7.23.10 Issue #437 Forward This Newsletter To A Colleague


Nancy Caudill
Senior Consultant
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Do I Need a Consultant?
By Nancy Caudill, Senior Consultant McKenzie Management

Case #225
Dr. Sandra Sheraton

As you can imagine, this question is asked of McKenzie Management on a regular basis, whether it is at a convention, during a conversation when a doctor calls or in an email from a doctor that is curious.

It is a very logical question because “you don’t know what you don’t know.” This was also the case with Dr. Sandra Sheraton. During a brief conversation with Dr. Sheraton, it was easy to acknowledge that she was very knowledgeable about many statistics pertaining to her practice. She was tracking everything that she could possibly think of, such as number of days worked, production and collection totals, how many hygiene patients were seen, etc.

In her mind, the practice was performing at the top of its game. 

Dr. Sheraton’s practice statistics

  • Net collections were at 98.5% of net production
  • Production adjustments were less than 5%
  • Goals were established for the doctor and hygienists
  • No outstanding insurance claims over 60 days
  • 30+ comprehensive exams per month (new patients)

It appears to be the “perfect” practice. However, she was still unhappy because she felt like there was more that could be accomplished… but what else could possibly be “tweaked” to improve the performance even more?

I was impressed that Dr. Sheraton was keeping her scoreboard.  At the same time, she did recognize a couple of areas that were deficient:

  • Percent of periodontal procedures were not within industry standards
  • The practice was not growing at the rate that she felt it should based on the number of new patients coming in
  • The number of hygiene days were unchanged over the past 5 years

Managing your practice’s statistics is helpful in understanding the primary health of the practice. It is also necessary in helping your business team be accountable for their performance. They appreciate the fact that the doctor is aware of their hard work to keep the practice stats healthy. It is the intangible areas of practice management that dentists are unaware of that make the difference between a good practice and an outstanding practice. Let’s review a couple of these areas relative to Dr. Sheraton’s practice.

Increasing Periodontal Production
It starts with the doctor and the hygienists being on “the same page” from a diagnostic standpoint.  Do you recommend Scaling and Root Planing (SRP) with 4mm and bleeding or 5mm and bleeding? Do you use bone loss as a guideline as well? How do you diagnose isolated periodontal pockets versus a full quadrant, and how do you bill those isolated areas so it is reasonable and fair to the patient? This article is not written to address all these issues, but instead, to bring it to your attention to help you see that there are guidelines within a practice that need to be established to improve diagnosis and treatment planning for periodontal therapy.

How do you market this need to your patients? Do you have helpful brochures, photos, etc. that will assist your patient in “selling” their diagnosis to their spouse or other co-decision-maker at home? There is a very good chance that when your patient shares this information with someone at home, they are going to receive negative comments that could lead to the cancellation of their appointment for treatment.

No one likes to be the bearer of bad news. However, “supervised neglect” is right at the top of the list of reasons that doctors are sued. You don’t want to attempt to explain to your State Board why your patient with 5-6mm pockets and bone loss, who obviously is experiencing all the indications of periodontal disease, was undiagnosed and untreated.  Remember that it is not your fault or your hygienist’s fault that your patient has the misfortune of having periodontal disease. However, it IS your responsibility to diagnose it, and it is your hygienist’s responsibility to educate your patients and encourage them to accept treatment.

Practice Not Growing
First, let’s define “growing.” A practice can increase production and collections annually by increasing fees and adding additional services for patients. For our purposes here, “growing” is when the active patient base increases. What is considered active? Patients that have been seen in the past 12 months in hygiene and are scheduled or due to be scheduled over the next 12 months.

Why is this definition important, as opposed to patients that were seen in the past 18 months? A “patient” could have been seen in the practice 7 months ago, for example, for emergency care. They were not interested in a comprehensive exam or seeing the hygienist. They only wanted pain relief. All dental offices have these patients, and that is okay. It allows the practice to provide a service to the community and it is a revenue-maker.

Another “patient” was seen in hygiene 14 months ago. They did not reschedule their hygiene appointment or possibly scheduled and subsequently canceled their appointment. As a result, they are not in the recall system for the next 12 months.

So what, you ask? These patients are NOT contributing to the growth of the Hygiene Department, and this is where the growth must take place. If your practice, as with Dr. Sheraton’s, has not added another day or more of hygiene in the past 12 months and you are continuing to see 25-30 Comprehensive Exams per month, your system is broken - but you don’t know it! At least 50% of a dentist’s production comes from the recall patients. The more mouths you look in, the more opportunity you have to diagnose treatment or reconfirm the already-diagnosed treatment.

Summary
Systems were placed in Dr. Sheraton’s practice to monitor the growth of her practice from the standpoint of the increase in her active patient base. She is scheduled to bring on an additional two days of hygiene as the past due recall patients are “reactivated.” A system was implemented to plug the hole that was allowing active patients to “escape” from the practice without follow-up.

Follow your instinct, as Dr. Sheraton did. She recognized that something was wrong with her practice, but she didn’t know what it was or how to fix it. She did everything she knew to monitor the statistics, but “she didn’t know what she didn’t know.” Find out what you “don’t know” by contacting McKenzie Management. You will be glad you did!

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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