Decreasing Sleep “No Shows”

By Sean B. Gipson

As we are looking at the downward trend of COVID (let’s hope it continues that way), I’ve had the pleasure of finally getting back out into the world. In doing so, I have had the opportunity to attend some of the recent sleep conferences, like The Philadelphia Sleep Conference in late March, and prepare for some of the larger national-based meetings. Those opportunities have given me the ability to speak with many of you out there; the sleep techs, managers, and administration of sleep labs. Some of the common issues that we all once knew are re-emerging and being heard loud and clear. A front runner from the beginning of sleep medicine is combating the age-old problem of no-shows.

I do not have the magic elixir. However, I do have three decades of pounding my head on the doors of empty sleep center bedrooms that have resulted in a few tricks of the trade that I’m happy to share with you.

When looking at the average no-show rates across our nation, general daytime outpatient clinics are between 25%-28%. However, when looking specifically at the sleep lab, the no-show rates average around 37%-40%. That quickly adds up to well over $300,000 for a single four-bed lab in a year’s time. So let’s break this down to the whys and what we can do to reduce this in our sleep labs! For those that don’t read this top secret material, we’ll watch them fade in our rearview mirrors.

We have all heard the plethora of excuses why our patients did not make the appointment. We have also all heard about the solutions that “other labs” have used, including no-show fees that are not remissible to commercial or federal payors. Elimination of no-show fees keeps the relationship positive and avoids negative patient reviews, and doesn’t put staff in the awkward position of trying to collect those fees. Quite honestly, when patients are penalized with a fee, they typically find another provider to complete their study.

In my experience, I wanted to eliminate the most used patient excuses. The excuse list came down to three primary issues in this order. They simply forgot, money or payment issues (deductibles), and anxiety of sleeping in a strange place with “people” watching. So I sat down with my clinicians and some of our patients to develop the following solutions: When scheduling the patient for a sleep study, they were taken on a tour of the sleep lab and shown the rooms that are used for sleep studies (physically or video if not onsite). Yes, it takes time, but avoiding one no-show paid for the extra time.

Secondly, monetary arrangements were scheduled for full payment before testing. Patient access to payment plans and/or payment options were added. This again eliminated some patients who simply did not want to pay their deductibles, but it keeps your center legally clean and your schedule clear of those looking to “make a deal.” The final issue we will explain in depth.

So there’s no secret to knowing that communication is key! However, we as technologically advanced individuals need to make the most of all resources available and apply multiple paths to communicate with our patient populations to the best of our abilities. Research shows that the evolution of communication has changed drastically in the last fifty years. When I talk with sleep lab leadership, they almost always mention that they call their patient population with reminders of their sleep study appointments. That’s great!

My next question is when and how often? With calls alone, I’ve found that the most effective call is one 72 hours prior, then 24 hours prior. So you all are saying, okay, we do that. Here’s the shocker…do it in the evening between 6:00 PM and 7:00 PM when they are home and not distracted by their day-to-day jobs. Often, you will not even get an answer on a personal line as some employers look negatively on personal calls during work hours. So those calls may get pushed to voicemail and forgotten for days or even weeks.

Additionally, it’s no secret that many times it’s the patient’s bed partner that has “pushed” the patient to have the study done, and you are most likely to make that call with that significant other nearby during an evening call. Try it. You may be surprised!

Okay, the phone call is done, and our sleep-deprived patient has answered the call, or maybe a voicemail was left, so the office has chalked up the patient as notified. That should not be the end. With today’s advanced technology, much of our population utilizes several forms of technology and media to communicate. We, as medical providers, also need to do the same. Newer office phone systems can send text messages directly to patients. We often ask for permission to text in the new patient initiation paperwork.

I’ve found that the text messaging option is usually responded to more often than answered calls with a patient population under 55. Reminder text messages have been successful for us, as they are easy to set up and are triggered via technology (not requiring a paid employee to be there pushing buttons). We send text reminders 24 hours before the appointment, the noon hour on the day of, and two hours before the scheduled arrival time. Patients can reply with response options that will trigger scheduling or technician messages that our offsite staff can answer.

In many cases, the same technology can also trigger calendar reminders on smartphones or office software that much of our population now uses to keep their lives organized. These messages can be sent in several ways; however, the most popular methods are email and text messaging.

The key to all of this is to be helpful and not burdensome to our patients. So these tools should be taken advantage of but not abused and arduous to the recipient.

If your patient is a no-show, send the referring physician a medical note. This will keep the provider up to date on any delays and create a note for their chart.

I have seen a much better success rate using visual, auditory, and written (tactile) forms of communication that have shaved our no-show rate to consistent months of single digits; making our centers and patient turn-around highly efficient. The end result equals happy patients, happy referring professionals and happy technical staff with full schedules.

As sleep providers, we have to “speak” to our patients in all forms possible. We must make the most of what technology and time offer us to deliver the most up-to-date medicine and medical solutions so we can compete in an ever-changing and competitive market.

Sean B. Gipson, RPSGT is an accomplished healthcare executive based in the Dallas Fort-Worth Metroplex. 

This article originally appeared in Sleep Lab Magazine Mar/Apr 2022.

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