iStock_000005827812SmallI’ve heard you talk about reducing no-shows at outpatient addiction programs. That’s a big concern for us, particularly in our busy IOP. Can you provide more info?”

Happy to. Start with a measurement. There’s an excellent site called NIATx that offers lots of suggestions for process improvements. If you haven’t visited them, they’re worth a look.

The measure they use for no-shows:

(Number of Clients with an assessment) divided by (Number of Clients who schedule an assessment appointment)

That’s a good front-door indicator. However for IOP, where clients are usually required to attend several sessions weekly for two to four months, we sometimes use this measure:

(Total number of IOP sessions attended) divided by (total number of IOP sessions scheduled)

We track that monthly and by quarter. So if your program had 40 clients scheduled to attend IOP that week, at 3 sessions each, you’ve got 120 sessions scheduled. If you wound up billing for only 90, you know that you had a ‘show rate’ of 77%, leaving 23% no-shows. Rates tend to fluctuate so it’s important not to draw conclusions based on that small a sample. Track it for at least one quarter to get a baseline, and then monthly or quarterly.

Note that we still haven’t determined the cause of a no-show. Could have been excused. We’ll need to look a bit further. Still, it’s a beginning.

If it helps, the data can also be broken down into subcategories: primary clinician, group facilitator, referral source (say, Court- vs self-), payer (MA versus private insurance or self-pay), and so forth. We sit down with the staff and go over the results.

We don’t compare individual clinicians in that meeting, because we want everyone to view no-show as a challenge for all of us. No patient can benefit from a session he or she didn’t attend (at least, we hope not.) But we avoid setting clinical staff into a position where they compete with one another. In the long run, that saps motivation rather than enhancing it.

The NIATx model I’ve already mentioned is more formal so feel free to check that out and make use of their suggestions if it’s a better fit.

That’s our motto: whatever works.


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