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5 Steps to Reducing Patient Non-Compliance in Surgery Centers

Unused capacity due to patient no-shows and non-compliance with preoperative and postoperative instructions can be a significant cost burden for ambulatory surgery centers, but swift action can prevent time slots from going to waste.

"An ASC needs to take steps to make sure the patient is actually there and ready for the procedure," says Adam C. Powell, PhD, president of Payer+Provider Syndicate. "If the facility has adequate lead time, it can find another person to fill the slot from future scheduled appointments, instead of suffering the cost of having spoiled capacity in the present."

Dr. Powell discusses how to ensure that patients arrive prepared and how to manage last-minute cancellations in a cost-effective way.

1. Establish the patient's preferred contact method upfront. There are three primary ways in which a patient can be non-compliant: the patient does not show up for the procedure; the patient has not followed preoperative instructions, such as not eating before the procedure; or the patient does not follow postoperative instructions, such as arranging for a caregiver to accompany him or her. The surgery center has the greatest chance of preventing these issues from occurring by establishing a clear method of communication with the patient at the time of registration, and then by following up with the patient as the time of treatment approaches.    

"When meeting patients for the first time, ask how and when they prefer to be contacted," says Dr. Powell. "This can be noted in patient files." Secure email and phone calls are the ideal methods of communication for confirming schedules and providing detailed information, he says.

2. Contact the patient one week before the procedure. One week serves as ample time to remind patients of their procedure date and any preoperative and postoperative instructions. "If you reach the answering machine or send an email, request that they call back during business hours to confirm — it's important to have verbal communication," says Dr. Powell.

3. Aim to speak with the patient. Human conversations are preferable to automated messages and worth the extra efforts from staff, he says. "Research has shown that no-show rates are lowest when patients are contacted by an actual human being." Verbal and secure online communication also enables the surgery center to verify the patient's identity before disclosing medical information, he says. Dr. Powell noted, “It is essential to not disclose protected health information to third parties. Having a means to confirm the patient’s identity enables providers to provide detailed instructions rather than vaguely worded reminders.”

4. Contact the patient again two days before the procedure. As preoperative protocols can require a full day of preparation, it is ideal to contact the patient again two days before the procedure, says Dr. Powell. If the patient must cancel the procedure, two days is also sufficient time to attempt to schedule another patient in the newly-open time slot.

5. Attempt to fill cancelled time slots with patients scheduled for the upcoming month. In the event of a cancellation, the surgery center should begin contacting patients with appointments scheduled in the next several weeks. Patients undergoing elective procedures may appreciate the opportunity to have the surgery performed sooner, says Dr. Powell.

When looking for the appropriate patient to fill a cancelled time slot, consider the duration and staffing requirements of the procedure to pinpoint a patient with similar needs, he says. It is also ideal to pull a patient who is at least two weeks ahead in the schedule, so long as they have completed the necessary preoperative preparation. Dr. Powell concluded, "When proactively rescheduling patients, you're creating another gap in your schedule, but the gap is farther out and you have more time to fill it."

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