Taking Your Practice From Good to Great (June 01, 2004)

by Lisa Philp, RDH

With summer’s arrival, now is the time to turn up the heat on your commitment to move your practice from “good” to “great”. In the final part of this two-part article I’ll share with you what is working for “great” practices for their financial health as well as advanced scheduling techniques.

Making dentistry affordable for more patients

Once the dentistry has been diagnosed, planned and presented we must find ways to fit the financial investment comfortably into the patient’s budget and individual financial situation.

The temptation of the past was for the practice to act like a bank and carry a high accounts receivable by offering long-term payment plans. This is no longer considered common practice for present day dentistry due to the labor required for collections, hundreds of statements, postage costs and numerous collection calls required. Not to mention jeopardizing the patient relationship because accounts are overdue.

“Great” practices and their teams have made a commitment to get out of the banking business and have significantly changed the way they think about billing by aligning themselves with outside financial partners. CareCredit is one example of a third party company finally available in Canada and the practices who are taking advantage of their three, six, and 12 month interest free programs are achieving higher case acceptance and eliminating their accounts receivable.

The following are strategies to move a good practice to a great practice in regard to financial health:

Create a proactive financial policy that the entire team understands and can present to the patient at any time no matter what role they play in the practice. Educate the team on why billing can no longer be a part of the practice philosophy and how fee-for-service will maintain the practice’s level of excellence. The policy should be consistent, clearly written and signed by patients prior to treatment. Acceptable options include cash, cheque, major credit cards, debit or an outside financial partner.

Consider offering patients a five percent cash courtesy, or accounting reduction for prepayment at time of scheduling treatment. This option allows the money to be deposited in the bank before the treatment is rendered. Because of this, you are happy to pass along the five percent savings due to the saved time in confirmation, collections and receivable management. If the patient pre pays they are assured to show up for their scheduled appointment and this reduces stress in the scheduling department. Be aware if insurance is involved, the reduced fee must be submitted and communicated to the insurance company.

When presenting, use effective verbal skills and show your non verbal enthusiasm for now being able to offer a ’12 Month No Interest’ payment plan programme, for the first time in Canada. Other features include no initial down payment, no annual fees or pre-payment penalties and monthly payments as low as five percent of the outstanding balance. (For example the payment on a balance of $1000 is $50.)

Some verbal skills may sound like the following:

“We are proud to offer you ways to fit the dentistry that you want into your individual financial budget.”

“We are committed to making our high quality dentistry as cost effective as possible”

“To assist you with your healthcare investment, we provide the following payment options, pre-payment courtesy, cash, cheque, credit cards or a payment plan”

“We now can offer you a flexible payment plan (such as CareCredit). Its program allows you to begin your treatment today and spread the payments over time. It takes a few minutes and there is no fee to apply and it does not require any down payment.”

When a patient needs financing to accept their treatment you can still provide win-win situations for all involved. Patients can pay with a low monthly payment option and the practice doesn’t compromise its financial health. A patient’s behavior changes when the financial obligation is taken out of the practice because they no longer attach the dental service or the appointment to the financial obligation.

Organized advanced scheduling

Once the dentistry is accepted and there is a signed financial agreement, scheduling can occur. In our consulting work, one of the biggest challenges we see practices dealing with on a daily basis is how to effectively schedule to maximize time and efficiency.

Dentistry is the only healthcare profession that does not structure its days based on procedures, operator fatigue or pre-planning by procedures. A common practice is to just fill the blanks with as many patients as they can, squeeze in the last minute emergency patients and guess at how much time is needed for procedures while hoping the dentist will be able to check one to three hygiene patients an hour. This lack of organized scheduling causes high stress, low productivity and serious time management issues for the patient

“Great” scheduling is best defined as organizing each and every day for a variety of procedures, setting aside emergency time and making sure procedures have been analyzed for time accuracy. The goals of great scheduling are to see fewer patients per day yet do more dentistry per patient. This decreases stress, respects patients’ time and provides last-minute emergency care smoothly.

Schedule middle-of-the-day appointments first

The middle of the day is usually the hardest to fill, so fill it first! Those 8 a.m. and 4 p.m. to 8 p.m. appointments are easy to fill and are your prime time. The middle of the day is the best time to pre-block emergency time; if the patient has a true emergency (up all night, swelling, extreme pain) they will find a way to arrive in the middle of the day. Don’t let your emergency patients make you run behind or adversely affect the schedules of your other pre scheduled patients. The most successful time for practices to pre-block emergencies is usually last appointment of the morning and first appointment after lunch.

Pre-block primary appointments in advance

Pre-blocking the schedule reserves specific times for specific procedures by allowing a variety of procedures to be performed every day while reaching productivity for financial goals. It also provides a template for your team of what an ideal week entails and how their roles are involved for their daily preparation.

Determine a daily production goal that is realistic and supports the profitability of the practice. If you pre-block half of every day for primary procedures you will be assured to reach your daily goals. Primary procedures have the highest dollar per hour rate available in each department. For example, primary appointment blocks in the restorative department are crowns, veneers, bridges, root canals, and quadrant dentistry.

The doctor’s schedule is pre-blocked four to six weeks in advance and hygiene should be pre-blocked six months in advance due to pre-booking for primary procedures such as active therapy root planning, comprehensive oral evaluations (COEs) and multiple sealants.

The key to pre-blocking is to be disciplined and not schedule with any other procedures unless it is a desperate situation. The restorative department holds blocks until 48 hours prior to the scheduled times and hygiene holds them open until four days prior to the day.

Manage hygiene exams

Eighty percent of the restorative primaries come from the diagnosis on the patients of record via the recare exam. A doctor should be able to check hygiene patients at the natural breaks in his/her schedule. If there are multiple hygiene checks, the doctor should take the opportunity to cruise the entire hygiene department and complete them all at once.

To effectively support the doctor, the hygienist needs to have a procedural flow to appointments so that all diagnostic information is collected in the first 15 minutes of each appointment. It is much easier to break in the hygiene treatment for a check than wait until the end of the appointment.

Once the hygienist has collected all diagnostic information he/she ca
n let the doctor know that they are ready for a check and he/she has 30 minutes to get there. If the dentist can’t leave their operatory right away they have some flexibility as to how soon they need to be in hygiene. Do not wait until the end of the hygiene visit to ask for a check, this almost always will cause the schedule to run behind. Great practices usually do not have stress and frustrations related to the doctor checking hygiene by following these simple systems.

In summary, a “great” dental practice possesses a high performing team of auxiliaries, are effective communicators with their people skills, provide eloquent case presentations, make dentistry affordable and utilize advanced scheduling principals.

Hundreds of other practices across Canada are enjoying the fulfillment and rewards of being truly “great” by choosing to look at the future with excitement, having openness to change old habits, having the curiosity to learn and the passion to be better than yesterday.

Lisa Philp RDH, CMC, is president, Transitions Group.

Part I appeared in the Spring 2004 issue of Dental Practice Management.