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Missed appointments negatively impact mission

SCHRIEVER AIR FORCE BASE, Colo. -- Missed medical appointments at Schriever Air Force Base have increased to a rate nearly double the acceptable Air Force standard during the last few years, according to information released by the 21st Medical Squadron.

"During the past few years, Schriever personnel empanelled at the 21 MDS clinic have been averaging 100 missed appointments per month with an approximate 10 percent missed appointment rate," said Maj. Jackie Kim, 21 MDS Group Practice Manager.

According to Air Force Instruction 44-176, medical treatment facilities need to keep no-show rates at no more than five percent of all booked appointments. An appointment is considered a no-show when the patient either does not keep a scheduled appointment or cancels within two business hours of the appointment.

Kim said the missed appointments reflect no-shows not just for the Schriever clinic, but for appointments across the Colorado Springs Military Health System which include 21 MDS Clinic here at Schriever, 21 MDG Clinic at Peterson,  10 MDG Clinic at the AF Academy, and Evans Army Community Hospital at Fort Carson.

During calendar year 2014, Schriever personnel had 1,316 missed appointments with 70 percent coming from active-duty members, according to statistics from the 21 MDS. Of that 70 percent, 30 percent were repeat offenders.

The total cost of missed appointments in 2014 is estimated to be $197,000 in funds and resources, the statistics show. A single missed appointment costs between $100 to $200 due to wasted time, resources and manpower.

"We can't pinpoint an exact cost unless we go through each type of missed appointment, but it's ranging from $100 to $200," Kim said. "Obviously for more complex conditions or for surgeries, it's even more." 

In addition to the monetary cost, missed appointments can also negatively affect the mission through loss of man hours. Missed appointments by active-duty members can affect their overall health status, thus affecting their ability to effectively execute the mission.

A missed appointment can also disrupt a patient's continuity of care, which can negatively affect overall quality of care especially for those with chronic issues, Kim said. Continuity of care is part of the 21 MDS commitment to the patient-centered medical home model. Essentially it means patients will see the same provider every time they make an appointment.

"Say you have chronic issues, like diabetes or a heart condition, more than likely you'll have to come in more frequently than the standard patient so you'll want to see the same provider," Kim said. "You want someone who understands your medical history. If you miss your appointment, it's not guaranteed we can get you in with your regular primary care manager."

21 MDS has classified no-shows for the clinic as "missed medical appointments".  Missed medical appointments are patients who arrive five minutes past their scheduled appointment time. Kim said patients arriving beyond the five minute mark can still wait to be seen, but there's no guarantee staff will have time to get them in.

"Our providers have back-to-back 20 minute appointments so if a patient is late, they're delaying care for others," Kim said.
Clinic staff understand that life happens and are willing to work with patients who make an effort to keep staff updated when last minute issues arise, Kim said.

"I know that a lot of times the folks in the restricted area get locked in and we try to be mindful of that," Kim said. "As much as possible let us know ahead of time, or call us to say that you're locked in and going to be late. Depending on the schedules, we may be able to accommodate. Communication is key."

Patients can avoid a missed appointment by calling the appointment line at 524/526-2273, sending an online message to their provider team through MiCare Secure Messaging or accessing their patient account on TRICARE online. The cancellation needs to occur more than two hours ahead of the scheduled appointment time in order to avoid being listed as a no-show. If an appointment is scheduled between 0730 and 0900, the patient will need to cancel by close of business the day prior.  The two hour window gives the clinic some time to rebook the appointment for another patient that requires care.

"We're such a small clinic and we pride ourselves on being able to take care of our active-duty members and their families," Kim said.

Kim added she is working with unit commanders, first sergeants and base leadership to try to find ways to cut down the number of missed appointments here at 21 MDS Clinic.

For more information, contact Kim at 567-4121. Stay updated with 21 MDS by liking their Facebook page at www.facebook.com/#!/SchrieverClinic
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