Text reminders can reduce patient no-shows at imaging centers

Text reminders to patients scheduled for MRI exams reduced patient no-shows at Massachusetts General Hospital, according to a study published in the Journal of the American College of Radiology. While it didn’t improve punctuality to appointments, the mere 1.3 percent reduction in no-shows would generate an additional $300,000 in revenue annually.

Patient no-shows are a major contributor to waste within healthcare, disrupting carefully crafted clinic schedules and realizing poorer patient outcomes when they go without care. Some care providers have experimented with financial penalties for overbooking, but penalizing no-shows disproportionately punishes low-income patients and overbooking can clog workflows when all patients show up.

Instead, a group of researchers from Harvard Medical School and Mass General implemented a text-based reminder system, recording changes in the rate of no-shows for four months.

From July 2016 through October 2016, all patients scheduled for MRI were assigned to either the texting or nontexting group, depending on the day. The nontexting group received the usual phone call two days before the procedure, while the texting group received both the phone call and a text message one day prior.

MRI was a logical place to start, according to the authors.

“First, MRI appointments have some of the longest waiting times between ordered and scheduled time at our hospital,” wrote lead author and medical informatics analyst Chang Liu. “Second, given that MRI appointments are longer than many other imaging examinations, a missed appointment is both a waste of a valuable slot and a potentially long delay in the care of the patient as they wait for the next open slot. Finally, the high costs associated with MRI means greater resource and revenue losses associated with MRI no-shows.”

The researchers found the no-show rate decreased to 3.8 percent from 5.1 percent, even with 30 percent of the texting group lacking a valid phone number.

“We perform approximately 45,000 outpatient MRIs across all of our facilities annually, translating into about $25 million in revenue,” wrote Liu et al. “Thus, decreasing outpatient MRI no-shows from 5.1 percent to 3.8 percent means nearly $325,000 in increased revenues annually. What’s more, the potential for savings is even greater with increasing text message adoption and application of the system to other imaging modalities.”

However, the texts didn’t improve punctuality—though they did prompt Mass General to change the phrasing of their reminder messages.

Previously they had implored patients to arrive 30 minutes prior to the scheduled appointment—for example, "please arrive at 7:30 a.m. for your scheduled 8:00 a.m. exam." Instead, the hospital simply told patients what time they preferred they arrive.

“Based on the findings of our study, this alternative communication strategy could potentially decrease non-punctual arrival from approximately 40 percent (the number of patients who fail to arrive “30 minutes before”) to 10 percent (the number of patients who fail to arrive before the scheduled time), thereby avoiding the associated operational challenges and revenue losses,” wrote Liu et al.