Hospitals Lose Millions to Cancelled Appointments

24 May


While patients may not think much of not showing up for an appointment or canceling, it can have serious long-term consequences for hospitals and their bottom line. According to researchers involved in a 2009 study at Tulane University Medical Center, 327 of 4,876 (6.7 percent) scheduled elective outpatient surgeries were cancelled, which ended up costing the hospital almost $1 million for the year.
Since surgeries are responsible for about 60 percent of the hospital’s revenue, that loss had a major financial effect, says study author Sabrina Bent, MD, MS, clinical associate professor of anesthesiology and director of research at the Tulane University Department of Anesthesia, in New Orleans.
However, the researchers pointed out that patients who have a preoperative visit with an anesthesiologist are considerably more likely to keep their appointment in the operating room.
“People need to recognize that there is a cost to cancelled surgeries that is not insignificant,” said Dr. Bent, who presented the findings at this year’s American Society of Anesthesiologists Conference on Practice Management.
Much of cost associated with cancelled surgery stems from the fact that hospitals can’t fill in those slots with other surgical on short notice. 
One step in minimizing surgery cancellations is understanding why they happen in the first place. According to Dr. Bent, 30 percent of patients in the study didn’t show for their surgery due to transportation problems, confusion over the appointment date, forgetting about the appointment, among other reasons.
While those issues may be difficult to remedy, about a third of the cancellations were actually due to internal hospital issues, including a lack of beds or equipment and scheduling errors. Sometimes equipment is needed in two operating rooms at once, equipment fails, or there is no room in the ICU.
Researchers’ Recommendations
  • Dr. Bent and her colleagues recommend that hospitals make sure all patients have a preoperative visit with an anesthesiologist, since they found those patients had a 7 percent advantage in the cancellation rate (11 percent vs. 4 percent).
  • Make sure patients are medically ready for surgery and that they receive the proper preoperative instructions for the day of the procedure.
  • Improve equipment and resource allocation.
  • Hospitals should focus on areas they can have the biggest impact, such as the specialities with the highest cost associated with their cancellations. The top two were neurosurgery and urology, with an average cost per case of 5,962 and $4,758 respectively.
“I think this study suggests that it is reasonable for medical centers to bear a significant cost to maintain the anesthesia preoperative clinic,” said Dr. Glick, MD, MBA, associate professor of anesthesia and critical care at the University of Chicago. “It enables them to save more money down the line, when surgeries are not cancelled.”