How to Reduce No-shows to Virtual Appointments

Director, Great Lakes ATTC, MHTTC, and PTTC

Is this a familiar scenario for your organization?
Day 1: Stay-at-home order: Your agency enacts social distancing guidelines.

Day 3: Your agency has switched in-person counseling to telephonic or video-based counseling.

Day 12: Virtual services, particularly telephone, have increased engagement rates!

Day 30: The honeymoon is over: show rates to virtual appointments are decreasing, especially among new consumers.

In the COVID-19 era, an old nemesis has returned: appointment no-shows. While telehealth has removed some barriers to behavioral health services, other engagement challenges are emerging. Agencies can take the “how exactly are we going to do this?” approach that COVID-19 has thrust us into since the beginning.

Another way is to turn to existing tools and proven practices to address the new no-show dilemma.

Three Tips to Reducing No-Shows During COVID-19 and Beyond
Apply these three tips, in this order, and watch your no-show rates decrease and show-rates increase.

1. Track No-Show Performance 

You can’t improve what you do not measure. No-shows should be measured. Measure no-shows to virtual appointments the same way you measured no-shows to in-person appointments before COVID-19. Compare no-show rates pre- and post- COVID. Segment the data as needed: new vs. existing client; by client age; by appointment type, etc. This measurement creates a foundation for improvement.

2. Use PDSA Cycles!

The Plan-Do-Study-Act (PDSA) method creates a simple process to test new approaches and observe their impact on no-shows. (See related post from NIATx coach Mat Roosa: Learning from Crisis: PDSA in Times of Challenge.) Plan a change; Do a change; Study the impact of the no-shows; then, Act on the change. (Adopt, adapt, or abandon.) You can conduct PDSA Cycles as part of an organized agency-based improvement initiative. Or, individual clinicians can perform PDSA cycles to improve their show rates.

What are good practices for addressing no-shows in a PDSA cycle? See Tip 3:

3. Use Proven Practices to Reduce No-shows
While COVID-19 provides us with some very new situations, we can learn a lot from what’s worked in the past to reduce no-shows.

Open scheduling: Book appointments to accommodate consumers’ schedules. Evening hours? Weekend hours? Ask the consumer, “When would you like us to talk next?”

Reminder calls, e-mails, and text messaging work for virtual appointments as well as they do for in-person appointments. Note the scheduling of the reminder message or text: Two days prior seems to work best for in-person appointments; one day before or on the day of for virtual appointments.

Evidence-Based Practices to Reduce No-Shows

Use Motivational Interviewing (MI) to reduce no-shows by increasing the consumer’s interest in coming back. The growing evidence base for MI shows its effectiveness in a variety of settings.

Use incentives or Contingency Management. Contingency Management is proving to be an effective EBP to enhance retention, particularly for stimulant use disorders. Offer consumers an incentive to reward attendance: a recognition certificate, gift card, or other small prizes.

Learn more about Motivational Interviewing and Contingency Management through the free online courses available through HealtheKnowledge, the ATTC Network’s online learning portal.

Patient no-show trend analysis can identify high-risk no-show patient categories (new vs. existing patients, payer source, patient age) as well as situations (day of the week, time of day, location). Develop patient scheduling practices to increase show rates from identified areas. This practice is particularly relevant as we need to understand better when, where, and how virtual appointments have greater participation.

Interested in learning more about how you can use these tips to reduce no-shows in your organization? Watch for information on the new Virtual NIATx Change Leader Academy—details available soon on the Great Lakes ATTC, MHTTC, and PTTC websites.

What have you found most useful in increasing participation in virtual care? What conditions and practices hurt appointment attendance? What have helped? Let us know in the comment section below.

Dr. Todd Molfenter is the deputy director of the Center for Health Enhancement Systems Studies at the UW-Madison. He is also the director of three SAMHSA-funded Technology Transfer Centers: the Great Lakes Addiction Technology Transfer Center, Mental Health Technology Transfer Center, and 
Prevention Technology Transfer Center. Todd specializes in implementation science, with a particular focus on technology and evidence-based practices in behavioral health.

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