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The Perennial Problem of No Shows in NEMT

No shows – when patients miss scheduled rides without canceling – have plagued non-emergency medical transportation (NEMT) providers for years. While no-shows are frustrating and cost money, they’re often unavoidable in NEMT. Let’s break down why they happen and some ways to reduce their impact.

Defining the No Show Issue

A no show occurs when a patient fails to cancel an NEMT ride they no longer need. The driver still gets dispatched and fuel/time is wasted. No shows can stem from:

  • Patients getting other transport
  • Forgotten or changed appointments
  • Hospital admissions
  • Simply forgetting about the ride

No show rates of 10-30% are common in NEMT. And some patient groups like dialysis patients have especially high no show rates.

The Costs of No Shows

No shows bring significant costs for NEMT providers:

  • Wasted driver time and mileage
  • Call center labor to contact patients
  • Lost opportunity for a paying ride in that time slot

Industry estimates suggest no shows can cost NEMT providers $200,000 to $600,000 per 100,000 trips. That really adds up and hurts efficiency and profitability!

Medicaid reimburses only per completed ride, offering no compensation for no shows. So it directly impacts revenues.

Why Do No Shows Happen?

No shows most often occur because of forces outside the NEMT provider’s control. Contributing factors can include:

  • Unreliable patients with chaotic lives or memory issues
  • Last minute appointment changes or hospitalizations
  • Patients using other rides from family/friends, public transit, etc.
  • Confusion over pickup times
  • Patients feeling too unwell to travel
  • Bad weather or traffic preventing travel

With an elderly, low-income NEMT user base, some degree of no shows is inevitable. It comes with the territory of providing inclusive NEMT access.

Strategies to Reduce No Shows

While NEMT providers can’t eliminate no shows, some helpful strategies can optimize operations:

  • Overbooking rides and using driver downtime efficiently
  • Calling/texting patients in advance with reminders
  • Collecting accurate callback numbers during scheduling
  • Tracking frequent no show offenders
  • Allowing drivers to mark patients as no shows in real-time
  • Using apps for ride updates and ETAs
  • Partnering with health providers to get patient admit data

The key is balancing great service with efficient use of resources. With forethought, providers can adapt to minimize disruption and costs when no shows do happen.

The Future of Managing No Shows

New technologies may help refine no show prevention and response. Options like automated reminders and mobile tracking can nudge patients and capture real-time changes.

But human oversight will still be needed to guide fragile populations. No shows are just part of the reality of NEMT. But a bit of preparation can make their impact less of a pain point.