Types And Causes Of Liquidity Risks Finance Essay - Free Essay Example

Sample details Pages: 7 Words: 2039 Downloads: 5 Date added: 2017/06/26 Category Finance Essay Type Cause and effect essay Did you like this example? There are many causes of liquidity risk liquidity risk actually arises when the one party wants to trading an asset cannot do it because in the market no one wants to trade that asset .The persons who are about to hold or currently hold the asset and want to trade that asset then liquidity risk become partial important to them as it affects their ability to do business. From drop of price to zero is very different from that appearance of liquidity risk. In the case when the assets price drop to zero then market said that asset is valueless. Don’t waste time! Our writers will create an original "Types And Causes Of Liquidity Risks Finance Essay" essay for you Create order On the other hand when one party found that the other party is not interested in buying and selling of an asset then it become a big problem for the participant of a market to find the other interested party. so we can say that in the emerging markets or low volume markets the risk of liquidity is higher. Due to uncertain liquidity the liquidity risk is known as a financial risk. An institution might lose liquidity if its  credit rating  falls, it experiences sudden unexpected cash outflows, or some other event causes counterparties to avoid trading with or lending to the institution. A firm is also exposed to liquidity risk if markets on which it depends are subject to loss of liquidity. Liquidity risk tends to compound other risks. If a trading organization has a position in an illiquid asset, its limited ability to liquidate that position at short notice will compound its market risk. Suppose a firm has offsetting cash flows with two different counterparties on a given day. If the  counterparty  that owes it a  payment  defaults, the firm will have to raise cash from other sources to make its  payment. Should it be unable to do so, it too will default. Here, liquidity  risk  is compounding  credit risk. A position can be hedged against market risk but still entail liquidity risk. This is true in the above credit risk example-the two payments are offsetting, so they entail credit risk but not market risk. Another example is the 1993  Metallgesellschaft  debacle. Futures contracts were used to hedge an Over-the-counter finance OTC obligation. It is debatable whether the hedge was effective from a market risk standpoint, but it was the liquidity crisis caused by staggering margin calls on the futures that forced Metallgesellschaft to unwind the positions. Accordingly, liquidity risk has to be managed in addition to market, credit and other risks. Because of its te ndency to compound other risks, it is difficult or impossible to isolate liquidity risk. In all but the most simple of circumstances, comprehensive metrics of liquidity risk do not exist. Certain techniques of asset-liability management can be applied to assessing liquidity risk. A simple test for liquidity risk is to look at future net cash flows on a day-by-day basis. Any day that has a sizeable negative net cash flow is of concern. Such an analysis can be supplemented with stress testing. Look at net cash flows on a day-to-day basis assuming that an important counterparty defaults. Analyses such as these cannot easily take into account contingent cash flows, such as cash flows from derivatives or mortgage-backed securities. If an organizations cash flows are largely contingent, liquidity risk may be assessed using some form of scenario analysis. A general approach using scenario analysis might entail the following high-level steps: Greenspan (1999) discusses management of f oreign exchange reserves. The Liquidity at risk measure is suggested. A countrys liquidity position under a range of possible outcomes for relevant financial variables (exchange rates, commodity prices, credit spreads, etc.) is considered. It might be possible to express a standard in terms of the probabilities of different outcomes. For example, an acceptable debt structure could have an average maturity averaged over estimated distributions for relevant financial variables in excess of a certain limit. In addition, countries could be expected to hold sufficient liquid reserves to ensure that they could avoid new borrowing for one year with certain ex ante probability, such as 95 percent of the time. 2.6.3-Scenario analysis-based contingency plans: The FDIC discuss liquidity risk management and write Contingency funding plans should incorporate events that could rapidly affect an institutions liquidity, including a sudden inability to securitize assets, tightening of collateral requirements or other restrictive terms associated with secured borrowings, or the loss of a large depositor or counterparty.Greenspans liquidity at risk concept is an example of scenario based liquidity risk management. 2.6.4-Diversification of liquidity providers: If several liquidity providers are on call then if any of those providers increases its costs of supplying liquidity, the impact of this is reduced. The American Academy of Actuaries wrote While a company is in good financial shape, it may wish to establish durable, ever-green (i.e., always available) liquidity lines of credit. The credit issuer should have an appropriately high credit rating to increase the chances that the resources will be there when needed. 2.6.5-Derivatives: Bhaduri, Meissner and Youn discuss five derivatives created specifically for hedging liquidity risk.: Withdrawal option: A put of the illiquid underlying at the market price. Bermudan-style return put option: Right to put the option at a specified strike. Return swap: Swap the underlyings return for LIBOR paid periodicially. Return swaption: Option to enter into the return swap. Liquidity option: Knock-in barrier option, where the barrier is liquidity metric. 2.7-Quantity of Liquidity Risk Indicators: The following indicators, as appropriate, should be used when assessing the quantity of liquidity risk. It is not necessary to exhibit every characteristic, or a majority of the characteristic, to be accorded the rating. 2.7.1-Low: Funding sources are abundant and provide a competitive cost advantage. Funding is widely diversified. There is little or no reliance on wholesale funding sources or other credit-sensitive funds providers. Market alternatives exceed demand for liquidity, with no adverse changes expected. Capacity to augment liquidity through asset sales and/or securitization is strong and the Bank has an established record in accessing these markets. The volume of wholesale liabilities with embedded options is low. The Bank is not vulnerable to funding difficulties should a material adverse change occur in market perception. Support provided by the parent company is strong. Earnings and capital exposure from the liquidity risk profile is negligible. 2.7.2-Moderate Sufficient funding sources are available which provide cost-effective liquidity; Funding is generally diversified, with a few providers that may share common objectives and economic influences, but no significant concentrations. A modest reliance on wholesale funding may be evident. Market alternatives are available to meet demand for liquidity at reasonable terms, costs, and tenors. The liquidity position is not expected to deteriorate in the near term. The Bank has the potential capacity to augment liquidity through asset sales and/or securitization, but has little experience in accessing these markets. Some wholesale funds contain embedded options, but potential impact is not significant. The Bank is not excessively vulnerable to funding difficulties should a material adverse change occur in market perception. The parent company provides adequate support. Earnings or capital exposure from the liquidity risk profile is manageable. 2.7.3-High: Funding sources and liability structures suggest current or potential difficulty in maintaining log-term and cost-effective liquidity. Borrowing sources may be concentrated in a few providers or providers with common investment objectives or economic influences. A significant reliance on wholesale funds is evident. Liquidity needs are increasing, but sources of market alternatives at reasonable terms, costs, and tenors are declining. The Bank exhibits little capacity or potential to augment liquidity through asset sales or securitization. A lack of experience accessing these markets or unfavorable reputation may make this option questionable. Material volumes of wholesale funds contain embedded options. The potential impact is significant. The Banks liquidity profile makes it vulnerable to funding difficulties should a material adverse change occur. There is little or unknown support provided by the parent company. Potential exposure to loss of earnings or capi tal due to high liability costs or unplanned asset reduction may be substantial. Liquidity risk management Achieving best practice Managing liquidity risk is often about applied common sense, like operational risk it requires a firm-wide approach and this places a high demand on the right processes and procedures. Any management information system used to mitigate liquidity risk should be: Accurate The best way of encouraging accuracy is to keep reporting simple. Communicative Report and information should speak plainly. Regular Timely reporting allows managers to judge changes in the market and their organizations liquidity profile. Comprehensive Must reflect your organizational reality, such as different entities, jurisdictions and regulations. Realistic Scenario must be rigorous if risk is to be identified in real situations. 2.8-Quality of Liquidity Risk Management The following indicators, as appropriate, should be used when assessing the quality of liquidity risk management. 2.8.1-Strong Board approved policies effectively communicate guidelines for liquidity risk management and designate responsibility. The liquidity risk management process is effective in identifying, measuring, monitoring, and controlling liquidity risk. Reflects a sound culture that has proven effective over time. Management fully understands all aspects of liquidity risk. Management anticipates and responds well to changing market conditions. The contingency funding plan is well-developed, effective and useful. The plan incorporates reasonable assumptions, scenarios, and crisis management planning, and is tailored to the needs of the institution. Management information systems focus on significant issues and produce timely, accurate, complete, and meaningful information to enable effective management of liquidity. Internal audit coverage is comprehensive and effective. The scope and frequency are reasonable. 2.8.2-Satisfactory Board approved policies adequately communicate guidance for liquidity risk management and assign responsibility. Minor weaknesses may be present. The liquidity risk management process is generally effective in identifying, measuring, monitoring, and controlling liquidity. There may be minor weaknesses given the complexity of the risks undertaken, but these are easily corrected. Management reasonably understands the key aspects of liquidity risk. Management adequately responds to changes in market conditions. The contingency funding plan is adequate. The plan is current, reasonably addresses most relevant issues, and contains an adequate level of detail including multiple scenario analysis. The plan may require minor refinement. Management information systems adequately capture concentrations and rollover risk, and are timely, accurate, and complete. Recommendations are minor and do not impact effectiveness. Internal audit is satisfactory. Any wea knesses are minor and do not impair effectiveness or reliance on audit findings. 2.8.3-Weak Board approved policies are inadequate or incomplete. Policy is deficient in one or more material respects. The liquidity risk management process is ineffective in identifying, measuring, monitoring, and controlling liquidity risk. This may be true in one or more material respects, given the complexity of the risks undertaken. Management does not fully understand, or chooses to ignore, key aspects of liquidity risk. Management does not anticipate or take timely or appropriate actions in response to changes in market conditions. The contingency funding plan is inadequate or nonexistent. Plan may exist, but is not tailored to the institution, is not realistic, or is not properly implemented. The plan may not consider cost-effectiveness or availability of funds in a non-investment grade or CAMEL 3 environment. Management information systems are deficient. Material information may be lacking or inaccurate, and reports are not meaningful. Internal audit covera ge is nonexistent or ineffective due to one or more material deficiencies. 2.9-Common problems and misconceptions: Liquidity  risk  is one of the least understood and most underestimated risks that financial markets participants are exposed to. Reasons for this include: ÃÆ' ¢Ãƒ ¢Ã¢â‚¬Å¡Ã‚ ¬Ãƒâ€šÃ‚ ¢ Under normal market conditions,  liquidity  problems are not observed ÃÆ' ¢Ãƒ ¢Ã¢â‚¬Å¡Ã‚ ¬Ãƒâ€šÃ‚ ¢ Liquidity  risk  does not lend itself to readily usable measures ÃÆ' ¢Ãƒ ¢Ã¢â‚¬Å¡Ã‚ ¬Ãƒâ€šÃ‚ ¢ Despite specific BIS recommendations,  liquidity  risk  management  is left out of capital adequacy calculations due to a lack of control and regulation ÃÆ' ¢Ãƒ ¢Ã¢â‚¬Å¡Ã‚ ¬Ãƒâ€šÃ‚ ¢ Liquidity  management is often confused with liquidity  risk  management ÃÆ' ¢Ãƒ ¢Ã¢â‚¬Å¡Ã‚ ¬Ãƒâ€šÃ‚ ¢ Market and credit  risk  management  focus on assets, while  liquidity  risk can stem from liabilities as well Liquidity  risk  is also different in natu re to market and credit  risk  and needs to be thought of differently; ÃÆ' ¢Ãƒ ¢Ã¢â‚¬Å¡Ã‚ ¬Ãƒâ€šÃ‚ ¢ Normal markets analyses (expected or going-concern situations) are insufficient; liquidity  risk  can only be understood with scenario-based stress testing ÃÆ' ¢Ãƒ ¢Ã¢â‚¬Å¡Ã‚ ¬Ãƒâ€šÃ‚ ¢ Historical measures of  liquidity  are irrelevant; prospective views are essential ÃÆ' ¢Ãƒ ¢Ã¢â‚¬Å¡Ã‚ ¬Ãƒâ€šÃ‚ ¢ Liquidity  risk  cannot be readily hedged, and can only be mitigated against through rigorous monitoring and controls ÃÆ' ¢Ãƒ ¢Ã¢â‚¬Å¡Ã‚ ¬Ãƒâ€šÃ‚ ¢ The pricing of many instruments does not properly charge for  liquidity

Happiness Is A Glass Half Empty - 918 Words

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Training and Development Assessment Plan

Question: Discuss about the Training and Development Assessment Plan. Answer: Introduction The present work environment is quickly becoming dynamic and embracing change every time. Therefore, it calls for employees to be skilled and always embrace the latest trends in the market to attain a sustainable business strategy. Training is an important aspect in increasing employees performance and for a business to remain competitive in the market. Resources can be adequate in a business environment but fail to match the required skills of employees in a firm. In this respect, the need for training arises forcing the management to embrace the option for change. The paper examines the need for training and carries out an assessment towards improving work performance. Reason for Training Need Assessment A need assessment helps in aligning and achievement of goals in organizations. In so doing, it reduces the existing gap between the skills required and the competency demonstrated in performance. A training need assessment is essential towards identifying the present level of competence concerning skills and knowledge in one area compared to another in a separate institution (Tracey, Hinkin, Tran, Emigh, Kingra, Taylor Thorek, 2015). In this respect, the concept aims at driving a competitive nature between individuals in the same industry. The difference between the present and the required competency develops the training needs which if addressed lead to business success (Anitha, 2014). Training need assessment is important towards establishing who in the organization needs training and development and for a specified reason towards business performance. Assessment of the needs can be done at any given time either during actual work performance or at the point after selection of employees to drive a particular skill in them. At the same time, training assessment can be done during performance review period where there is an indication for improvement or succession planning in the organization. The performance measurement can be done periodically to promote and monitor the level of business success achieved. Step 1: Identification of the Business Needs Performance Analysis The training need assessment in the organization focuses on the performance analysis which indicates a performance gap between the required stature and the performance presently being demonstrated (Armstrong Taylor, 2014). The organization has sufficient numbers of machines suitable for producing several amounts of goods but fails to perform optimally due to the reduced knowledge among the operators related to technology. The firm upgraded its technology and introduced faster machines supposed to deliver beyond the past technology in the organization. However, there is no significant increase in performance measured by the results displayed in the outputs. In this case, a training and development assessment has to be done to determine and increase the productivity rate of individuals given the new technology. According to Bell, Tannenbaum, Ford, Noe Kraiger, 2017), the present workplace environment requires individuals to become independent thinkers able to make conscious thoughts that steer business growth. In this respect, training is essential to impact the necessary skills to employees displaying inferior skills at their workplace. There are several competencies that shall be assessed and used in the determination of the training needs which range from decision making, communication, technology use, business knowledge, innovation, planning to teamwork in driving change to the organization. Performance Gap Analysis Assessment Techniques Observation The evaluation team used direct observation in examining the pace at which individual worker carries out their tasks. The speed and level of technology use displayed determined the competency level in information technology towards production. At the same time, observation on the coordination and team work spirit ascertained the level at which employees correlated with each other to solve existing issues (Certo, 2015). At the workplace, there are individuals who are conversant with the technology and do their best towards achieving their targets. However, there is another set of employees who were performing optimum in the previous technology who have failed to demonstrate the same in the present one. In this case, observation shall be used to identify such cases for training needs. Interview Inquiry into the knowledge and challenges experienced in the process of business performance is a perfect way of communicating the needs for training towards competency. The assessment carried out a one-on-one session with the employees in the production department to verify their levels of competency and ascertain the extents to which the new technology boosted production (Reason, 2016). Employees were guaranteed the freedom from victimization and made to understand the need for the interview to communicate all the issues affecting their production. In this way, the assessment team was able to understand the competency levels and the challenges faced by the individuals in the processing plant related to the new use of technology. Questionnaires Assessments utilize questionnaires where every aspect of inquiry is offered for the respondents to communicate the different needs of their business. The questionnaires had no names to enable the workers to divulge as much information as possible. At the same time, the questions targeted the specific hindrances to production to understand the reason behind the performance gap experienced in the firm. As a result, the assessment team understood the challenges and developed a training program to enable individuals to achieve expected success. Focused Group Discussion The assessment team used the group discussions where members of the concerned department meet to air out issues dealing with productions. The evaluation team was able to understand the hindrances in place and had the employees in the discussion suggest the best measures that can boost their production (Law, Hills Hau, 2017). The discussion further opened the managements mind to the needs of the employees thereby assisting in the development of training plans and other motivational factors to increased production. Assessment Focus Points The analysis focused on the key performance issues in outlining the training needs of the production department. First, an analysis was done on the tasks performed by each to understand the skills applied and provide knowledge on whether they match with the resources in place. Secondly, the analysis examined the frequency of the work performance to understand the extent to which experience could drive change in the business as employees are expected to change and adapt over time whenever carrying out a similar task (Reason, 2016). Thirdly, the analysis sought to understand the importance of every step in the task performance and relate it to the special attention given to each segment. The fourth assessment focused on the knowledge needed in performing the task as the information was used in comparison to the existing skills demonstrated by the employees. After identifying the necessary skills, the assessment moved to the category of determining the level of difficulty involved in carrying out a certain part of the task assigned. In the end, the study focused on the proposal by the individuals to determine the necessary training available to boost production at workplaces. Evaluation of the Assessment Process The evaluation process was instrumental towards understanding the need for training in the production department after the introduction of technology in the processing unit. The assessment sought to learn on the difficulties to production by airing out the challenges faced leading to the unexpected production rates compared to the previous case where the use of technology was absent (Noe, 2002). All the six steps used produced necessary information essential for arriving at the training solution to the production issue. The assessment of the tasks performed enabled the team in understanding the kind of work done and recommending the type of skills that can be used in completing the said tasks. Reporting on the tasks done indicated the difference in the previous circumstance compared to the present case. As a result, it indicated the shift in work patterns thus allowed understanding on the challenges that might be experienced given the fact that technology was introduced (Reason, 2016). On the other hand, the frequency of the task performance enabled the assessment in understanding the rate at which a given task is repeated. In this case, the difficulty experienced could be understood given the fact that a repeated action on a similar concept leads to experience which culminates to proper performance and mastery (Miller, 2016). The lack of improvement on the task indicated the assumption that some of the processes were being done in the wrong manner repeatedly. As a result, it formed a background to the fact that there was no sufficient training and knowledge on the use of the machines. The importance of each task enabled the assessment to understand how and why some tasks were performed perfectly with others performed dismally. The category allows for the determination of the processes that required deep training to understand the aspects involved in making them match their importance to the finished products. Consequently, the facts were recorded and used for evaluation to determine the training needs that would make all the processes important towards production (Noe, 2002). Every step in processing is important to the overall product formulation and hence has to be done perfectly according to plan. The category of the knowledge needed for certain tasks was essential in understanding the knowledge present and that absent about the results observed in overall production. In this case, the assessment realized the gaps in training which denied the workers the power to deliver at optimum levels. Besides, the difficulty of each task was critical in understanding the challenges experienced and outlining measures to ease the difficulty and lead to prosperity according to business goals (O'Neill, Albin, Horner, Storey Sprague, 2014). Lastly, the types of training available were important in understanding whether the training was effective and implementing more training to curb the underperformance experienced. Therefore, the two aspects were critical in developing a training plan that would yield benefits for the organization. Recommendation on Training The recommendation tends to answer the question to the training needs needed, where it is needed, who needs it, how it will be done, the cost of training, and the impact on the business. The firm has the required number of employees who were previously performing better compared to the records shown after the introduction of the technology. The fact points towards the lack of knowledge on the current technology use and thus points to the need for in-service training and staff development. Since the existing training failed, there is a need for the organization to carry out a fresh plan that is all-inclusive (Noe, Hollenbeck, Gerhart Wright, 2006). First, there is a need for induction to freshly introduce the employees to the technology by briefing them on their importance and basic use. Afterward, there is need to conduct workshops and short-term courses on the theoretical and practical approaches when dealing with the technology (Noe, Wilk, Mullen Wanek, 2014). The training would assist in the first stage of performance which can be done for two weeks. Afterward, maintenance or refresher training becomes essential in updating the assessment team on the mastery and enabling individuals further understanding issues disturbing them at the moment. Consequently, on job training would be essential here where a team of experts would give hands-on practice to the employees to instill mastery in the operations (Phillips Phillips, 2016). Afterward, the firm should give the employees room for career development by allowing them to conduct part-time studies on the technology to improve the task and their experience. Besides, the management can develop simple ways of approaching the technology to ease the burden of work using the technology. The implementation team should carry monitoring and evaluation plans at every stage of training to gauge the extents to which the change impact on production (Seidle, Fernandez Perry, 2016). On the other hand, the firm needs to motivate the employees once the improved performance is registered by increasing their remuneration and appreciations in the process of meeting targets. Besides, in-house recruitment should be done in the department to ensure employees embrace career development thus promoting performance (Serkan Emir, 2014). At this stage, maximum adoption is expected as every employee has been subjected to training and development as well as proper remuneration. At this stage, it is necessary for the management to transfer non-performing workers to lesser need departments and monitor and evaluate their performance (Vickerstaff, Phillipson Loretto, 2015). On the other hand, employees who fail to meet the target of the organization ought to have their services terminated since they become a burden to the production if maintained. The need assessment process is essential towards performance. It identifies the problems existing in a business and addresses the concerns through training and other motivation measures in production. The assessment provides the steps to follow and the considerations to make in the process of driving change. In the end, the recommendations given would result in positive performance given the satisfaction of the needs that employees required for performing at optimum level. Performance in organizations must be monitored and evaluated to maintain the competitive strategies towards change. References Anitha, J. (2014). Determinants of employee engagement and their impact on employee performance.International Journal of Productivity and Performance Management. Armstrong, M., Taylor, S. (2014).Armstrong's handbook of human resource management practice. Kogan Page Publishers. Bell, B. S., Tannenbaum, S. I., Ford, J. K., Noe, R. A., Kraiger, K. (2017). 100 years of training and development research: What we know and where we should go. Certo, S. (2015).Supervision: Concepts and skill-building. McGraw-Hill Higher Education. Law, M. S., Hills, P., Hau, B. H. (2017). Engaging Employees in Sustainable Development - a Case Study of Environmental Education and Awareness Training in Hong Kong.Business Strategy The Environment (John Wiley Sons, Inc),26(1), 84-97. Miller, B. A. (2016).Assessing organizational performance in higher education. John Wiley Sons. Noe, R. A. (2002). Employee training and development. Noe, R. A., Hollenbeck, J. R., Gerhart, B., Wright, P. M. (2006). Human resource management: Gaining a competitive advantage. Noe, R. A., Wilk, S. L., Mullen, E. J., Wanek, J. E. (2014). Employee Development: Issues in Construct Definition and Investigation ofAntecedents.Improving Training Effectiveness in WorkOrganizations, ed. JK Ford, SWJ Kozlowski, K. Kraiger, E. Salas, and MS Teachout (Mahwah, NJ: Lawrence Erlbaum, 1997), 153-189. O'Neill, R. E., Albin, R. W., Horner, R. H., Storey, K., Sprague, J. R. (2014).Functional assessment and program development. Nelson Education. Phillips, J. J., Phillips, P. P. (2016).Handbook of training evaluation and measurement methods. Routledge. Reason, J. (2016).Managing the risks of organizational accidents. Routledge. Seidle, B., Fernandez, S., Perry, J. L. (2016). Do leadership training and development make a difference in the public sector? A panel study.Public Administration Review. Serkan, B., Emir, C. (2014). Impact of Training and Development on Employees Performance in Bosnia And Herzegovina.Evropejskij Issledovatel?, Vol 89, Iss 12-2, Pp 2125-2132 (2014), (12-2), 2125. Tracey, J. B., Hinkin, T. R., Tran, T. L. B., Emigh, T., Kingra, M., Taylor, J., Thorek, D. (2015). A Field Study of New Employee Training Programs Industry Practices and Strategic Insights.Cornell Hospitality Quarterly,56(4), 345-354. Vickerstaff, S., Phillipson, C., Loretto, W. (2015). Training and development: the missing part of the extending working life agenda?.Public Policy Aging Report,25(4), 139-142.

Appointment scheduling and tem... free essay sample

Appointment scheduling and templates are built to maximize providers productivity as well as utilize staffing appropriately. Currently, the third next available appointment reports have long wait times and the patients no show rates are consistently high for adult primary care clinics located in the Sarasota County Health Department. These high no show rates reduce the productivity of providers and reduce potential revenue. The long wait times are hindering the ability to meet performance goals that could be generating payment incentives for the chronic disease and the complex high acuity patients. In addition, we know that access to care is important for overall quality health delivery as well as disease prevention, detection, and screening.BackgroundExpectations from Medicaid, Medicare or other insurances are for the provider to improve managed care and deliver quality outcomes. This requires patients have access to care for providers to maintain patient care. Managing these outcomes is now directly related to reimbursement rates. There is no current data or existing research studies that identify any patterns or times that could be contributing to these high no show rates at Sarasota County DOH Ringling office. My August 2017 field experience report found monthly rates to be the lowest at 11. 76% for provider A, while being the highest at 24.61% for provider B. Then the data in September was completely opposite, with provider A at 37.5% and provider B at 18.46%. There did not seem to be any obvious identifiable reasons, determinants or variables for the providers monthly no show rate variability. This particular health department needs to be generating revenue for its increased expenses as the DOH is in a two-year transition releasing its Federally Qualified Health Center (FQHC) status to a private nonprofit. It is critical that the DOH maintain its revenue, quality of care and staffing productivity and utilization during this transition.Statement of PurposeThe purpose of this study is to identify days and times for additional appointment times to be built into the templates. The primary objective will be to analyze data to distinguish if there is a pattern of days or times that are consistent or identifiable in six adult health provider clinics. This data may be critical to adjusting immediate scheduling needs and increasing provider productivity and patient access to appointments. Now more than ever, time is of the essence and a deeper analysis of no shows root causes cannot be evaluated quickly.Costs of No ShowsPatients not showing for their appointment have many costs. Patients who frequently miss medical appointments have poorer health outcomes and are less likely to use preventive services (Crutchfield ; Kistler, 2017, p2). In addition, these patients can overburden the whole health system by using the emergency room for non-urgent matters when they miss their scheduled appointments. According to The Washington Post (2011) Medicaid recipients used the ER three times as much as people with private insurance due to difficulty finding providers.Since the 1990s, the National Committee for Quality Assurance (NCQA) developed a standardized tool to measure health care performance (NQCA, n.d.). These Healthcare Effectiveness Data and Information Set (HEDIS) measurements are a way to improve the healthcare system and a majority of insurance companies are expecting providers to manage the patient to meet these HEDIS measurements for reimbursement for services. The shift has become based on the patient outcomes and value-based care management versus fee for service (HealthPayer Intelligence, 2017). These reportable measures make it possible for customers to compare providers and health plans. These measures become a problem for providers and their ability to meet HEDIS measures if their patients are not showing up. It also scores the health plans poorly is the providers are not meeting standards of care. This situation, in turn, reduces the payment amounts to providers and could assess penalties against them, up to and including shutting the organization down with poor performance for three years (CareNational, 2017, para 7). Primary care should be managing their patients and long wait time for appointments could contribute to the poor performance scoring of providers thus reducing payments on the patients that are showing. Receiving a low rating could also detour new patients from seeking care from these providers and impact future business.FQHC designation puts this practice into a fixed prospective payment system. This payment system varies for a FQHC, based on geographical location factor and patient visit type. However, the 2017 rate is set at $163.49 (Nordian, 2017). If this figure is used and applied to the 25% of a schedule that is not showing up for care, the impact of 6 providers daily having 25% no show rates (5 pts. per day ave.) could be 30 wasted appointments times daily. With 6 providers having 5 no shows, it is approximately $4,900 daily loss of revenue. If the practice is open 5 days a week that brings the total to about $24,500 weekly loss of potential revenue. If even 20 patients could be accommodated for overbooking appointments or urgent needs, it would help divert care from the nearby hospital ER rooms.Factors associated with no shows Fear and emotions play a part in appointment keeping. Not wanting to hear bad news was one of the three reasons found by Lacy, Paulman, Reuter Lovejoy (2004). Not understanding the scheduling process and feeling disrespected in the health care system were the other two reasons. The article reflected patients having to wait for appointments, wait to be seen and waiting in the exam rooms for providers were also perceived to be disrespectful. A retrospective study in primary care by Kaplan-Lewis and Percac-Lima (2103) found that no show rates are higher in underserved populations and that the patients simply forgetting was the most frequent reason for the no show. Kheirkhah, Feng, Travis, Tavakoli-Tabasi and Sharafkhaneh conducted a retrospective cohort study spanning from 1997-2008 comparing 10 clinics from primary care to subspecialty clinics. The goal was to evaluate economic consequences, predictors and prevalence. The authors presented a mean rate of 18.8% for no shows, the average cost of $196 for 2008. The article concluded with the data reflecting a major financial burden on the healthcare systems and womens clinics with higher no show rates.Demographics and no showsThe findings and factors vary from clinic to clinic. Fiorillo, Hughes, I?Chen, Westgate, Gal, Bush, ; Comer (2018) found that there was an association and a 24% no show rate for new patient visit types in pediatric otolaryngology. While adult patients not showing for otolaryngology appointments tended to be younger aged females who had to wait longer for appointment dates (Cohen, Kaplan, Kraus, Rubinshtein ; Vardy (2007). Menendez and Ring (2014) reported that an outpatient hand surgery clinic study found that their no-shows data were in the beginning of the week. Monday and Tuesday were the days with a higher prevalence of missing the appointment. While a pediatric otolaryngology practice found morning appointments and June to be the highest times for no shows (Huang, Ashraf, Gordish-Dressmand, Mudd (2017). Butterfield points out that younger men who are unmarried, and those patients living 19-60 miles away from the practice had higher no show rates (Butterfield, 2009). Dantas, Fleck, Cyrino ; Hamacher (2018) reviewed over 105 in a systematic review of literature available and found that certain patient characteristics were identifiable overall. Younger age, lower income, no private insurance and l iving farther from the clinic has a more frequent no show association. Mehra, A., Hoogendoorn, C., Haggerty, G., Engelthaler, J., Gooden, S., Joseph, M., Carroll, S. , Guiney, P. set out to when their patients were not showing and to apply interventions to reduce no shows. They also concluded in their conclusion that four factors impacted no show rates. The younger patients, a lower socioeconomic status, previous no shows and not understanding the purpose of their appointment were identifiable factors.Scheduling and no showsThe no shows rates can increase appointment wait times. Drewek, Mirea and Adelson (2017) reviewed pediatric patient no shows. The theory of appointment lead times was tested for association with no shows in outpatient pediatric specialty clinics. Overall those scheduled less than 30 days resulted in 23% no shows while those over 30 days were at a 47% rate. In addition, new patients were 30% of those while follow-ups were 21% if scheduled within the 30 days. Over 30 days resulted in similar rates with new patients at 46% and follow-ups 48%. The authors concluded there was a risk factor for no shows in the time distance to an appointment. Giunta, D., Briatore, A., Baun, A. , Luna, D., Waisman, G. and de Quiros, F., also found a strong association between the time of the request for the appointment and the date given for the appointment.Insurance and no showsCheeseman, Trivedi, Peterseim, Blice, and Unkrich complied a retrospective study from July 2014 through June 2015. The evaluated the patient insurance carriers of no shows at a university pediatric based practice. Their study found that the Medicaid insurance population had the highest rates of same day cancelations as well as now shows. Norris, Kumar, Chand, Moskowitz, Shade, ; Williss (2014) empirical investigation also found four factors of the highest association. The greatest was the lead time between the call for an appointment and the appointment interval the type of insurance payer, the patient age, and the previous no show history of the patient.Overbooking and no showsParente, Salvatore, Gallo, Cipollini (2018) reported work from their quasi-experiment on developing a model to overbook appointments where they predicted a no show. The variables they use to predict were age group, previous no show record percentage, returning patient or new and insurance status. These March 2018 results concluded that further studies were needed, but it was positive evidence that an overbooking strategy could improve managing clinics and health centers. MethodsThe data for this retrospective study was generated from Sarasota County Health Departments Health Management System (HMS) electric medical records system. S ix adult health primary care providers were selected that work specifically at the Sarasota County Health Departments Ringling location. (Dr. Santun, Dr. Siegal, Dr Nygen, Dr. Brand, C. Finney ARNP and K. Ferris ARNP ) Patient no shows were defined as the appointment times that patients failed to make appointments and did not call to cancel. No show reports were modified to report only appointment time and date, generated from HMS for a period of one year (February 2017- through February 2018). No patient identifying data was included for this study. Days and appointment times were logged into Excel sheets. The total number of no shows was counted for each appointment time, day and month for each provider. Data was then put into graph format for each provider and a total for all six providers to see complete totals for this study.