D.16- MENTAL HEALTH NO SHOW AND CANCEL PROCEDURES- SEPT 2023.pdf

MENTAL HEALTH NO-SHOW AND CANCEL PROCEDURES

SOP 528a7-116-013

Syracuse VA Medical Center Syracuse, NY 13210

Signatory Authority:

Associate Chief of Staff for Mental Health

Responsible Owner:

Associate Chief of Staff for Mental Health

Service Line(s):

Mental Health

Effective Date:

September 2023

Recertification Date:

September 2028

1. SUMMARY OF CHANGES

a. Major changes are as follows:

2. PURPOSE AND JUSTIFICATION

a. The purpose of this standard operating procedure (SOP) is to establish procedures on what to do when a Veteran “no-shows” or cancels their appointment (‘Cancel by Patient’) or the appointment is cancelled by the clinic. This SOP must be followed by all Syracuse VAMC personnel.

b. This SOP sets forth mandatory procedures and processes to ensure compliance with VHA Directive 1230, Outpatient Scheduling Management, dated June 1, 2022 and Directives, Standard Operating Procedures (SOPs) & Guidebooks (sharepoint.com) and VHA Directive 1232(5), Consult Processes and Procedures, dated August 24, 2016, amended December 5, 2022, and Standard Operating Procedures for Outpatient Mental Health Consults (VIEWS 6076225) dated October 7, 2021.

3. PROCEDURES

a. Documentation. The scheduler/provider will document the Veteran contact or attempts at contact in the Electronic Medical Record (EMR) and/or appropriate scheduling application.

b. No-Show Information. For all no-shows, the following minimum scheduling effort will be made:

(1) Four contact attempts.

(a) The second attempt must be made using a different modality than the initial contact effort and may be completed on the same day.

(b) Subsequent contact attempts must be at least 24 hours apart.

ATTACHMENT D.16 RFP 36C24224R0049

https://dvagov.sharepoint.com/sites/vhaovac/cpm/SitePages/AccessPolicyResources.aspx#standard-operating-procedures-%28sop%29-and-guidebooks-on-vha-policies

(c) Schedulers must wait a minimum of 14 calendar days from the second contact attempt before taking further action (e.g. dispositioning the request).

(2) Staff must use contact methods appropriate to the Veteran’s specific situation when it is not possible to reach the Veteran using traditional methods (e.g. Homeless Outreach or Certified Mail).

c. High-Risk Flag Information. The process outlined here must be followed for all Veterans with a high-risk flag for suicide, that no-show or have a cancelled appointment (for any reason).

(1) No Shows and Cancellations.

(a) For any Veteran, new or established, with a High-Risk Flag (HRF) who does not present for their scheduled appointment (no-shows) or cancels a scheduled appointment without rescheduling, it is the responsibility of the clinical provider with whom the Veteran was scheduled to complete a minimum of three (3) outreach attempts by phone with a minimum of one hour in between each attempt.

1. The three phone contact attempts must be within two business days of the missed appointment.

a. These efforts must be clearly documented in the Electronic Medical Record (EMR) through the appropriate note title.

b. If unable to reach the Veteran after the three required attempts or the clinical provider believes the Veteran may be at imminent risk, they will follow established guidelines in SOP 116-044 Standard Operating Procedure for Determining the Need for and Requesting Welfare Checks, Section 2.

(2) Dispositioning appointments/appointment requests for Veterans with a HRF for suicide.

(a) For established Veterans.

1. The provider will document in the Veteran’s EMR if the Return to Clinic (RTC) order can be discontinued or canceled, and notify the scheduler via the EMR as an additional signer on the note or by notation on an RTC.

(b) For new Veterans.

1. If the consult was entered by a mental health provider, it is the responsibility of that provider to complete the disposition.

a. If additional scheduling attempts are needed, the provider will alert the scheduler via the EMR.

2. If the consult was entered by a non-mental health provider or was a direct schedule request, the scheduler will alert the Suicide Prevention Team via the EMR to review the consult and disposition it.

a. If additional scheduling attempts are needed, the provider will alert the scheduler.

d. Discharge from Service Information. A Veteran may be irregularly discharged from treatment within a specialty clinic if they do not respond to attempts to be contacted (failed scheduling attempt) or if they no show-or cancel two consecutive visits in the same clinic.

(1) However, as Veterans can direct schedule for Mental Health, if a Veteran would like to re-engage in care after being discharged, the scheduler will either reschedule the Veteran or reach out to the provider for guidance.

e. No-Show Appointments – For Established Veterans.

(1) A phone call will be made to the Veteran by the provider the Veteran was scheduled with, during the time of the no-showed appointment.

(a) The outcome of the call will be documented in the EMR using the appropriate section of the “BEHAVIORAL HEALTH TELEPHONE NOTE” template.

(2) If the Veteran is not reached, the provider will leave a message that includes the main clinic number.

(3) The provider notifies the scheduler(s) via email grouper ‘VHASYR

MHICCNOSHOWCANCELATION’.

(4) The scheduler will review the email and mark the appointment as a ‘no-show’.

(a) A no-show postcard will be automatically mailed to the Veteran.

(b) For programs that have opted out of postcards (example, Homeless, Mental Health Intensive Care Management (MHICM) Vocational Rehabilitation), this will NOT automatically occur. Those programs will mail their own no-show letter and follow up with the appropriate number of contact attempts. The no-show letter is in VistA/Consult Tracking Manager (CTM).

(5) No sooner than 24 hours from the previous attempt, but within four days from the previous attempt, the scheduler will make a third attempt to contact the Veteran.

(a) If the Veteran is reached, the scheduler will reschedule the appointment based on the Veteran’s preference.

(6) If the Veteran is unable to be reached and does not contact the clinic within 14 days of the second contact attempt, the scheduler will disposition the Return to Clinic (RTC) order.

f. No Show Appointments – For Consults.

(1) A phone call will be made to the Veteran by the provider from the clinic where the no-show occurred, during the time of the no-show appointment.

(a) The no-show attempt will be documented on the consult in the EMR.

(b) If the Veteran is not reached, the provider will leave a message that includes the main clinic number.

(c) If the Veteran is reached, the provider will document the content of the call in the

EMR.

(d) The provider will notify the scheduler(s) via email grouper ‘VHASYR

MHICCNOSHOWCANCELATION’.

1. If the Veteran no longer desires an appointment, the provider will note this in the EMR, and the scheduler will cancel the consult using Consult Toolbox.

(d) The scheduler will record the no-show, and a no-show postcard will be sent to the Veteran once the appointment is marked as a no-show in the scheduling package.

1. The postcards are automatically generated and will automatically mail to the Veteran.

(e) For programs that have opted out of postcards (e.g., Homeless, MHICM, Vocational Rehabilitation), this will NOT automatically occur. Those programs will mail their own no-show letter and follow up with the appropriate number of contact attempts.

The no-show letter is in VistA/Consult Tracking Manager (CTM).

(f) No sooner than 24 hours from the previous attempt, but within four (4) days from the previous attempt, a third contact attempt will be made to the Veteran by the scheduler or consult administrator.

1. If the Veteran is reached, the appointment will be rescheduled based on the Veteran’s preference.

a. The phone call will be documented in the EMR on the consult using the Consult Toolbox.

(g) No sooner than 24 hours from the previous attempt, but within four (4) days from the previous attempt, a fourth contact attempt call will be made to contact the Veteran by the scheduler or consult administrator.

1. If the Veteran is reached, the appointment will be rescheduled based on the Veteran’s preference.

a. The phone call will be documented in the EMR on the consult using the Consult Toolbox.

(h) If the Veteran is unable to be reached by phone and does not contact the clinic within 14 days of the second contact attempt, the scheduler or consult administrator will cancel the consult.

g. ‘Cancel by Clinic’ Appointments.

(1) The clinic will make every effort to not cancel appointments. In the event that an appointment needs to be cancelled, the scheduler will contact the Veteran to reschedule the appointment.

(2) The scheduler will send a clinic cancellation letter to the Veteran unless the Veteran is already scheduled or has specified that they do not wish to be rescheduled.

This will be documented in the EMR using the Administrative Staff Scheduling Attempt note.

(3) A minimum of four contact attempts will be made. The second attempt must be made using a different modality than the initial contact effort and may be completed on the same day. Subsequent contact attempts must be at least 24 hours apart.

Schedulers must wait a minimum of 14 calendar days from the second contact attempt before taking further action (e.g. dispositioning the request).

(a) Automated communications may be used as the first notification to the Veteran.

(b) If the first attempt is not a telephone call, the second contact attempt must be a telephone call.

(c) The scheduler will wait 14 days following the second attempt to disposition the request (RTC or consult).

h. ‘Cancel by Veteran’ Appointments.

(1) Appointments independently cancelled by Veterans using a software application do not require the clinic to initiate rescheduling unless the Veteran has a High-Risk Flag for Suicide. (Please refer to section 2.c.)

(2) The scheduler/provider will follow the MyVA Access protocols, to include asking the Veteran if they need to speak with a provider immediately.

(3) If the Veteran contacts the clinic:

(a) The scheduler/provider will inquire if the Veteran would like to be rescheduled and will act accordingly using the appropriate patient/provider indicated date (PID) and following current scheduling policies, SOPs and/or Memorandums.

(b) Appointments cancelled by Veterans will be rescheduled based off the Veteran’s preference.

(4) If the Veteran speaks with the provider:

(a) The provider will enter a note in the EMR.

(b) The provider will send an email to the schedulers using the ‘VHASYR MHICCNOSHOWCANCELLATION’ email grouper.

(c) The scheduler will review the note, cancel the appointment and send a cancellation letter to the Veteran.

(5) If the Veteran contacts the provider directly:

(a) If the contact is within one (1) hour of the scheduled appointment, in addition to a note in the EMR, the provider will also directly contact the schedulers via instant message or face-to-face communication to request that the appointment is cancelled.

(b) If the contact is within the next one (1) to 24 hours of the scheduled appointment, in addition to a note in the EMR, the provider will also send an encrypted email to the schedulers via “VHASYR MHICCNOSHOWCANCELLATION” email grouper.

(c) If the Veteran is on the phone, the provider can instant message (IM) the schedulers and then transfer the call to the front desk.

(d) If the Veteran declines to reschedule at the time of the call, the scheduler will enter a “Veteran’s Request for Service” note in the EMR and alert the provider to inform them of the Veteran’s cancellation and that they did not want to reschedule.

(e) The provider will follow up with the Veteran, as clinically appropriate.

4. ASSIGNMENT OF RESPONSIBILITIES

a. Service Chief. The Service Chief is responsible for:

(1) Communicating this SOP and any changes to all appropriate staff.

(2) Reviewing and ensuring all appropriate changes are made to this SOP.

(3) Ensuring all information contained herein follows any and all governing guidance where appropriate.

(4) Ensuring all appropriate staff adhere to this SOP.

b. All Mental Health Staff. All Mental Health Staff are responsible for:

(1) Following the steps outlined in this SOP and the Syracuse VA Medical Center scheduling requirements.

c. Mental Health Team Leaders. The Mental Health Team Leaders are responsible for ensuring that their staff are following the SOP.

d. Business Office. The Business Office is responsible for ensuring that scheduler staff follow the SOP.

e. Associate Chief of Staff for Mental Health. The Associate Chief of Staff for Mental Health is responsible for ensuring that Team Leaders follow the SOP.

f. All Other Staff. All Other Staff are responsible for:

(1) Adhering to this SOP.

5. DEFINITIONS

None

6. REFERENCES

a. VHA Directive 1230, Outpatient Scheduling Management, dated June 1, 2022.

DIRECT LINK. NOTE: This is an internal VA website that is not available to the public.

b. VHA Directive 1232(5), Consult Processes and Procedures, dated August 24, 2016, amended December 5, 2022. DIRECT LINK. NOTE: This is an internal VA website that is not available to the public.

7. REVIEW

The SOP will be reviewed at recertification or when there are changes to the governing document (for example, national policy or a health care accreditation body mandate), and any regulatory requirement for more frequent review.

8. RECERTIFICATION

This SOP is scheduled for recertification on or before the last working day of August 2028. In the event of contradiction with national policy, the national policy supersedes and controls.

https://vaww.va.gov/vhapublications/index.cfm https://vaww.va.gov/vhapublications/ViewPublication.asp?pub_ID=9810 https://vaww.va.gov/vhapublications/index.cfm https://vaww.va.gov/vhapublications/index.cfm https://vaww.va.gov/vhapublications/ViewPublication.asp?pub_ID=3230

9. SIGNATORY AUTHORITY

LAUREN LOVE-DUBEAU, LCSW-R

Associate Chief of Staff for Mental Health Syracuse VA Medical Center Date Approved: September 1, 2023

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

DISTRIBUTION: Automated distribution email sent weekly to VHASYR Managers & Supervisors email group at SYR-M&S@med.va.gov. SOPs are available at: Syracuse Medical Center Document Control SharePoint (DCS).

https://dvagov.sharepoint.com/sites/VHASYR/svdc. NOTE: This is an internal VA website that is not available to the public.

mailto:SYR-M&S@med.va.gov https://dvagov.sharepoint.com/sites/VHASYR/svdc/ https://dvagov.sharepoint.com/sites/VHASYR/svdc/