If you've tried to schedule a doctor's appointment recently, especially with any sort of specialist, you've probably had to plan out weeks or even months.
It's a struggle to get an appointment, so what happens when you get one...and then just don't show up?
Some hospital systems level a fine on no-show patients of $100 or more. After all, a 2023 study shows a no-show costs medical professionals an average of $200.
But, even as other studies show no-show rates rising, some are questioning how effective fees are.
“At the end of the day, it further contributes to, really, some of the issues that we see in regards to lack of adherence to care plans,” said Amanda Mishler, senior vice president of Clinical Operations for OSF Medical Group. “And it doesn’t really allow the patient to get the access that they need. Especially if we have patients that are already financially constrained.”
She estimates OSF fluctuates between a 20 to 30% no-show rate across all specialties.
However, the Peoria-based hospital system has never charged a fee for no-shows, but the reasons for that have changed.
“I think what has changed over the years is our ability to be able to know more about our patients. Specifically within that social determinant, social driver aspect,” Mishler said.
When Mishler says "social determinants," she's talking about things like transportation, food, finances, and education. They're the things where having easy access, or lacking it, change the way we move through the world.
“As an example, medication cost is certainly a financial impact to many patients that we see,” Mishler said. “And so we do have alternate options, where we can offer generic options within medications and/or vouchers to help patients be able to pay for some of their medications.”
In order to know more about the "social aspects" of patients, Mishler says a survey collects data on these points when they go through the new patient process. This can also include a new patient agreement, where the patient has to make a commitment to show up.
“If we do end up continuing to see a lack of adherence to showing up to appointments, we will administer some other policies which kind of puts them back into a new patient waiting pool, if you will,” Mishler said.
This opens up future appointments the chronically absent patient may have had scheduled for others on a waitlist for openings. It also encourages the patient to re-up their commitment to showing up, without impacting them financially.
“Giving them a fine for not showing up to their appointment is not going to help them on their health care journey,” Mishler said. “It’s going to further impact their healthcare.”
One of the scenarios Mishler describes that sometimes results in a no-show is someone admitted to the hospital in an emergency not understanding they require follow-up care after they're released.
“Sometimes it’s just purely a lack of education and understanding on the patient’s side about the criticality and importance of those appointments,” Mishler said. “And really, that we’re there to help support them as they transition, maybe, from an inpatient to an ambulatory setting.”
Worst case scenario, that patient's condition worsens and they end up back in the emergency room, requiring care more expensive than preventative measures that would have been taken during their appointments.
That, Mishler says, increases the cost of healthcare for everyone.
Skipping the fees on no-shows isn't necessarily a rare practice in Central Illinois. In a statement, a spokesperson of Carle Health told WCBU the hospital system doesn't impose fines either.
But, no shows are still a problem. Mishler says the solution will take work, educating patients, future patients and the healthcare consumer community in general on the impact and strain no-shows put on healthcare systems.
In the meantime, Mishler says OSF uses measures like reminder texts and calls, and the MyChart app to try and keep patients on top of their medical schedule.
