When Exception to Policy Is Exceptional Policy: How Booking Physical Therapy Appointments Too Far in the Future May Adversely Impact Access to Care, Business Optimization, and Readiness

Sarah E Baker; Jason Silvernail; Charles Scoville; Scott Kushner; Lance Mabry; Lisa Konitzer; Sean Easley; Brian Iveson; Crystal Sims; Steven Stoeker; Genevieve Gudorf

doi:10.1093/milmed/usz287

When Exception to Policy Is Exceptional Policy: How Booking Physical Therapy Appointments Too Far in the Future May Adversely Impact Access to Care, Business Optimization, and Readiness

Mil Med. 2020 Jan 7;185(Suppl 1):565-570. doi: 10.1093/milmed/usz287.

Authors

Affiliations

¹ Physical Therapy Clinic, Fort Belvoir Community Hospital, 9300 Dewitt Loop, Fort Belvoir, VA 20060.
² Physical Therapy Clinic, Walter Reed Military Medical Center, 4494 North Palmer Road, Bethesda, MD 20889.
³ Physical Therapy Clinic, Malcolm Grow Medical Clinics and Surgery Center, 1050 W Perimeter Rd, Andrews Air Force Base, MD 20762.
⁴ Physical Therapy Clinic, DiLorenzo Health Clinic, The Pentagon, Corridor 8, Pentagon, Washington, DC 20310.
⁵ Physical Therapy Clinic, Andrew Rader U.S. Army Health Clinic, Fort Myer, Arlington, VA 22211.
⁶ Physical Therapy Clinic, Naval Health Clinic Quantico, 3259 Catlin Avenue, Quantico, VA 22134-6050.
⁷ Physical Therapy Clinic, Kimbrough Ambulatory Care Center, 2480 Llewellyn Ave Ste 5800, Fort Meade, MD 20755.

PMID: 32074310
DOI: 10.1093/milmed/usz287

Abstract

Introduction: Physical therapy (PT) is a high-volume service that treats musculoskeletal injury and improves return-to-duty rates. Our experience suggests that no-show (NS) and patient cancellation (PC) rates increase the further appointment that is booked in the future, impede access to care, and increase the healthcare delivery costs. The article's purpose is to examine PT National Capitol Region (NCR) appointment data to inform appointment policies.

Methods: We utilized one year of retrospective Military Health System Management and Reporting Tool and Composite Health Care System Ad Hoc Data Pulls to review NCR PT appointment data to evaluate the effect of timing on NS and PC rates.

Results: We analyzed 797 new appointments at Walter Reed National Military Medical Center. Data revealed that 16% of patients seen within 10 days NS or PC; 22% of patients seen between 11 and 20 days NS or PC; 28% of patients seen 21 to 30 days NS or PC; and 25% of patients seen over 30 days after consultation NS or PC. We analyzed 182,134 PT appointments (all types) in the NCR. The NS rate was 11.1% (range 8.4-14.9%).

Conclusions: At Walter Reed National Military Medical Center, 17% of new appointments were lost when they were booked over 20 days in advance; additionally, NS and PC rates were greatest after 20 days from consultation.

MeSH terms

Adult
Appointments and Schedules*
Cost-Benefit Analysis
Female
Forecasting / methods
Health Policy / trends
Health Services Accessibility / standards*
Health Services Accessibility / statistics & numerical data
Humans
Male
Maryland
Musculoskeletal Diseases / therapy*
Physical Therapy Modalities / standards*
Physical Therapy Modalities / statistics & numerical data
Retrospective Studies