Part two: Maximizing hygiene production: 4 ways to build a better, stronger practice

Many dentists today don't realize that an inefficient, or worse, an uncoordinated hygiene department can break their practices. Kevin Wilson explains how to make the most of your dental hygiene department.

Sep 22nd, 2016

Kevin Wilson

Editor's Note:This is part two of a three-part series on building a better, stronger practice through your hygiene department. The first article appeared in the August issue of DE.

Many dentists today don't realize that an inefficient, or worse, an uncoordinated hygiene department can break their practices. Last month I discussed how many dentists improve this problem by vetting hygienists with high personal and clinical caliber, and by improving efficiency. Here we'll review good internal coordination (scheduling, fees, insurances), and ways hygienists can actually increase overall practice financial health.

Internal coordination

Internal coordination involvesscheduling, no-shows, reschedules, and cancellations. It includes having a standard protocol in writing so there is no confusion about what is expected. It also includes proper and known fees for the work that is done.

You might have a situation where cancellations, reschedules, or no-shows are more prevalent in the hygiene schedule than they are in the doctor's schedule. We've certainly seen this, especially since the economy crash of 2008. Greater care needs to be taken with the hygiene schedule than ever before. Here are some points that I have found to make or break the hygiene schedule and production.

• First, when patients try to reschedule, many could actually keep their appointments if it were important to them to do so. They aren't normally irresponsible when they try to reschedule. They just don't know what you know regarding why that appointment is just as necessary as their operative appointment. And guess what? Your staff doesn't always know either.

• Second, whoever is confirming, appointing, and handling the hygiene schedule absolutely needs to understand that the cleaning is more important than just getting a sparkly fresh mouth. They need to know that putting off the appointment can truly be a bad mistake. But let's be honest-does it truly matter clinically in some cases? Truth be told, in most cases when we see a recall patient two weeks or two months late, it may not matter that much. But you have your own experiences to the contrary, rare though they may be. If you don't have experiences to the contrary, you've at least heard or read some very alarming stories.

For instance, a young mother with four young children still at home missed her recall appointment. This was not a catastrophe in the big scheme of things. She was busy running a household, driving four kids around, and more. She fell off the book and was not seen again for quite some time. When she finally did return, the unthinkable had happened. She had stage 4 cancer that had started orally. This is sad beyond belief. Could this have been prevented if she'd been on time for her recall appointment with the standard cancer screening? Perhaps not, but perhaps so.

Yes, it is an incredibly small percentage of patients who present with something suspicious in their mouth. But why would you want to take a chance on that next patient who is trying to reschedule? The person might be the one who should not be put off.

If you have your own story, share it with whomever schedules your hygiene appointments. Share it with your hygienists. The fact is, if they truly know how vital it is for their patients to keep their appointments, they will be more motivated to get those patients to keep them. I'm not saying you should use scare tactics on patients to get them to come in. But I am pointing out that the dental and medical reasons patients do need to keep their appointments are often not known or not thought of by the patients, and sometimes even by your staff.

Coordination points to remember

Once the patient has arrived, there are additional points of coordination that can maximize your production. Here are the main coordination points to remember:

• Ensure that the hygiene coordinator and hygienist know well the dental and medical reasons patients must keep their appointments. Share stories you've experienced or heard. Ensure they can communicate this importance to the patients who are trying to reschedule or cancel.

• When making a hygiene appointment, whether for a new patient or a recall patient, patients should be reminded that they need to keep this appointment and be on time. This is for their dental health as well as their cancer screening.

• Ensure all fees are known and charged. Isolated units of curettage and scaling are to be charged. For most insurance companies, four or more units of scaling can be charged as a quadrant.

• Ensure all proper documentation that's needed by insurance companies is provided upon submission of claims on all periodontally involved patients. This includes required x-rays, probing chart, and sometimes a narrative.

• Ensure perio maintenance exams and procedures are charged separately, as well as x-rays, for three-month and six-month perio recalls.

• Make sure you are aware of what can be charged and what cannot. Have a policy in place for your staff regarding this. This is a very weak point in many practices. Fees for your practice cannot be altered by any staff at their adjudication. We've seen this many times, where an insurance coordinator, whether trying to be nice, is too busy, or is uninformed, may not relay the full maximum billing allowed. You need to check on this periodically because insurance coverages do change. Staff should stay on top of this and attend insurance seminars, use the resources available on the internet, and do whatever else they can do to keep current and educated on this subject.


Kevin Wilson is CEO of Sterling, an award-winning management consulting firm that has twice appeared on the Inc. 500 list of America's fastest growing, privately held companies. Founded in 1983, the firm has delivered more than 500,000 hours of business consulting and completed more than 135,000 training sessions among 175,000 business professionals from 1,700 cities throughout the United States. Wilson is the author of Personnel: Your Most Valuable Resource or Greatest Burden (2010). He can be reached at kevin@sterlingdentists.com. Visit SterlingDentists.com for more information.

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