Letter to the Editor by Mullen on Improving Communication with Low-Income Women Using Today’s Technology

Nursing Technologies: Innovation and Implementation

January 11, 2013

Response by Beth Mullen on Improving Communication with Low-Income Women Using Today’s Technology,  by Nancy J. Cibulka, PhD, RN, WHNP-BC, FNP-BC; Harry W. Fischer, MA; Anna J. Fischer, BFA (March 26, 2012)

with reply by authors

Dear Editor:

Thank you for publishing the informative article “Improving Communication with Low-Income Women Using Today’s Technology” by Cibulka, Fischer, & Fischer (May 2012). This article was extremely revealing in regards to challenges of low-income women in attending their appointments. As a future nurse leader, I am concerned about the financial ramifications of these missed appointments on already financially-challenged, predominantly Medicaid-supported facilities. In an effort to increase patient accountability and to increase revenue in a cash-strapped program, the state of Arizona has allowed providers to charge a fee to Medicaid patients who do not reschedule their appointments within specified guidelines (AHCCS, 2012). My concern is that implementing a fee will not prevent missed appointments from occurring. These women are already low-income. Applying a fee to an already missed appointment would just further keep the patient from receiving the needed services.The question then becomes how these clinics can support these individuals so that they are more likely to attend their appointments.

I have had several patients verbalize their preference for the ability to schedule, reschedule, or cancel appointments via text message.As noted in your article, this may be one method for allowing greater flexibility with their patients. It may take some training with the staff but ultimately using texts may cut down on missed appointments if the patient who receives a text message as a reminder is able to respond and promptly cancel that appointment. Another option clinics should consider is extending hours of operation. As mentioned in the article, the younger population has to juggle children, school, a job, and even transportation. Permitting this population to seek care outside of normal business hours allows greater flexibility in scheduling. As a result, these patients are more likely to keep appointments resulting in higher capturing of revenues for clinics.In fact, some hospitals in the United Kingdom have already implemented a text messaging system. One facility found a decrease in missed appointments by 2% after beginning a text message reminder system (Department of Health, 2012).

As a former ER nurse turned case manager, one thing I have learned is that you must meet your patients where they are. By addressing their barriers accordingly, they may receive appropriate, timely care. This will, in turn, increase revenues for already financially-challenged facilities and prevent further complications for our patients.

Thank you,

Beth Mullen, BSN, RN, CCM
MSN in Nursing Administration Student


AHCCS: Arizona’s Medicaid Agency.(2012). Penalty for missed appointments.Retrieved from www.azahcccs.gov/commercial/ProviderBilling/PenaltyMissedAppointments.aspx

Cibulka, N., Fischer, H., Fischer, A.(2012). Improving communication with low-income women using today’s technology.Online Journal of Issues in Nursing, 17(2).Retrieved from www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-17-2012/No2-May-2012/Articles-Previous-Topics/Communication-With-Low-Income-Women-and-Technology.html

Department of Health (DOH).(2012).NHS hospitals using innovative solutions to prevent missed appointments. Retrieved from www.dh.gov.uk/health/2012/08/do-not-attends/