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Ask Dr. Christensen: Simple methods to increase service to patients and revenue

May 15, 2015
The major third-party payment company in my area recently decreased payments by about 15% or more.


The major third-party payment company in my area recently decreased payments by about 15% or more. This change is very significant to me since my overhead cost is about 60% of total gross revenue, and the third-party payment company dictates what I can charge as long as I'm a "provider" for them. What can I do? Are there methods to help overcome this challenging situation?


You are definitely not alone! All of us feel hopeless when our operating costs are fixed and the third-party payers continue to reduce their benefits. I've had to face the same situation you describe. There are many ways to legitimately increase revenue, and you must decide which of the concepts are best for you, your staff, and patients. Below are some of the most significant methods that I've developed to at least partially overcome this significant financial challenge.

Incorporate additional staff-oriented clinical procedures into your practice.

There are numerous income-producing clinical procedures that can be legally accomplished by staff persons. These increase patient service and revenue. I've listed 10 of the most important ones that I guarantee will not only serve your patients better, but will also excite and motivate your staff, and as a result, increase your revenue. All of these procedures are easily delegated to educated and competent staff. However, each task requires staff education for competence. If you currently do these procedures yourself, you can educate your staff to do them. If you do not have these procedures in your practice, I suggest finding appropriate CE courses to properly instruct your selected staff persons.

Athletic mouthguards (figure 1)-It has been estimated that 80% of mouthguards made in the U.S. are inadequate. Your staff needs a course in pressure-laminated mouthguards, which have been shown to be among the most adequate and easiest to make.

Figure 1: Stock or boil-and-bite mouthguards for athletes of all ages are generally inadequate. A major need is for more dentists to make pressure laminated mouthguards. Increases in service and revenue will be realized.

Desensitization of external tooth surfaces-Hygienists commonly find sensitive external tooth surfaces. Your hygienists can learn techniques to desensitize those surfaces, and patients are happy to pay a reasonable fee.

Diagnostic data collection (figure 2)-Hygienists and assistants can learn to collect all of the data for diagnostic and treatment planning appointments. Meanwhile, your time can be spent on other revenue-producing procedures that only you can do legally. Delegating these procedures motivates staff. They collect far more information than when dentists accomplish the tasks, and both staff and dentist produce revenue.

Figure 2: Dental hygienists and assistants can learn to collect diagnostic data in a well-organized data collection appointment, releasing the dentist to do clinical procedures that only a licensed dentist can do. The reduction in overhead for the diagnostic appointment is significantly reduced.

Educating patients-This is not directly an income-producing task, but staff accomplishing patient education in your office significantly increases patient acceptance of treatment plans.

Local periodontal antibiotics-Hygienists often observe periodontal pockets that do not respond to conventional scaling and root planing. Placement of a local antibiotic when indicated is easy and beneficial.

Occlusal splint construction and placement (figure 3)-About one-third of adult patients in a general practice have grinding or clenching bruxism. Most of them do not know they have bruxism. You are legally responsible to educate them about their condition. Most just need to be told about it. Educated staff can legally accomplish the entire procedure in most geographic locations. Initiating this procedure alone will be a major financial boost to overcome the decreased revenue challenge.

Figure 3: Few patients realize they are abusively wearing their teeth. When they're educated about placement of an occlusal splint, this can easily and effectively be delegated to qualified staff.

Preventive appointment-About one tenth of patients in a typical general practice need extensive preventive care, including fluoride in trays. This half-hour appointment can be accomplished entirely by staff.

Sealant placement-Yes, staff place sealants in most practices, but our research shows that most have minimal service potential, and the materials used as sealants wear down rapidly. Educating children's parents about the need and correct timing for this treatment is essential.

Snore appliances (figure 4)-About 30% to 50% of adult patients snore, and most people know someone who snores! Just share information with them that you can stop their snoring, and you have a fantastic service and revenue source. This procedure is staff-oriented, from impressions to seating the appliances.

Figure 4: It is well known that up to 50% of the adult population snores. Get involved with sleep medicine. Much of the clinical responsibility can be delegated to staff, and the desire for this service is enormous.

Tooth whitening-This is nothing new to you. However, I feel that many dentists do not emphasize this concept to their patients. If every adult patient was educated about tooth whitening, a high percentage of patients would accept the procedure. Whitening is the entry to many other esthetic procedures.

The majority of the clinical time to accomplish these oral procedures may be done by staff persons under the supervision of a dentist. I have no reservation in stating that full incorporation of the procedures noted here will increase both your patient services and practice revenue.

Complete coding

Procedure codes change often. I commonly see dentists who are not aware of the many changes that occur in codes. As a result, they don't notify benefit companies about the procedures they've accomplished, and the payments to them do not represent what they've legitimately done.

Business staff should carefully review the ADA codebook as each new edition is published. Also, business staff should take continuing education courses from a practice management educator to ensure they're coding properly and completely.

Enhance dental assistant skills

Dental assistants can be reactive or proactive with their skills. If they merely accomplish the well-recognized and routine dental assisting tasks, they fulfill a significant role in your office, but there's much more they can do with their skills.

The proactive dental assistant has her or his mind several steps ahead of the procedure the dentist is currently doing. As a result of the assistant's thought and preparation, procedures flow rapidly and time is saved. A so-called "roving" assistant, who helps when and wherever needed, can also assist a proactive dental assistant. If your dental assistants are not proactive, there are good CE courses to educate them about this concept. A video on this subject is noted at the end of this article.

Expand the procedures that you, the dentist, accomplish

Several procedures are not in the treatment repertoire of most dentists. A few are:

All aspects of occlusion including treating bruxism, TMD, and other occlusal maladies.

Sleep medicine is increasing rapidly, and educated dentists can be a major part of the team of board-certified sleep physicians, sleep technicians, dental technologists, and dentists.

Sports dentistry is necessary in all geographic areas, but few dentists become involved. Accidents involving orofacial structures occur frequently, necessitating the expertise of dentists.

Implant placement is slowly growing among general dentists in the U.S. It is already a commonly accomplished procedure for general dentists in most developed countries. Go for it!

Involving yourself with these activities is exciting and invigorating for you, serves patients well, and produces more revenue.


I empathize with you regarding your difficulty making enough revenue to satisfy the necessities of life when recognizing the third-party provider limitations you described. We must be creative in developing ways to overcome the challenge by delegating more responsibilities to staff, enhancing the abilities of staff, coding properly, and expanding the variety of services we provide.

Gordon J. Christensen, DDS, MSD, PhD, is a practicing prosthodontist in Provo, Utah. He is the founder and director of Practical Clinical Courses, an international continuing-education organization initiated in 1981 for dental professionals. Dr. Christensen is a cofounder (with his wife, Dr. Rella Christensen) and CEO of Clinicians Report (formerly Clinical Research Associates).

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