12.04.09 Issue #404 Forward This Newsletter To A Colleague

Jean Gallienne RDH BS
Hygiene Consultant
McKenzie Management
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Some Reasons Why Hygiene Departments Don’t Produce

So many hygiene departments are not producing enough income. As a result, doctors are looking for help in trying to find out why their hygiene is not profitable and how can it be fixed. First, let’s look at some of the reasons why hygiene departments are under producing.

The number one reason is that recall is not continuously worked in a systematic way that will keep the hygiene schedule full. If you just count how many hygiene appointments were not filled, last minute cancellations, or no shows in the last month and multiply that by what the average hygiene appointment produces, this will give you one portion of the puzzle. However, the other piece of the puzzle usually has to do with the periodontal side of the production being low. This may be because of the way things were done in the past, i.e., misuse of codes, or periodontal therapy not being treatment planned correctly or on a routine basis.

There was a time when the hygienist would do root planing and then the patient would return in 3 months and be billed as a prophylaxis. Then the patient would continue to return at a 3-month interval, and continue to be billed out as a prophylaxis. Eventually the patient may be referred to a periodontist and the patient may refuse to go. So the hygienist keeps cleaning them as a prophylaxis every 3 months. This is still true in many offices today.

The other thing that has happened in practices is that they learned that the patient should be billed as a periodontal maintenance once they had root planing. The next time the patient came in for what they thought was going to be the cost of a prophylaxis, they were now billed out as a periodontal maintenance and it cost more money out of the patient’s pocket. Now the patient is on the phone complaining and mad at the front office, hygienist, and the doctor because they did not perceive anything different was done and they were billed more for the same procedure, it was just called a different name. This caused a lot of patients to seek treatment elsewhere because they lost trust in the dental office.

Then there are the offices that are probing the new patients and continuing to follow the old way of thinking that only 5 mm or above need to be root planed. So they use the code for full mouth debridement and having the patient return for a prophylaxis in 2 weeks and then come back in 3 months for their continuing care. The problem with this is that the patients that are being billed out as full mouth debridement probably need to be treatment planed for root planning, whether it is one to four quadrants, 1-3 teeth or 4 or more teeth. They are not entering the correct insurance code with the treatment needed.

The code for a full mouth debridement is very specific in its use and I may have seen two patients in an entire year that require this code. Misusing the full mouth debridement code is not doing a favor to your patients, hygienist, or practice production. Using this code is usually under-treating a periodontally involved patient, and makes the hygienist work twice as hard at half the cost that it should be done. It usually costs the patient more out of pocket money also. Many insurance companies will not even cover the full mouth debridement code. Even if they do, it may only be covered once in the patient’s lifetime or it may only cover a portion of the amount.

There is always the concern of the periodontal maintenance being put in the computer correctly and linked to the correct code and months in the future. In many software, if the patient is anything other than a 6 month prophylaxis, you have to actually go in and change the months and put it in as perio. When this is not done correctly, you have patient recall that should be at 3 months set for 6 months. As a result, the patient will receive two less appointments than what they need, and this is two less possibilities in a year that an appointment could have been filled with a patient that needed it. This will add up quickly if not caught, and when they do return, it will be in the computer as a prophylaxis and not a periodontal maintenance. The result - your office will bill it out as a prophylaxis and not a periodontal maintenance, causing the production per hour to be less.

All of the above and more are causes of why many offices are under productive when it comes to looking at the periodontal production compared to overall production of the hygiene department. Thirty three percent of your hygiene production should be periodontal therapy treatment.

Interested in knowing more about how to improve your hygiene department? Email hygiene@mckenziemgmt.com.

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