Format

Send to:

Choose Destination
See comment in PubMed Commons below
Med Decis Making. 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.

Author information

  • 1Department of Systems Engineering & Operations Research, George Mason University, Fairfax, Virginia (BPB).

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

PMID:
23515215
[PubMed - indexed for MEDLINE]
PMCID:
PMC4153419
Free PMC Article
PubMed Commons home

PubMed Commons

0 comments
How to join PubMed Commons

    Supplemental Content

    Full text links

    Icon for HighWire Icon for PubMed Central
    Loading ...
    Write to the Help Desk