Health Forward Foundation

Reducing Canceled Appointments Improves Finances for Mental Health Providers

David Swann

KANSAS CITY, Mo. – Reducing no-shows is one of the most significant ways mental health providers can improve their finances, a practice improvement expert said in a Wednesday presentation at the Mid-America Regional Council offices.

Bringing more people in the door means more reimbursements – not to mention providing better service to the patient, said David Swann, a consultant who also serves as chief clinical officer for Partners Behavioral Health Management, a managed care organization based in Gastonia, N.C.

Swann said that one center he has worked with brought in an additional $300,000 through better no-show management. That, in turn, allowed the center to hire additional staff, which then translated into serving more people.

“It’s a domino effect,” he said. “You are peeling the onion as fast as you can. It’s the only way to build capacity to where we need it.”

Organizations don’t have to immediately go out and hire more staff when reducing no-shows, Swann said, since to a certain extent the clients are filling what used to be unscheduled down time for therapists.

It’s not uncommon, he said, for agencies to have a 30 percent no-show rate.

Swann addressed about 40 mental health practitioners at a forum sponsored by Metropolitan Mental Health Stakeholders, a behavioral health planning group.

He kicked off a series of forums the group has scheduled for the remainder of the year, all addressing the overall topic of better integrating behavioral health and medical care. The next one is scheduled for June.

Swann’s point was that, in a healthcare system that is moving more toward a pay-for-performance model, behavioral health providers must become more efficient so they are better able to coordinate care with medical providers.

“There is no one thing you have to do,” he said. “It’s a multitude of things you have to do in layers.”

Instituting the capacity for same-day appointments was one step, he said.

One of the biggest complaints primary care physicians have about mental health providers, he said, was that it’s hard for them to get their patients an appointment.

One way to institute same-day scheduling, Swann said, was to block out a section of time for each counselor during the week when they would be available for walk-ins.

Swann said one of his clients recently informed the primary care physicians in its community that it would accept same-day referrals before 3 p.m. After that, the office would see the patient on the next business day.

“The primary care doctors absolutely doubled over – beat up the roadway – to get to those mental health providers thanking them,” he said.

The Johnson County Mental Health Center is one of his clients. Swann said one of their strategies has been to hire an “engagement specialist.”

That staffer, a trained interviewer, contacts clients 48 hours in advance of their appointments. If a client seems unsure about coming, then the specialist might suggest another option, such as a group session happening that day.

If the client decides to go that route, then the specialist consults a “back-fill list” of clients waiting to see a therapist. That makes another client happy by getting them in for an individual therapy slot.

Another way to improve patient outcomes, Swann said, was to institute “collaborative documentation.” That means practitioners fill out paperwork during billable hour time with the client.

This not only saves time, he said, but it engages the patient and makes them a participant in their care.

Dennis Meier, associate executive director of Synergy Services in Parkville, Mo., told Swann that the new environment he described seemed like a “wonderful and terrible challenge at the same time.”

He said he wondered how a small nonprofit like Synergy Services, which assists victims of family violence, could afford the type of electronic medical record system that Swann said was critical in tracking costs and outcomes.

Swann said when providers talk about new collaborative models, such as ones where a number of organizations manage the care of a patient through a single reimbursement, it made sense for small agencies to think about partnerships.

Meier also expressed concern about what Swann called a treat-to-target approach.

That’s where therapists treat a specific problem – such as depression interfering with work performance – with an immediate solution that might involve medication and some self-help tactics.

Swann said that under the old model, where payers weren’t as focused on outcomes as they are today, a therapist might have delved deep into the patient’s past to find the source of the depression.

Meier worried that such a quick-fix approach might downplay some past experiences that are contributing to the person’s condition.

“I bet you all are smart enough to weave that all in,” Swann said.

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