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. 2013 Nov;33(8):976-85.
doi: 10.1177/0272989X13478194. Epub 2013 Mar 20.

Estimating the cost of no-shows and evaluating the effects of mitigation strategies

Bjorn P Berg  1 , Michael Murr  2 , David Chermak  3 , Jonathan Woodall  3 , Michael Pignone  4 , Robert S Sandler  5 , Brian T Denton  6
Affiliations

Estimating the cost of no-shows and evaluating the effects of mitigation strategies

Bjorn P Berg et al. Med Decis Making. 2013 Nov.

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: colorectal cancer; discrete event simulation; efficiency; gastroenterology; operations research.

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Figures

Figure 1
Figure 1
The expected net gain is presented for the baseline scenario (18% no-show rate) where fixed costs are assumed to consume 70% of reimbursements.
Figure 2
Figure 2
The expected net gain is presented for where the no-show rate is 5%.
See this image and copyright information in PMC

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