Telemedicine was supposed to reduce no-shows because there’s no barrier to seeing a doctor by video, right?
More than 70 percent of consumers are open to telehealth, and there is little difference between the quality of care versus in-person appointments. Nevertheless, no show rates for telehealth are often 30 percent or more, twice as much as for in-person visits.
How can that be?
There’s more to the story than just the stats
According to Brandon M. Welch, PhD, Assistant Professor at Medical University of South Carolina and founder of telemedicine provider Doxy.me, it may not be due to the nature of the visit — by video instead of in person — but rather how the visit is promoted, scheduled, and implemented by the healthcare organization.
For example, many enterprise health systems offer telehealth visits with a pool of qualified physicians who may or may not be the patient’s primary care doctor. This variable alone could account for an apparent increase in no-show rates.
“So you’re not really comparing telemedicine to in-person because there is more than one variable,” Dr. Welch said. “To determine if no-show rates are really higher among telemedicine appointments, other variables (such as the provider-patient relationship) must be controlled.”
So why aren’t patients showing up?
That said, the no-shows in telemedicine are real. They still present a hurdle to ensuring quality care for patients and create a financial and administrative burden for healthcare systems.
Patients miss their virtual visits for a variety of reasons. Here are the top five:
#5 Technical challenges
Technical challenges are one obvious barrier. If patients don’t understand how to use the technology, they’re less likely to follow through with their appointment. Needing to download an app or log in to a patient portal both present opportunities to abandon the appointment. Passwords are forgotten. And sometimes, new tech is just confusing. Research indicates that usability issues at the initiation phase of the appointment account for the greatest patient frustration.
#4 When it’s not seen a real appointment
Patients may think there’s no harm in not showing up for their appointment — like they’re not hurting a real person or wasting real time. This is especially true when patients are seeing someone other than their primary care physician.
Welch views telemedicine as complementary to the traditional in-person care model, rather than a replacement for it.
“The movement to replace in-person appointments with telemedicine will fail, along with quality and satisfaction of care, if it severs the patient-provider relationship,” he said. “Doctors need to adopt and add telemedicine as an option to their practice, rather than organizations trying to replace that traditional in-person relationship.”
#3 Thinking “I can just book another appointment!”
When there’s no consequence to the patient not showing up — no bill and no long wait time to reschedule another appointment — patients may be less motivated to keep their appointments.
One solution to reducing patient no-shows is to implement a policy that penalizes patients with a straight fee or a “three-strikes-you’re out” policy. However, the first approach can scare off patients and discourage them from seeking care with you. The second can actually contribute to patient attrition — not what you’re looking for.
#2 No Good Reason
One of the toughest reasons to address may be the one that doesn’t exist. Sometimes human behavior is inexplicable and people have no good reason for doing or not doing something.
#1 I just forgot
It’s easy to forget an appointment, especially when you’re dealing with an illness or injury. Digital amnesia, forgetting information stored on a digital device, amplifies that tendency. When a patient makes an appointment online, they are more likely to need frequent reminders to keep it.
Engaging patient communication and delightful virtual experiences offer promising solutions to many of the reasons for virtual care no-shows. WELL partners with enterprise health systems offering virtual care and uses its bidirectional text messaging to reach patients where they already are — on their phones.
WELL clients have seen telehealth no-show rates cut in half — especially for the patients who simply forgot to attend. Before the appointment, a series of conversational messages help the patient log in to the portal and check in to the appointment. Because the text appointment reminders are bidirectional, office staff can chime in when needed to help a patient get their appointment started.♥
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Pamela Ellgen is WELL’s Health Editor. She began her career in community journalism at The Asian Reporter and later covered business at The Portland Tribune. She is the author of more than a dozen published books and a graduate of Washington State University.