Computers, flow, & profit

April 1, 2004
Improve your systems, relieve front-desk congestion, and increase efficiency by installing computers in your operatories.

by Chad W. Roskelley, DDS

Systems flow in the dental office usually meets its greatest obstacle at the front desk. Your clinical staff does their best to provide a comfortable and timely patient experience only to release them into the long line that leads to the front desk. There your administrative "octopus" is working furiously to get all completed procedure codes submitted to insurance, collect and post all payments, provide walk-out statements, check charts for future treatment needs, schedule future appointments, set up patients for recall, take incoming phone calls, and on and on and on! This can make an otherwise pleasant and efficient visit to your office end in delay and frustration for the busy guest.

Since the front desk would erupt into total chaos if your administrative octopus ever moved his or herself from that position even momentarily to clarify completed or needed treatment, he or she is expected to be proficient at E.S.P. to determine what treatment is a priority, appointment length, and determine when it would be most efficient to schedule that particular procedure.

Yet who gets the blame for scheduling the wrong treatment or misappropriating the amount of time needed for clinical appointments? The administrative staff!

One obvious solution would be to increase the size of the patient check-in/out area and to hire more expensive staff members. But I will propose a solution that will improve systems flow, decrease the frustration of guests and staff, and increase profitability by increasing production to payroll ratios. Let me illustrate with two possible scenarios:

Scenario No. 1

Mr. S., a valued patient, shows up for a dental appointment on time and has set aside the prescribed amount of time to complete the required clinical care. Right from the start, check-in is difficult and time consuming because of the congestion at the front desk. Patients are checking in and checking out. When the patient is finally seated in the operatory, there is some confusion over what treatment is needed and what has already been completed because the written charts are incomplete or unreadable. Though great care is taken to provide quality dental care, the patient is uncomfortable over the seeming disrespect for his busy schedule and the confusion over treatment needs. Finally the patient exits the operatory, only to be put into the front-desk line where congestion makes the final experience stressful and frustrating.

Scenario No. 2

Mr. S. shows up on time and is greeted by the clinical assistant and escorted to the clinical area, where he is checked-in on the operatory computer. The patient's chart is opened and shows a graphical display that even the patient can understand, showing what treatment has been completed and what needs attention. The assistant hands the patient the television remote and headphones, then places a topical anesthetic. The doctor comes in, confirms the necessary treatment from the open chart and proceeds to complete clinical treatment. After treatment is complete, the patient, the doctor, and the assistant look at the chart and together determine the need, timing, and scheduling for future appointments. The appointments are made while the patient is still thinking about clinical needs. The staff gives the patient a reminder card, and discusses financial arrangements. The only stop at the front desk that may be necessary is to pay the fee for today's visit, and the patient is on his way.

Advantages of computers in the operatories

Many of the duties that congest the front desk can be moved into the operatories and be performed much more efficiently. This improves systems flow and improves the patient experience.
Administrative staff can function more efficiently at the duties that require their expertise like posting payments to accounts, providing walk-out statements, and wrestling with the insurance companies (collecting your money!).
The staff member who spends the most time with the patient (hygienist or assistant) develops a close relationship with the patient. This in turn helps the staff member foster a keen understanding about the patient's future clinical needs, which allows the hygienist and/or assistant to schedule clinical care appointments accordingly.
All clinical care arrangements can be made while the patient is still thinking about dental needs rather than at the front desk where the focus changes to financial.
This system gives you the ability to support advanced patient care programs such as digital radiographs, intraoral cameras, and patient education programs.
Computers allow nonprofessional staff to do more of the responsibilities traditionally thought of as administrative, which will increase production per payroll dollar, reduce overhead, and increase profitability.

Disadvantages

Keyboard, mouse, and monitor create additional asepsis challenges.
The cost for computer systems and software can seem excessive compared to the potential return.
A large investment of time and overhead needed to become familiar with computers and programs.
The real potential for electronic problems like computer lock-up, systems crash, or loss of data.

However, if you want to hit systems flow where it meets its biggest obstacle, move some of the administrative duties into the operatories where they can be completed more efficiently and appropriately.

If you want to hit overhead where you can do the most good, look at payroll. The average dental office spends over 26 percent of monthly production on payroll and only 3 to 4 percent on equipment. A computer network and software may cost you approximately the same as one month's payroll and will increase productivity for years to come. It will allow clinical staff to take over many burdensome duties from the often over-taxed administrative staff, allowing them time to focus on collecting insurance pending and past due accounts. More profit!

Admittedly, computers can present unfamiliar problems that require creative solutions. But the benefits far outweigh the challenges. And finally, if systems do fail, the office can always revert back to the old, inefficient methods. Believe me, that is when you will realize how much you rely on computers in the operatories.

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