions on the expected net gain. Results The base schedule booked 24 patients per day. The daily expected net gain with perfect attendance is $4,433.32. The daily loss attributed to the base case no-show rate of 18% is $725.42 (16.36% of net gain), ranging from $472.14 to $1,019.29 (10.7% to 23.0% of net gain). Implementing no-show interventions reduced net loss by $166.61 to $463.09 (3.8% to 10.5% of net gain). The overbooking policy of 9 additional patients per day resulted in no loss in expected net gain when compared to the reference scenario. Conclusions No-shows can significantly decrease the expected net gain of outpatient procedure centers. Overbooking can help mitigate the impact of no-shows on a suite’s expected net gain and has a lower expected cost of implementation to the provider than intervention strategies.

Appointment reminders by text message in a safety net health care system: a pragmatic investigation

“…[1][2][3][4][5] The impact is particularly important within safety net organizations, which primarily care for underserved patients and which often operate with limited resources. 3 This pragmatic investigation of the impact of short message service (SMS) text message appointment reminders was conducted as part of Denver Health's (DH) 21 st Century Care program, funded under a Health Care Innovation Award grant from the Center for Medicaid and Medicare Innovation to explore the impact of novel models of care on the triple aim (1C1CMS331064-01-00).…”

Operational research techniques applied throughout cancer care services: a review

“…However when applying their model to real data on colonoscopy services, they find that symptomatic patients should be prioritised. Berg et al (2010Berg et al ( , 2013) also investigate colonoscopy procedures, but unlike Güneş et al (2015), they use discrete event simulation. Berg et al (2010) experiment with changing the staff-to-room ratio, appointment times and turnaround time.…”

“…Berg et al (2010) experiment with changing the staff-to-room ratio, appointment times and turnaround time. On the other hand, Berg et al (2013) investigate the effect of overbooking versus alternative strategies to reduce missed appointments. In terms of assessing performance, Berg et al (2010) consider throughput and a range of resource utilisation measures.…”

“…In terms of assessing performance, Berg et al (2010) consider throughput and a range of resource utilisation measures. Berg et al (2013) combine operating costs, waiting time, and overtime costs into a single performance measure that represents expected net gain. Berg et al (2010) recommend that there should be at most two rooms per endoscopist and that the gap between patient appointments should be increased by five minutes, which would decrease waiting time without lengthening the clinic day.…”

“…Berg et al (2010) recommend that there should be at most two rooms per endoscopist and that the gap between patient appointments should be increased by five minutes, which would decrease waiting time without lengthening the clinic day. Berg et al (2013) find that overbooking is the most successful strategy. Sofer, Zeng, and Mun (2003) optimise how biopsies are used to detect prostate cancer.…”