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Health dept. battles no-shows

Tom Jackson • Apr 2, 2014 at 2:20 PM

Officials at the Erie County Health Department are trying to teach patients at the new dental clinic that it’s important to show up for appointments.

To do this, they’ll have to figure out how to get folks to show up for class.

Janet Mesenburg, who directs the health department’s dental clinic, told Erie County’s health board Tuesday about the results of the department’s first class for “no-show” patients who have been suspended for missing appointments. Ten students were enrolled, but only three showed up.

Another class will be held in April, said Mesenburg, the health department’s director of nursing.

Dealing with no-show patients can be challenging, but Joe Liszak, CEO of Community Health Services in Fremont, said he believes Erie County will be able to make inroads on the problem. Erie County’s program is modeled on the Fremont center’s, which succeeded in sharply reducing the clinic’s no-show rate.

Last year, Erie County’s health department unveiled a new dental clinic that’s open to everyone, regardless of ability to pay. It serves many patients who are on Medicaid, or who don’t have any health insurance at all.

The dental clinic, and the department’s medical clinic, have both had a no-show rate of about 15 percent to 20 percent, said Pete Schade, Erie County’s health commissioner.The department’s policy for the dental clinic is that new patients are suspended from the program if they miss their first appointment. Existing patients are suspended if they miss three appointments.

To get back in, they have to attend Mesenburg’s no-show class, an hour-long program that aims to teach responsibility and explain how it’s better to cancel an appointment than to just not show up.

“Of course, we don’t want any idle time,” Schade said. “I don’t want people sitting around”

The Register tried to find out how much of a problem no-shows create for the Medicaid program nationally. A spokeswoman for the federal Department of Health and Human Services said the department doesn’t track the problem. A spokesman for Ohio’s Medicaid office said the same thing.

The Kaiser Family Foundation also had no information, although it referred the Register to Liszak’s program.

Liszak said when his Fremont clinic encountered no-show rates that were higher than 30 percent of the appointments, it sought help in figuring out how to deal with the problem. It could not find anyone who could offer help.

So the clinic solved the problem itself, setting up the policy that Erie County has now adopted: Patients are suspended if they miss an initial appointment or miss three appointments, and they must attend a class to get back in the program.

Liszak later published an article on the program, “A Model Program to Reduce Patient Failure to Keep Scheduled Medical Appointments,” in the Journal of Community Health.

The paper explained once the Fremont clinic carried out its new policies, the no-show rate for its medical clinic dropped from 18 percent in 2003 to 11 percent in 2010. It went from a high of 54 percent in 2003 for the dental clinic to 15 percent in 2010.

Schade said the health department is also trying to deal with no-shows by overbooking appointments.

That can create its own problems, the Liszak paper warns. Sometimes overbooking can give a clinic more patients than it can handle, resulting in delays and overtime payments for staffers who have to work longer hours.

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