title: Estimating the cost of no-shows and evaluating the effects of mitigation strategies.
abstract: To measure the cost of nonattendance ("no-shows") and benefit of overbooking and interventions to reduce no-shows for an outpatient endoscopy suite.
  
  
  
  We used a discrete-event simulation model to determine improved overbooking scheduling policies and examine the effect of no-shows on procedure utilization and expected net gain, defined as the difference in expected revenue based on Centers for Medicare & Medicaid Services reimbursement rates and variable costs based on the sum of patient waiting time and provider and staff overtime. No-show rates were estimated from historical attendance (18% on average, with a sensitivity range of 12%-24%). We then evaluated the effectiveness of scheduling additional patients and the effect of no-show reduction interventions on the expected net gain.
  
  
  
  The base schedule booked 24 patients per day. The daily expected net gain with perfect attendance is $4433.32. The daily loss attributed to the base case no-show rate of 18% is $725.42 (16.4% of net gain), ranging from $472.14 to $1019.29 (10.7%-23.0% of net gain). Implementing no-show interventions reduced net loss by $166.61 to $463.09 (3.8%-10.5% of net gain). The overbooking policy of 9 additional patients per day resulted in no loss in expected net gain when compared with the reference scenario.
  
  
  
  No-shows can significantly decrease the expected net gain of outpatient procedure centers. Overbooking can help mitigate the impact of no-shows on a suite's expected net gain and has a lower expected cost of implementation to the provider than intervention strategies.
authors.affiliation: Department of Systems Engineering & Operations Research, George Mason University, Fairfax, Virginia (BPB).
authors.forename: Bjorn P
authors.initials: BP
authors.lastname: Berg
authors.affiliation: Edward P. Fitts Department of Industrial & Systems Engineering, North Carolina State University, Raleigh, North Carolina (MM)
authors.forename: Michael
authors.initials: M
authors.lastname: Murr
authors.affiliation: Performance Services, Duke University Medical Center, Durham, North Carolina (DC, JW)
authors.forename: David
authors.initials: D
authors.lastname: Chermak
authors.affiliation: Performance Services, Duke University Medical Center, Durham, North Carolina (DC, JW)
authors.forename: Jonathan
authors.initials: J
authors.lastname: Woodall
authors.affiliation: Division of General Medicine and Clinical Epidemiology (MP) University of North Carolina, Chapel Hil
authors.forename: Michael
authors.initials: M
authors.lastname: Pignone
authors.affiliation: Division of Gastroenterology and Hepatology (RSS), University of North Carolina, Chapel Hil
authors.forename: Robert S
authors.initials: RS
authors.lastname: Sandler
authors.affiliation: Department of Industrial & Operations Engineering, University of Michigan, Ann Arbor (BTD)
authors.forename: Brian T
authors.initials: BT
authors.lastname: Denton
mesh_terms: D000554:Ambulatory Care Facilities / Q000191:economics*; D001071:Appointments and Schedules; D014487:Centers for Medicare and Medicaid Services, U.S.; D003365:Costs and Cost Analysis; D004724:Endoscopy; D017059:Models, Econometric; D014481:United States
keywords: colorectal cancer; discrete event simulation; efficiency; gastroenterology; operations research