Dealing with no-shows among Medicaid patients

By some estimates, up to ten percent of dental appointments end up as no-shows, causing significant financial losses for dental practices.  In the Medicaid population, this number increases, with some studies putting the no-show rate at 30-40%.  Many methods have been suggested by practice managers and consultants to reduce no-shows including the use of reminder calls, text messaging, emails, and use of confirmation APPS.  All these activities have helped to reduce no-show rates, but the problem continues at an unacceptable level.  This is an especially challenging problem in low-income areas and among the Medicaid population where dental needs are often most acute.

Recently Delta Dental conducted a study among dentists, hygienists, practice managers, and health policy decision-makers about the no-show problem within the Medicaid population.  The following five key suggestions came out of this study:

1. Offer creative and flexible scheduling.
   Most dental practices operate 4-5 days a week during normal daytime business hours with few providing appointments in the very early hours, during the evening or on weekends.  For Medicaid patients, visiting the dentist often means a loss of much needed hourly income as well as the additional challenge of getting employers to allow them time off work for dental care.  For parents and guardians, there is also the challenge of obtaining and paying for child care so the caregiver may be seen.  It would be helpful to offer once a week early morning or early evening appointment hours.
2. Make the most of each appointment.
   Since scheduling and attending each appointment is a challenge, it is important to complete as many procedures as possible if the patient is willing and able.  This decreases the risk of future cancellations and no shows.  It also ensures that patients receive the maximum amount of care while their benefit is active, as many Medicaid members lose and regain coverage throughout the year as their eligibility changes.
3. Provide incentives.
   This is a simple idea that is easy to implement and isn’t costly. For instance, Medicaid patients would receive a “conquer cavities education kit” for every visit or a special incentive for not missing any dental appointments in the past year.  Perhaps offer an inexpensive electric toothbrush following their annual exam & x-rays.   Another idea is to enter Medicaid patients into a drawing and select one winner each month who would then receive an electric toothbrush, toothpaste, floss, or other promotional merchandise from the practice.
4. Assistance with transportation.
   Medicaid programs offer non-emergency medical transportation services to help members get to and from appointments for medical, dental, vision or behavioral health.  Practices should always keep transportation vendor information handy and refer patients as needed.  Also, awareness of the closest bus stops and providing directions to the office for drivers is key to patients finding the office and improving appointment show rates.
5. Work with local non-profits that focus on community healthcare gaps.
   Most communities have one or more organizations focusing on health disparities.  There are always opportunities for dentists to collaborate with community-based organizations and the business community to improve access to dental care.  Being associated with community groups such as churches, food banks, daycare centers, athletic groups, and others builds trust and loyalty which reduces missed appointments.  There may also be funding available to cover all or portions of dental care for those who need additional financial assistance.

While there is no easy solution to missed appointments, there are many creative strategies that help reduce this problem.  At Delta Dental, we are committed to ensuring our members receive the best care, but also to supporting our providers in that pursuit.  Assistance is available for providers regarding scheduling, transportation, and practice management.  Financial compensation may also be available for no shows, lab fee reimbursement for undelivered prostheses, and for increasing utilization among patients.  In addition, we heavily invest in the community to support healthy lifestyles, oral health innovation, and donated services.  By thinking creatively, offering strategic practice management solutions that improve patient relationships, and establishing deeper ties within the community, Delta Dental is offering key strategies that make a difference.