Putting a dollar figure on hygiene
Here`s how to compute the true financial potential for the hygiene portion of your practice.
Robert E. Hamric, DMD, FAGD
I spent three years studying 10 practices that gross over $1 million annually. I was looking for seven traits of a million-dollar practice. After I put all the material together, we ended up with 21 traits (Dental Eco-nomics, June 1996).
Three things really stood out in all these practices:
- Staff members seemed to enjoy working together-truly team efforts.
- The practices had motivating, effective incentive-bonus systems for their staff (they were truly part owners).
- They all had fantastic hygiene/perio programs.
In the past, management experts would tell their clients to expect 25 percent of gross production to come from hygiene. Hygienists would clean teeth and look for work for the dentists to do. This has changed with the modern approach of early detection of periodontal disease. Treatment before surgery is required.
Hygiene production in the million-dollar practices can be as much as 50 percent of the gross production. That`s good news! It is production being performed by someone other than the dentist. But, most importantly, we are helping people discover periodontal disease early, treating the disease without surgery, and maintaining a healthy mouth, so patients can keep their teeth.
Ironically, people who are very concerned about gum disease become concerned about their restorative procedures. They want good restorative, complete dentistry-not patchwork care.
Just a `Break-Even` Deal?
The average hygienist produces between $400 and $500 per day, or, on a 200-day-per-year work schedule, $80,000 to $100,000 per year. At best, this is only a "break-even" business situation for the practice, and certainly a supervised neglect program for the patients.
A practice that does prophys in 30 minutes, does not probe for periodontal disease, and does not do a PSR is, in my opinion, a malpractice.
The ADA states 88 percent of the American population has periodontal problems of some type-granted a large percentage will be Type I gingivitis. Is your office diagnosing and informing the patient and treating the problem? Are you looking, but not seeing?
What could be your true financial potential in your practice and in hygiene? How many active patients do you have in your practice? Active patients are those people who have been in the office in the last two years.
Finding Real Numbers
Take time to establish a real number here. Don`t guess! Count charts. Perhaps, you can get this information from your computer. The actual number is important.
The average practice will have between 1,500 to 2,000 active patients. If the average patient value for your practice is $350, your true practice potential would be:
1,500 x $350 = $525,000
or
2,000 x $350 = $700,000.
Is that your gross? If not, you may need some management help. Now, look at your production figures and see what portion of your gross is hygiene. You may be surprised!
Hopefully, your computer will give you a printout showing you how many prophys have been performed (Code No. 01110) and how many root planes per quadrant have been performed (Code No. 4341). This will give you some idea of how many patients are in the perio-therapy program.
Let`s look at an example where 129 prophys (Code No. 01110) have been performed, as well as 16 root planes/per quadrant (Code No. 4341).
Sixteen root plane/quad would indicate that 16 patients are under treatment for perio out of the 129 seen, or 8 percent. The ADA states 88 percent have perio disease-are you really diagnosing perio disease?
The Perio Boost
The practice that provides the complete perio therapy program will find the hygienist producing in the $1,000 per day area (or $200,000 per year). Therefore, with proper verbal skills and diagnostic training, a practice with three hygienists easily could produce $600,000 in hygiene alone.
How many patients can a hygienist see over a year`s time? Figure the math: 200 days per year, eight patients per day, equals 1,600 people yearly. But, if those patients normally come every six months, that number is divided by two, or 800 people.
So, a practice with one hygienist can adequately treat only 800, and perio therapy requires more than two visits per year. So, time is a problem . Time is the major reason many practices clean teeth with infected gums and, when the disease gets bad enough, refer to a specialist.
If the patient should lose a few teeth from periodontal disease, I hope they don`t sue you for neglect!
A Meaningful Pause
What`s the answer? Stop the practice for a moment, and reassess your values and your practice mission. This should be done in a retreat setting. Decide what you really want in your hygiene/perio program. If you have a very busy practice, expand to another hygienist and provide a dental assistant and hygiene coordinator for your program.
No longer do you want to rush patients through and book in a way where solid, new patients can`t have perio therapy. To tell your patients, "You need to start brushing better and floss every day," is like telling a child to stop sucking his thumb-they don`t hear you.
If only 25 percent of your existing patients needed perio therapy and each patient requires three extra visits, you can see how another hygienist and assistant would be a necessity. Production would increase from $400 per day to $1,000 per day, per hygienist; therefore, a $2,000 hygiene day now makes the hygiene department a profit center for the practice, not a loss leader.
The author practices part-time in Birmingham, Alabama. He has conducted many seminars, and frequently speaks at major dental meetings. He can assist you in developing a perio therapy program. Call (800) 685-7230, Ext. 6293.
Personnel for Expanded Hygiene/Perio Program
Hygiene coordinator-This person`s responsibility is to see that the hygiene department is productive (no loss of time). She controls the schedule, can present perio therapy in the conference room, talks to patients on the phone, etc.
In other words, she coordinates all of the department`s activities. The coordinator does not need to be a hygienist, but should be very informed about all perio procedures and a real warm people-person.
Hygienist-This person should do everything allowed within the State Dental Practice Act to be productive. She must be excellent with scalers, gentle, know how to communicate with patients, and not be afraid to tell people they have a problem.
Hygiene Assistant- This is the person who works with the hygiene coordinator. She seats patients, assists the hygienist, as needed, and is responsible for radiographs, room setup and instrument sterilization.
