04.17.09 Issue #371 Forward This Newsletter To A Colleague


Nancy Caudill
Senior Consultant
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Holes in Hygiene?…How to Avoid Them

Dr. Gary Shipyard – Case Study #114

It appears that a primary concern from doctors contacting our office is too many openings in hygiene.  It is surprising that they are not also concerned about their own production, as 50% of the doctor’s production comes from returning patients through the hygiene department. Dr. Shipyard was concerned about his Hygiene Department.  Let’s take a look at his practice stats:

  • 4 days of hygiene per week
  • Practice is 8 years old
  • Averaging 18-22 new patients a month
  • % of periodontal services performed was 15%
  • Average daily hygiene production was $791
  • Hygienist salary was $350 per day

What is Considered “Healthy”?
A practice that is 8 years old and averaging 20 new patients a month should need 7.5 days of hygiene if the patient retention was 80-90%.  Here is the math:

8 years x 12 months = 96 months x 20 NP/mo = 1,920 new patients. 
If 85% of the patients were retained and each patient was seen 2x a year = 3,264 appts needed
3,264 appts/9 appts per day seen = 362 hygiene days/48 weeks of work = 7.5 days of hygiene

This indicates that Dr. Shipyard had a retention problem even before this difficult economy…he just didn’t notice it.  He should have had 7.5 days of hygiene and only had 4.

Also, based on the nationwide statistics of estimated persons with periodontal disease, an average general practice should be seeing about 33% of their patient base needing periodontal therapy and subsequent 3-4 month periodontal maintenance.  Again, Dr. Shipyard was only posting around 15% of periodontal service by his hygienist.

Lastly, his hygienist should be net producing 3x her daily salary.  Several reasons were keeping her production at less than optimal:

  • Not enough periodontal procedures
  • Too many openings
  • Radiographs not taken as often as necessary based on guidelines
  • Scheduling too much time for each appointment, reducing her hourly production rate.  Her hourly production should be $150 and instead, hers was $98.88

In order to address Dr. Shipyard’s primary concern of “too many openings in hygiene”, first we must determine what is considered “too many”.  If his Hygiene Coordinator was scheduling his hygienist to her daily goal of $1,200 ($350 x 3) and allowing a15% increase for PPO adjustments) it is not necessary to have all the openings filled.  With an increase in periodontal services, it is possible to observe openings in the hygiene schedule and still be scheduled to goal.  Therefore, more important than “filling the holes”, is scheduling to a daily goal.

5 Monthly Hygiene Follow-up Steps
After interviewing Dr. Shipyard’s Hygiene Coordinator, it was noted that she did not have a specific protocol that she followed for following up on recall patients.  Truthfully, she didn’t even realize that this was her primary objective, as she didn’t really have a Job Description.  Her understanding was that she was supposed to help the other business employee do everything in the business area.

In order to be responsible for a department in a dental practice, the team member must have a clearly defined job description to follow and is held accountable to the doctor for her performance.

These five monthly tasks were defined for her:

  1. Send out the monthly notices with the hygienist’s personal notes on each one to add value.  These notices are sent two weeks in advance of the first due date and are for patients with and without appointments. 
  2. Print a 30-day past due recall report and call each patient.  If the contact is with voice mail, leave a message indicating who is calling and ask the patient to return the call.  Try to contact the patient again during the month at a different time of the day or during the early evening.
  3. Print a 60-day past due recall report and send each patient a “we miss you” letter signed by the doctor.  Include an educational brochure regarding the importance of their appointment.  Use the mail-merge feature of the dental software to make this task simple.
  4. Print a 6-month past due recall report and contact the patient again, either by phone or letter.
  5. Print a 12-month past due recall report and send a “reactivation” letter.  This is the last attempt to invite this patient back into the practice.  Consider offering a “free” service, such as an oral cancer screening using one of the new screening methods, or even whitening.

“Dialing for Dollars”
The number one most important task that maintains a hygiene schedule that is productive (scheduled to goal) is the effort that must be applied by the Hygiene Coordinator by using her most valuable tool – her telephone!  On average, 10 calls must be made in order to make 1 appointment.

Conclusions:
Now that Dr. Shipyard’s Hygiene Coordinator has a better understanding of her responsibilities, she is focused on her primary job – scheduling the hygienist to her daily goal.  Where the hygienist was averaging 10 time units per day open, the Hygiene Coordinator has managed to reduce this to 4 time units per day, a great improvement.  More importantly, the daily production has increased 25% and is continuing to improve!

If you would like more information on how McKenzie's Practice Enrichment Programs can help you IMPLEMENT proven strategies, email info@mckenziemgmt.com.

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