By Beverly Maguire, RDH
Armed with pertinent data from the hygiene department, the task at hand is to evaluate that data. What do the numbers mean? How effectively are we dispensing needed services to patients, how productive is the department, and what exactly are our goals ?
The first area to evaluate is the ratio of prophy to periodontal codes dispensed by each hygiene provider. In spite of the vast body of knowledge and research available, hygiene services remain overwhelmingly prophy-based. Between insurance pressures, a schedule-driven focus, and the logistical challenge that change represents, hygiene care often comes down to doing the best we can in the time we have available. According to both the ADA and AAP, the definition of prophylaxis a coronal focus designed to treat health and prevent disease.
To evaluate your status, the codes 1110, 4355, 4341, and 4910 should be converted to percentages. 4355 and 4341 are grouped together as therapeutic procedures. A conservative goal is a 40/60 mix of prophy/perio codes. These rates are based on the research that 75 to 85 percent of all adult patients have some degree of periodontal disease, including gingivitis. This mix of basic hygiene codes is one of the key indicators a dentist should monitor. Hygienists should monitor their numbers as well, because it keeps them more realistically aware of their contribution to the practice and of their role as one of the two production sources for the practice. In short, successful hygiene departments are most often the result of constant evaluation and monitoring of appropriate statistics.
Practices must also evaluate productivity. Analyzing the differences in productivity among hygiene providers is enlightening. Productivity follows the probe. Your most personable, friendly hygienist - whom most patients love - may not be the most productive. However, the hygienist who probes and charts routinely and effectively reports the findings to the doctors for diagnosis will be the most productive. Prophys simply create a glass ceiling in hygiene productivity, which has long been the concern of the business-owner dentist. Luckily, by gathering the needed data, evaluating it, and diagnosing appropriate treatment based upon the AAP Parameters of Care, unproductive prophy-hygiene departments should be a thing of the past.
Case acceptance rate is a critical area to evaluate. The number of nonsurgical periodontal cases and referrals presented monthly to your patient base is one of the key indicators I evaluate to determine the effective use of hygiene protocols. Most single-doctor/hygienist practices treat more than 120 patients per month in the hygiene department. If 75 to 85 percent of adult patients have some degree of periodontal involvement, is a diagnosis rate of one or two perio cases per month realistic? Yet, I commonly see these numbers come across my desk. Doctors, a very rudimentary way to evaluate your status is to ask yourself when you last diagnosed periodontal disease in your patient base. If you can't recall, it's a red flag! And, of those patients who are presented with treatment options and referral recommendations, what percentage say yes?
I find that most offices do not routinely monitor their hygiene numbers. Once they have an initial hygiene assessment followed by a professional evaluation of the data, most practices find a great deal of opportunity for both improved quality of patient care and increased practice productivity. Often, the help of a qualified hygiene consultant can make a real difference in the interpretation of the data and can lead to a refinement of hygiene protocols within the practice.
We must always understand where we are starting from and where we want to go before we can achieve our goals. This is also true for the hygiene department.
Beverly Maguire, RDH, is a practicing dental hygienist. She is president and founder of Perio Advocates, a hygiene consulting company based in Littleton, Colo. She can be reached at (303) 730-8529 or by email at PerioAdvocates@aol.com.