Last week’s Pro Tip(opens in new tab) discussed communicating and documenting general non-compliance. Today let’s specifically discuss what should be happening when high-risk patients miss appointments.

Following the “no-show” your staff calls and leaves a message. (Morning no-shows should be called before lunch and afternoons by the end of the clinic day). 

The patient misses again.

What happens next?

When a patient has an ulcer, infection, post-op complication, vascular concern or another condition where delayed care could result in significant harm, documenting “No Show” may not be enough.

The higher the potential risk to the patient, the more important it is to demonstrate that your practice made reasonable efforts to encourage appropriate follow-up.

Create an Escalation Protocol

Consider establishing a written policy for high-risk patients who miss necessary follow-up appointments:

1st missed appointment:

Document the no-show and attempt to contact the patient by phone and/or portal.

Repeated missed appointment:

Attempt contact again and document why timely follow-up is medically important.

Continued inability to reach the patient:

Escalate communication appropriately. Depending upon the circumstances, this may include written correspondence or certified mail advising the patient of the need for follow-up and the potential consequences of delaying care.

Document More Than “Patient Called”

The medical record should tell the story.

Instead of:

“Called patient. LM.”

Consider documenting:

“Patient missed scheduled follow-up for diabetic foot ulcer. Attempted telephone contact; voicemail left requesting patient contact the office to reschedule. Timely follow-up remains important to reassess wound healing and monitor for signs of infection or deterioration.”

If the patient is reached but refuses to return, document the recommendation, the risks discussed, the patient’s response and any alternatives offered.

When the Pattern Continues

Repeated no-shows or refusal to follow medically necessary recommendations may eventually warrant consideration of formally terminating the physician-patient relationship. The referring provider or primary care physician should also be informed of the situation. 

But don’t simply stop scheduling or communicating with the patient. Patient dismissal should follow a formal practice policy and applicable state law, payer requirements and continuity-of-care obligations, including appropriate notice and instructions for obtaining continued care. 

Pinnacle Perspective:

Don’t let the chart go silent.

If a patient is at significant risk and repeatedly fails to follow up, your documentation should demonstrate that the practice recognized the risk, communicated the importance of care and made reasonable efforts to help the patient receive it.

You cannot force a patient to participate in their care—but the medical record should never leave someone wondering:

“The patient didn’t come back. Did anyone notice?”