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Appointment ‘no-shows’ pose hidden costs

19 Oct 2010 | Sgt. Heather Golden

Missed appointments, or “no-shows,” are an ongoing challenge everyone from the Combat Center’s higher command to the Robert E. Bush Naval Hospital Twentynine Palms staff is fervently trying to eliminate. 

No shows affect every medical facility in the DoD. What many patients do not realize, however, is the negative impact missing an appointment can have on staff schedules, medical care costs, manpower availability and access to appointments for other patients who are in need of medical care. More importantly, it may affect their own health and opportunity for timely healthcare services.

Hospital reports indicate an average of 823 appointments are missed each month, and no-shows for July and August exceeded that number, said Navy Command Master Chief Kevin Hughes, the hospital’s top enlisted.

These numbers translate to nearly 10 percent of all appointments being missed and $58,762 lost each month, said Navy Lt. j.g. Bill Lawson, the hospital’s data analyst.  This is money lost that could have been used to provide better patient care. A year’s worth of missed appointments is the equivalent of closing the hospital one month out of the year.

The biggest impact no-shows have is on other patients seeking care, said Navy Cmdr. Maria Young, the director of Nursing and Surgical Services and the department head of the hospital’s Healthcare Operations. “If all the appointments are booked, and a new patient calls, they can’t be seen,” she said.

Appointments cancelled at least 24 hours prior to the appointment time are filled with other patients 95 percent of the time, said Young, a Monroe, N.Y., native. In contrast, less than 50 percent of no-show appointments are ever filled, leaving available providers with time open and no patients to see.

This has the potential to affect an active duty patient’s deployment readiness. Medically-unfit personnel can’t deploy, and this may impact a Marine whose presence is critical to the mission, Young said.

As fewer patients are seen by each provider, patient care reports sent to higher headquarters at Navy Medicine West could impact the overall staffing of providers, nurses, and Corpsmen stationed at the Combat Center, said Navy Captain Mike Moeller, the hospital’s executive officer.

“It has an impact on the resources allocated,” he explained. “If resources are not used, they may be taken away.”

Colonel John P. Holden, the Combat Center’s Chief of Staff, echoed Moeller’s concerns.

The no-shows suggest the hospital does not have patient loads similar to other facilities, he said. As a result, more personnel could be augmented to other units, and there will be fewer providers here.

“Obviously, we have a requirement here in the high desert,” Holden said. “We just need those making appointments to follow through or cancel in a timely manner so the majority doesn’t have to pay the price.”

The impact of no-shows trickles into other aspects of hospital operations, said Navy Cmdr. Sharon W. Kingsberry, the hospital’s director of Medical Services.

Many patients who cannot make a timely appointment will head to the emergency room for care, she said.

Emergency Room staff do not have as detailed access to each patient’s medical history as a primary care facility would. The result is the breakdown in the continuity of patient care and the ability for patients to see the same provider on a consistent basis  The ER providers are left to treat the patient based on what they can observe and what the patient can tell them. No one knows a patient better than their own provider, added Kingsberry, a Bronx, N.Y., native.

Also, non-emergency visits to the ER can create gridlock. This leads to wait times easily approaching four hours, and possibly more if a patient suffering from a heart attack or other trauma arrives, said Navy Lt. Cmdr. Raul Carrillo, the ER’s department head. With flu season just around the corner, non-emergency patients can expect even longer wait periods, said Carrillo, who is from San Antonio.

The solution to this problem is simple and as easy as making a quick phone call to cancel appointments as soon as possible, said Lawson, a Salt Lake City native.

“One-hundred percent of the time, we’d rather have a patient cancel than no-show,” Lawson said. “Just that call or e-mail would have a huge impact, because we can easily re-book that appointment for someone else.”

Kingsberry agreed, saying “cancelling is a good thing.” However, she also encourages those who need treatment, and even those who followed proper cancellation procedures, to still book another appointment as soon as they can.

“We want to promote health, and in order to do so, we need patients to come in,” she added.

Ensuring Marines are medically fit and following through on appointments is a leadership issue, and leaders at every level need to take a vested interest in their Marines’ medical readiness, said Sgt. Maj. Harrison L. Tanksley, the Combat Center's sergeant major

“I expect a Marine's word to be their bond,” Tanksley said. “Missing medical appointments is simply not acceptable. It is a violation of our core values of honor, courage and commitment. Leaders have an obligation to support their Marines as they schedule and keep appointments. In those cases where Marines have flagrantly disregarded their appointments, I expect their leadership to hold them accountable. As for family members, cancel your appointments if you cannot make it. It is that easy.”

To make it as easy and convenient as possible, the hospital created a dedicated cancellation line at 830-2369. Patients can book their primary care appointments by calling the dedicated appointment line at 830-2752. Cancellations or rescheduling an appointment can also be done using the hospital’s direct e-mail at NHTP-CAPC@med.navy.mil.

Both numbers and e-mail are also listed on the back of the appointment reminder cards provided to each patient when they book an appointment in person. 


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Marine Corps Air Ground Combat Center Twentynine Palms