The Dreaded “C” Word in Practice Management

by Dale Tucci, TMFD Financial

Cancellations are a major issue for those who own dental practices. Dentists frequently ask for advice about reducing downtime in hygiene schedules, often seeking strategies to minimize cancelled appointments in provider schedules. Although the “C” word is a common reason for downtime it is not the only culprit.

I’ll begin with the most common system issue: Confirmation. Whenever a practice is dealing with short notice cancellations start by checking your confirmation methods. Whether you use telephone, email and or text messages be sure that all systems are being employed and working correctly.

Perhaps, the current confirmation system needs to be examined. Ask yourself: “When was the last time you reviewed confirmation systems? It may be time to re-evaluate and update them to include the use of technology. Many dentists may avoid automated confirmation systems due to the cost, however weigh the benefits of reaching patients compared with the cost of missed or cancelled hygiene appointments. After this exercise most dentists agree the benefits override the expense.

If confirming by telephone or offering a courtesy reminder, train team members to use effective verbiage to secure appointments. All too often, we hear “pre-confirmation” or “could you let us know if this appointment is still good for you.” This type of communication allows patients to renege on their appointments.

Many patients nod their heads in the treatment room when their hygienist discusses the appropriate hygiene care interval. So the caregiver assumes the patient understands the value of hygiene treatment and will commit to keeping the appointment. Fact of the matter is, many business personnel will tell us their patients did not fully comprehend their diagnosis and need for their specific hygiene interval. Although the patients schedule in the hygiene treatment room they frequently cancel at the confirmation.

The patient’s dentist and all team members need to support the hygiene diagnosis and be able to communicate the value of on-time care with the hygienist.

Many patients use the lack of insurance benefits as a reason for cancelling hygiene appointments. This is a common reason used by patients and it highlights the importance of patient education. Patient compliance to hygiene is a practice management issue for the dentist and team members to overcome. We strongly recommend dedicated team meetings focused solely on improving patient education aimed at improving patient compliance.

Simply put, are there enough resources to manage the hygiene department or is this a task added to business personnel responsibilities? Hygiene is a significant area of practice management and with five hygienists dedicated and trained personnel should be deployed to manage hygiene schedules. In terms of resources, ensure you have the appropriate number of staff working on this system. In addition, the team need to be working the hours your patients can be reached to schedule.

Next, ask yourself how well the practice management software is utilized in the practice. Does it have a built-in short call/courtesy call list that can be sorted by patient preferences, such as date, time of day and preferred provider? Does it allow you to access patients who are booked as well as patients who are not appointed? Does it allow your team to record the number of times patients have been offered their preferred appointment? When was the last time you purged your recare lists as many staff hours can be consumed working through lists that are inaccurate. One of the reasons for increased open time may be the use and data within the software.

Patient Management
If you look at patient behavior and management you may see that patients who have been able to cancel and have experienced no consequences, repeat this behavior. Determine with the owner the approach to be taken with these patients and record in the software.

For those practices that choose to levy a cancellation fee, keep in mind that the penalty usually does nothing to alter the patient’s behavior. In many offices, these cancellation fees remain in the accounts receivable and may not be collected or are often written off.

The practice hours may no longer be convenient for some patients. If you look to the short call lists you may be able to see trends. For example, are many patients waiting for a Saturday or after 4 pm? If so, the owner may wish to add hours so patients can schedule hygiene appointments.

Appointment Methods
If you are using a pre-appointing method this can increase short notice changes or cancellations. By choosing a “one shoe fits all” approach to pre-appointing you may inadvertently be increasing downtime in the schedules.

There are many factors that can contribute to an increase in hygiene openings. It is worth the time and energy to delve into this issue, so you can take corrective action.