D.24 No Show-Minimum Scheduling Effort SOP 02.pdf

D.24 NO SHOW MINIMUM SCHEDULING EFFORT SOP

36C25923R0040

MINIMUM SCHEDULING EFFORT FOR OUTPATIENT APPOINTMENTS

STANDARD OPERATING PROCEDURE (SOP)

1. PURPOSE AND AUTHORITY:

A. The purpose of this standard operating procedure (SOP) is to establish the minimum scheduling efforts(MSE) required for scheduling and rescheduling an appointment.

B. This SOP applies for internal and community care appointments. It must be followed by staff whomanage and schedule appointment requests for new and established patients.

C. This SOP sets forth mandatory procedures and processes to ensure compliance with

VHA Directive 1230, Outpatient Scheduling Processes and Procedures dated July 15, 2016.

D. This SOP excludes same day virtual appointment scheduling/rescheduling for Clinical Contact Center providers. Further details for same day virtual Clinical Contact Center provider appointments are outlined in the Clinical Contact Center Modernization Guidebook: “Provider Minimum Contact Attempts”, available at the following link:

https://dvagov.sharepoint.com/:f:/r/sites/VHAClinContacts/Library%20Documents/CCC- Modernization-

Guidebook?csf=1&web=1&e=6ssRoE

2. RESPONSIBLE PARTIES

A. The processes and procedures outlined in this SOP apply to the staffing roles and positions listed below:

(1) Staff who schedule and manage appointment requests within the VA or in the community.

(2) Scheduling supervisors who oversee the scheduling and management of appointment requests within VA or in the community.

B. The medical center director has overall responsibility to ensure staff document and track minimum scheduling efforts to include the modality type when reaching out to the Veteran.

3. PROCEDURES

A. OVERVIEW AND GENERAL REQUIREMENTS

(1) Staff who schedule appointments must adhere to the non-mental health and mental health minimum scheduling effort (MSE) requirements when contacting a Veteran to schedule or reschedule an appointment. See Appendix A for a high-level view of the process.

(2) These standards apply to appointment requests associated with new or established patients (e.g., return to clinic (RTC) orders and consults), appointment cancellations, no-shows, and new enrollee appointment requests (NEAR).

i. Special Cases. Details regarding the minimum scheduling efforts for Veterans who fail to report (no-show), Veteran-initiated appointment cancellations, VA Online Scheduling (VAOS) appointment requests, and Recall Reminder entries can be found in Section D "Special Cases."

(3) VA medical facilities, services, or individual providers may determine that additional contact attempts beyond the minimum requirement are necessary before a request can be dispositioned.

(4) Facilities may not disclose Veteran personal health information (PHI) when using unsecured modalities such as email and VEText when contacting the Veteran to schedule an appointment. NOTE: VEText users will continue to follow privacy requirements when using this modality to contact the Veteran to schedule an appointment.

(5) Facilities must follow national guidance on set-up requirements and processes for one-way secure messaging and email. Refer guidebooks: "Scheduling Contact Attempt Process Using Secure Messaging" and "Scheduling Contact Attempt Process Using Email”.

(6) Contact Attempts and Modalities:

i. Initial Contact Attempt. The first attempt to contact a Veteran can be made by telephone, secure message, text message, or email.

ii. Follow-up Contact Attempts. If the initial contact attempt is unsuccessful, follow-up contact efforts can be conducted via letter or any contact modalities previously mentioned (e.g., telephone, secure message, text message, or email).

iii. The first and second contact efforts must use different modalities. (e.g., first contact made via telephone call, and the second contact effort is made via secure messaging).

iv. Clinic Cancellation Notifications:

a. Automated communications (e.g., VEText) used to notify the

Veteran of their appointment is cancelled may be used as the first scheduling contact attempt.

b. The second contact attempt must be a telephone call to personalize the communication due to the inconvenience of the clinic canceling the appointment

NOTE: This applies to cases where the Veteran has a telephone.

Staff must use contact methods most appropriate to the Veteran's specific situation when it is not possible to reach the patient using traditional methods (e.g., homeless outreach or certified mail).

(7) Dispositioning the Request. Schedulers must wait 14 calendar days after the second contact attempt before dispositioning the request to allow the Veteran time to respond.

i. High-Risk Flag (HRF) for Suicide Exemption: Mental Health patients who have an electronic health record (EHR) category 1 HRF for suicide require provider review before dispositioning the consult or RTC order. Please see Section C, "Process Requirements for Mental Health Appointments," for additional information.

NOTE: VA medical facilities, services, or individual providers may determine that additional contact attempts are necessary before a request can be dispositioned.

ii. Consults: Consults are dispositioned as "cancelled" following failed minimum scheduling efforts.

https://dvagov.sharepoint.com/sites/vhaschedulingcommunity/SitePages/Scheduling-Contact-Modalities.aspx https://dvagov.sharepoint.com/sites/vhaschedulingcommunity/SitePages/Scheduling-Contact-Modalities.aspx https://dvagov.sharepoint.com/sites/vhaschedulingcommunity/SitePages/Scheduling-Contact-Modalities.aspx https://dvagov.sharepoint.com/sites/vhaschedulingcommunity/SitePages/Scheduling-Contact-Modalities.aspx

iii. CPRS RTC Orders and VS GUIRTC Requests: CPRS RTC orders are completed when the associated VS GUI RTC request is scheduled. The CPRS associated VS GUI RTC request in the scheduling software is dispositioned as "removed no longer necessary" at the APPT/VETERAN disposition prompt.

(8) Documentation. Failed contact attempts must be recorded using the following procedures:

i. CPRS RTC Order: Document contact attempts and modality used to contact the Veteran in CPRS Admin Notes or VS GUI. Disposition the RTC Request in VS GUI by selecting "failure to respond" at the APPT/VETERAN disposition prompt. This will discontinue the RTC Order in CPRS.

ii. Consult: Document contact attempts in the Consult Toolbox (CTB) using CTB "Contact Attempts" tab to capture standard text for "failed mandated scheduling effort" and modality used to contact the Veteran. The appropriate CTB cancellation reason must be used when cancelling consults due to failure to respond.

iii. VAOS Appointment Request: Document contact attempts in CPRS Admin Notes and disposition the request as "cancelled – unable to reach Veteran/Servicemember" in Scheduling Manager at the cancel request prompt.

iv. NEAR: Document failed contact effort(s) and modality used to contact the Veteran in the comments field when changing the status of the NEAR entry in VistA using the NEAR Management Edit Option.

a. After the first failed contact effort, enter the status of the application as "in process" in the comments field using the VistA NEAR Management Edit Option.

b. After the second failed contact attempt, disposition the request as

"cancelled" and enter "unable to contact the Veteran" in the comments field using the VistA NEAR Management Edit Option.

c. Document contact attempts in CPRS Admin Notes.

(9) Scheduling Dispositioned Requests.

NOTE: Dispositioned requests refer to appointment requests dispositioned in CPRS and/or VS GUI. Applies to appointment requests that were never scheduled due to failed scheduling efforts or those where the original appointment was scheduled and later cancelled, or a no-show and the scheduler wishes to reschedule the appointment.

i. Consults: Any consult in "cancelled" status may be resubmitted by clinical or administrative staff. The following actions apply when a cancelled consult is resubmitted.

a. The original patient indicated date (PID) is retained when a cancelled consult is resubmitted.

b. The date the consult is resubmitted is the new PID when the original PID has lapsed.

c. Discontinued consults cannot be resubmitted and will require a new consult.

ii. CPRS RTC Orders: CPRS RTC orders are discontinued when the associated VS GUIRTC request is dispositioned as outlined in above.

a. The scheduler creates a new VS GUI APPT request to schedule the appointment using the PID of the patient.

b. Discontinued CPRS RTC orders may be scheduled without further provider review when the PID has not lapsed. The appointment should be scheduled as close to the original PID as possible.

c. Clinical triage is required when an appointment is requested after the original PID has lapsed.

B. PROCESS REQUIREMENTS FOR NON-MENTAL HEALTH APPOINTMENTS

(1) Contact Attempts and Modalities. For non-mental health appointments, the scheduler must make a minimum of two documented attempts using different contact modalities.

i. Both contact attempts may be completed on the same day.

a. For example, if the scheduler attempts to contact the Veteran via telephone and is unsuccessful, then he/she may also send a secure message or letter that same day, requesting the Veteran to contact the medical center to schedule an appointment.

NOTE: Refer to Clinic Cancellation Notifications

(2) Dispositioning the Request. A scheduler is permitted to:

i. Discontinue contact attempts and disposition the appointment request if the patient fails to respond within 14 calendar days of the second contact effort.

ii. Cancel the consult using the CTB or disposition the VS GUI RTC request without provider review after a failed scheduling effort – unless the provider previously determined that additional contact attempts are necessary based on clinical needs.

NOTE: See Section D “Special Cases” for review Recall Reminder process.

C. PROCESS REQUIREMENTS FOR MENTAL HEALTH APPOINTMENTS

(1) Contact Attempts and Modalities. For mental health appointment requests, contact attempts must be conducted by a staff member with the ability to record in CPRS.NOTE: This includes but is not limited to schedulers, Licensed Practical Nurses, Peer Support Specialists, and health technicians.

i. A minimum of four contact attempts must be performed when scheduling and rescheduling mental health appointments.

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

b. Schedulers must wait a minimum of 14 calendar days from the second contact attempt before dispositioning the appointment request to allow the patient time to respond.

NOTE: Refer to Clinic Cancellation Notifications

c. The third and fourth contact attempts must be made on separate days using the facility's preferred contact modality.

− NOTE: This is completed during 14-calendar day wait.

ii. Staff must use contact methods most appropriate to the Veteran's specific situation when it is not possible to reach the patient using traditional methods (e.g., homeless outreach or certified mail).

(2) High-Risk Flag (HRF) for Suicide Exemption. Attempts to contact patients with EHR category 1 HRF for suicide cancel or no-show must be made by qualified staff who possess a scope of practice including evaluation and triage of high-risk behaviors.

(3) Dispositioning the Request.

i. A scheduler can cancel the consult or disposition the VS GUI RTC request after failed scheduling efforts unless the provider previously determined that additional contact attempts are necessary based on clinical needs.

ii. High-Risk Flag (HRF) for Suicide Exemption. Mental Health patients who have an EHR category 1 HRF for suicide require provider review before cancelling the consult or dispositioning the RTC request.

D. SPECIAL CASES

(1) Veterans Who Fail to Report ("No-Show") or Cancel an Appointment. If a Veteran is a no-show or cancels an appointment, schedulers are not required to contact the Veteran to reschedule under the following circumstances:

i. VHA- designated Low-Risk Clinics. The appointment request may be cancelled after one appointment cancellation/no-show. This includes both appointments associated with and without a consult. See Appendix B for a listing of low-risk clinics.

ii. Non-Mental Health and Non-Low Risk Clinics. Veterans who no-show or cancel an appointment twice in non-mental health and non-low risk clinic do not require rescheduling efforts. The appointment request can be cancelled after the second cancellation/no-show without contacting the Veteran.

iii. Mental Health Clinics. With the exception of mental health patients who have a HRF for suicide flagged in EHR, the following applies:

a. Veterans who no-show or cancel an appointment twice consecutively in a mental health clinic for a consult or a RTC do not require rescheduling efforts, unless the Veteran requests to reschedule at the time he/she cancels. The consult or appointment request is cancelled by administrative staff after the second cancellation/no-show (or combination) when reviewed and approved by the receiving clinician or an appropriate clinician in the receiving service. The no-show letter or communication must indicate the option for same day services and the phone number to contact for the service.

b. Sites may implement local clinical policy that identifies when rescheduling efforts may be stopped for established patients who repeatedly cancel and/or no-show throughout an episode of care. The no-show letter or communication must indicate the option for same day services and the phone number to contact for the service.

iv. Cancellation via Virtual Applications. Established patients who cancel using applications such as VEText or VAOS do not require rescheduling efforts except for Veterans who have an EHR category 1 HRF for suicide.

These Veterans require outreach to reschedule the appointment.

NOTE: The VSSCPatient-Generated Cancellations Report identifies appointments cancelled through these technologies.

v. Strategies on how to manage “no-shows” are available on the No Shows Community SharePoint site located: VHA No Shows Community

- Home (sharepoint.com)

(2) VA Online Scheduling (VAOS) Appointment Requests. If a Veteran submits a VAOS appointment request and the requested times are unavailable, scheduling staff must contact the Veteran to negotiate a new time. In such cases, schedulers must adhere to the minimum scheduling effort requirements for mental health and non-mental health appointments. NOTE: Schedulers are permitted to schedule VAOS appointment requests without calling the Veteran when the appointment preferences identified by the Veteran are available.

(3) Recall Reminders. The following standards apply to non-mental health and mental health Recall Reminder entries.

i. Initial Contact Attempt. The recall reminder postcard/letter is the initial contact attempt for Veteran appointment requests entered in the Recall Reminder system. Documentation of the initial scheduling contact effort in CPRS is not required.

a. The recall parameters for a postcard/letter are to be set between 30

– 60 days before the recall date (i.e., PID).

ii. Follow-up Contact Attempt. If the Veteran fails to respond to the postcard/letter, the second contact attempt can be made using telephone, secure message, text message, email, or letter via US mail and recorded in CPRS. A second recall reminder notice will satisfy this requirement.

a. To allow the Veteran time to respond, schedulers must wait at least 14 calendar days after the first scheduling contact effort before initiating a second attempt to contact.

iii. Dispositioning Delinquent/Past Due Recall Reminder Entries. Staff must wait at least 14 calendar days after the second failed contact attempt before dispositioning the entry as "failure to respond" in VS GUI.

a. Delinquent recall reminders (i.e., when PID has lapsed) must have evidence of a failed second contact attempt recorded in CPRS before dispositioning.

b. There should be no past due recall reminder entries.

https://reports.vssc.med.va.gov/ReportServer/Pages/ReportViewer.aspx?%2fAccess%2fAppointment%2B-%2BPatient%2BGenerated%2BCancellations&rs%3ACommand=Render https://dvagov.sharepoint.com/sites/vhano-shows-community https://dvagov.sharepoint.com/sites/vhano-shows-community

4. REFERENCES

A. VHA Directive 1230, Outpatient Scheduling Processes and Procedures dated July 15, B. Scheduling Contact Modalities SharePoint

C. Appointment - Patient Generated Cancellations - Report Viewer

D. OVAC Directives, Standard Operating Procedures (SOPs) & Guidebooks

5. REVIEW

This SOP will be reviewed no less than annually.

6. SIGNATORY AUTHORITY

Mia D Powers-Higgins 212604

Mia Powers-Higgins

Digitally signed by Mia D Powers-Higgins

212604

Date: 2022.08.05 15:43:51 -04'00'

Director, Optimization, Integrated Access Office of Integrated

Veteran Care (IVC) Date Approved: [DATE]

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

https://vaww.va.gov/vhapublications/ViewPublication.asp?pub_ID=3218 https://vaww.va.gov/vhapublications/ViewPublication.asp?pub_ID=3218 https://dvagov.sharepoint.com/sites/vhaschedulingcommunity/SitePages/Scheduling-Contact-Modalities.aspx https://reports.vssc.med.va.gov/ReportServer/Pages/ReportViewer.aspx?%2fAccess%2fAppointment%2B-%2BPatient%2BGenerated%2BCancellations&rs%3ACommand=Render https://dvagov.sharepoint.com/sites/vhaovac/cpm/SitePages/AccessPolicyResources.aspx

Appendix A

Minimum Scheduling Effort at a Glance

Appointment Types

Process Step All Non

-MH

MH

Contact Attempts

Initial attempt to contact the Veteran may be performed via telephone, secure message, text message, or email. X X X

The second contact attempt can be accomplished through telephone, secure message, text message, email, or letter. X X X

All contact attempts are to be recorded in CPRS. X X X

Perform a minimum of two contact attempts using different modalities. X

Perform a minimum of four contact attempts, where the third and fourth attempts occur on separate days.

X

Facilities, services, or providers may determine that additional contact attempts are necessary based on clinical needs. X

Attempts to contact patients who cancel/no-show that have an EHR category 1 HRF for suicide alert must be made by an appropriately trained staff who possess a scope of practice including evaluation and triage of high-risk behaviors.

VAOS appointment requests can be scheduled without calling the Veteran if the requested date and time are available. X

Dispositioning

Wait 14 calendar days from the date of the second contact attempt before dispositioning. X X X

Consult, or RTC requests for patients with an EHR category 1 HRF for suicide require provider review before dispositioning. X

Scheduling after Failed Contact Efforts

RTC Orders: Previously dispositioned RTC requests can be scheduled without provider review if the Veteran requests to schedule before the PID. Clinical triage is required if requested by the Veteran after the PID has lapsed.

X X X

Consults: Cancelled consults with PID in the future ("original PID has not passed") do not require a new PID when resubmitted.

However, cancelled consults with the original PID that has passed require anew PID when resubmitted (new PID date consult is resubmitted).

X X X

Patients who no-show or cancel do not require rescheduling efforts after the second consecutive cancellation/no-show combination in non- mental health and non-low risk clinic.

Patients who no-show or cancel an appointment in VHA-designated low-risk clinics do not require rescheduling efforts, and the consult may be cancelled after one appointment cancellation/no-show. This includes both appointments associated with and without a consult request.

Patients who do not have a HRF for Suicide who no-show or cancel an appointment twice consecutively in a mental health clinic for a consult or a RTC do not require rescheduling efforts, unless the Veteran requests to reschedule at the time he/she cancels.

X

Appointments cancelled by patients independently usinga software application do not require the clinic to initiate rescheduling efforts. *

X X X*

If a Veteran submits a VAOS appointment request and the requested times are unavailable, staff are to contact the Veteran to negotiate a new time per the minimum scheduling effort requirements.

X X X

* Exception: Does not apply to mental health appointments where the Veteran has a EHR category 1 High-Risk Flag [HRF]for suicide

Minimum Scheduling Effort at a Glance

Appointment Types

Recall Reminder Process All Non-

MH

MH

Postcard/letter mailed as part of the software's recall process serves as the initial contact attempt. CPRS documentation is not required for the initial contact effort.

X X X

The second contact attempt can be accomplished through telephone, secure message, text message, email, or letter via US Mail. It is made no earlier than 14 calendar days from the initial contact effort outlined above and recorded in

CPRS.

X X X

The second scheduling effort must be made no later than the recall entry PID. The facility must wait no less than 14 calendar days after the second contact effort before dispositioning the request. There should be no past due recall reminder entries

Clinic Cancellation and Minimum Scheduling Effort

Automated communications (such as VEText) used to contact the Veteran that the clinic has canceled their appointment may be used as the first scheduling contact attempt.

X X X

The second contact attempt when using automated communications to cancel by clinic must be conducted by telephone (when the Veteran has a phone) to personalize the communication for the inconvenience of the clinic canceling the appointment. This will satisfy the requirements for non-mental health minimum scheduling effort requirements.

X X X

The third and fourth contact attempts must be made on separate days using the facility's preferred contact modality (mental health only).

Appendix B

LIST OF LOW-RISK CLINICS

1. Physical Therapy

2. Occupational Therapy

3. Kinesiotherapy

4. Acupuncture

5. Smoking Clinic

6. MOVE Clinic

7. Massage Therapy

8. Chiropractic Care

9. Erectile Dysfunction Clinic

10. Pulmonary Function Test (Outpatient)

11. Energy Medicine Healing Touch Clinic/Palliative Care

12. Bariatric Information Session

13. Bariatric Surgery Support Group (Interfacility Consult [IFC] From Other VAMC)

14. Pain Education

15. PM&R

a. PM&R Outpatient Craniosacral Therapy

b. PM&R Outpatient Occupational Therapy

c. PM&R Outpatient Physical Therapy/ABJ

d. PM&R Outpatient Physical Therapy/JB

e. PM&R Outpatient Shoulder Home Exercise Program

f. PM&R Outpatient Equipment OTSelf-Care Aids/JB

g. PM&ROutpatient Equipment Power Wheelchair/Scooter Request

h. PM&R Outpatient Equipment PT Mobility Aids/JB

16. Biofeedback-Outpatient

17. Compensated Work Therapy (CWT) Consults

18. Sexual Dysfunction Clinic

19. Nutrition Clinics (All Sites)