5 Reasons Patients Miss Telehealth Appointments


Telemedicine was supposed to reduce no-shows because there’s no barrier to seeing a doctor by video, right?

Not exactly.

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.♥

Messaging systems: from automation to conversation


Wherever there are appointments, there are no-shows. In healthcare, they’re a big problem. According to Jamie Gier, chief marketing officer at SCI Solutions, missed healthcare appointments cost the industry a whopping $150 billion per year in the United States alone. A recent review of studies found a no-show rate of 23% across all specialties. And some especially unlucky practices report that their patients miss around 40% of their appointments.

No-shows hurt patients as well as healthcare providers. The biggest problem is that patients are not getting the care they need.

Missed appointments can also cost hospitals and doctors’ offices in hidden ways. No-shows often signal that patients are not properly engaged. We’re potentially losing a patient, from a customer perspective, to another health system.”

The reminder system

Hence the reminder system. At this point, there’s a strong body of evidence that shows that reminder systems really do work. They don’t eliminate no-shows, but they can reduce them significantly. Meta-analyses conducted in both 2016 and 2012 found overwhelming evidence that SMS reminders improved patient attendance in a variety of circumstances.

Despite the effectiveness of text reminders, many offices still call their patients manually. They may be trying to maintain a personal touch, turned off by the cost, or simply wary of automated reminder systems. “The old process is more personal, better in that that you’re forcing yourself to engage in a conversation,” said WELL’s chief strategy officer, Joe Tischler. And the evidence suggests that it’s an effective method: to name just one example, a 2017 study found that only 3% of patients who received a live voice reminder missed their appointments, compared to 24% of patients who only received a voicemail.

But that’s assuming you get a live person on the phone, not an answering machine. And according to Kenneth Hertz, a principal consultant with the Medical Group Management Association’s consulting group, you’re just as likely to end up in an endless game of phone tag. “For those practices that are still relying on person-to-person communication, it’s so asynchronous that it’s impossible,” he said.

Moving to automation

As effective as manual phone calls can potentially be, they consume too much time and labor to make them effective for most practices. Enter first the auto-dialer, then the automated text message. The issue is that neither is bidirectional—a patient who needs to talk to a live human will still need to pick up the phone and call—and they’re primarily intended to keep slots filled, not increase engagement. “It’s more a convenience for the doctor,” Tischler said. “There’s not a lot of value in it for the patient.”

The problem with generic text reminder systems is that they’re just replacing the old telephone-call reminders. What we need is to reimagine the entire process. We have to have a way to securely message back and forth.

Toward conversation

There’s a new generation of platforms, like WELL, that are designed to do precisely that. Rather than being a simple transaction (“Press ‘Y’ to confirm”), WELL’s text reminder is an initial contact that’s designed to open up a conversation between patient and healthcare organization.

“Oftentimes patients forget things; they don’t know what their status is; they have to check up on terms they don’t understand after they come back from the doctor’s office,” said Yifeng Hu, associate professor and chair of Communication Studies at The College of New Jersey and a senior lecturer in the Mailman School of Public Health at Columbia University. For patients who need clarification or just want to talk to a live human, the new conversational model is a boon. But it’s also better for medical staff, who can use the opened conversational door to take care of pre-appointment paperwork, insurance clearance, and patient questions.

“If you continue the conversation, you can alleviate more workflow, so that patients have as much of the work done as possible before they come to the doctor’s office,” said Tischler. The conversational platform may also recapture a lot of what’s lost when you pick up a phone and call your patient. As Hu pointed out, there’s evidence that what’s called “computer-mediated communication”—essentially, chatting through an electronic device—can actually be more productive and fulfilling than talking face-to-face.

What conversational chat offers is this continuous blanket method for people to access healthcare at their convenience, at their choosing. Patients feel like they have more access to their care, and it happens on their time.

“There’s got to be an easier and more direct way for us to do it, where if I have a question I can just get it addressed,” said Hertz. “If I could have that kind of dialogue [over text], I’d be thrilled.”♥

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