No-Shows, Access, Scheduling: We Speak with Dr. Nick Fabrizio

Nick Fabrizio, PhD, FACMPE, is a principal consultant with the MGMA Health Care Consulting Group. He has more than 20 years of practice management and health system experience, having served a wide range of clients throughout the United States. Nick serves on the faculty at Cornell University’s Sloan Program in Health Administration, where he has also served as the executive in residence. He has presented at several local and national conferences and written widely-read articles on the topics of re-engineering, governance, electronic medical records installations, customer service, medical group operations, planning and development, financial and non-financial incentives, and mergers and acquisitions. Nick is the author of Goals into Gold: Strategic Planning for Healthcare Professionals and Integrated Delivery Systems: Ensuring Successful Physician- Hospital Partnerships.

Nikki: No-shows continue to be a big problem. What are some innovative ways you have seen practices improve no-show rates?

Nick: Some of the ways I have seen is opening up their scheduling templates for patients. For example, an open access scheduling system allows patients to be seen when they want to be seen. The other thing I have seen practices do is to insert or start the day with acute appointments at the beginning of the day and top of the hour. Some practices will have a provider who does nothing but acute appointments for the day. They will assign an acute care provider for the day who will have a completely open schedule that will allow people to walk in. Some of the practices that I work with do that in response to the minute-clinics. They are trying to stay competitive with that through innovative ways because they have the most important resource available to them- the providers.

Nikki: According to a study of commonly used specialty physicians in 15 major U.S. cities, “Patients are waiting an average of 24 days to schedule an appointment with a doctor.” Is this consistent with your experience?

Nick: I have seen that and longer wait times. It is very frustrating. One of the problems is that the popular physicians and providers keep getting picked on. If word of mouth and reputation are that the physician is really good, patients hear that and have not experienced it and want to be placed into that provider’s schedule.

The other frustration to that is in a competitive market if a patient calls and you have a 24-day waiting time, the patient may go ahead and book the appointment. Looking at no-show rates, I have seen patients who are booking that, finding out the wait, and then calling your competitor and getting right in, establishing care in that office.

Nikki: What are practices doing to reduce the number of scheduling errors?

Nick: It’s about communication. This is one thing that practices really don’t have the time to do. They need to find the time to do this. It’s back to the good old staff meetings. You would be surprised at the number of practices I visit where less than half of them have staff meetings. Even fewer than that, in the past couple of years, less than 10 or 15 percent of the practices that I meet with have weekly team huddles or meetings. Conversely, some of the more successful practices that I see have morning and afternoon huddles to go over the scheduling, look at complex patients, discuss the day, and in real time work out any issues or problems that they’ve seen in the schedule to prevent future scheduling errors.

Nikki: Practice managers are constantly bombarded with new technology that claims to solve their problems. At the same time, we know that the solution is rarely technology alone. In fact, it’s usually a combination of people, process, and technology. How do you advise your clients who are considering making investments in technology?

Nick: This is a great topic because it’s one that I encounter a lot. The misconception is that a new piece of technology will help your processes when in fact, sometimes it highlights and makes the process worse. I always tell my clients to look at your workflow, understand your processes, and try to work out any issues you have with them.

So technology into that situation will really highlight those problems. What they need to do is sit down and try to find some common ground where maybe they can group those. If you can narrow down the number of different options, you are going to have a better-performing scheduling system with fewer errors from the staff and a better chance for your technology to be successful.