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Looking to Reduce No-Shows? Language Access May Play a Role

Patients in waiting room

Clinics and hospitals schedule appointments with intention, but the problem with relying on a rigid schedule of appointments is that patients don’t always show up.

Appointments help maintain a steady flow of patients throughout the day, provide patients with care in a timely manner based on specific health needs, and avoid overwhelming physicians and staff with patients showing up on random days or times. Estimates for the number of patients that miss appointments range from 5% to 50% , and can vary by clinic and specialty. The top reasons people don’t show up for appointments include:
  • Logistics — Patients who lack reliable transportation or have a hard time getting off work during the day may not make it to their scheduled appointments.
  • Cost — Patients without insurance or with high-deductible plans are at the highest risk of missing critical care because they can't afford it.
  • Disrespect — When patients perceive that providers or medical staff do not value their time, opinion, or feelings, they may skip future care.
  • Fear — Some patients don’t show up because they don’t want to hear bad news, and negative emotions outweigh the potential benefit of keeping the appointment.
  • Communication barriers — Patients who don’t understand the scheduling process, or the reasons why it’s important for them to come for a future appointment, may skip it. This is a common challenge with limited-English proficient (LEP) patient no-shows.

Economic and Medical Ramifications of No-Shows

No-show appointments are different from canceled or rescheduled appointments because they leave staff with no time to backfill a time slot with another patient. It’s simply a gap in the provider’s schedule that has financial and medical consequences.

One study found that missed appointments cost the healthcare system a total of $150 billion per year in lost revenue. Individually, they could cost a single physician or clinic tens or even hundreds of thousands of dollars annually. Many administrators and physicians build clinical financial plans on the assumption that providers will see a certain number of patients each day. No-shows make it harder to create an accurate financial forecast. Missed appointments also make it harder for healthcare systems to meet value-based care goals of lowering total costs and improving quality.

But the cost of no-shows extends beyond clinic finances. When a patient doesn’t show up to get necessary care as part of their overall treatment plan, there are medical consequences too. Patients who fail to come for follow-up care:

  • Won’t have continuity of care to manage acute or chronic health conditions
  • May end up with unnecessary and expensive visits to the emergency room (ER) for things a primary care provider (PCP) or specialist could have addressed in the missed appointment
  • May have to be readmitted to the hospital after discharge because they don’t get necessary preventive or follow-up care
  • Create longer wait times for patients who need to get in to see a PCP or specialist

The Role of Language Barriers in Missed Appointments

Healthcare is a personal and intimate experience. Patients need to be able to effectively communicate their health concerns and symptoms with care providers. Physicians and other clinical staff must also be able to clearly communicate information about:

  • Diagnosis
  • Treatment plan
  • Medications
  • Follow-up care

When language is a barrier, patients and providers are both at risk of missing out on critical information. The number of patients in America with limited-English proficiency is growing. About 8% of the U.S. population, or more than 25 million people, have limited ability to speak, read, understand, or write English.

Multiple studies over the years have confirmed that LEP patients are more likely to experience adverse events that result in physical harm. These barriers can also contribute to no-show appointments.

Simple (and costly) Miscommunications

As an example, imagine an LEP patient is discharged from the hospital after surgery. The hospital staff schedules them for a follow-up appointment with the surgeon in two weeks to check on their recovery. If the patient cannot understand why they need to come for an appointment, or there is a miscommunication about when their appointment will be, they may not show up.

Now imagine that same patient has complications after their hospital stay. They end up with an infection and have to go to the emergency room, where they are readmitted to the hospital, this time to get treatment for the infection. If they had come for their follow-up appointment as scheduled, the provider may have seen early signs of the infection and could have treated it with low-cost antibiotics.

Cultural Insensitivity

Another challenge for LEP patients is the risk of encountering cultural insensitivity in their medical care. For example, a doctor’s office might schedule a patient to come for an appointment on a religious holiday when the person doesn’t want to leave their home. If they can’t clearly communicate their reasons for not coming that day and convince the scheduling staff to change the appointment date, they may just skip the appointment instead.

Unclear Expectations

Patients who cannot clearly speak and understand English may simply not realize the importance of medical appointments. For example, a patient diagnosed with a very severe illness may miss critical aspects of the conversation with the doctor if they don’t have a medically qualified interpreter to help convey the message. They may skip subsequent appointments because of this lack of understanding.

Socioeconomic barriers

Social determinants of health often contribute to health disparities, especially for patients with language barriers. Barriers like lack of transportation, discrimination, limited social support, and low health literacy all make it more difficult for patients to get to their scheduled appointments.

How to Address No-Shows with Comprehensive Language Support

The best way to minimize the risk of no-shows due to language barriers is to have comprehensive language support services, including:

The language services you provide should include medically qualified interpreters who are fluent in the patient’s native language. They should be qualified to communicate complex medical and health concepts in a way that patients can understand.

Additionally, clinics and providers should engage in ongoing analysis of their LEP patient flow. Compiling and analyzing data that specifically identifies LEP patients, how many do not show up for appointments, and the reasons for the no-show (if available) help you find gaps in care and increase overall operational efficiency.

GLOBO Language Access Services Can Help You Address No-Shows

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