1. 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

2. 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

3. 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

4. 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.

6. 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.

7. 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

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.
The Medical Group Management Association (MGMA), founded in 1926, is the nation's principal voice for medical group practice.

9. 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.

10. 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