Practical opportunities for IOC centers
John H. Jameson, DDS
Dentists who have practiced for a number of years sometimes find that their practices may have plateaued so they search for a spark to help restart the fire they feel has gone out. New practitioners who are having difficulty starting their practices look for a key that will accelerate the acceptance rate of recommended treatment at a level that will make their practices profitable. Both scenarios describe environments where intraoral cameras, when properly used in an organized system, help dental teams experience practice success they would not otherwise experience.
Before intraoral cameras become a priority profit center, I feel we must first develop a structure for storage of the images taken. Now, more than ever, we need to be able to retrieve images during consultation appointments that not only show the patient his or her existing conditions, but also show before-and-after images of similar conditions and the results the practice was able to achieve. This experience improves the value of the treatment recommendations in the patient`s eyes and lets him/her know that this practice actually can provide this type of care.
With this in mind, the practitioner should select a storage format today that provides this ability. The most-used formats today are digital storage systems. These primarily involve the use of a CPU (Central Processing Unit) to store images. The next step is to decide where to locate this piece of equipment.
1. If the practice is using a cart system for camera use, the CPU could be located on the cart. An image-storage software is used to organize the captured images in individual patient files. This alteration often necessitates the change of monitors and printers.
2. If the practice has an existing analog network system, storage can be achieved by placing the CPU in a remote area and capturing and retrieving images there. Again, when making this change, monitors and printers may need to be changed or the wiring altered to create a functional system. One disadvantage to this system is that only one individual can capture or retrieve images at a time.
3. In practices where clinical computer workstations exist that have CPUs equipped with capture boards or which can accept images directly into the management software for storage in the patient`s file, images can be captured and stored in the computer network, usually in the server. Here you must evaluate the management software that is in use because many existing softwares do not allow you to do this.
You might ask why I have taken so long dealing with storage of images when addressing profitability of the intraoral camera system. The most powerful educational media today is the television. If images are captured, viewed initially on the monitors, printed only for retrieval and when the screen is cleared the images are lost forever, the practice has lost most of the power of the information that is conveyed in that picture. The impression made and the sense of urgency created by viewing existing conditions and before-and-after views on a 15-inch or 17-inch monitor vs. a 4-inch by 6-inch print is much stronger.
There are a variety of opportunities in the practice where the camera system can be used to make the practice more profitable.
New patient experience - This is one of the most powerful times for the used of the intraoral camera. A prescribed series of images can be captured and saved as part of the patient`s permanent record. You now can retrieve their images and have access to the patient`s exact condition as if they were personally present.
A brief review of their images to show areas of concern helps the patient understand the importance of the consultation appointment to discuss treatment opportunities prior to being dismissed. Then they can see the areas of concern and the breakdown that has occurred.
Consultation appointment - This is a special event that, in many practices, is either unidentified or not scheduled at all. As I say in my lectures, we now want to take the gathering of clinical data, the preparation of the treatment opportunities, coordinating the investment in the dental care and the scheduling of the first appointment to begin treatment from being an "aside" in the practice to becoming a primary focus of the practice. This is the pothole in most patient relationships that doctors and team members fall into. For years, we have offered treatment recommendations by "winging it." No advance preparations, or very little, are done prior to the patient arriving for one of the most important opportunities we have with this patient. The use of our stored intraoral-camera images now strengthens our position and image in the eyes of our new patient, since he/she is not having to visualize existing conditions and restorative options.
Hygiene - In many practices, this is the most important area when the intraoral camera can be used. In mature practices, the amount of diagnosed treatment waiting to be provided is phenomenal. There is enough dentistry to be provided that some practices essentially do not need a large number of new patients. Reactivation into restorative care of more of the existing patient base is what needs to happen. Here, we have patients that already have a relationship with the practice. By increasing this group of patients` sense of urgency about proceeding with treatment and scheduling the care to be provided, the practice experiences increased productivity.
The intraoral camera gives the patient a visual image showing further breakdown of existing conditions when compared to stored images from the initial evaluation. The patient now can better understand the benefits of proceeding with treatment immediately.
Tracking incomplete treatment plans - When each chart, whether on the hygiene schedule or in the doctor`s schedule, is reviewed at the daily huddle, an ongoing chart audit can be provided. Each treatment plan can be presented to evaluate what treatment needs to be done next to be sure that the patient is rescheduled at the end of this appointment for the appropriate next treatment. This prevents the patient from falling through the cracks or reactivates him if he is returning to the practice. We have stressed for years that doctors in mature practices have a practice within their practice. What that means is that in a mature practice, there is enough diagnosed treatment waiting to be provided in the practice`s charts that this daily process of reviewing all incoming patients treatment plans to either keep them active or reactivate them is the most cost-effective time that can be spent. These people already have a relationship with the practice and should be more willing to accept further treatment recommendations because of this established relationship.
Emergency patients - One of the most frequent ways new patients enter a practice is during an emergency situation. This could either be a periapical problem or a periodontal situation. Both areas of concern can be shown to the patient with the intraoral camera. This not only increases the patient`s understanding of existing conditions which he may not have understood before, but also increases the credibility of the practice in the eyes of the patient by positioning itself as a state-of-the-art practice. The patient now perceives that the quality of care in this practice already is superior and he or she will be more likely to accept treatment, keep appointments and remain active than if there was not a total understanding of treatment recommendations.
Validation of insurance claims - When a claim request is questioned by an insurance consultant, the use of a photograph gives a multi-dimensional view of the questioned area. This is a much better validation of treatment recommendation than an x-ray alone. The fact that this information may be needed is one of the important reasons why intraoral images should be stored digitally. Having a series of digitally stored, before-and-after images as part of the patient`s record is important. You never knows when this information might be needed.
The use of modems with capture software or practice-management software gives us the potential to digitally transmit images to requesting sites. There are a variety of ways today to transmit and receive these stored images. The system to be used must be determined by the transmitter and the receiver.
Before-and-after photography - These digitally stored photographs provide evidence that the doctor could, in fact, provide the treatment that was recommended. When a release to use the images for educational purposes is signed, the practice now can use actual cases to motivate new patients or returning hygiene patients to proceed with needed treatment.
Prints of digitally stored photographs can be made using color-laser or ink-jet printers. These prints then can be sent with a personal note, thanking the patient for allowing the practice to provide his or her care. Ask the patient to please refer any friend or family member who might want the same type of care. Also place two or three business cards with the prints and the note and send it to the patient`s place of employment.
Offset buyer`s remorse - When a patient returns for a post-treatment evaluation, the finished photos are taken and stored. If the patient had any reservations about his or her decision to have accepted treatment, we try to put those doubts to rest using the "before" and "after" images.
The number-one way new patients come to our practice still is by personal referral. The hope is that after treatment, the patient will become a disciple for the practice. Now is the time to eliminate any potential for a patient to leave unsatisfied.
Today`s dentists are far more aggressive in the amount of continuing education they take compared to practitioners in the past. Many are very prepared to provide sophisticated reconstructive, restorative and cosmetic treatments. However, many of these suburban clinicians are suffering financially because of low case acceptance and referral rates. When using an intraoral-camera system in an organized manner - with digital storage for image retrieval - doctors and team members can develop a better system of case presentation. They can educate the patient more effectively concerning:
(1) The conditions that exist.
(2) Treatment opportunities that are available.
(3) The benefits of having treatment.
(4) The disadvantages of not having the treatment.
(5) The investment responsibilities of having the treatment provided.
It is this choreographed-consultation appointment, using the stored intraoral images, that helps practices experience a 10 to 25 percent increase in case acceptance. For yearswe have known that patients buy what they want, not what they need. Many patients floating in and out of our practices have diagnosed treatment, but incomplete treatment plans. They have not bought into the value of our treatment recommendations, largely because they are trying to visualize existing conditions.
Referral rates in practices that use intraoral-camera systems regularly and in a well-structured program increase significantly because the patient now recognizes this practice as "state-of-the-art." Patients are more likely to accept treatment and refer others. They also desire a long-term relationship, since they perceive that the total experience is of a higher quality.
