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How post-ACA health care is like the airline business

One of Camden's many vacant homes.

As the Affordable Care Act unfolds, we’re following the city of Camden, N.J., to see how the new law impacts one community. This is the latest update from Camden.

Cooper University Hospital is expecting a huge wave of patients starting next month, as millions of consumers get health insurance, some for the first time. The question for hospital executives in Camden, and around the country, is how to manage this new population. For one, there is a chance this new patient population will exacerbate existing problems at Cooper.

Today, "the patient no-show rate is in high 20s, 25, 30 percent," says Jonathan Vogan, the associate director for financial and performance measurement at Cooper’s outpatient clinic, the Urban Health Institute. 

The Urban Health Institute serves more than 8,000 patients, virtually all of them low-income. Vogan says the poorer the patients, the more likely they'll miss their appointments. And that's an expensive problem. But Vogan says the solution is simple.

"If not all of your patients show up then the easiest thing to do is, well, just book more of them," he says.

In the next year, 9 million new people are expected to sign up for Medicaid as part of the new health law. Still, convincing doctors at Cooper to act like airline executives -- and just book more customers -- hasn't been easy.

'There was a little pushback based on the concern of 'what if all these patients show up?'” says Dr. Phillip Dellinger, Medical Director at Cooper. Dellinger says physicians had to be sold on what Cooper administrators call "smart booking."

"By far the best way to get physicians to change their behavior -- you need to show them data on what they are doing," he says.

When about a quarter of patients miss appointments? That is some persuasive data. For now, "smart booking" seems to be working at Cooper. UHI executive director Kathy Stillo expects to cut losses from no shows by 10 percent this year.

"Our goal is to lose less and ultimately to at least break even," says Stillo. "But what we need to do now is apply business thinking to solve the problems with how you deliver care to patients."

Of course, overbooking has its downsides. (Just ask any frequent flier.)

"The biggest threat is poor service that customers, or patients, are constantly having long waits imposed on them," says Northwestern Martin Lariviere.

For now, the clinic is willing to risk that. Long term, Stillo says the goal is to identify patients who don't show up and figure out how to get them to the doctor.  

About the author

Dan Gorenstein is the senior reporter for Marketplace’s Health Desk. You can follow him on Twitter @dmgorenstein.
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