(1082) Impact of patient-directed financial penalties on appointment non-adherence rates in an academic maternal-fetal medicine clinic

Objective: To examine the impact of patient-directed financial penalties on appointment non-adherence rates within a single academic institution's maternal-fetal medicine (MFM) outpatient clinic.

Study Design: This retrospective policy effectiveness study included administrative data from all appointments at Eastern Virginia Medical School's MFM outpatient clinics from May 1, 2018 to April 30, 2022. The institution-wide patient-directed financial penalty for appointment non-adherence was implemented on May 1, 2020. Institutional Review Board approval was waived for this study. An interrupted time series analysis (ITS) stratified by patient insurance type was performed after adjusting the model for the effect of COVID-19.

Results: There were 272,335 appointments; 29,452 (10.8%) were not attended. Pre-implementation mean (standard deviation) per month was 5,586 (466) appointments with11.1% (0.99%) non-adherence rate.  Post-implementation was 5,762 (429) appointments with 10.6% (1.36%) non-adherence rate. Publically insured patients had a higher non-adherence rate (pre-: 15.60% (1.56%); post-: 15.46% (2.13%)).

Adjusted ITS models observed a statistically significant immediate (1.47% fewer appointments; p=0.01) and sustained (0.09% additional appointments; p=0.02) effect on number of non-adherent appointments per month.

Stratified by insurance, non-publically insured patients observed a significant immeidate effect (1.66% fewer appointments; p=0.02). Publicly insured patients observed a significant sustained effect (0.18% additional appointments; p< 0.01).

Conclusion: A clinically significant reduction in appointment non-adherence was not observed in a single academic center’s MFM outpatient clinic after institutional implementation of patient-directed financial penalties for appointment non-adherence. Patient-directed financial penalties for appointment non-adherence may not be an effective strategy for decreasing appointment non-adherence rates. The impact may differ based on patient insurance type.