S02 - SOLICITATION ATTACHMENT - D.31 BVAC No Show and Cancel by Patient.pdf

D.31 – No Show and Cancelled by Patient Appointments

NO SHOW AND CANCELLED BY PATIENT APPOINTMENTS

SOP 116-13

Syracuse VA Medical Center Syracuse, NY 13210

Signatory Authority:

BVAC Careline Manager

Responsible Owner:

BVAC Careline Manager

Service Line(s):

BVAC

Effective Date:

August 2020

Recertification Date:

August 2025

1. PURPOSE AND AUTHORITY

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). This SOP must be followed by all providers and administrative staff who encounter situations where a patient no shows for an appointment or cancels their own appointment.

b. This SOP sets forth mandatory procedures and processes to ensure compliance with VHA Directive 1230(2), Outpatient Scheduling Processes And Procedures, dated July 15, 2016, and amended on July 12, 2019 and VHA Notice 2019-09(2), Minimum Scheduling Effort Required For Outpoint Appointments: Updates To VHA Directive 1230 and VHA Directive 1232(1), dated April 24, 2019 and amended on September 23, 2016 and VHA Directive 1232(1),Consult Processes and Procedures, dated August 24, 2016 and VA Memo from Acting Deputy Under Secretary for Health Operations and Management (10N): My VA Access: Mental Health Breakthrough Initiative, dated April 22, 2016.

2. PROCEDURES

a. Additional No Show Information. For all no shows, the following minimum scheduling effort will be made: four contacts (3 phone calls that must be at least 24 hours apart, the first on the same day as the appointment and 1 letter that can be mailed on the same day as the first phone call).

b. Additional High-Risk Flag Information. For any Veteran with a high-risk flag (HRF) who is a no show or cancels by patient and is unable to be reached, the provider will consult with the Suicide Prevention Team around the need for a health welfare check. In addition, the MSA/PSA will notify the Suicide Prevention Team and the provider if a return to clinic order (RTC) is closed without an appointment being scheduled.

c. Additional 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 and if they no show 3 consecutive visits in the same clinic.

(1) No Show Appointments – For Established Patients

August 2020 SOP 116-13

(a) A phone call is made to the Veteran by the provider from the clinic where the no show occurred, during the time of the no show appointment. The no show attempt is documented in CPRS using the “BVAC No Show” Note Title and the appropriate telephone clinic. If appropriate, the encounter is marked historical.

1. If the Veteran is not reached, the provider leaves a message that includes the main clinic number.

(b) The provider enters a RTC with “no show” indicated and instructions to include the patient indicated date (PID) for follow up if the Veteran contacts the clinic to reschedule.

1. Medical Support Assistant (MSA) or Program Support Assistant (PSA) receives RTC and no shows the appointment. The no show postcard will automatically generate.

a. If you are a program that has opted out of “postcards” (e.g.: Homeless, MHICM), this will NOT automatically occur and you will need to send your own no-show letter. (See attachment A for a suggestion.)

(c) Within the next 48-72 hours, the MSA/PSA will make a second phone call to contact the Veteran.

If the Veteran is reached, will reschedule the appointment based on clinical need.

(d) Within the next 48-72 hours after the 2nd call, the MSA/PSA will make a third phone call to contact the Veteran. If the Veteran is reached, will reschedule the appointment based on clinical need.

(2) If the Veteran is unable to be reached by phone and does not contact the clinic within 14 days of the no show letter, the MSA/PSA will close the RTC.

(3) No Show Appointments – For Consults (New Patients):

(a) A phone call is made to the Veteran by the provider from the clinic where the no show occurred, during the time of the no show appointment. The no show attempt is documented in CPRS using the “add comment” function in CPRS. (Go to “Action” then “Consult Tracking” then “Add Comment”.)

1. If the Veteran is not reached, the provider leaves a message that includes the main clinic number.

2. If the Veteran is reached, the provider will document the content of the call.

(b) MSA/PSA records 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. The postcards are automatically generated.

1. If you are a program that has opted out of “postcards” (e.g.: Homeless, MHICM), this will NOT automatically occur and you will need to send your own no-show letter. (See attachment A for a suggestion.)

(c) Within the next 48-72 hours, a second phone call will be made to contact the Veteran by the MSA/PSA or consult administrator. If the Veteran is reached, the appointment will be rescheduled based on clinical need. Phone call is documented in CPRS on the consult using the consult toolbox.

(d) Within the next 48-72 hours after the 2nd call, a third phone call will be made to contact the Veteran by the MSA/PSA or consult administrator. If the Veteran is reached, the appointment will be rescheduled based on clinical need. Phone call is documented in CPRS on the consult using the consult toolbox.

(e) If the Veteran is unable to be reached by phone and does not contact the clinic within 14 days of the letter being sent, the MSA/PSA or consult administrator will discontinue the consult.

(4) Cancel by Patient Appointments:

(a) If the Veteran contacts the clinic and requests appointment(s) to be cancelled.

1. The MSA/PSA will follow the MyVA Access protocols, to include asking the Veteran if they need to speak with a provider immediately.

2. If the Veteran wants to reschedule at that time the MSA/PSA will cancel the appointment by patient and schedule a new appointment using the appropriate PID.

a. The MSA/PSA will send an encrypted email to the provider to inform them of the Veteran’s cancellation and the new appointment date.

3. If the Veteran declines to reschedule at the time of the call the MSA/PSA will cancel the appointment by patient.

a. The MSA/PSA will send an encrypted email to the provider to inform them of the Veteran’s cancellation and that they did not want to reschedule at this time.

b. The provider will follow up with the Veteran.

(b) If the Veteran cancels through the provider:

1. If the Veteran leaves a message on the provider’s phone, the provider will call the Veteran and document the call.

2. If Veteran answers provider’s phone call and does not want to reschedule, provider documents in CPRS.

3. If Veteran answers provider’s phone call and wants to reschedule, provider places RTC for cancellation and to reschedule.

4. If the Veteran’s appointment is more than 24-hours away, the provider will place the RTC and can IM the front desk group and then transfer the call to the front desk.

a. The MSA/PSA will cancel the appointment.

(1) The MSA/PSA will send a cancellation letter unless the Veteran is already scheduled or has specified that they do not wish to be rescheduled.

(2) If the Veteran does not contact the clinic within 14 days, the MSA/PSA will close the RTC.

5. If the Veteran’s appointment is within the next 1 hour to 24 hours, the provider will place the RTC and send an encrypted email to the VHASYR BVAC ADMIN email group with the subject line “CX by Pt within 24 hours”. If the Veteran is on the phone, the provider can IM the front desk group and then transfer the call to the front desk.

a. The MSA/PSA will cancel the appointment.

(1) The MSA/PSA will send a cancellation letter unless the Veteran is already scheduled or has specified that they do not wish to be rescheduled.

(2) If the Veteran does not contact the clinic within 14 days, the MSA/PSA will close the RTC.

6. If the Veteran’s appointment is within the next 60 minutes, the Provider will enter the RTC and then walk to the MSA/PSA to inform them of the cancellation RTC.

a. The MSA/PSA will cancel the appointment.

(1) The MSA/PSA will send a cancellation letter unless the Veteran is already scheduled or has specified that they do not wish to be rescheduled.

(2) If the Veteran does not contact the clinic within 14 days, the MSA/PSA will close the RTC.

(5) If the Veteran cancels through Audiocare, Secure Messaging or another way in which they are not directly calling the MSA/PSA:

(a) the MSA/PSA will call the Veteran and ask if the Veteran would like to re-schedule the appointment.

1. If the Veteran wants to reschedule at that time the MSA/PSA will cancel the appointment by patient and schedule a new appointment designating the appointment using the appropriate PID.

2. If the Veteran declines to reschedule at the time of the call the MSA/PSA will cancel the appointment by patient.

a. The MSA/PSA will send an encrypted email to the provider to inform them of the Veteran’s cancellation and that they did not want to reschedule at this time.

b. The provider will follow up with the Veteran and document in CPRS.

3. If the Veteran does not answer MSA/PSA phone call, MSA/PSA will leave message, if possible, and send letter to Veteran.

4. If the Veteran has a HRF for suicide, the MSA/PSA will follow HRF protocol and make an additional two phone calls (for a total of four attempts) prior to closing the RTC. If the RTC is closed without an appointment being scheduled, the MSA/PSA will notify the Suicide Prevention team and the provider.

3. ASSIGNMENT OF RESPONSIBILITIES

a. All Behavioral Health Staff are responsible to follow the steps outlined in this standard operating procedure and the Syracuse VA Medical Center scheduling requirements.

b. BVAC Team Leaders are responsible for ensuring that their staff are following the SOP.

c. BVAC Administrative Officer and Management & Program Analyst are responsible for ensuring that MSA/PSA staff follow the SOP.

d. BVAC Careline Manager is responsible for ensuring that Team Leaders follow the SOP.

4. DEFINITIONS - None

5. REFERENCES

a. VHA Directive 1230(2), Outpatient Scheduling Processes And Procedures, dated July 15, 2016, and amended on January 22, 2020.

b. VHA Directive 1232(2), Consult Processes And Procedures, dated August 24, 2016, and amended on September 23, 2016.

c. VA Memo from Acting Deputy Under Secretary for Health Operations and Management (10N):

My VA Access: Mental Health Breakthrough Initiative, dated April 22, 2016.

6. 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.

7. RECERTIFICATION

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

8. SIGNATORY AUTHORITY

Lauren Love-Dubeau, LCSW-R Behavioral Health Careline Manager Date Approved: August 24, 2020 https://vaww.va.gov/vhapublications/index.cfm https://vaww.va.gov/vhapublications/index.cfm https://vaww.va.gov/vhapublications/index.cfm https://vaww.va.gov/vhapublications/index.cfm https://dvagov.sharepoint.com/sites/vhaaccess-mental-health-services/Shared%20Documents/Forms/AllItems.aspx?FilterField1=Catagory&FilterValue1=Educational%20Roll%2Dout&FilterType1=Choice&id=%2Fsites%2Fvhaaccess%2Dmental%2Dhealth%2Dservices%2FShared%20Documents%2F04222016%20%2D%20My%20VA%20Access%20%2D%20Mental%20Health%20Breakthrough%20Initiative%2Epdf&parent=%2Fsites%2Fvhaaccess%2Dmental%2Dhealth%2Dservices%2FShared%20Documents https://dvagov.sharepoint.com/sites/vhaaccess-mental-health-services/Shared%20Documents/Forms/AllItems.aspx?FilterField1=Catagory&FilterValue1=Educational%20Roll%2Dout&FilterType1=Choice&id=%2Fsites%2Fvhaaccess%2Dmental%2Dhealth%2Dservices%2FShared%20Documents%2F04222016%20%2D%20My%20VA%20Access%20%2D%20Mental%20Health%20Breakthrough%20Initiative%2Epdf&parent=%2Fsites%2Fvhaaccess%2Dmental%2Dhealth%2Dservices%2FShared%20Documents

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

DISTRIBUTION: SOPs are available at: Syracuse Medical Center Document Control SharePoint (DCS).

https://dvagov.sharepoint.com/sites/NADqms/syrvamc/default.aspx

APPENDIX A: Sample Letter

MONTH DAY, YEAR

VETERAN NAME

STREET ADDRESS

CITY, STATE ZIP

Dear VETERAN NAME, We are sorry that you were unable to attend your appointment on MONTH DAY, YEAR in the CLINIC NAME clinic. We attempted to contact you at the time of your appointment and was unable to reach you.

If you would like to reschedule your appointment, please call the clinic.

We realize that sometimes things come up that make it impossible to attend appointments. If you are unable to make a scheduled appointment, we kindly ask that you notify us at least 24 hours in advance by calling the CLINIC NAME at CLINIC NUMBER (Monday-Friday; TIME-TIME). If you are unable to attend an appointment, notifying us beforehand may allow us to offer your appointment to another Veteran. This will help us better serve Veterans with mental health needs. You may re-schedule any missed appointments by contacting the clinic.

Open communication with your support system is an important part of the recovery process. Please contact your recovery team if you are missing appointments due to an increase in stressors or mental health symptoms. Your recovery team is here to help. If you need to reach the Veterans Crisis Line, they are available 24 hours, 7 days a week by calling 1-800-273-8255 + Press 1.

If you are covered by a private health insurance plan, please bring your insurance identification card with you to your next appointment.

We want you to know that we are thinking of you and that our services are available to you if you wish to reschedule. We look forward to seeing you.

Sincerely, YOUR NAME

Syracuse VA Behavioral Health

CLINIC ADDRESS

CLINIC PHONE NUMBER