Mental Health Patient Scheduling Preferences
IndustryView | 2015

Mental health professionals have an array of appointment scheduling and reminder tools to chose from, which help them reduce missed appointments through the use of phone calls, text messages and emails. This report will help mental health providers determine the most effective methods for reducing patient no-shows and cancellations.

Key Findings:

  1. Forty-three percent of patients admitted to having missed mental health appointments without giving prior notice.
  2.  
  3. Among those who missed appointments, conflicting work or family obligations (27 percent) and forgetting (27 percent) were the most common reasons.
  4.  
  5. The greatest percentage of patients (43 percent) preferred personalized text message and phone call reminders over their automated counterparts.

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Introduction

One of the most difficult parts of many jobs in the mental health field is getting patients to consistently schedule and attend appointments. In 2004, a National Institute of Health (NIH) study reported that the no-show rate for mental health patients could be as much as 50 percent, which is significantly higher than the no-show rate of other medical professions.

Even more alarming is the fact that just four missed appointments per week can result in an annual loss of $30,000 or more in revenue. As a result, finding an appointment scheduling and reminder system that resonates with patients is key to running a successful mental health practice.

To help professionals determine how to effectively encourage patients to attend appointments, we surveyed U.S. patients currently receiving mental health treatment about their preferences, and consulted providers to see how they selected scheduling tools for their practice.

Nearly Half of Patients Miss Appointments Without Notice

Among patients surveyed, 43 percent admitted to missing an appointment with a mental health care provider, even if they did so only “rarely.” Most troubling, however, were the 12 percent of patients that confessed to missing appointments “very often,” who likely represent a significant loss of income and an increased scheduling burden on clinicians.

  • Frequency of Missed Appointments

    Frequency of Missed Appointments
  • Frequency of Cancelled Appointments

    Frequency of Cancelled Appointments

A slightly larger percentage of patients (54 percent) noted that they had cancelled an appointment with a mental health professional on one or more occasions. Cancellation policies can vary from clinician to clinician: Most require at least 24 hours’ notice to cancel an appointment without penalty, but some insist on at least 72 hours’ notice. Depending on factors such as how far in advance a patient cancels, canceled appointments can still result in a loss of revenue if the appointment slot can’t be filled by someone else.

Over One-Quarter of Missed Appointments Due to Forgetting

With these financial repercussions in mind, we took a closer look at why patients miss appointments without giving advance notice. We found a diverse range of common reasons, chief among them conflicting work or family obligations (27 percent) and forgetting the appointment (27 percent).

Twenty-six percent of patients reported missing an appointment due to experiencing symptoms of a mental illness, which could include being unable to get out of bed. Some patients were no-shows because the appointment was too difficult to cancel (19 percent), or for various “other” reasons (15 percent).

Reasons for Missed Appointments

Reasons for Missed Appointments

Although no-shows due to work or family conflicts may seem unavoidable, it’s possible that some of these patients did have time to cancel the appointment, but chose not to or forgot until the last minute.

One strategy for reducing no-shows among this population is to clearly explain the practice’s cancellation policy (including any missed-appointment fees), and to get patients to verbally agree and sign a cancellation agreement at their first appointment. Some practitioners get the attention of repeat offenders by sending letters, rewarding patients who show up on time with discounts and/or personally thanking patients who follow the cancellation policy.

For those respondents who confessed that they had missed an appointment because they simply forgot, there is an easy remedy: the effective use of appointment reminders.

Patients Prefer Personal Reminders

Reminding patients about their appointments is one of the most common ways to combat no-show rates. Our survey found that 43 percent of patients preferred a personalized reminder over an automated one, with 22 percent opting for a text message (SMS) and 21 percent preferring a phone call. Email reminders, which were favored by 18 percent of respondents, are typically automated but can be made to appear personalized through the use of templates.

Preferred Appointment Reminder Methods

Preferred Appointment Reminder Methods

These findings are well supported by studies showing that reminders from a person, rather than a machine, have a more significant impact on no-show rates, possibly because connecting with a human confers an added sense of responsibility. However, providers need to ensure that both personal and automatic messages sent to patients are done through a HIPAA-compliant platform.

Appointment reminder and scheduling modules are often provided as a part of mental health electronic health records (EHR) and practice management applications. One example is PIMSY, which offers an optional messaging feature as an add-on. Leigh-Ann Renz, the company’s marketing and business development director, says one of its clients saw a 10 percent drop in its no-show rate after one year of using a combination of personal phone calls and automatic text message alerts.

"Our client was pleased with the amount of time and money saved, since they no longer had to physically call each patient," said Renz. "It also helped them to reach patients who may not have an active number or minutes on their cell phone, but were able to text and email."

Digging into the data further, we also wanted to see whether preferred reminder methods differed based on a patient’s age. As expected, they did: We noticed that patients under 35 years old were significantly more interested in text message reminders, whether personal (27 percent) or automatic (26 percent). On the flip side, the greatest percentage of patients over 35 (26 percent) favored receiving a personal phone call reminder.

  • Preferred Appointment Reminder Methods, Under Age 35

    Preferred Appointment Reminder Methods, Under Age 35
  • Preferred Appointment Reminder Methods, Over Age 35

    Preferred Appointment Reminder Methods, Over Age 35

Given these findings, it’s important for providers to consider the demographics of their patient population before implementing or modifying a reminder system. Additional research has shown that younger patients are more likely to miss health care appointments, suggesting that professionals at all practices should try to target this population directly.

However, it’s also important that providers test out different reminder methods to find the ones that work best for their practice. Takiya Paicely, licensed clinical social worker (LCSW) and owner of Paicely Consulting and Therapy Services, says she tried using phone, email and text message reminders before settling on just using phone and email.

“Surprisingly, I have noticed that individuals between the ages of 30 and 45 have enjoyed digital appointment reminders [more than]  my younger clients,” she reports.

More middle- and senior-aged  individuals are connected to email than in the past, so it’s important not to write these patients off as disconnected from technology. Trying out the use of digital appointment reminders is the only way to gauge how a specific group of patients will respond.

Patients Prefer to Schedule Next Appointment During Last One

Scheduling methods are an important, if overlooked, strategy for getting patients to attend their appointments. If patients are offered several scheduling options to choose from, they could be more likely to select a method that will help them remember their appointment.

Unsurprisingly, 36 percent of patients preferred the convenience of scheduling their next mental health appointment during their previous one. Twenty-seven percent of patients stated they would rather call to schedule over the phone, and 24 percent said they would like to make appointments online, either via email or a patient portal. Just 11 percent would feel most comfortable texting a clinician to address their scheduling needs.

Appointment Scheduling Preferences

Appointment Scheduling Preferences

This data is in line with our recent patient portal survey, which showed that 24 percent of patients were interested in scheduling appointments online. Patient portals and other online scheduling tools also benefit providers by reducing the volume of incoming calls for making, changing or canceling an appointment.

Over Half of Patients Prefer to Cancel Via Phone or Online

Since 19 percent of patients missed appointments because they were difficult to cancel, we decided to examine patients’ preferred channels for canceling and rescheduling appointments. The results were mixed: 29 percent of patients preferred to call the office to cancel, followed closely by the 28 percent who would rather cancel appointments online. Not far behind were the 22 percent of patients who would prefer to respond to a text-message reminder and the 19 percent who wanted to call the provider directly.

Appointment Cancellation Preferences

Appointment Cancellation Preferences

As mentioned above, appointment cancellations ahead of time are beneficial only when patients give enough notice for new appointments to be booked in their place. Offering patients multiple cancellation methods is one valuable strategy for making sure that patients who know they cannot make it will cancel in a timely manner.

Provider Selection Influenced by Digital Reminders

Finally, we asked patients how likely they would be to select one provider who offered digital appointment reminders over another who did not. Although the availability of these reminder types do not appear to be a major factor in the decision-making process, they do have some weight.

A combined 61 percent of patients responded that they would be at least “minimally” more likely to select one provider over another based on the types of appointment reminders offered, with 14 percent of those being “extremely” likely to do so.

Likelihood to Select Provider Offering Appointment Reminders

Likelihood to Select

This is further evidence that providing a variety of types of appointment reminders can help more patients attend appointments more often.

Conclusions

The results of our survey indicate that the effective use of appointment scheduling and reminders is crucial to reducing no-shows and cancellations at mental health practices. Here are some key tips for providers to keep in mind when adding a new scheduling and reminder system:

  • Many patients prefer personalized appointment reminders over automatic ones; while automation may be easier, a personal touch could be what actually gets patients in the door.
  • Consider patient demographics, but don’t assume that one age group will automatically prefer one form of appointment reminder over another.
  • Record how patients respond by comparing no-show rates before and after implementing a new system. Without data, it’s hard to tell if a new system is working.
  • Consider collecting reminder preferences from new patients as a part of an intake form or first appointment. Some mental health EHR systems allow patients to opt in or out of different reminders, and permit providers to create both automated and personalized reminders using templates.

Methodology

To find the data in this report, we conducted a five-day online survey of eight questions, and gathered 3,096 responses from random patients within the United States who had been under the care of a mental health professional for at least a one-month period. All survey questionnaires undergo an internal peer review process to ensure clarity in wording.

Sources attributed and products referenced in this article may or may not represent partner vendors of Software Advice, but vendor status is never used as a basis for selection. Interview sources are chosen for their expertise on the subject matter, and software choices are selected based on popularity and relevance.

Expert commentary solely represents the views of the individual. Chart values are rounded to the nearest whole number.

If you have comments or would like to obtain access to any of the charts above, please contact kathleenirwin@softwareadvice.com.


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