reducing missed appointments Archives

Card Acceptance

Has the idea of a cashless society finally moved away from the theoretical and into the plausible? It would certainly seem so if a number of surveys in 2015 are to be believed. According to the Payments Council, in 2014 for the first time cash became less popular than cards as a means of payment although it still did account for 48% of all transactions.

A separate survey by the Halifax in April of this year revealed that amongst its customers cash withdrawals accounted for just £18.33 of every £100 spent. Debit cards at £30 and faster payments at £15 were also proving increasingly popular according to the Halifax analysis.

The UK may not have gone as far as Denmark which earlier this year proposed a law which would allow businesses to refuse to accept cash for transactions but it does seem that we are well on the way towards seeing cash as simply one method of payment rather than as the main payment option. The launch of Apple Pay in the UK last week can only add to the range of payment options and encourage people to choose the most appropriate payment method for each transaction.

The increased acceptance of cards as a payment method is also good news for those organisations which seek to move their customers away from cash and cheque and towards alternative payment means such as credit and debit cards. Being able to take card details at the time of booking helps those businesses which rely on appointments to secure payment. This is particularly appropriate in the independent health sector where no-shows can cost physiotherapists, osteopaths and others both time and income.

Interestingly it has been found that taking card details at the time of booking helps to improve attendance rates. It seems as though there is something about having handed over card details that acts as a reminder to attend booked appointments. Add on an appointment reminder either by SMS text or phone and the chances of clients turning up for treatments are increased; or at the very least clients may be prompted to get in touch to cancel, enabling replacement bookings to be made.

For those few who still fail to make it to their appointment, the fact that card details have been taken in advance enables the practitioner to take a no-show fee in accordance with advertised practice. Once card details have been taken either on the telephone or via an online booking system, the card can be pre-authorised, effectively reserving a balance to be taken once the appointment has been completed. Should the client opt to use a different card or pay by cheque on the day, the preauthorisation can simply be cancelled. Either way, the invoice delay time is effectively eliminated, helping to streamline cash flow.

We may have some way to go until we are a fully cashless society but the more that options such as secure card payment processing move into the mainstream, the closer we will get; whilst at the same time having the added bonus of enabling businesses to reduce no-shows and smooth out their cash flow.

Secure Card Processing

Black Friday, Cyber Monday; whichever day you have earmarked as the time to break the back of your Christmas Shopping the chances are that both shops and internet will be working to capacity. In fact, as a speech by the Managing Director of the Payment Systems Regulator, Hannah Nixon, revealed recently our love of automated transactions is growing apace. And the more we use our cards the more important it is for the payments industry to ensure that secure card processing happens as a matter of course.

According to Hannah Nixon, in the UK in 2014 some 40,000 transactions are made every minute on average. With early reports that spending on the two ‘major’ Christmas shopping days so far this year was well up on 2013 it is easy to believe that transaction volumes also were far higher than average.

One of the reasons for Hannah Nixon’s speech was to highlight the way in which the PSR is working to improve payment systems in order to provide new options for consumers and to make existing options better and easier to use. Much of what she said was more directly relevant to those who provide the systems rather than end users but if the PSR vision is realised then we will have “world class payment systems operating in the best interests of service users and the wider UK economy.”

Over the last few years we have already seen a huge development taking placed in the payment card sector. Contactless payments, online payments, swift transfers between accounts; all have improved payment options for businesses and consumers alike. We now expect to be able to use our cards as a prime payment method. And with that expectation comes the acknowledgement that ease of payment for consumers and swifter receipt of funds for retailers delivers a win-win result.

Take booking health appointments for example. By allying a secure card payment processing service to online booking, health practitioners can take a pre-authorised payment at the time of booking. Once the appointment has taken place, payment can be confirmed, helping to smooth out cashflow. Another advantage of secure card processing is that it tends to reduce the number of ‘no-shows’, particularly if clients know that they will be faced with an automatic cancellation fee if they fail to turn up for their appointment. Should clients decide to pay by an alternate means then the pre-authorisation can simply be cancelled.

Secure card processing is just one way in which the health practitioner can reduce administration time whilst at the same time helping to ensure that appointment slots are filled as much as practicable. SMS text reminders also help to reduce no-shows and can be pre-scheduled to be sent out at a set time before the appointment. Health practitioners may only account for a small proportion of the billions of transactions which already take place every year but if secure card processing can help to cut workflow and smooth cashflow then the more developments in card payment options which the PSR can encourage the better.

The Rise in Health Literacy

Once upon a time the pronouncements of health professionals were treated as absolute. We attended their clinics and surgeries, described our symptoms and took whatever treatment was prescribed. Whilst in some ways unquestioning faith may have been easier for the health practitioners, it also meant that the level of health knowledge within the general population was fairly poor.

The result of this was that many diseases went undiagnosed until it was too late and ‘old wives tales’ were as likely as not to determine health levels in some districts. What was needed was a good dose of education; a way of helping the general population to be better informed about health issues.

Fast forward to the internet generation and we are all far more likely to be health aware. We can look up symptoms, check healthy diets and delve into treatment options for illnesses. In fact the only challenge facing us nowadays is to distinguish between the reputable sites and those which rely rather more on rumour and gossip than is good for us. Oh yes and having the strength of mind to work through the list of diseases associated with symptoms and be realistic rather than just plumping for the one at the top of the page or which looks most alarming. But in general being more aware of the course of illness and disease helps us to work with health professionals in designing a treatment plan which is appropriate for us.

And surfing our symptoms is not confined to the young. The rise of the silver surfer has resulted in the elderly also being more aware of what treatments are better for them. So much so that a recent BBC report revealed that regular internet use in older people was associated with good health literacy. In other words, the more familiar we are with surfing the more likely we are to research symptoms, ask for help in a timely manner, and engage with treatment.

But our increasing familiarity with the internet and associated technologies also has other benefits for health practitioners. Those who are used to surfing the web are more likely to accept time saving options such as online booking allied with pre-payment by card. This not only saves health practitioners time, it also is more likely to result in patients who show up for treatments. Additional reassurance can be gained by adding a SMS text reminder to the online booking system, prompting patients to attend appointments or to cancel in time for the slot to be refilled.

Linking in a pre-payment by card module to the booking system also enables practices to easily take a cancellation fee in the event of no-shows, bringing the added benefit of smoothing out cash flow. There are those who say that the ability to look up symptoms online can result in a generation of hypochondriacs but there have always been those who take their symptoms too seriously. What internet surfing does do is help practitioners and patients to work together to create the optimum solution and that can only be good for the health of the nation.

The cost of health

The Royal College of Nursing (RCN) has overwhelmingly rejected a proposal to charge patients for NHS appointments. Had the proposal been successful it would have led to the RCN backing the idea of a £10 charge for health appointments, but in the end 91% of delegates at the RCN conference voted against.

Those in favour of the proposal said that making a charge would not only raise much needed revenue for the NHS it would also emphasis the value of NHS appointments. In other words, charging for appointments would help people to appreciate the value and cost of NHS appointments and in the process make people think a little more about the way in which they use NHS resources This would in turn, the proponents argued, result in the twin benefits of reducing unnecessary appointments and reducing no-shows; both of which waste considerable NHS resources as well as potentially delaying urgent treatments. After all, it helps no-one if health practitioners are sitting idly by waiting in vain for someone to turn up. That time would far better be used in helping another patient.

Commenting on the vote a spokesperson for the Department of Health said “We are absolutely clear that the NHS should be free at the point of use, and we will not charge for GP appointments.” But with no-shows a constant drain on both NHS and private health care services, practices are increasingly turning towards the use of appointment reminders as a means of encouraging people to attend booked appointments or to cancel them in good time.

Sent by phone, SMS text or e-mail, appointment reminders not only jog patients’ memories, they also act as a spur for patients to get in touch and cancel appointments if they are unable to attend. This in turn enables health practices to re-book appointment slots.

For health practices such as osteopaths or physiotherapists which do charge for appointments, not only do no-shows waste valuable treatment time, they also act as a cost drain on the practice. Whilst the option of sending out appointment reminders is one option, another great way to cut down on no-shows is to take a secure card pre-authorisation at the time the appointment is booked. Having a card pre-authorised tends to sharpen the mind when it comes to remembering to attend appointments. Pre-authorising a card doesn’t prevent the patient from paying by other means when they attend the appointment but should the patient not attend the health practice can charge a pre-agreed sum to the card. Pre-authorised card booking can be taken either over the phone or when an appointment is booked online.

With a report from the BBC revealing that the NHS may be facing a funding gap of some £2billion in the next year, we suspect that the debate about the way in which health care is funded and managed will rumble on for some time. Adopting systems such as appointment reminders which help to ensure patient care is delivered when it is required whilst at the same time maximising resources can only be a positive move.

The power of sport

It may be the top sportsmen and women who hit the headlines but the power of sport to engage and enthuse at all levels never ceases to amaze. From rumbustious back street kick-abouts to photos in the Guardian recently of Brazilian children practicing overhead kicks on a flooded pitch; sport can be a unifying and defining activity.

One thing is certain, with Wimbledon and the World Cup around the corner, our streets and parks will soon be filled with enthusiastic sports players all dreaming that one day they will be able to emulate Murray or Messi, Nadal or Neymar. But, played at any level, sport can come at a price.

That price is the chance of injury. You may be a top flight sportsperson, used to training every day and carefully balancing nutrients to optimise body health and fitness. You may be a weekend player, turning out for the local team before heading off for a drink; or you may be an occasional player, turning out with short bursts of enthusiasm before retreating to more sedentary forms of support. Whatever level you play at, the odds are that injury will hit at some stage. And when injury hits, the quicker it is treated the better.

For health professionals such as physiotherapists, chiropractors, sports injury practitioners and osteopaths, the challenge is to be on hand to treat regular clients, whilst at the same time squeezing in more immediate cases. No-one wants to leave diary slots vacant but equally no-one wants to turn down prospective patients. The answer is to take every opportunity to ensure that prospective clients can make and attend appointments.

Online booking will capture some clients but others may prefer to speak to a person at the end of a phone. Switching phones to a virtual assistant will help to ensure that when the phone rings, someone will answer without the need to interrupt ongoing treatments to answer the phone. In fact, using a virtual assistant service has multiple benefits including improving the image of the health practice, establishing a dialogue with clients and freeing up treatment time which would otherwise be spent in answering or returning telephone calls.

Once the appointment has been made it is important both for the patient and the health practice to ensure that treatment starts in the timescale agreed. No-shows not only delay the start of important treatments, they leave empty gaps in health practitioners’ diaries which could have been filled by other patients.

Encouraging clients to keep the appointments which they have made is a two-fold process. Appointment reminders sent out via SMS text or e-mail have been shown both in the NHS and private practice to reduce the number of no-shows. Similarly, confirming bookings with a pre-authorised debit or credit card sum also serves to improve attendance rates, generally because this means that the health practice can take a non-attendance fee in accordance with advertised practice.

World cups, tournaments, championships; the sporting calendar rolls ever onwards and with every passing phase brings a new crop of injuries. Making sure that they are on hand to provide prompt treatment will earn health professionals their own niche in the sporting hall of fame.

Tackling Late Payments

The economy may be improving but late payment of invoices is still a problem for small business. So say the Forum of Private Business (FPB) whose latest survey revealed some worrying statistics in respect of late payers.

According to the survey 23% of respondents say that they have seen an increase in the number of late payments whilst 29% report that the number of days payments have been delayed beyond the deadline have also increased. In the light of this, respondents have called for better publicity in respect of late payment issues as well as a range of sanctions for late payers to include barring persistent offenders from government contracts.

Responding to the survey’s findings, FPB Chief Executive, Phil Orford MBE said “upwards of £30 billion remains tied up in late payments, costing a typical small business 130 hours a year to chase and meaning that a third are forced to seek external finance to cover the gaps in cash.” Tackling late payments is a challenge which potentially affects every business and even those within the health sector are not immune. In fact, businesses such as physiotherapy and osteopathy which rely on patients paying for treatments not only have to cope with potential late payers but also with a loss of income from those who fail to turn up for appointments.

Alongside diary management and appointment reminder solutions which aim to cut down on missed appointments, health practices may also wish to turn to secure card processing as a means of ensuring swift payment for treatments. With booked appointments backed up by a pre-authorised card payment the health practitioner knows that they will receive prompt payment following the appointment. And if the patient fails to turn up, a card payment can still be taken in accordance with the practice’s cancellation policy.

Pre-authorising a card at the time of booking doesn’t commit the patient to using that card following their appointment. If they choose to pay by cheque or cash or to use another card then the pre-authorised amount can simply be cancelled. This means the patient retains payment flexibility whilst at the same time the practice receives prompt payment; helping to smooth over cash flow issues. The simple fact that a payment has been pre-authorised also helps to act as a spur to patients to keep their appointments, helping to reduce the number of gaps in a practice diary and ensuring that those who need treatment receive it promptly.

Changing the UK’s Health

Sometimes for change to happen it requires a seismic shift in technology or actions, but on other occasions a series of small individual acts can come together to create something special. That was the idea behind NHS Change day; a time when individuals can make small pledges which could result in significant change for the NHS.

At the time of writing over 450,000 people have made their pledges and with the last pledge date for 2014 still some weeks away the final total is expected to be far higher. Some pledges are designed to support and strengthen local campaigns whilst others have been made on a far more individual basis.

One national campaign which the NHS is promoting through NHS Change Day is the idea of reducing no-shows. With 12 million GP and 6.9 million hospital appointments missed in the last year costing a total of £270m, every person who makes an individual pledge not to miss an appointment in future will be saving the NHS money and improving treatment for themselves and others.

In an attempt to cut down on no-shows NHS practices are adopting a range of measures from reminder calls and texts to encouraging direct booking online. But it is not just health practitioners within the NHS who suffer from missed appointments. Health practitioners across the board from chiropractors to physiotherapists and from beauticians to counsellors all suffer if a patient fails to attend an appointment. And in many of these cases it is not just the taxpayer who loses out but the health practitioner themselves, not to mention other patients who could have taken that vacant slot.

So for health practices everywhere, anything which can be done to cut down on no-shows should be done. Appointment reminders, online booking services, ensuring continuity of telephone answering; all can play their part in working towards a full diary and effective treatments.

The pledges being made for NHS Change day are not just confined to reducing missed appointments. Challenging culture, enhancing leadership, patient safety, improving skills, the list goes on. Some of the pledges are from patients, others from those on the front line or back office who are working to improve the NHS from within and without. From individual pledges to walk more or eat healthily to sharing knowledge and experience with others, the pledges may individually not be earth shattering. But if enough people see the pledges and join in then health care for all could be the winner.

Time to ski

With Bonfire night safely out of the way it is time to turn our thoughts ahead to the winter ski season. Whilst some forecasters have predicted a harsh winter ahead for the UK in 2013, the Met Office recently took pains to stress that it is still too soon to produce an accurate forecast and accused those who are predicting “the worst winter in decades” of crystal ball gazing.

Whatever the outcome, UK winters are still too unpredictable to guarantee good snow leaving ski enthusiasts having to look elsewhere to get their skiing fix. This means that the annual exodus to the European slopes and further afield is about to get underway.

The first week in November has already brought a good snow covering to some alpine resorts, resulting in predictions of an early start to the season and no repeat of last year’s green slopes. Hopefully the weather conditions will bring good safe skiing but whilst the majority will return safely from their adventures, there will be some who suffer on the slopes and need attention on their return.

It’s not surprising therefore that whilst eager skiers travel outwards, back in the UK physiotherapists and other health professionals are bracing themselves for a busy winter. Broken limbs, strains and pulls are an inevitable consequence of skiing accidents. Add in those whose year-round sedentary lifestyle has not prepared them for the physicality of skiing and chiropractors, osteopaths, and physiotherapists alike are an unforeseen consequence of a winter holiday on the slopes. And if winter in the UK does turn out to be harsh then there will be an additional crop of home-grown injuries to treat.

Hopefully some individuals will have thought ahead, consulting health professionals for pre-ski exercise regimes which will prepare them for a holiday on the slopes. And hopefully some people (particularly the elderly or frail) will have prepared for icy conditions at home, stocking up on essential supplies or arranging for additional support perhaps from a neighbour or health professional. But many won’t be prepared and even if they are, it is impossible to guard against accidents. All this means additional demands on the services of health professions who in turn will need to gear up their timetable to run as smoothly as possible. This includes taking steps to ensure that the time given to treatments is maximised.

All this means that health professionals need to gear up their timetable to run as smoothly as possible. Missed appointments not only means a lack of income but also another patient who will not be speedily treated. Having to interrupt treatments to take phone calls means that treatment may not be as effective as it should be. And if calls are missed then patients suffer and diaries are not as full as they should be.

The answer is to bring in the services of a virtual assistant. With calls answered, diaries can be maintained as full as practicable without patent treatments suffering. Add in an appointment reminder service and no-shows are reduced again helping diaries to be maintained at an optimum level. Skiing can be fun, but when something goes wrong, a speedy return to fitness with quick and professional help is the best way to prepare for the next season on the slopes.

Telephone reminders

We’ve written before about the way in which telephone reminders can help to cut down the number of no-shows but it is always a pleasure to be able to report on a practical example. Earlier this year the Great Western Hospitals NHS Foundation Trust introduced a reminder service for those with outpatient appointments.

Since the reminder service started the trust reports that no-shows have reduced by a third and the trust is therefore expanding the service to its physiotherapy departments. Using a mixture of texts and automated calls the trust decided to adopt the appointment reminder service as a way of cutting down on the 39,871 appointments missed in 2012.

In announcing the extension of the service the trust’s deputy general manager responsible for outpatients told the Wiltshire Times: “The reminders seem to making a real difference. I hope that patients find the service helpful and it makes it easier to cancel or rearrange. If we know a patient won’t be attending, we can offer the appointment to someone else. By making sure all of our appointments are used, we can see more patients and patients will be seen sooner.”

Patients who fail to show up for appointments are not just a problem for NHS trusts. Health practitioners everywhere from osteopaths to physiotherapists and from beauticians to specialised health clinicians all need to run with as full a schedule as possible if they are to remain competitive. Not only can missed appointments lead to delays in treatment times for the patients concerned and others, for those who rely on the appointment to generate income, every gap is a loss. The Wiltshire trust estimated that for them each missed appointment cost some £108 and the opportunity cost charge can easily be higher for those in private practice.

It is hardly surprising therefore that telephone appointment reminders are increasingly becoming a necessary feature of health practice. This writer has received reminders within the past few months from their optician, dentist and doctor, all of whom have adopted versions of the reminder system. Set alongside a virtual assistant service which can also take calls and arrange bookings, even the smallest of health practices can move towards a fuller diary with fewer no-shows. This in turn means that health practitioners can keep their prices competitive whilst maximising both their income and patient treatment times.

Divide and conquer

A hospital in Derbyshire has been reaping the benefits of a new cleaning rota. Using an idea gleaned from overseas, the Royal Derby Hospital split its cleaning workforce into teams, each responsible for specific areas such as corridors or toilets. Previously a single cleaner had been responsible for an entire ward or area of the hospital.

The new system of team cleaning by area has lead to a reduction in cross-infections, traditionally a pre-cursor of the need to close wards for deep cleaning. In fact this new working pattern has been so successful that the hospital has been put forward for two Nursing times awards including the Golden Service award.

Hospital bosses have also found that by using teams rather than a succession of individuals, cleaning patterns are more flexible. This in turn has reduced the incidence of wasted cleaning processes, such as cleaning a patient area just before a patient is due to be discharged as well as ensuring teams are on hand in case an emergency clean is required.

The story is a perfect example of the way in which those at the forefront of health provision are finding ways to work smarter rather than harder. For example many health providers are looking to make savings by replacing follow up appointments with telephone calls or using the phone to make routine check-ups on those with ongoing problems.

It has to be acknowledged that telephone coaching is not universally successful if used in isolation as a study by UK researchers revealed earlier in August. They concluded that telephone coaching of those with long term conditions is not effective unless it is carried out as part of an integrated system of care.

Health professionals too are using this “divide and conquer” principle to maximise patient treatment time and minimise disruptions. Simply by outsourcing their phone answering to a virtual assistant service, health professionals can ensure that their phones will be answered, appointments made and reminders sent out whilst the health professional can concentrate on treating their patients. With no need to interrupt a treatment to answer the phone and no missed calls, professionals such as osteopaths, chiropractors and others can provide a more streamlined and efficient service to their patients.

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