The Importance of Patient Follow-Up

Executive Summary

Missed appointments and patient failure to follow-up create potential liability risks for physicians. It’s important to develop a follow-up system to ensure that patients don’t fall through the cracks and to reduce liability for potential delayed diagnoses, treatments or referrals.

Recommended Actions

• Consider using an automated appointment reminder system to ensure that patients are prompted for upcoming appointments.
• Make reasonable attempts to contact a patient when they have missed appointments or recommended tests to reschedule the appointment and reinforce the importance of treatment plans.
• Implement a tracking system for patients who require a follow-up in which they remain active until follow-up is complete. Include documentation of informed refusal after your practice has made reasonable attempts to encourage patient compliance.

With patient no-show rates estimated to be between 5 and 55 percent, doctors are struggling to provide adequate patient follow-up care. Physicians rightfully question the extent of their liability when patients miss scheduled appointments or don’t comply with their plan of care. It’s a valid concern, as missed appointments and failure to follow-up do create potential risks for physicians. However, they can take the following steps to improve follow-up visit compliance:

1. Make reminder calls. Patients are busy, too, and timely reminders do help them remember and keep appointments. You may want to explore using an automated appointment reminder system if you currently don’t.
2. Reduce wait times. Maintaining reasonable patient wait times continues to be a universal challenge. When wait times are excessive, they become a major source of patient dissatisfaction. Reduced wait times leave a better impression on patients, shows respect for their time and may increase the probability the patient will return for follow-up appointments.
3. Create a welcoming reception area while protecting the patient’s privacy, particularly at intake.
4. Let patients know how long their wait times may be extended and give them the option of rescheduling or coming back later.

What about patient no shows? We suggest that you:

1. Inform patients of the need for follow-up and document those discussions in the medical record. Patients need to share responsibility for following the agreed-upon treatment plan and to return as advised for ongoing assessments of health, illness and treatment outcomes.
2. Make reasonable attempts to contact the patient when they skip appointments or tests. It is important to make an effort to contact the patient, reschedule the appointment and/or reinforce the importance of tests. Be sure to document each attempt to contact the patient and any explanation the patient may give.
3. Implement an electronic or paper tracking system for patients who have been identified for follow-up. The purpose of the tracking system is to alert the provider to the patient who needs to return to the office and by what date. The patient will remain active in the tracking system until one of three potential outcomes occurs: (1) follow-up is complete; (2) informed refusal is documented, or (3) there have been reasonable attempts (usually three) to encourage patient compliance. Document all attempts to contact the patient. We advise the last contact attempt be in writing, clearly explaining the necessity of follow-up and the potential consequences of failing to do so.
4. When all follow-up efforts have failed, dismissing a patient from care is a physician’s last resort.

It’s important to develop a follow-up system that works for you, your organization and your patients to ensure that their missed appointments don’t fall through the cracks and to reduce your professional liability for potential missed or delayed diagnoses, delayed treatments and/or referrals.

Lessons Learned

• Inform patients of the importance of follow-up care and risks of delaying care during their original appointment. Avoid patient rescheduling or missed appointments.
• Consider implementing an online portal where patients can automatically reschedule their appointments if they are unable to make the originally scheduled time.
• Considering offering a patient who has consistently missed or rescheduled appointments accommodations that best fit into their schedule, such as virtual appointments.

Potential Damages

Although a patient is responsible for attending scheduled appointments and tests, physicians who do not contact patients or adequately attempt to contact patients after a missed appointment risk liability if they have not informed the patient of the importance of such treatment. Lawsuits regarding follow-up care are a growing source of litigation and are costly to defend.