For a variety of reasons, Community Medical Center, a 25-bed critical access hospital in Falls Park, Nebraska, faced a lot of no-shows, specifically in its behavioral health department and outpatient clinic.

THE PROBLEM

Many of the behavioral health patients had difficulty managing schedules and other priorities. And outpatient specialty clinic patients usually had more time between appointments because Community Medical Center has specialty-trained doctors travel once or twice a month to be on location. This often led to patients forgetting.

Additionally, the high number of no-shows was causing frustration and inefficiency for providers. Many patients had appointment blocks that ranged from 15-40 minutes. If a patient didn’t show, that meant a lower reimbursement rate and a loss of productivity for the team.

Further, to try to prevent no-shows, the medical center had clinical team members chasing down patients via phone – which caused many to feel like they weren’t practicing at the top of their license.

PROPOSAL

Community Medical Center tried the phone reminder system in its NextGen electronic health record. It automated phone calls, but that did not help as much as staff was hoping it would. Knowing a lot of people do not answer the phone, staff could not confirm who was receiving the calls and who was not. Overall, it was not what the staff had hoped.

“We had talked about texting before, knowing dentists had been using it for some time, but we weren’t sure about moving forward with it,” said Ryan Geiler, advanced clinical applications and analytics director at Community Medical Center. “Automated voice calls didn’t work well when we were faced with the idea to physically call problematic patients 2-3 days before appointments.”

So the medical center turned to patient relationship management IT vendor Solutionreach. The vendor has a three-tiered reminder approach where patients get reminders two weeks, two days and two hours before their appointments via text message. This has left staff free to focus on welcoming patients and getting them settled for their appointments.

MARKETPLACE

There is a variety of patient relationship management tools on the health IT market today. Some of the vendors of these tools include RevenueWell, Salesforce, Solutionreach, Weave, WebPT and WELL.

MEETING THE CHALLENGE

“It surprised us to see how many patients preferred texting outside of their reminders,” Geiler said. “Many of our patients reach out that way independently for additional information, directions, etc. And it’s great. Rather than hearing phones ring consistently and having to put patients on hold, the two-way texting allows staff to prioritize messages appropriately and respond in a way that allows for efficiency to flourish.”

Additionally, the ability to create independent patient groups from the EHR and generate reports is a bonus, he added.

The family medicine practice (which includes all providers), the orthopedic clinic, the outpatient clinic (including pain management) and the outpatient specialty clinic all use the patient relationship management tool, which is mainly used by front-office staff and nursing.

“The primary use of Solutionreach at CMC is to help patients remember their appointment and care plan needs, and staff with confirmation to improve productivity,” Geiler explained.

“Before, staff used to spend time leaving voicemails, but now the team saves time and prevents both patients and staff from a bad experience. Really, we just set up the reminders and go. The platform has an interface that sets up scheduling and appropriate cadence around the proper locations and timing for patients all by connecting with our EHR.”

Solutionreach integrates with Community Medical Center’s NextGen EHR, and with the MediTech EHR used in the outpatient specialty clinic. The platform has never experienced downtime, unless self-induced by staff because of holidays, Geiler reported.

RESULTS

“No-shows have been significantly reduced and are now well below the industry standard,” he said. “This has made the team happy and reduced the overall feeling of frustration and burnout.”

Additionally, revenue has increased and the number of people who received their flu vaccine increased, he added.

“Texting with our ongoing outreach has always been an excellent combination because it gives us the ability to text a group of patients and send out information important to their health,” Geiler said. “Most of our patients are from a rural setting, so when they think of healthcare, it’s a ‘fix a problem’ mindset. But because we’ve implemented patient engagement tools, we’ve seen a shift to a ‘prevent a problem’ mindset.”

ADVICE FOR OTHERS

“It’s better to do something decent today and optimize later,” Geiler advised. “A lot of organizations, including CMC, face decision paralysis, and that’s bad. Ultimately, you just have to do it and refine the process as you learn.”

Staff should be open to change, he added. When Community Medical Center introduced texting, staff saw apprehension throughout the team, until they realized a few days later how much it positively impacted their workflow, he explained.

“Finally, the sooner you can implement patient engagement tools, the better,” he concluded. “The change and speed for service is much needed as the current reimbursement model begins to become adopted by private insurance organizations. The quicker organizations can connect with patients digitally and focus on the quality of care, the better I believe they will improve on the Merit-based Incentive Payment System.”

Twitter: @SiwickiHealthIT
Email the writer: bill.siwicki@himss.org
Healthcare IT News is a HIMSS Media publication.