No-Show Rates in the Vascular Laboratory: Analysis and Possible Solutions

Abstract

To report the consequence of missed appointments ("no-shows") in the noninvasive vascular laboratory of a large teaching hospital and evaluate the effect of one potential solution. The financial effect of missed appointments by outpatients during a 9-month period was calculated on the basis of weighted average reimbursement rates for the technical component of a bilateral venous duplex examination. In addition, the effect of an automated telephone reminder system on the no-show rate was studied over a subsequent 17-month period. The overall no-show rate for outpatients in the vascular laboratory was 12%, with an average of 7.6 missed appointments per week. This translated to a gross annual revenue loss of $89,107 assuming a per-appointment revenue equal to the 2005 technical component of the reimbursement rate for outpatient bilateral duplex venous ultrasound studies. Of the 8,766 patients offered automated reminder calls, 4,648 (53%) agreed to receive the calls. The no-show rate was significantly greater for those patients who chose to receive automated reminder calls (8.9% vs 5.9%, P < .0001). A 12% no-show rate offers an opportunity for significant cost savings and improved efficiency in the vascular laboratory. Automated reminder systems did not appear to significantly reduce the no-show rate. Various strategies are outlined to achieve the goal of a 5% no-show rate, including methods of scheduling, pre-examination notification, and advanced overbooking techniques. Further investigation into these strategies to reduce the no-show rate is needed.