Estimating the Cost of No-Shows and Evaluating the Effects of Mitigation Strategies

Bjorn P. Berg, Michael Murr, David Chermak, Jonathan Woodall, Michael Pignone, Robert S. Sandler and Brian T. Denton

Medical Decision Making, 2013, vol. 33, issue 8, 976-985

Abstract: Objective. To measure the cost of nonattendance (“no-shows†) and benefit of overbooking and interventions to reduce no-shows for an outpatient endoscopy suite. Methods. We used a discrete-event simulation model to determine improved overbooking scheduling policies and examine the effect of no-shows on procedure utilization and expected net gain, defined as the difference in expected revenue based on Centers for Medicare & Medicaid Services reimbursement rates and variable costs based on the sum of patient waiting time and provider and staff overtime. No-show rates were estimated from historical attendance (18% on average, with a sensitivity range of 12%–24%). We then evaluated the effectiveness of scheduling additional patients and the effect of no-show reduction interventions on the expected net gain. Results. The base schedule booked 24 patients per day. The daily expected net gain with perfect attendance is $4433.32. The daily loss attributed to the base case no-show rate of 18% is $725.42 (16.4% of net gain), ranging from $472.14 to $1019.29 (10.7%–23.0% of net gain). Implementing no-show interventions reduced net loss by $166.61 to $463.09 (3.8%–10.5% of net gain). The overbooking policy of 9 additional patients per day resulted in no loss in expected net gain when compared with the reference scenario. Conclusions. No-shows can significantly decrease the expected net gain of outpatient procedure centers. 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 than intervention strategies.

Keywords: efficiency; discrete event simulation; operations research; gastroenterology; colorectal cancer (search for similar items in EconPapers)
Date: 2013
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Citations: View citations in EconPapers (5)

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Persistent link: https://EconPapers.repec.org/RePEc:sae:medema:v:33:y:2013:i:8:p:976-985

DOI: 10.1177/0272989X13478194

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