Candidate for the Lee B. Lusted Student Prize Competition
Purpose: To measure the cost of no-shows and benefit of no-show interventions and overbooking for an outpatient endoscopy suite.
Method: We used a discrete event simulation model based on an outpatient endoscopy suite at UNC Hospital in Chapel Hill, NC, to measure the effect of no-shows on expected net gain. Expected net gain is defined as the difference in expected revenue based on CMS reimbursement rates and variable costs based on the sum of patient waiting time and provider and staff overtime. To build the model, we used a combination of historical time stamp data and time studies to estimate probability distributions for all parts of the endoscopy process including intake, procedure, and recovery times. No-show rates were estimated from historical attendance (18% on average). We used reported improvements in no-show rates from published intervention studies, such as phone reminders, and pre-assessment clinics, with relative reductions in no-show rates ranging from 34.5% to 75.5% to measure their associated effects on expected net gain. In addition to no-show interventions, we evaluated the effectiveness of scheduling additional patients (overbooking) on the expected net gain. We compared interventions and overbooking to a perfect attendance scenario of n=24 patients (the reference scenario) on the basis of expected net gain.
Result: The daily expected net gain with perfect attendance (reference scenario) is $4,433.32. The daily loss attributed to the base case no-show rate of 18% is $725.42 (16.36% of net gain). This loss is sensitive to the no-show rate, ranging from $472.14 to $1,019.29 (10.65% to 22.99% of net gain) for no-show rates of 12% and 24%, respectively. The daily loss relative to the reference scenario associated with implementing no-show interventions ranges from $166.61 to $463.09 (3.76% to 10.45% of net gain). The overbooking policy of 37.5% additional patients resulted in no loss in expected net gain when compared to the reference scenario.
Conclusion: No-shows can significantly decrease the expected net gain of outpatient procedure centers. Interventions such as phone reminders and pre-assessment clinics reduce the no-show rate; but can be costly, challenging to implement, and do not resolve the problem entirely. Overbooking can help mitigate the impact of no-shows on a suite’s expected net gain and has a lower expected cost of implementation to the provider.