By Charles Blair, DDS
Many dentists believe busyness is dependent on the number of new patients. This is true to some extent; however, dentists with busyness problems routinely focus on advertising or joining discount (PPO) plans to increase new patient flow. This action tends to be the least cost-effective approach to attracting new patients and ultimately may damage the profitability of the practice. Let’s look at the busyness issue by the numbers and determine where your practice stands. What determines doctor busyness, and how can busyness be maximized?
New patient flow
Let’s examine Dr. Busyness by analyzing new patient flow, just one of the factors. The source of new patient flow is derived from both internal and external marketing. Internal methods are the most cost-effective but require more attention to detail and time. The best internal marketing is simply asking for referrals. External methods such as direct mail, Yellow Pages, advertised promotions, and the Internet demand a substantial investment.
When dealing with phone shoppers, it’s imperative that the business staff knows the practice, the services offered, and have the requisite phone skills to convert inquiries into appointments. The first step is for the doctor to record calls, listen to them, and then evaluate the calls for effectiveness. Special care and attention should be given to each call if the practice does not participate in PPO plans. Dentists should not neglect staff training. Dentists should invest in the staff to increase the call conversion rate, and give them any tools they need.
Inquiry conversion rate
The number of shoppers or referred patients scheduled for appointments reflects new patient conversions. This number should be tracked. The string of new patients entering the practice for an initial evaluation/exam is the new patient flow. The new patient flow required for a practice to remain healthy is directly related to the productive capacity of the dentist. A million dollar producer would require twice the new patient flow of a $500,000 producer. New patient requirements directly correlate to the dentist’s production level.
In a general practice, a numerical value of $4,500 per new patient ratio will roughly predict the new patient flow required for adequate busyness. This does not mean $4,500 of treatment per new patient. Adequate busyness is defined as the dentist being solidly booked ahead 10 days to two weeks. For instance, a $900,000 practice will need about 200 new patients per year for adequate dentist busyness. Likewise, a smaller $450,000 practice would need about 100 new patients a year for adequate dentist busyness. If the practice has a high percentage of children, add 10% to the calculation. If the practice has over 15% PPO revenues, add 10% to the new patient calculation. This simple calculation can roughly determine new patient count requirements. The equation is fairly accurate as long as the dentist does a thorough diagnosis, provides an average mix of services, has a good case acceptance rate, and has effective recare.
Hygiene department size
Another factor relating to dentist busyness is the size of the hygiene department (number of hygiene visits). A practice with average fees will need a hygiene day per week for each $115,000 of doctor collections. A higher producing dentist needs a bigger hygiene department to feed his or her production. Assume an average $600,000 practice with one hygienist who works four to four-and-a-half days per week. In this scenario, the dentist produces about $460,000, requiring four days of hygiene for adequate busyness. The larger $800,000 to $1,000,000 practice would require two full-time hygienists working four to 4.5 days. The hygiene-to-doctor-day ratio is critical for adequate doctor busyness. One of the reasons for associate busyness problems is an inadequate hygiene base or the inability to increase the number of hygiene days to be checked.
Clinical service mix breadth
The third component of doctor busyness is the breadth of the clinical service mix. Broadly, we classify dentists as a Refer-O-Dontist, Average Dentist, or Decathlon Dentist. The Refer-O-Dontist provides about 60 discrete office procedures, the Average Dentist about 90, and the Decathlon Dentist about 120 procedures. These procedure counts include all hygiene procedures. The service mix can easily be determined by generating an office procedure report listing the procedures by ADA code for a 12-month period. To make this determination, simply count all the different procedures provided during the report period.
The dentist who does a “little bit of everything” can be busier and thrive with fewer new patients. The Refer-O-Dontist needs a greater number of new patients to survive. With the current economic challenges and the profession’s rapid shift to PPOs, there is a much greater need to expand the service mix to maintain busyness. The number of full-fee patients is ever shrinking. Many dentists have developed a sense of entitlement over the years and have reduced the procedures they perform. They do only what they enjoy. This entitled group often rejects young patients or even emergencies. Times are changing, and this group is in decline!
Clinical treatment intensity
The next component of busyness is the clinical treatment intensity. One example of this number is the number of sealants done per 100 child prophys. How many crowns, fillings, surgical extractions, core buildups under crowns, etc., per 100 prophys are done? With missing teeth, does the dentist’s treatment plan include a partial denture, fixed bridgework, an implant, or nothing at all? An analysis of the clinical treatment intensity compared to other peer group dentists is illuminating.
Many insurance companies conduct analysis of the procedure intensity levels of their doctors. As a result of these “audits,” some companies have notified the “outlying” dentists (particularly those in network) that they are performing too many crowns, core buildups, SRP, etc. These “outliers” may be placed on a “watch list” or scheduled for audit. Naturally, the more aggressive the treatment intensity per patient base, the less new patient flow and hygiene base are required.
Case acceptance rate
The last number to review to determine the dentist’s busyness is the patients’ acceptance of care. The patient acceptance rate is a function of the patient’s financial ability to pay for care. This rate may be increased with patient education software, effective use of the intraoral camera, digital X-rays, ease of third-party financing, and effective communication on the part of the dentist and staff. A high case acceptance rate lowers the new patient flow requirements for adequate busyness.
Sum of the components
Since dentist busyness is derived from the sum of the five components discussed in this article, each discrete component may affect the whole. For instance, a weaker new patient flow may be offset by higher-than-average clinical treatment intensity, more extensive procedure mix, or higher case acceptance. The ultimate goal is that the dentist’s schedule be booked solid for about 10 days to two weeks. Booking beyond two weeks results in patient inconvenience, staff stress, and indicates that the dentist needs to step up production, drop a plan, or consider an associate for a day or two per week.
Before spending money on external marketing or joining additional PPOs with increasing write-offs, evaluate your current situation by the numbers and act accordingly.
Charles Blair, DDS, is the publisher of the CDT-2013 Coding with Confidence Manual, Insurance Solutions Newsletter, and developer of Practicebooster.com. His Clinical Treatment Analyzer consultation service can provide the analysis of the numbers described above and provide a customized road map to success. Many offices have gone through the program and enjoyed amazing results. Call (866) 858-7596 or contact Dr. Blair at [email protected] for more information on his programs. Go to PracticeBooster.com for more information regarding the website, newsletter, or new CDT-2013 coding manual.
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