News, Analysis, Trends, Management Innovations for
Clinical Laboratories and Pathology Groups

Hosted by Robert Michel

News, Analysis, Trends, Management Innovations for
Clinical Laboratories and Pathology Groups

Hosted by Robert Michel
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Text-based Appointment Reminder System Cuts Patient No-Show Rates by One-Third at California’s Largest Physician-Owned Medical Practice

Could clinical laboratories use texting to improving patient compliance with the medical laboratory test orders given to them by their doctors?

California’s largest physician-owned medical practice has employed text messaging to reduce patient no-shows. Just as other innovations such as same-day walk-in clinical laboratory testing and patient at-home self-testing made it easier for patients to comply with physicians’ lab test orders, text messaging appears to help get more patients through the doors and into doctors’ exam rooms.

At least that’s the experience at Riverside Medical Clinic (RMC) in Riverside, Calif. The multi-specialty practice has more than 170 providers who see more than 400,000 patients annually. After struggling to lower its 15% baseline no-show rate using a phone-only reminder system, RMC turned to a two-way texting appointment reminder system from Santa Barbara, Calif.-based WELL Health (WELL).

According to a case study, prior to the texting system implementation, no-shows were costing RMC more than $3 million per year. “The problem we were trying to resolve was getting a hold of our patients in an expedient manner without having to do redundant work,” Diego Galvez-Ramirez, Associate Vice President, Patient Business Services at Riverside Medical Clinic, told Healthcare IT News. “We wanted to give time back to our staff. A big frustration was not having enough time for staff to accomplish their duties.”

After RMC implemented WELL’s HIPAA-compliant text-based reminder system, front office efficiency and productivity improved, and the practice experienced a 33% decrease in appointment no-shows.


  • No-shows decreased from 15% to 10% within the first month of going live across the enterprise.
  • Confirmed appointments rose from 29.45% to 94.45%, translating to a savings of more than $40,000 in two months.
  • 91% of patients who confirmed via WELL presented for their visit.
  • Phone volume at RMC’s two call centers decreased by 4% to 6%.

Galvez-Ramirez suggests that healthcare providers—including clinical laboratories and anatomic pathology groups—keep pace with the realities of today’s connected world. “Most of the time, the cell phone is not used to make phone calls,” he told Healthcare IT News. “You have to adapt to the new ways that your patients want and are used to communicating.

“In our environment,” he continued, “you also have to be quick to respond to your patients. No patient wants to spend unnecessary time on a phone call. Being able to send them their appointment to their phone is not a new concept, it’s an expectation.”

Based on an Axway survey of 1,200 smartphone users aged 18-60, the graphic above supports the view that text messaging is now the preferred method of communications for most people. Could clinical laboratories employ text messaging to lower patient no-shows and increase the proportion of patients who actually show up at a patient service center to provide a specimen in response to the medical laboratory test orders given to them by their physicians? (Graphic copyright:

The WELL messaging app draws a patient’s information from the physician’s electronic health record (EHR) system to configure the appointment reminder. This includes appointment type, date/time, and location. Based on the patient’s preferred method, the system sends reminder messages via phone, text, or e-mail.

As Healthcare IT News noted, WELL’s competitors in the patient communication space include:

Texting Reduces No-Shows at Other Healthcare Networks

Other healthcare organizations also have replicated RMC’s success in reducing its no-show rates by moving away from telephone-based reminders.

An Athena Health study examined 54.3 million patient visits in 2015 and found no-show rates dropped to 4.4% when patients received a reminder text from their provider. By comparison:

  • Athena patients who received a phone call instead of a text failed to show up 9.4% of the time;
  • E-mail reminders resulted in a 5.9% no-show rate; and,
  • 10.5% of patients who received no form of reminder message missed their appointments. 

Is Texting Secure and HIPAA Compliant?

A 2018 poll conducted by the Medical Group Management Association (MGMA) found that 68% of healthcare organizations used text messaging to communicate with patients about appointments. But is it secure?

An MGMA article notes that according to HIPAA Journal, “Recent changes to HIPAA have introduced new rules relating to how Protected Health Information (PHI) should be communicated and many healthcare organizations and other covered entities are now at risk of financial sanctions and legal action should an avoidable breach of PHI occur.” The MGMA goes on to state that, “As text messaging is not typically a fully-secure channel for the communication of PHI, practices must be vigilant when sending information via text messages.”

With proper training and precautions, clinical laboratories and pathology groups might want to add text messaging to their patient outreach programs. Data indicate that doing so could improve patient compliance with the medical lab test orders given to them by their physicians. Industry experts estimate that for every 100 medical lab test requests written by providers, only about 60% of patients show up to provide the specimens needed for a lab to perform those tests. Improving on those numbers would help clinical laboratories and patients alike.

—Andrea Downing Peck

Related Information:

Text-based Tool Reduces Patient No-Shows by More Than Two-Thirds

Case Study: Largest Physician-Owned Practice in California Sees a 33% Reduction in No-Shows in One Month

MGMA Stat Poll Indicates Most Organizations Use Text Messaging to Communicate Appointments

Getting No-Shows to Show Up

Not Texting in Healthcare? Here’s Why You Should

Text Messaging Remains an Effective Tool for Patient Appointment Reminders

To Get Patients in the Door, Try Texting

5 Ways Home Healthcare Providers Grow by Texting Clients, Employees

HHS Proposes One-Year Delay for ICD-10 Implementation: Is This Good News for Clinical Pathology Laboratories?

AMA opposition to ICD-10 deadline moves HHS to reconsider, while leaving some transition-ready providers rankled

When it comes to implementation of ICD-10 in the United States, the “do it later” crowd seems to have convinced the Department of Health and Human Services (HHS) of the need to once again move back the compliance date for ICD-10. On April 9, HHS announced a proposed rule to defer implementation by one year, with a new effective date of October 1, 2014.

Clinical laboratories and anatomic pathology groups have a big stake in a successful transition from ICD-9 to ICD-10. Among other reasons, Medicare Part B claims for medical laboratory  tests must be submitted with an appropriate ICD code [provided by the physician who ordered the lab tests] for the clinical lab or pathology group to be paid by the Medicare program.

Clinical Laboratories Beware: Many Payers May Not Be Ready for HIPAA 5010 on January 1, 2012

Bigger challenge will be adoption of ICD-10 across entire U.S. healthcare system in 2013

Two disruptive events in the world of coding, billing, and claims reimbursement are about to engage the full attention of clinical laboratories and pathology groups. First is implementation of HIPAA 5010 forms for claims submission by all types of healthcare providers. This is scheduled to occur on January 1, 2012—just seven months away!

Second is implementation of ICD-10 codes. Federal law currently requires all payers and providers to begin using ICD-10 on October 1, 2013. On that date, the existing ICD-9 codes will no longer be used.


Graduating Physicians Opt for Jobs in Hospital-Owned Practices over Private Practices

Trend could prove unfavorable to independent clinical laboratory companies

More physicians now join hospital-owned practices than any other type of practice. That’s one conclusion reported in a survey conducted by the Medical Group Management Association (MGMA). This is a trend that may have negative implications for independent clinical laboratory companies and pathology groups that provide medical laboratory testing to office-based physicians.

In the MGMA survey, higher compensation packages offered by hospital-owned practices were cited as one reason why growing numbers of physicians choose a hospital-owned practice. The survey also determined that physicians believe they will have a better chance for reimbursements in hospital-owned practice settings, compared to other practice models.


Ranking the Nation’s 20 Largest Doctor Groups Reveals Surprises

Nine of the 10 largest medical groups are located on the East and West coasts

When it comes to the list of the 20 largest physicians groups in the United States, Kaiser Permanente is at the top. With 7,000 physicians, Permanente Medical Group in Northern California is the nation’s largest. Number two is Southern California Permanente Medical Group, based in Pasadena, California. At number 20 is the University of Indiana School of Medicine with 1,481 physicians.

This list was prepared by the Medical Group Management Association  (MGMA) and published in Modern Healthcare . One interesting fact is that all but one of the 10 largest medical practices are located on the east or west coast. Overall, six of the top 20 medical groups are located in the Midwest, one in Texas, and the rest in coastal cities.

There are 51, 280 physicians practicing in the nation’s 20 largest medical groups. This represents about 6.4% of the 800,000 physicians licensed in the United States – P. Kirk

20 Largest Medical Groups:  

1. Permanente Medical Group 7,000 Oakland
2. Southern California Permanente Medical Group 6,400 Pasadena
3. Bellevue Hospital Center 4,000 New York
4. University of Medicine & Dentistry of Newark 2,816 Newark
5. Albert Einstein College of Medicine of Yeshiva Univ. 2,775 New York
6. University of Pittsburgh Medical Center 2,700 Pittsburgh
7. Johns Hopkins University 2,694 Baltimore
8. Columbia University Medical Center 2,189 New York
9. David Geffen School of Medicine at UCLA 2,000 Los Angeles
10. Mayo Clinic 1,995 Rochester
11. University of Washington Medicine 1,830 Seattle
12. Northeastern Ohio Univ. Colleges of Med & Pharmacy 1,800 Rootstown
13. University of Michigan Health System 1,746 Ann Arbor
14. Massachusetts General Hospital 1,746 Boston
15. University of Pennsylvania Medicine 1,700 Philadelphia
16. Baylor College of Medicine 1,607 Houston
17. University of Illinois Medical Center at Chicago 1,604 Chicago
18. Northwestern Memorial Hospital 1,600 Chicago
19. Winthrop University Hospital 1,525 Mineola
20. Indiana University School of Medicine 1,481 Indianapolis
Total all physicians from all groups: 51,208  
Source: MGMA, Englewood, Colorado    

Related Information:

Largest medical group practices

Is Integration in Large Medical Groups Associated With Quality? (PDF)

Benefits of and Barriers to Large Medical Group Practice in the United States (PDF)