Annette Ashley Linder, BS, RDH
Greetings in 2004! The new year provides an opportunity for beginning anew with a fresh look at where we are and where we want to be. Throughout the country, a pattern for effective hygiene has emerged. Here are some benchmarks to work toward in order to achieve clinical and production excellence.
Benchmark: Hygiene production as a percentage of practice revenue.
Goal: Twenty-five to 35 percent of production generated from hygiene. This goal will vary, depending upon the size and focus of the practice. For example, in a solo boutique-type practice where the dentist is performing large cases on fewer patients, hygiene production usually does not comprise 30 percent of the practice production.
Benchmark: Hygiene mix of services. This would comprise a full range of services (per state regulations), including nonsurgical periodontal services, sealants, anesthesia delivery, tooth-whitening, halitosis treatment, tobacco cessation, nutritional counseling, and dispensing and training in the use of home-care dental products.
Review the Hygiene Procedures Analysis for 2003. If production consisted of 90 percent prophys and 10 percent periodontal services, then something is wrong. The AAP estimates that 70 to 85 percent of the adult population has some level of periodontal disease. Current research correlating systemic health and periodontal infection mandates the need for ongoing periodontal evaluation. Translation: Just because a patient-of-record was "healthy" at his or her last dental hygiene appointment, don't assume this individual will be periodontally healthy forever.
Goal: Twenty to 30 percent of hygiene revenues generated from periodontal procedures. This includes Codes 4341, 4342, 4355, 4910, and 4381. Review and update office periodontal protocols, based on the current research.
Benchmark: Health of the patient-retention (recall) program. Recall and patient retention form the heart of the practice. However, dental practices average 50 to 60 percent in recall. Translation: Four to five out of 10 existing patients-of- record (often good patients) are sitting in the central file, overdue for an examination and overlooked for needed dental care. The hygienist plays a huge role in the continuing success of any patient-retention (recall) program. Chart audits and patient activation should be ongoing projects as a result of thorough daily reviews, regular computer reports, and accountability. Tracking systems and monitors should be in place so that patients do not fall through the cracks.
Goal: Ten to 15 percent of patients will leave a practice through normal attrition (move, pass away, change dentists). Therefore, an achievable retention-rate goal is that 85 to 90 percent of patients will be retained Who is responsible for recall and the daily schedule in your practice?
Benchmark: Scheduling efficiencies. Cancellations, failures, and open time in hygiene cost the practice big, big bucks. Losses are seen in both hygiene and doctor revenue. The typical practice averages 1 to 2.5 openings each day in hygiene. The hygiene recall program allows for prescheduling, ideally with the hygienist in the treatment room. In this model, the hygienist can gain control of the schedule with a productive and positive day. Scheduling patients with the units of time based on clinical need — rather than every patient being seen for the same amount of time — is working very well throughout the country. Accordingly, an appropriate fee should be based on the amount of time involved in the services performed for each patient. Time is reserved to properly assess, inform, discuss, educate, and instruct the patient.
Goal: Less than 10 percent of patients leave without their next appointment being scheduled. Ninety percent of patients leave the dental visit with a new and profound understanding of the importance of regular and ongoing dental care. The hygienist sets the stage for ongoing care and patient compliance by helping the patient see that hygiene services are not simply cosmetic in nature. The patient should be involved in appointment-scheduling. This active participation creates ownership and accountability, thus reducing the cancellation and failure rate. Written information should be dispensed, such as an "Oral Health Fitness Report" (visit AnnetteLinder.com and download a copy). The scheduling ratio should be no less than 93 percent for the month (i.e., patients actually seen measured against available appointment-time units).
Benchmark: Compensation to production ratios do not exceed 35 percent. Hygienists know and understand the goals for their department and how to achieve and exceed those goals. Consider giving an incentive for production once the break-even point has been met. Continue with monthly meetings throughout the year. Review the month's monitors and track where you are, what is going right, and what needs "fixing" in order for you to stay on target.
Annette Ashley Linder, BS, RDH, is a recognized leader in the field and an award-winning speaker and consultant. Since 1989, she has presented more than 350 seminars and consulted in dental practices throughout the world. 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 AnnetteLinder.com, via email at Annette@annettelinder.com, or by phone at (804) 745-6015.