D.13 NO SHOW POLICY 36C24423R0132.pdf

BEHAVIORAL HEALTH & SCIENCES

NO-SHOW/CANCELLATION POLICY

SOP 600-11

VA Medical Center 595 Lebanon, PA

Service Line(s):

Behavioral Health & Sciences

Signatory Authority:

ACOS, BH&S

Effective Date:

September 10 2020

Responsible Owner:

Business Manager, BH&S

Recertification Date:

September 10, 2025

1. PURPOSE AND AUTHORITY

a. The purpose of this standard operating procedure (SOP) is to establish policy and procedures to address no-shows and cancellations of scheduled appointments by patients, or clinic cancellations by clinicians.

b. This SOP sets forth mandatory procedures and processes to ensure compliance with established Lebanon Veterans Affairs (VA) Medical Center policies in addition to the Veterans Health Administration (VHA) Handbook 1160.01, Uniform Mental Health Services in VA Medical Centers and Clinics.

c. Veterans who are no-shows for their scheduled appointments in Behavioral

Health & Sciences (BH&S) clinics may be at risk for emotional decline if they fail to receive or continue mental health care as deemed clinically appropriate by the clinical team and treating clinician. Therefore, it is incumbent upon all BH&S staff to establish a proactive approach in helping Veterans receive mental health care as appropriate.

d. It is the policy of the BH&S Care Line to provide timely and professional care for our Veterans. Cancellation of scheduled patient appointments should only occur after all alternatives, such as seeing another clinician or nurse, have been exhausted.

Recurrent cancellations of appointments, or no-shows, are addressed in a Veteran-centric, as well as systematic, approach. BH&S will take all necessary and reasonable steps as detailed below to contact Veterans who are no-show to, or cancel, their appointment and inquire as to their health and needs (see Appendix A).

e. In emergent or extenuating circumstances, including but not limited to natural disasters, pandemics, etc., the BH&S Administrative Office staff will direct rescheduling efforts to be with another clinician to ensure timely access to care for Veterans so that their care needs are addressed.

September 10, 2020 SOP 600-11

(1) At no time, however, will staff give out their personal phone numbers to Veterans receiving mental health care.

(2) It is the expectation that all clinical staff who receive a call on their government-issued cell phone or pager respond in a timely fashion, within 15 minutes of the time of call or page.

(3) For clarification purposes, an established Veteran is one who has received mental health care at our facility within the last 24 months in a 500 series stop code (with the exception of stop code 538-Psychological Testing) (adapted from MCM 136- 09, Veterans Health Information Systems and Technology Architecture (VISTA) Patient Scheduling; and Veterans Health Administration (VHA) Handbook 1160.01, Uniform Mental Health Services in VA Medical Centers and Clinics).

2. PROCEDURES: BH&S clinics utilize the appointment reminder letters (see Appendix B), and telephone reminders prior to the Veteran’s appointment date. The following procedures will be followed for all BH&S Veterans who no-show or repeatedly cancel appointments:

a. New consults: No shows: Following MCM 20-20, Consultation Procedures, section 5h(2), new consults will be discontinued when the Veteran no-shows for two scheduled appointments, or when the Veteran cancels without rescheduling and refuses service. When consults are discontinued, the ordering clinician gets an electronic notification. The ordering clinician will need to reassess the patient’s need for the consult, contact the patient to discuss the consult, and submit a new consult to BH&S, if needed.

b. Established Veterans:

(1) No shows: Following the VHA Handbook 1160.01, Uniform Mental Health Services in VA Medical Centers and Clinics, Veterans who no-show for their scheduled mental health appointment will be contacted for patient follow-up as indicated below.

Follow-up will be made by telephone and a letter in most cases.

(a) Veterans without a Computerized Patient Record System (CPRS) high risk suicide alert: If the Veteran no-shows for an appointment, the Behavioral Health Consult clerk will send the no-show letter and make one telephone attempt per day for 3 consecutive business days to contact the Veteran with electronic documentation of each attempt. If the scheduling clerk cannot make personal contact with the Veteran via telephone after three attempts within 3 consecutive workdays, the scheduling clerk will notify the clinician via a progress note. The clinician will determine a plan for appropriate BH&S services. This could include:

1 Reschedule the patient in _____ weeks.

2 Do not reschedule at this time. A letter advising him/her how to access community crisis intervention, VA Crisis Line and behavioral health services in the future, if desired or needed, has been generated (see Appendix C).

3 Consultation requesting additional follow-up made to:

a Outpatient Behavioral Health service b Suicide Prevention Program c Transitional Care Management (TCM) program (formerly OEF/OIF/OND program) d Primary Care-Mental Health Integration team (PC-MHI) e Residential Rehabilitation Center (RRC) f Psychosocial Rehabilitation and Recovery Center (PRRC) g Substance Use Disorder outpatient team (SUD) h Other

4 Other disposition (free text box).

Note: If the clinician determines that a letter is to be sent, a computer generated letter will be issued, with electronic documentation of such, inquiring as to the Veteran’s interest/need for continuing mental health treatment (see Appendix C); no further appointments will be scheduled until Veteran initiates contact with the clinic or the clinic clinician recommends that an appointment be rescheduled at appropriate time interval.

5 The scheduling clerk’s supervisor will routinely conduct record reviews to monitor compliance with the above practice, providing feedback on compliance to the clerk and BH&S administrative staff as needed.

(b) Veterans with a CPRS high risk suicide alert - Patient Record Flag (PRF): If the Veteran no-shows for an appointment, the scheduled clinician or member of the Veteran’s behavioral health interdisciplinary treatment team will attempt contact on that same date. If contact is made, documentation of the contact and follow-up plan must be placed in CPRS. The Suicide Prevention Coordinator (SPC) or other staff within the Suicide Prevention (SP) team will maintain tracking and ensure proper clinical follow-up practices are followed.

1 If the clinician or member of the Veteran’s behavioral health interdisciplinary treatment team does not make contact via telephone on the day of the missed appointment, documentation of the clinician’s attempted contact and plan for follow-up must be placed in the Veteran’s record, including alert to Suicide Prevention staff via additional signature on this note. The Suicide Prevention clinical staff will ensure three additional attempts are made to reach the Veteran with electronic documentation in CPRS of each attempt. If the Suicide Prevention or other clinical staff makes contact with the Veteran, they will coordinate continuation of care as deemed appropriate, including arrangement for a new appointment and notification to Veteran of same. If the Suicide Prevention staff cannot reach the Veteran via telephone contact after three attempts, or sooner if clinically warranted, local law enforcement will be contacted as clinically necessary, and if a health-and-welfare check is warranted. Documentation of and follow-up regarding this decision must be placed in the Veteran’s electronic chart by the Suicide Prevention staff.

2 The SPC, or designee, will routinely conduct record reviews to monitor compliance with the above practice, providing feedback to Suicide Prevention staff and BH&S administrative staff as needed.

(2) Cancellations: If the Veteran cancels his/her appointment via the scheduling line, the employee in the scheduling line will notify the scheduling clerk assigned to BH&S, and/or the clerk’s supervisor, via an encrypted email message by close of same business day, also indicating whether or not the Veteran desires to be rescheduled. If the Veteran cancels an appointment via Audiocare, the clerk supervisor is notified and communicates the new openings to clinic clerk staff and BH&S Administrative staff. If the Veteran cancels his/her appointment by calling the clinic directly, the scheduling clerk will address the scheduling needs directly.

(a) Veterans without a CPRS high risk suicide alert: If a Veteran has cancelled three consecutive appointments, the scheduling clerk will notify the clinician via encrypted e-mail. The clinician will review the case, and as clinically needed will direct the scheduling clerk to reschedule or mail the follow-up letter (see Appendix D) via CPRS note with the scheduling clerk as an additional signer. The clerk will create an addendum to the CPRS note verifying contact has been made or letter has been mailed. If the scheduling clerk and/or clinic clinician have made one documented attempt in each of three successive business days to contact the Veteran without success, the scheduling clerk assigned to BH&S will send a follow-up letter (see Appendix D) informing the Veteran of rescheduling options.

(b) Veterans with a CPRS high risk suicide alert: If a Veteran has cancelled an appointment, the SPC Program Support Assistant and/or the scheduling clerk assigned to BH&S will notify the clinician and the SPC by the close of business day. The SP staff will then contact the Veteran, enter proper documentation in CPRS, and assist in ensuring continued care, as appropriate. If the SP staff cannot reach the Veteran via telephone contact after a total of four attempts within consecutive workdays, local law enforcement will be contacted as facilitated by the SPC at any time if/when a health-and-welfare check is warranted. Documentation of and follow-up regarding this decision must be placed in the Veteran’s electronic chart by the SP staff and co-signed by the clinician.

(3) Clinician Call-off/Clinic Cancellations:

(a) Following MCM 20-63, Management of Patient Care for Clinician Leave, when a BH&S clinician calls off for the day between the hours of 4:30 p.m. and 6:30 a.m., they will notify the Administrative Officer of the Day (AOD) via telephone, and the contingency plan will be put into effect (see Appendix F). The AOD will contact patients scheduled up to, but not including, the 10 a.m. slot, and notify them of their appointment rescheduling/cancellation. The AOD will inform the patient that clinic staff will contact them for rescheduling as soon as possible. The AOD will then notify appropriate staff of the clinician call-off via e-mail. The clerk will cancel the clinic for the whole day, contact all patients, offer them available appointments and schedule them as directed by the BH&S Administrative office. Ideally, Veterans would be given a choice of either seeing a different clinician or being rescheduled to a time that is convenient to the Veteran and within 14 business days of Veteran’s cancelled appointment date. The lead clerk will call all patients from the clinician’s appointment list and offer each patient the following options:

1 “Would you like to be seen by another clinician today?” (Prepare to offer location).

If yes, follow options below. If no, follow 2.

a If slots are available at same clinical location, clerk will provide patient with new appointment information. The clerk will schedule patient into open slot in respective clinician’s clinic, and clinician will be alerted to this new appointment.

b If slots are not available at same clinical location, the clerk will schedule patient for same day at different clinical location into respective clinician’s clinic. This could be scheduled as a face-to-face visit or as a virtual (video or telephone) visit. The clerk will provide patient with new appointment time, location, and directions, if necessary, and clinician will be alerted to this new appointment.

2 “Would you like to reschedule with same clinician for another day?” If patient prefers this option, clerk will schedule patient with established clinician ideally within 14 business days of Veteran’s cancelled appointment date, or as directed by clinician upon return.

a Upon the clinician’s return to duty he/she will review the provided list of rescheduled appointments via email from BH&S Admin office stating the following:

“Please review the rescheduled appointments. Per MCM 20-63 all Veterans rescheduled due to a clinician call-off should be rescheduled ideally within 14 business days of the cancelled appointment. Please advise for advancement of any appointments that are clinically warranted and reply to this email within 3 business days with requested changes or your concurrence with the rescheduled appointments.”

(b) The outpatient clinic manager may always consider utilization of a virtual platform to ensure coverage remotely, if appropriate for the level of care indicated.

(c) When a BH&S clinician in an outpatient clinic has to leave after having reported to duty or will be out the next day or another day or period of time in the foreseeable future, the clinician must first inform the respective Behavioral Health Outpatient Clinic Manager. The clinician will then review his/her schedule of remaining patients for that day or the respective day or period of time in the future with the Outpatient Manager to determine coverage and identify any patient that must be seen by another clinician.

The clinic clerk will then follow procedure 4b(5)(a)(b) above to reschedule the patients, incorporating the above clinical direction (see Appendixes F and G).

(d) Following guidance set forth in MCM 20-63, clinicians within BH&S will give 45-days advance notice for all planned leave requests, in order to minimize the adverse effects on Veterans and fellow staff. Any leave request placed less than 45 days in advance needs to follow the guidance outlined in paragraph (c) above.

3. ASSIGNMENT OF RESPONSIBILITIES

a. Associate Chief of Staff (ACOS) for BH&S. Has overall responsibility for this policy.

b. Group Practice Manager (GPM) and/or Health Administration Service (HAS) supervisory and clerk staff. Have responsibility to address the scheduling needs of the Veteran, ensuring appropriate clerk staff and BH&S Administrative staff are notified of any cancellations and the scheduling action the Veteran desires by close of same business day; contacting Veterans as outlined within this policy; notifying BH&S clinicians of their Veteran no-shows/cancellations; taking action as determined and indicated in this policy, including auditing of no-show practice; all other practices noted in this policy pertaining to GPM/HAS staff interventions.

c. BH&S Administrative Office. Has overall responsibility to work with clinicians and GPM/HAS to ensure smooth coordination of scheduling needs for the Veterans when a BH&S clinician calls off between 1630-0600, or when placing time off request with notice of less than 45 business days as in MCM 20-63.

d. SPC and SP Team. Have the responsibility to follow up with CPRS high risk suicide alert Veterans as indicated above and comply with this policy.

e. BH&S clinicians. Have responsibility to take action as indicated above and for overall compliance with this policy.

4. DEFINITIONS

None

5. REFERENCES

a. Current MCM 20-20, Consultation Procedures

b. VHA Handbook 1160.01, Uniform Mental Health Services in VA Medical Centers and Clinics

c. Current MCM 136-09, Veterans Health Information Systems and Technology Architecture (VISTA) Patient Scheduling

d. Current MCM 20-63, Management of Patient Care for Clinician Leave

e. VHA Notice 2020-26, August 13, 2020 Revision Clinic Cancellation of Patient

6. REVIEW

This SOP must be reviewed at minimum at recertification and including when there are changes to the governing document.

7. RECERTIFICATION

This SOP is scheduled for recertification on or before the last working day of September 10, 2025. In the event of contradiction with national policy, the national policy supersedes and controls.

8. SIGNATORY AUTHORITY

X Piro Rjepaj, MD Associate Chief of Staff, Behavioral Health a...

Appendixes: 7

NOTE: The signature remains valid until rescinded by an appropriate administrative action.

DISTRIBUTION: Distributed to VHALEB BH STAFF. SOPs are also available at https://vaww.lebanon.va.gov/LVAMC_Document_Directory.asp https://vaww.lebanon.va.gov/LVAMC_Document_Directory.asp

Appendix A

Established Veterans New Consults

Cancellation

Discontinued if Veteran refuses service; View Alert automatically submitted to ordering clinician who will need to reassess the patient’s need for the consult.

CPRS HIGH RISK?

Scheduling clerk will make an attempt to contact Veteran via phone.

Documentation of attempt and plan for follow-up will be documented in the Veteran’s electronic chart.

Scheduled clinician or member of the Veteran’s Behavioral Health interdisciplinary treatment team attempts contact via telephone.

Documentation of contact and plan for follow-up will be documented in the Veteran’s electronic chart.

No-Show CPRS HIGH RISK?

Clerk will attempt to contact Veteran.

Suicide Prevention (SP) team will make three attempts to contact Veteran via phone.

Contact made? Contact made? Contact made?

Contact made?

New appointment made.

Letter sent (Appendix C).

SP will contact scheduling clerk, if appropriate, to reschedule Veteran.

Local Police will be contacted to initiate health and welfare check, and SP team will follow up as appropriate.

Letter sent (Appendix D).

New appointment made as appropriate.

Yes No No

No No Yes Yes Yes

Yes

Yes

No

No

Three Consecutive Cancellations

Cancellations

Suicide Prevention team will make three attempts to contact Veteran via telephone. Each attempt at contact will be documented in the Veteran’s electronic chart.

BH&S

No-Show/Cancellation Policy Decision Tree

Discontinued after second no-show;

View Alert automatically submitted to ordering clinician who will need to reassess the patient’s need for the consult.

No-Show

Appendix B

05/05/2020 Hl229

Veteran Name Veteran Address City, State Zip Code

Dear Veteran

This is a reminder of your appointment(s) at the LEBANON VA MEDICAL CENTER located at 1700 South Lincoln Ave, Lebanon, PA:

Date/Time:

Clinic:

Location:

Telephone:

Provider:

MONDAY JUN 15, 2020 10:00 AM

LEB TELE/BH&S PSYCHIATRY-3

TELEPHONE APPOINTMENT

8004098771 Telephone Ext.: 5105

MASTON,SYLVIA SCHNEIDER

--For medicine refills (Allow 10 days for the medicine to reach you.)

Call 272-6621 Ext: 5991 or 1-800-409-8771 Ext 5991.

--For your test results or if you have questions regarding your lab work, call 272-6621/1-800-409-8771 Ext 6041 between 7-4:30 Monday thru Friday.

Sincerely, VA Medical Center www.lebanon.va.gov www.myhealth.va.gov www.facebook.com/VALebanon www.twitter.com/VALebanon

***Stay up to date on Lebanon VAMC! Subscribe to our e-mail list or view our latest newsletter at lebanon.va.gov/news*** http://www.lebanon.va.gov/ http://www.myhealth.va.gov/ http://www.facebook.com/VALebanon http://www.twitter.com/VALebanon

Appendix C

Date

Dear Veteran:

Our records indicate that you missed your recent Behavioral Health appointment. We have tried to contact you to reschedule the appointment via telephone without success. We would like to continue to provide your behavioral health treatment through the Lebanon Veterans Affairs (VA) Medical Center.

If you are still interested in receiving behavioral health treatment, please contact us to schedule an appointment with your provider. Our telephone number is 1-800-409-8771, extension 5105. If you need to access emergency services please call the Veteran’s Crisis Line at 1-800-273-8255, or your county’s Crisis Intervention Service.

If we do not hear from you, we will assume that you do not wish to be rescheduled.

If you have any questions, please feel free to contact us.

Sincerely, /es/ xxxxx,xxxx

Patient Record Number XXXXXX

FORM LETTERS-BH NO SHOW APPT (595-DT-516)

Appendix D

Date

Dear Veteran:

Our records indicate that you have not been seen by your Behavioral Health provider for three consecutive scheduled appointments. We have tried to contact you via telephone without success. At this time you have not been rescheduled. We would like to continue to provide your behavioral health treatment through the Lebanon Veteran Affairs (VA) Medical Center.

If you are still interested in receiving behavioral health treatment, please contact Primary Care or our clinic to request a consult. Our telephone number is 1-800-409-8771. If you need to access emergency services please call the Veteran’s Crisis Line at 1-800-273-8255, or your county’s Crisis Intervention Service.

If we do not hear from you, we will assume that you do not wish to receive further behavioral health treatment.

If you have any questions, please feel free to contact us.

Sincerely, /es/ xxxxx,xxxx

Patient Record Number XXXXXX

FORM LETTERS-BH MULTIPLE MISSED APPTS (595-DT-517)

Appendix E

Assisting Callers Who May Be Suicidal

Gather Critical Information

• Name, address, telephone # and county

• Is anyone with you?

• Could I have the number of someone close to you who I may contact, if we get disconnected?

• Have you ingested any pills, alcohol, street drugs or other substances?

• Do you have any guns or weapons?

• Do you need immediate medical attention?

If yes, respond “We are contacting emergency personnel.”

(Call Emergency Hotline at x4999)

• “I’m going to stay on the line while we contact a clinician to talk with you ”

• If disconnected from the caller, please reach out to a Behavioral Health Provider listed in the chart and/or call the VA Police @ Ext. 4999.

• Please communicate and confirm with the providers listed in the chart via email. Skype, or phone for further follow-up instructions.

Keep caller on the phone until a clinician is ready to accept the Veteran’s Call or transfer Veteran the Nation Veterans Crisis Line .

Lebanon VA Medical Behavioral Health Provider Numbers.

Behavioral Health Clinic Ext. 4992 Damon Frantz, LCSW* Ext. 4040 Christy Deiner, LCSW Ext. 4361 Dr. Brad Pillman, Ph. D.* Ext. 4237 John Lucas, LISW+ Ext. 4366 Laura Elton, LCSW+ Ext. 3648 Charlee Redick, LCSW+ Ext. 4048 Tammy Shay, LCSW Ext. 5505 Lebanon VA Police Ext. 4999

• Behavioral Health Walk-in providers*

• Suicide Prevention Team +

Appendix E

Appendix F

When a BH&S clinician in outpatient clinics calls off for the day between the times of 4:30 p.m. - 6:30 a.m.

Options:

1- Would you like to be seen by another clinician today (prepare to offer location, as identified by BH&S)?

2- Would you like to reschedule with same clinician for another day?

Clinician contacts AOD, who notifies Veterans scheduled up to 10am.

Lead Clerk will cancel the clinic for the day and call all patients from the list, following BH&S Admin direction.

If yes to #1… To be seen same day by another BH clinician.

If yes to #2… Wait to be seen by patient’s established BH clinician.

Slots available at same clinical location; inform respective clinician ahead of time, inform patient, and schedule appointment in clinician’s clinic.

Slots not available at same clinical location; schedule patient same day at different clinical VA Community Clinics location or via CVT, inform clinician ahead of time, and schedule appointment in clinician’s clinic.

Patient seen and given follow-up appointment with assigned clinician.

Schedule patient back with established clinician ideally within 14 business days of Veteran’s cancelled appointment date, or as directed by clinician upon return.

SOP 600-11 September 10, 2020 Appendix G

Slots available at same clinical location; inform respective clinician ahead of time & inform patient, and schedule appointment in clinician’s clinic.

Slots not available at same clinical location; schedule patient same day at different clinical location, inform clinician ahead of time, and schedule appointment in clinician’s clinic.

Patient seen and given follow-up appointment with assigned clinician.

Schedule patient back with original clinician ideally within 14 business days of Veteran’s cancelled appointment date, or as directed by clinician.

Lead Clerk call all patients from the list, following BH&S Admin direction.

If yes to #1… To be seen by another BH clinician.

If yes to #2… Wait to be seen by patient’s established BH clinician.

Clinician informs

Outpatient Manager

When a BH&S clinician in outpatient has to leave after having reported to duty or will be out the next day….. Options:

1- Would you like to be seen by another clinician today (prepare to offer location, as identified by

BH&S)?

2- Would you like to reschedule with same clinician for another day?

Clinician reviews schedule of remaining patients with Outpatient Manager for coverage of the respective day and determines any patient that must be seen by another clinician.

BEHAVIORAL HEALTH & SCIENCES