Prevalence, Predictors, and the Financial Impact of Missed Appointments in an Academic Adolescent Clinic

Introduction  Missed appointments have been shown to have significant economic consequences on clinics and health systems. Furthermore, adolescents have been shown to miss appointments more frequently than other pediatric patients. Information regarding predictive factors for which patients will miss appointments has been researched for adolescents, but scheduling-related risk factors and the financial impact of missed appointments in an adolescent clinic are lacking. Therefore, we sought to identify the financial impact and schedule-related risk factors of missed appointments in an academic adolescent clinic. Methods  A retrospective chart review of financial and scheduling information of each missed appointment was conducted at the Adolescent and Young Adult Medicine Clinic at Helen DeVos Children's Hospital (HDVCH) in Grand Rapids, Michigan between November 2016 and October 2017. Information obtained was the day of the week, time of appointment, lead days till appointment, level of provider, historical weather data, appointment type (new patient, established physical, established visit, or injection only) and insurance type for each patient. Results  We report a 21.2% missed appointment rate. Monday had a significantly higher fraction of missed appointments than other days of the week (p < 0.001). An increase in nonattendance was also seen with an increase in the lead days until appointment (p = 0.026). Weather (p = 0.507), time of day (p = 0.665) and type of provider (p = 0.361) were not found to be significant. We estimated an annual billing and reimbursement loss from missed appointments of $170,100 and $51,289, respectively. Conclusion These results highlight that revenue lost from missed appointments is significant and directly affects the ability to improve patient access and care. Future efforts to decrease missed appointments should target schedule-related risk factors in addition to patient reminder systems.