Army New policy for no show/late arrival

[DD214_DOC]

I was informed that there is a recent policy regarding patients who arrive late to their appointments as well as for counting it as a no show. It seems pretty absurd and I was wondering if anyone else has heard of this, or if it's just a rumor/made up by someone.

Supposedly, a patient must be seen for their appointment no matter what time they show up. For example, a patient with an appointment scheduled at 1100 who doesn't show up to the clinic to check in until, say, 1545, must still be seen for that appointment. I assume it's if they can be fit in somehow. As an extension, then, no patients may be counted as a no show until COB.

Also, anyone who walks in and asks to speak to the physician or provider directly must be able to do so? This would be without any type of appointment.

Is this true? I really hope not given the absurdity.

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[turkish]

Been that way for a couple of years at Walter Reed. Your time does not matter. Only captured care dollars matter. So say those who make the rules about seeing patients but do not see patients.

 

[Gastrapathy]

There is an easy way to handle this:

"Sir, our clinic policy is to see any patient who walks in during business hours no matter how late they are for their appt. However, we strive to stay on time for the patients who arrive on time and do our best to work in late arrivals as quickly as we can. It is possible that there won't be an opportunity to work you in until then end of the clinic day but because we are trying to fit you in, we will need to remain here until you are called. You are free to reschedule at any time."

Our front desk staff had that script down. It worked like a charm.

90% will walk and you've complied with the directive. There are so many no-shows in most military clinics that fitting in that last 10% really isn't that burdensome.

 

[turkish]

You are aware that they overbook our schedules knowing there will no-shows, right? Your script is great, and I'll be using it, but I have to contest that there's always room for these people wonderful (ly entitled) human beings.

 

[Gastrapathy]

Bring back anyone in the waiting room who was on time or even the 80 yo who is 4 hrs early cause he came for breakfast first. After 3-4 pts go by, they reschedule.

I agree it's still crap to be treated that way. I can't argue with the suck (after all, I quit).

 

[Gastrapathy]

We also "closed" before we really closed and if an AD member was late twice, we required someone in their CoC to come to the next visit or they weren't seen. 2 no-shows = canceled consult, need new consult from PCP.

Never got any feedback from the command on these policies but I don't think they knew about it.

 

[HighPriest]

I do the same as Gastrapathy. No one sticks around save for the occasional VA player who lives at the hospital anyway.
Makes sense, too. For what I do, 90% of what I treat are totally first world problems. No one cares about their nasal congestion when there's a warlord sacking their village. But when TV's on the off season and spouse is deployed - look out, everyone demands to be seen immediately for the problem they've had for 25 years. Unless you make them bored. Boredom is always worse than their congestion.

 

[Homunculus]

@Gastrapathy and @HighPriest have shown you the way of the jedi.

before i sub specialized i was a primary care clinic OIC. we were handed this "we see everyone" edict back in like 2008. what they can't tell you is when to see the no shows. our policy was to fit them in at the next cancellation (no guarantee there) or at lunch if we could (again, no guarantees) or the end of the day-- with the caveat that they could *not* leave. i.e., they couldn't no show at 0900, leave and chill all day and cruise in at 1600 to be seen. or, we'd offer to rebook them an appointment. if it were an acute issue, we'd get a sense of what it was and if appropriate send them to the ED or work them in a little more urgently. i can't remember a single patient take the end of the day option.

our own office policy was 10 min late = no show. i'm a little more lenient now since my schedule isn't as intense, but i still find myself "refreshing" AHLTA around the 15 min mark and if they aren't checked it take a small amount of pleasure in no showing them. very small. but it's there. then about half the time they show up at the 20 min mark and i figure out a way to walk them in depending on their tale of woe. but i'm a sub specialist so it's little different. for primary care you don't have the time.

--your friendly neighborhood no soup for you! caveman

 

[DD214_DOC]

The problem is that this policy doesn't work for behavioral health, and I see only dependents. My no-show rate is already 5% or below and a very large percentage of my patient population have difficulty with boundaries as part of their pathology. Such policies do not help.

 

[HighPriest]

I always find the Army's fascination with no-show rates interesting in-and-of itself. Certainly no-shows are a problem, and certainly it is good to try to decrease the rate. civilian practices overbook as a mitigating measure, or they charge people for no showing. We can't charge people, although I think we should. I do overbook, although for the life of me I don't know why I do that.

But every time we meet with command to discuss our no-show rates they ask what we're going to do to decrease them. I don't really know how to answer that question. What can I do? Should I start personally calling people? Should I send a car?

 

[Gastrapathy]

The problem is that this policy doesn't work for behavioral health, and I see only dependents. My no-show rate is already 5% or below and a very large percentage of my patient population have difficulty with boundaries as part of their pathology. Such policies do not help.

So make a policy that does work. There is almost never anyone watching. You have to see them...ok what does that mean. I think it means you have to ensure there is no mental health emergency. So, write a script that says, "the physician will work you in...you'll probably have to wait forever...because you missed your appt, this will be a short visit and you'll be rebooked for a full visit. Lets book that appt now. You do understand that you are waiting for the doctor but he will only have 5-10 minutes for you today? Or you could just come back. Arriving after your appt counts as a no-show. 2 no-shows and you will only be booked at the end of the clinic day in the future (they can't hurt you if they are late for the last appt of the day).

 

[DD214_DOC]

So make a policy that does work. There is almost never anyone watching. You have to see them...ok what does that mean. I think it means you have to ensure there is no mental health emergency. So, write a script that says, "the physician will work you in...you'll probably have to wait forever...because you missed your appt, this will be a short visit and you'll be rebooked for a full visit. Lets book that appt now. You do understand that you are waiting for the doctor but he will only have 5-10 minutes for you today? Or you could just come back. Arriving after your appt counts as a no-show. 2 no-shows and you will only be booked at the end of the clinic day in the future (they can't hurt you if they are late for the last appt of the day).

The policy I believe came down from the OTSG and one of the civilian admin staff likes to blow the whistle when policies aren't followed. It's loads of fun.

 

[Gastrapathy]

What are they going to do to you?

 

[WernickeDO]

What are they going to do to you?

I very often say the same thing when a new threat comes down from some paper-pusher contractor...what do you intend to do about it? Fire me? Garnish my wages? Not sign my leave form?

 

[Homunculus]

The policy I believe came down from the OTSG and one of the civilian admin staff likes to blow the whistle when policies aren't followed. It's loads of fun.

this is where you do what you think is best, and when called into the principals office, ask them this: why is it it ok to punish the patients that show up early or on time but making them wait, due to the irresponsible behavior of another patient? ask how you are to handle the complaints that come from the next 3,4 or more patients that are late because of one person. it defies logic to piss off many people instead of one. as long as you attempt to accommodate the late party, you've done your duty-- even moreso if you do a cursory screen to see if they need to go to the ER.

if that fails, the next time you have a no show that shows up demanding to be seen-- see them, and hand out ICE cards to each person who is late because of it. or send them to patient rep. this really isn't something you should be stressing about 🙂

--your friendly neighborhood ICE card photocopying caveman

 

[DD214_DOC]

I very often say the same thing when a new threat comes down from some paper-pusher contractor...what do you intend to do about it? Fire me? Garnish my wages? Not sign my leave form?

Go straight to the department head (who is active-duty). I mean, in the end I guess not a whole lot can really be done to me either way.

 

[Gastrapathy]

Are you climbing the monkey pole or doing your time?

 

[WernickeDO]

Go straight to the department head (who is active-duty). I mean, in the end I guess not a whole lot can really be done to me either way.

I guess they could do that, but usually it's just me being difficult, my little passive aggressive way of pretending I have some modicum of control over my life and career. My favorite Biblical passage is "He who throws himself against the rock will be broken, but on whom the rock shall fall, it will grind him to powder". That's my general attitude for getting along in the military.

 

[DD214_DOC]

Are you climbing the monkey pole or doing your time?

No interest in climbing. I can accomplish much more out on my own.

 

[jabreal00]

There is an easy way to handle this:

"Sir, our clinic policy is to see any patient who walks in during business hours no matter how late they are for their appt. However, we strive to stay on time for the patients who arrive on time and do our best to work in late arrivals as quickly as we can. It is possible that there won't be an opportunity to work you in until then end of the clinic day but because we are trying to fit you in, we will need to remain here until you are called. You are free to reschedule at any time."

Our front desk staff had that script down. It worked like a charm.

90% will walk and you've complied with the directive. There are so many no-shows in most military clinics that fitting in that last 10% really isn't that burdensome.

I do this. If they are more than 50% past the time of their appointment I have the front desk tell them that I can see them if they wait and it could be towards the end of the day. Most reschedule. Some stick around. If I make up time with straight forward appointments or other no-shows then I'll work them in. I recently had the Command Sergent Major of the hospital come for his appointment with 5 minutes left of his appointment. He was given that spiel. He tried to run roughshod by waltzing into my office in an attempt to try to "flex." He gave some excuse about meetings he had. I listened for about 5 minutes and respectfully told him I did not have time at the moment to see him in clinic and I'd see him once I could fit him in that wouldn't inconvenience other patients who were on time. Of course he walked off.

 

[dr zaius]

Been that way for a couple of years at Walter Reed. Your time does not matter. Only captured care dollars matter. So say those who make the rules about seeing patients but do not see patients.

The kicker on this for us is that we basically have to see them whenever they show up. Maybe it's because we have residents, or it's command based...I'm not sure. If a patient misses their appointment and shows up a day later they. must. be. seen. Most of the time the patients aren't the sort to take kindly to waiting, either, so when they wait for a whopping 30min they get irate and complain to the patient advocate. Somehow we still get dressed down for it. It's very frustrating and occurs not infrequently.
And don't get me started on executive health. Doesn't matter if you're in the OR, have no clinic scheduled, or don't even have an attending in house at the moment. That patient must be seen absolutely at that moment because god forbid an admiral's grade II hemorrhoid or lipoma isn't addressed immediately.

 

[BlackFrancis33]

I agree the policy is difficult to swallow. A lot of times it is the fault of the horrible parking and layout of our hospital. A patient arrives to the parking garage 30 minutes early and cannot find parking until 30 minutes after the appointment start time. If the patient calls in to let me know they are running late near the appointment start time, I will usually bend over backwards to get them in for these reasons.

 

[Zenman1]

There is an easy way to handle this:

"Sir, our clinic policy is to see any patient who walks in during business hours no matter how late they are for their appt. However, we strive to stay on time for the patients who arrive on time and do our best to work in late arrivals as quickly as we can. It is possible that there won't be an opportunity to work you in until then end of the clinic day but because we are trying to fit you in, we will need to remain here until you are called. You are free to reschedule at any time."

Our front desk staff had that script down. It worked like a charm.

90% will walk and you've complied with the directive. There are so many no-shows in most military clinics that fitting in that last 10% really isn't that burdensome.

This is what our front desk clerks tell late arrivals, then they let me know and if I can see them I'll work them in. Even with no-shows the clerks will wait till COB to make them no shows.