Win-Win Practice Management Suggestions
Clinicians can immediately implement these suggestions to both benefit the patient and increase production.
It is astounding how much dentistry there is to offer the current patient pool and the number of treatment procedures and codes that are underutilized. The two suggestions below demonstrate some of the concrete changes clinicians can implement immediately to take advantage of such opportunities. The goal is to illustrate how thorough, thoughtful dentistry is not only best for the patient, but also adds to the production of the practice.
Changing Recall Protocol
A number of available treatments can be offered through the hygiene department. In the vast majority of practices in the United States, patients receive prophylaxes twice a year. In addition, in the typical practice, dentists perform check radiographs—typically four horizontal bitewings—once a year. While this classic four-bitewing series is typical, the seven-vertical bitewing series provides a view of the anterior teeth and the clinician can see much further apically. This series not only helps the clinician examine the upper and lower anterior teeth, but also shows the crestal bone in much greater depth and detail. This series of radiographs is better for the patient, as it provides more diagnostic information. By using this series of radiographs, clinicians can charge more and insurance pays more. This is the definition of a win-win situation: better diagnostic information benefits the patient’s oral health, and a higher fee benefits the practice.
The immediate impact on a practice of implementing seven vertical bitewings can be calculated, based on the following assumptions: Among eight hygiene patients seen in a typical day, half are due for radiographs, and there are 200 hygiene days a year. If the fee difference between four horizontal bitewings and seven vertical bitewings is $30, a practice can increase production by $24,000 per year just by converting to seven vertical bitewings. As this calculation is based on conservative assumptions, for many clinicians, this increased production will be many times this amount. Extrapolated over the average 35-year career of a dentist, this would result in an extra $840,000 in production with this same set of conservative assumptions and no fee increase.
Maximizing the New-Patient Experience
Depending on the practice philosophy, the patient’s first visit may be on the doctor’s or the hygienist’s schedule and, in some cases, both, with a time allotment ranging from 15 minutes to 3 hours. However, with a no-show percentage for new patients estimated at between 10% and 30%, a no-show can have a dramatic impact on production and can greatly affect the practice’s bottom line, especially when time is set aside on both the doctor’s and hygienist’s schedules.
To minimize the financial impact of no-shows, patients should first be separated into two groups based on their likelihood of showing up for their first appointment—those who come via direct referrals and those attracted by some form of advertising. These are two very different types of new patients and experience has shown that they should be treated very differently.
Given that it is rare for a patient referred by a friend or family member not to show up for an initial appointment, the author suggests committing 1 to 1.5 hours of doctor time on the schedule for those in this group to allow adequate time for rapport-building, data collection, and preliminary patient education. However, because it is patients with little-to-no personal investment in the practice who have the highest no-show rate, the author recommends using an alternative method that offers a better chance of bringing these “un-invested” new patients into the practice, while at the same time preventing it from having a negative affect on the bottom line if they are no-shows.
To implement this plan, the office should first determine which patient is which. Callers who identify themselves as prospective new patients should be asked how they heard about the practice. The answer to that question dictates the rest of the conversation and how such patients are scheduled for their first visit. The patient who just “found” you is scheduled for a 30-minute complimentary consultation involving a chance to “test drive” the practice—with a tour and a chance to travel to the office location and meet the staff and doctor. The advantage of this approach is twofold. First it gives the practice the opportunity to earn the patient’s return trip, which they are more likely to make without the pressure of the initial commitment involved in taking radiographs and other diagnostic records. At the same time, by scheduling the doctor’s secondary time, this appointment does not take away from his/her prime production time and therefore does not impact production or overhead.
The financial implications for the practice take two forms: the decrease in overhead loss due to new patient no-shows and the time savings realized on their return trip.
No-Show vs Return Trip Savings
In the first scenario, when the patient fails to appear for a scheduled visit, it is assumed that the number of potential-patient no-shows averages four per month and that meeting the financial obligations of the practice requires $250 per hour of production. Figuring 1.5 hours of chairtime at $250 per hour for the four no-shows, the practice would save $18,000 in wasted open chairtime in the course of 12 months.
However, when the high-risk new patient does present for the appointment, there is still an opportunity to take photographs and intraoral videos as well as radiographs. This enables the clinician to save a significant amount of time when the patient returns for the comprehensive examination, with records taken and rapport built during that first visit—all on the clinician’s secondary time.
In the return-trip scenario, it is assumed that 10 new patients who have received the “complimentary consultation” return for their comprehensive visit. With records already taken during that 30-minute visit, that half-hour out of the $250-per-hour overhead saved on 10 patients over the course of the year would save the practice $15,000.
In this conservative example using the patient entry protocol described, a practice can save $33,000 per year in chairtime overhead by minimizing non-invested new patients likely to become no-shows. Extrapolated over the typical 35-year dental career, a clinician would save $1,155,000 in overhead, without taking into account any change in overhead over the years.
According to the ADA, the average dental office in the United States produces an average of $300 per active patient per year. This would equate to $450,000 produced in a practice with 1,500 patients. It is the author’s contention that it is possible to increase this average annual production per active patient to around $1,000 with thorough diagnosis, superior patient education, and comprehensive dental care that maximize opportunities to enhance production and profitability.
About the Author
Christopher J. Perry, MS, DMD, FAGD | Dr. Perry is an Assistant Clinical Professor in the Department of General Dentistry at the University of Texas Health Science Center at San Antonio, and is the president of Perry Dental Health Consulting in San Antonio, Texas.