When you begin to examine costs, advises the author, review all aspects of the clinical appointment.
Mary Yakas and
Theresa Farah
It`s Monday in your office and it is extremely busy. Mr. Jones is in one operatory for recementing of a crown. Ms. Smith is in another operatory with your assistant for impressions. The third operatory is set up for your next appointment, an emergency patient. Things are moving along slowly and you call your assistant into the operatory. Rushing in, your assistant dispenses enough bonding agent to use for 10 composites. While you are thinking about the expense of that new bonding agent, you reach for the wooden wedges yourself while your assistant is gloving. Your assistant swings around and the box of wedges is knocked on the floor. Since things are busy, you move forward as best you can. Moving into the next operatory, you are glad to see that the new hybrid ionomer cement you wanted to try is set out for you. Without reading the instructions, you begin to mix the cement. It hardens much faster than expected and you attempt to seat the crown quickly. Meanwhile, the scheduled emergency patient never arrives. As you walk back to the lab to sandblast the cement-coated crown, you breathe a sigh of relief. Finally, a break in the schedule.
Sound familiar? Perhaps a different scenario comes to mind, but these situations are all too true for many dental offices. Stop for a minute to think about the situations just described. How much time and money were wasted during the last 30 minutes? It can be safely construed that most dental personnel are not aware of the tremendous costs associated with running a dental office. New technology, new materials and equipment, and infection-control requirements are some of the reasons costs have risen dramatically in the past five years. It is very important to analyze carefully your office budget, your staff and overall office efficiency.
Companies are now marketing the quickest impression material, the fastest sterilizer, the strongest cement and other products that will save time and money. Unfortunately, these advances are expensive. Infection-control requirements have caused an approximate 17 percent increase in costs over the past five years because of additional supplies needed. In addition, many offices need a faster turnaround time for instruments and equipment, which often requires another sterilizer or additional instruments.
Among the other infection-control requirements often not accounted for in budgets are laundering, staff training, sterilization-monitoring services, uniforms, vaccinations and waste disposal. All of the above certainly can increase costs, and it is likely that costs will continue to rise in these and other areas.
When you begin to examine costs in your office, review all aspects of the clinical appointment. Each task involved in one appointment should account for doctor and staff time, lab costs, sterilization time, and setting up and cleaning up rooms. We`ve all heard the expression "time is money" and time, along with the cost of materials, must be considered when looking at the cost of maintaining a profitable practice.
How do costs affect the average dentist? Let`s review the scenario above. Without taking into account the need to stay on schedule and the mistakes made, look at the costs incurred:
1. The bonding agent that was dispensed in excess can cost up to $60 per bottle or $1.15 per application!
2. The wooden wedges, which now are contaminated, cost between 5 and 7 cents each.
3. When these mistakes are made, doctor, assistant and patient time are wasted. In addition, sterilization costs increase.
4. The emergency patient who missed the appointment cost the office time and money. The assistant had to set up and clean up a room that was never used, and supplies were probably set out, wasted or contaminated.
5. The crown that was recemented cost the office time and materials. Was the patient charged for the appointment?
6. The cement that hardened inside the crown was wasted and the crown had to be disin-fected. Use of the sandblaster required staff time and supplies. Additional cement was needed for the second attempt to seat the crown.
Think about the number of times a patient comes in for one procedure and the treatment plan deviates from what is scheduled. What about the number of patients not charged for "small" appointments such as adjusting a crown, recementing a temporary or taking one X-ray? What costs are incurred in your office? Tray set-ups, the amount of time taken from an already busy schedule, and the amount of time and effort expended attempting to stay on time must be taken into account. This is where the opportunity to examine your scheduling with your office staff is helpful in budgeting and cost containment.
By using a worksheet similar to the one in Figure 1, you and your staff can figure out the cost of each procedure performed in your office. It is necessary to be aware of the amount of time you spend on a procedure, the amount of time your assistant spends on a procedure, rate of pay for each staff member utilized, any applicable lab fees, plus the cost of materials needed for the procedure. Completing the worksheet for each procedure performed should give you a good idea of cost and productivity in your office.
Once you begin thinking in terms of cost per application or cost per room set-up, it is easier to identify where you need to monitor overall costs. It may not be easy to look at pro-cedures performed every day and evaluate productivity; however, by looking at these costs over time, the picture becomes clear. Budgets can be trimmed and staff efficiency will increase. You may be surprised at what your office is capable of financially when examining ideas for cost containment with your staff.
Many new techniques require time to master and can be expensive if not used properly. Once learned, newer products offer ease of use, reliability and savings of time. Support staff must be trained to use these products in order to reduce waste and increase success in the procedure.
Most dental manufacturers have the dentist in mind when developing new products and equipment. Companies are now promoting time efficiency in designing their products and many are successful. Be sure to review the cost of products, equipment and learning time when considering a new purchase. Not only are the trends in dental products changing, but the introduction of computer-generated equipment has added new dimensions when looking at the costs of operation in your dental practice.
One consideration is time spent training and using new equipment vs. the benefit gained. Will bringing in a CAD/CAM unit or laser generate enough return on your investment to justify a purchase? Will it hurt your practice if you do not own this equipment? Enter a purchase with some caution. Not only are you faced with increased costs, but also the time to train staff and to receive reimbursement from insurance companies. Indeed, new technology offers incredible ideas for the dental profession, but carefully assess if the time is right before making a purchase.
There are many other ideas for cost containment in your practice. You may want to offer incentives to your staff for time- and money-saving ideas. Your staff is very important in determining your productivity. Discuss each aspect of your office and ways you can change or improve efficiency in areas such as ordering supplies, organizational charts, staff training or in-services, morning meetings and communication. In addition, examine your fee schedule and supply orders. Monitoring any system of your office and making necessary changes are essential to remain productive.
The authors are coordinators with Dental Consultants, Inc. Ms. Yakas has nine years of dental experience, including practice management, laboratory work and clinical assisting. Ms. Yakas has been with The Dental Advisor publication for 2 1/2 years. She manages her husband`s dental practice, as well as the offices of Dental Consultants, Inc.
