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2.10.06 Issue #205  
   
On Your Mark! Get Set! Stop!
Unscheduled Treatment's Holding You Back


Sally McKenzie, CEO
The McKenzie Company
sallymck@mckenziemgmt.com

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Do you ever feel like you just can’t get your practice off the starting blocks? You run into situations like this one regularly:  The patient, Mrs. Thompson, comes in for a routine appointment in June. She has a dental condition that you recommend she have addressed but, despite your advice, she doesn’t schedule the treatment.

In December, Mrs. Thompson is back again for another routine visit. She still hasn’t scheduled the treatment you recommended back in June. Why? This $64,000 question often has one obvious answer. Because the practice does not have a protocol for treatment presentation and follow-up. Yet the financial impact of this seemingly minor detail is nothing short of enormous. In some offices, we’ve seen nearly half-a-million dollars relegated to mere notations in the patient records – treatment that was diagnosed but never scheduled. 
                                                                                              
Take steps to turn those notations into real numbers. First, designate a member of the team to serve as treatment coordinator. This is your point person for treatment presentations. While the dentist plays an integral role in case acceptance, and the entire team is essential in continuously reinforcing the doctor’s recommendations, the details of the presentation are most effectively delegated to a trained member of the team.

The treatment coordinator follows a specific plan to achieve defined treatment acceptance goals, starting with existing patient records. As routing slips are generated for hygiene and other upcoming appointments, the treatment coordinator conducts record “audits” to determine which patients have outstanding treatment and schedules case presentations in conjunction with those appointments.

The treatment coordinator presents the treatment plan that the doctor believes represents the very best care for the patient. An effective treatment coordinator has been trained to stick to the plan and is able to effectively address patient objections or concerns without sacrificing the doctor’s recommendations. In addition, she/he follows a carefully formulated presentation for discussing treatment with the patient. The format, such as the one below, is a logical step-by-step strategy that enables the treatment coordinator to be fully prepared and the patient to be fully informed about the treatment under consideration.

  • Examine the plan and treatment options before the presentation. This will involve reviewing the record and it may require that the coordinator sit down with the doctor.
  • Clarify any aspects of the plan that are not completely clear with the doctor or other provider. There’s no room for guess work or “I think this is what the doctor is recommending.” That will never fly with the patient.
  • Review the case presentation mentally and if you are new to the process rehearse it verbally, so you are comfortable with the flow of the presentation.
  • Use necessary X-rays, models, or other visual aids during the presentation. Patients are most likely to respond favorably when they can actually see what the doctor is recommending, why he/she is recommending it, and what the results will be.
  • Use any other available educational handouts to underscore the case presented.
  • Prepare pre-determination or pre-estimate if that is part of the office routine.
  • Calculate the patient’s portion of payment using the insurance information received or estimate to the best of your ability.
  • Provide reasonable financing options such as those offered by CareCredit. These benefit the patient but not at the expense of the practice. And patients are far more likely to accept treatment when they can make affordable financial arrangements easily and quickly.
  • Respect the patients’ privacy when discussing financial arrangements. One of the fastest ways to undermine a signed, sealed, and nearly delivered treatment plan is to send the patient to the front desk to make financial arrangements before the waiting room audience. All arrangements and financial discussions should be made in private.
  • Have paper and pen available for the patient to take notes.
  • Give the patient plenty of opportunity to ask questions and raise concerns.
  • Address the patients’ concerns and answer questions thoroughly.

Remember, patients look to you and your team, as the dental professionals, for sound advice and encouragement to proceed with recommended care. If they perceive that you don’t feel specific treatment is important because you’ve only mentioned it to them once or twice or haven’t taken the time to spell out specifics, they simply won’t feel it is necessary. In many cases, patients are simply waiting for more information or enough information to justify pursuing treatment.

Interested in having Sally speak to your dental society or study club? Click Here.

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Leadership Lessons from a Home Remodel


Dr. Nancy Haller
Executive Coach
McKenzie Management
coach@ mckenziemgmt.com

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If you’ve been a reader of my column, you know that I find leadership lessons embedded in everything around us. From football coaching to reality to TV, I see examples of what leaders should and should not do. For the past few months I’ve had my own personal leadership training…in my home remodel of all places. Although I wasn’t running a Fortune 500 company, getting this project done on time and within budget was very challenging. I also had to manage a myriad of other life obligations simultaneously. The process was stressful and draining, but difficult experiences teach us the greatest lessons. While the outcome was favorable – my new bedroom and bathroom turned out great – I made the process more trying than it might have been had I adhered more closely to basic leadership principles. Here are my ah-ha’s.

  1. Having a vision is only a step toward your destination.

After thumbing through hundreds of magazines, visiting an assortment of showrooms, and talking with friends who had been through a remodel, I knew what I wanted. Or so I thought. After all I had a folder stuffed with pictures I collected during the previous six months. My general contractor nodded in approval when he saw them. Having an action-oriented style I jumped into demolition and construction quickly, believing we were on the proverbial ‘same page’. In hindsight it’s amazing that the end results turned out so well. 

Lesson: Take the time to develop a structured, detailed plan. A ‘map’ of what you want in your practice leads to the best outcome. 

  1. Choose the best people.

Fortunately my biggest investment of time and energy was in the selection process and it paid off. In fact, by hiring a great general contractor I was able to overcome aspects of the project that I did not handle as well.

Lesson: Be smart in your selection of staff. Employees can make or break your practice. If you do nothing else, hire the best people you can.

  1. Communication is a two-way street.

Though I pride myself on being a good communicator, what I said was not always what my contractor heard. And vice versa. At times we looked at each other as if we were speaking different languages. In truth we were. He’s experienced in construction and I am not. He’s a big picture thinker and I’m detailed. He operates well in the 11th hour. I hate last minute decision making.

Lesson: Know your staff, how they think and talk. Strive to close the gaps between different communication styles.

  1. Effective leadership means staying the course.

I’ll confess. Before and even during this remodel I had second thoughts. I wondered why I was doing it. I felt aggravated by the noise, the dust, the disruptions. The mantra one day at a time combined with my vision helped me to tolerate the process.

Lesson: Keep your eye on the destination. Leadership is hard work. Commit to your goals and strive for them no matter what. Remember to take care of yourself along the way.

  1. Evaluate your progress.

The project is done. There are a few loose ends to tie up but life is slowly returning to normal in my home. It’s fun to see the fruits of my labors, to realize that my trials and tribulations were worth it after all. It’s time to celebrate. And it’s time to evaluate. I credit myself for the positive contributions I made to the outcome. Those are my leadership strengths. Of equal importance is to note what I could have done differently. Not in a critical way but from a learning mindset perspective. By reflecting on these lessons learned I will be more effective in the future.

Lesson: Periodic self-assessment is crucial for leadership success. When and how are you most effective? What will you do in the future to use those qualities more often?

Research shows that the best leaders enhance their skills with on-going learning. By developing new abilities you improve not just your practice but also your personal life. When you navigate through challenging situations and accomplish your goals you gain confidence. In turn you’re more resilient, and more successful.

I’m off to remodel the kitchen next.

Interested in having Dr. Haller speak to your dental society or study club?
Contact her at coach@mckenziemgmt.com

To review her presentations, go here.

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Prophylaxis to Periodontal Based Hygiene Department


Jean Gallienne RDH BS
Hygiene Consultant McKenzie Management

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One of the many questions I have been asked is how do we take our prophylaxis based hygiene department to a periodontal based hygiene department? Hopefully you have been reading the past articles on how to monitor and progress aggressively with the treatment of periodontal disease.

I was recently asked this question by a dental office. “What do we say to our REGULAR patients when we charge more for their periodontal recall appointments- these are the "true" perio patients that have been seen previously by a periodontist and now we are charging MORE for the "SAME" treatment they have been receiving previously. We need help/scripting regarding this problem ASAP...

Part of the curriculum of the Advanced Hygiene Performance Enrichment Program that is taught is not only what the hygienist tells the patient, but even more importantly what the patient perceives. Therefore, the hygienists may want to do something different at the periodontal maintenance appointment (4910) than they did at the continuing care appointment (1110). As dental professionals we are well aware of the difference in the amount of work required when performing the treatment on a periodontal patient versus a continuing care patient.

However, the patient is going to have a hard time accepting that the treatment they are receiving is any different than any other prophylaxis. “After all, it feels like the hygienist is doing the same thing he/she has always done.Why should I pay more than I did in the past? I just want a cleaning.”   First words of advice, eliminate the words cleaning and deep cleaning from the entire staff. Educate the patient with the terminology prophylaxis, continuing care appointment, periodontal maintenance appointment and root planing. This starts at the initial phone call and the entire life of the patient in your office.
 
Now the question is, “How can I change the patient’s perception when it comes to a periodontal maintenance appointment versus a prophylaxis?”

The easiest and most beneficial to the patient is to really evaluate all of the patient’s periodontal condition. If you were not doing this in the past, now is a good time to start, it is never too late. If there is still bleeding while scaling and you have been doing periodontal maintenance appointments and billing out for prophylaxis for the last two or three years you may want to treatment plan the patient for root planing, 4341 or 4342 depending on what they need. This may be the time to refer the patient to the periodontist. This is one of the many protocols that the Advanced Hygiene Performance Enrichment Program will help your office establish.
    
Once you have determined that four quadrants of root planing are required, make sure you have the financial coordinator go over the treatment plan and that the periodontal maintenance fee is included in the treatment plan.

This is also when the hygienist and the financial coordinator would explain to the patient about the four quadrants of root planing that are needed and make sure to explain to the patient that "You will have periodontal maintenance appointments until the health of your gums stabilizes. If you continue to improve and your condition stabilizes, we may be able to extend the amount of time between visits. However, if your periodontal disease should relapse, further periodontal therapy may be necessary. We will continually evaluate the health of your tissue. "  This verbiage is designed that you may modify the above words and find the conversation that best suits you.

When the existing patient returns for their first periodontal maintenance appointment something different will need to be done. Of course this would be determined by the needs of the patient after the clinician has determined what would benefit the patient most. Any of the following treatments may be incorporated in a periodontal maintenance appointment.

  • Removal of subgingival and supragingival plaque and calculus
  • Utilization of an ultrasonic or piezoelectric scaler
  • Starting in the deeper pockets first with hand scaling, an ultrasonic cleaner, or piezoelectric scaler.
  • The use of chlorehexidine in the ultrasonic cleaner
  • Anesthetizing site specific areas
  • Placement of chemotherapeutic agents (this is an additional charge)
  • May or may not polish
  • Irrigate site specific areas with the product of your choice
  • Root desensitization

These are just a few things that may be incorporated in the periodontal maintenance appointment. Remember, it is quality of care and what the patient perceives that is most important. The patient will want to feel and notice a difference in the treatment being provided.

For existing patients, this is the best way to go when it comes to converting the patient over from a routine prophylaxis to the periodontal maintenance appointment they should have been charged for all along. The hygienist will be surprised at how many patients will benefit from having root planing.

The entire staff has to be on the same page when it comes to converting all of the existing patients. It is difficult to just start billing the patients for a periodontal maintenance appointment when they have only been billed for a prophylaxis in the past without communication, protocol and a plan.

For more information on The Advanced Hygiene Performance Enrichment Program in La Jolla CA or YOUR OFFICE, email info@mckenziemgmt.com.

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