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Profitable hygiene: It is possible!

Feb. 1, 2008
Is your HYGIENE DEPARTMENT playing a major role in the overall success of your practice? Why do some hygiene departments produce more than others? Do they see more patients? Do they perform more procedures? Do they work longer hours? Having spent the last 17 years traveling throughout the country consulting and lecturing, here are several key elements for creating excellence and profitability in hygiene.

Is your HYGIENE DEPARTMENT playing a major role in the overall success of your practice? Why do some hygiene departments produce more than others? Do they see more patients? Do they perform more procedures? Do they work longer hours? Having spent the last 17 years traveling throughout the country consulting and lecturing, here are several key elements for creating excellence and profitability in hygiene.

Organized recall and patient retention systems

New patients are crucial to the health and well–being of every dental office. Without new patients, the practice will shrink and production will suffer. Normal attrition rates account for 10 percent to 15 percent of patient losses – people move, pass away, or leave because you are not on their “insurance list.” You must have a continual flow of new patients walking in the front door to make up for those patients who are walking out the back door.

Patient retention (recall) is the heart of the practice. These are the patients of record who know you, value your care, accept your recommendations, and pay for treatment. They also trust you and your team and refer their families, friends, and colleagues to you. In essence, they are major contributors to the ongoing success of your business. In most cases, patients see the hygienist more regularly for continuing care than any other member of the dental team. That’s why the hygienist has a primary role in building and maintaining the patient base.

Key factors of an effective retention program

Preschedule 90 percent of patients – A major shift in patient attitude and compliance occurs when the hygienist is engaged in the scheduling (ideally at the chair). Dialogues are key to the success of preappointing patients.

Example: “Because our patients have asked to be able to reserve a convenient time for their next oral-health appointment, we are scheduling into next year. I recommend that we reserve your next appointment to assure a convenient time for you in the schedule. I know you need to schedule your appointments after work. To make sure you have your next appointment at the best time for you, I want to schedule and reserve this time for you now.”

As the practice’s oral health educator, the hygienist assures that patients are well informed about the relationship between oral health and systemic health. Patient involvement and active participation create ownership and accountability and reduce the cancellation and failure rates. The recall/hygiene appointment is the most canceled and failed appointment in dentistry. One cancellation per day in hygiene can lead to annual losses as high as $50,000 in hygiene and even more in doctor production. National norms for cancellations and failures in hygiene average 20 percent to 25 percent.

Successful hygiene departments achieve scheduling rates of 93 percent to 95 percent in daily scheduling. Monitor and track the scheduling ratio by taking the total number of patients seen in hygiene and dividing it by appointments available for the month. The hygiene or scheduling coordinator should then report the current scheduling rate to the team at monthly staff meetings.

Many dental practices charge a fee for failed appointments, and the effect of doing this has been positive in raising patient awareness of the importance of the time set aside for their appointments.

Team approach – Everyone on the team uses the correct terminology. Courtesy confirmation calls and written communications define the hygiene appointment (recall) with dialogues such as verifying reserved hygiene appointments, preventive oral-health examinations (including screening examinations for oral cancer and periodontal health), and dental prophylaxis (professional dental cleanings). By doing this, patients are moved beyond the“just-a-cleaning-and-a-check-up” mentality.

Accountability – Chart audit and patient activation must be ongoing projects in the office through daily reviews and computer reports. While everyone on the team plays an important role, one staff person (the hygiene or scheduling coordinator) is responsible and accountable for keeping the daily schedule full and productive. At staff meetings, the scheduling coordinator reports and discusses the scheduling effectiveness rate. Everyone needs to be aware of what is working and what is not working so that problem-solving can take place.

Appropriate mix of services

Hygiene procedures include all services that may be performed within the scope of practice per state regulations. These include preventive (prophylaxis), appropriate periodontal procedures, medicaments, and topical fluoride application (see JADA, May 2006, for those at risk, including medically-compromised patients), sealants, oral health home-care products, and delivery.

Periodontal procedures and protocols – The most well-intentioned practices continue to give periodontal services away. In addition to the legal ramifications, this perpetuates the cycle of incomplete dental treatment and low patient compliance.

Current research correlating oral inflammation, periodontal diseases, and systemic diseases validates the efficacy for initial stage treatment of periodontal diseases and mandates the need for ongoing soft tissue evaluation and treatment. The clinically excellent (and productive) hygiene department bridges the gap between the research and real, everyday practice application with periodontal protocols that offer individualized treatment including up–to–date mechanical and antimicrobial therapies. Treatment is offered based on what the patient needs and not what the hygienist thinks the patient wants or what the insurance will cover. There are no “Loss Leaders” or “Blue-Light Specials” (low-fee prophies). This type of message encourages patients to accept “only the treatment that insurance pays for.” Periodontal services are not charged out as Adult Prophylaxis and information is presented in a professional and positive format.

How do you know if you are giving perio away? Generate a “Provider by Procedure” computer report for perio Codes 4341, 4342, 4355, 4910, and 4381. Current research reports that 75 percent to 80 percent of adults will experience some form of periodontal disease at some time in their lives. Given this data, an expectation of 25 percent to 40 percent of hygiene revenue to be generated for perio-related services is achievable.

A full range of services and oral health home-care products are offered – Patient education is available in the reception area as well as the treatment room. Audiovisual monitors can display the latest in dental technology. Additional treatment, products, and services that may be offered in hygiene – such as sealants, impressions, tooth-whitening, halitosis treatment, tobacco cessation, nutritional counseling and dispensing of products, and training with dental home-care health products – should be constantly reviewed, monitored, and updated. The intraoral camera is utilized for co-examination and co-discovery to allow the patient to actively participate in his or her care. Estimates are that from 50 percent to 80 percent of dentistry is generated in hygiene, and the hygienist sets the stage for preassessment. The happiest dentists I know are those who have hygienists who nurture relationships with their patients and are supremely successful in setting the stage for preventive, restorative, esthetic, and cosmetic treatment.

Scheduling effectively for today and the future

To achieve optimum scheduling and assure a full and productive schedule (for everyone), the team prepares for the day by auditing patient records. The hygienist reviews patient records for incomplete dental treatment, updated X-rays, status exams, perio, etc., and is prepared to discuss, demonstrate (with an intraoral camera), answer questions, and provide facts and findings when the doctor enters the treatment room. Ideally, a brief meeting (the morning huddle) enables the entire team to communicate, delegate, and maximize the day. One of the most important topics reviewed at huddles with my consulting clients is having the clinical assistants audit their records and identify patients who are seeing the doctor that day that are overdue for hygiene care. Using “save–you-a–trip-back” patient communication is a great way to fill last minute openings in the hygiene schedule. The hygienist does the same if the doctor has an opening and the hygienist has a patient with undone dentistry.

To avoid running behind, establish a communication system for the periodic oral (doctor) exam. I recommend not waiting until the end of the appointment. Giving a heads-up hygiene signal as soon as histories are updated and necessary radiographs and preliminary clinical and periodontal evaluations are completed builds in a “grace period” for the exam over the next 15 to 20 minutes. Ideally, the assistant will be able to coach – that is, move the doctor to the exam when it is convenient. In addition, many doctors report reducing the stress of their day by doing the exam at a time that is convenient for them (usually in between patients, while waiting for anesthetic to take effect).

Practice philosophy is shared

Finally, by working together, the doctor and hygienist communicate and share a practice philosophy for the patients, the hygiene department, and the practice. Working with the dentist as a partner in oral (and systemic) health care, the hygienist is committed to the vision of the practice, proudly recommends dental treatment, and refers family and friends to the doctor. The practice should have an equitable compensation package that includes clear goals and an easily monitored system for sharing the profits. [Profit is defined as what is left over after everything has been paid for.]

Facilitate change by regularly scheduling meetings with your hygienist or hygienists to support and reinforce initiatives and explore new ideas and opportunities for growth and development. Open pathways for communication will lead to mutual respect and admiration and will be reflected in increased productivity, a happy and stable dental team, andmost importantly, healthier patients.

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Since 1989, Annette Ashley Linder, BS, RDH, has been a recognized leader in the field and an award-winning speaker and consultant. She is a featured speaker at dental meetings and provides in-office consulting services with her team of business and clinical consultants. She may be reached at her Web site at, via e-mail at [email protected], or by phone at (772) 546-2207.

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