Tackling The Not-So-Tough Questions That Keep Patients From Treatment
Still struggling up the paper chart mountain? You might as well write it on stone because that is as “with the times” as you are. Recently, I read an article in a local newspaper that “fluffy” toilet paper is not made from recycled product but from living trees because living trees produce a softer touch. To save trees, I will live with regular tissue. What is going to make you quit the paper and go chartless in your practice? As senior trainer for McKenzie Management’s Advanced Training Courses, it is apparent to me from the feedback of business teams that they are being held back on this technological advance by their employers. Hungry to use more than the typical 20–30% of their software program, they ask me, “How can I get my employer to go chartless and start using the clinical chart, treatment phasing and the periodontal module in the computer?” If saving a tree is not sufficient motivation, how about saving money?
Doing double entry becomes troublesome when time management is a barrier to better productivity. In many practices, doctors don’t seem to mind that the business team has to keep records on paper and digitally for accuracy. These same practices often employ extra staff to pull charts and then file them back at the end of the day, along with letters, radiographs, etc. Paper is becoming more and more expensive—as is the square footage to store all those charts. There is a lot of waste in this system. What are people waiting for? The doctor is afraid of losing all of the information should the computer go down. Or, When the computers are down we cannot get into the files, but if we have the paper charts, we‘re saved, say the trainees.
How many offices have emergency generators for electrical blackouts? If the fear is a computer crash on a daily or weekly basis, you need to get a computer support person in there who can troubleshoot your network or wiring issues. It is always wise to have someone with these talents as a member of your team or at least have a relationship with a company that has agreed to respond to your call promptly. But most offices say that they rarely have such problems (or they are short-lived at most) and that this is a small annoyance when you consider the efficiency of managing data electronically. Replacing paper with digital is not a trend that is going to end. Eliminating the need for a paper chart is something that is achievable now. We will still have to deal with paper but it will be a molehill and not a mountain.
What is the best plan to achieve this change without upsetting the flow of the office? Look at every piece of paper and form used to create the paper chart and then match it to its digital counterpart in the software program. Most offices have the appointment scheduler and the ledger posting under control and thus have eliminated the large paper appointment book and the pegboard system of tracking charges and payments. This is the first step. Keep up with software updates to keep your system support ongoing. If you have an old computer system, you will most likely need to upgrade to a system with full operating modules that handle insurance estimating, e-claims, tracking, and treatment planning and maintain a recall system and patient retention information. Your system must be compatible with the digital program that you intend to install. You must have security for the transfer of patient data and a fail-proof back-up system that is off site for best protection.
In the clinical operatories, computers and monitors are necessary for the clinical team to enter treatment plans and to record clinical notes. Hygienists must have a computer and monitor in order to record periodontal charting and recommended treatment notes. Having a system that allows for full integration of digital x-rays and intraoral photos is necessary to make accurate diagnosis and impressive treatment presentations.
Changing old habits is the biggest challenge, but realize that there is a learning curve to anything new. Keep focused on the benefits that going chartless will bring. Some of these benefits are
So get out of the Stone Age of paper charts and get into the cleaner, more efficient digital solution. For help implementing new systems, contact McKenzie Management today.
For more information about McKenzie Management’s Advanced Training courses, email firstname.lastname@example.org, call 1-877-777-6151 or visit our website at www.mckenziemgmt.com.
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Dr. Tim Lewis—Case Study #452
As a practice management consultant, there is nothing more gratifying than to have a doctor and team reach their goals! The purpose of this article is to help other practices look at their success or their struggle by making a comparison to Dr. Lewis’s practice goals. Keep in mind that this is not about reaching a specific production dollar amount compared to other practices. Each practice has its own unique production/collection goal.
How To Determine Your Monetary Goal:
Establishing a monetary goal is the most important standard that you should set. How do you and your team know how well you are doing if you don’t have a goal to reach every day? It would be like playing a basketball game and not keeping score. There is nothing to celebrate at the end of the game. Dr. Lewis learned to set these goals and put in place a course to achieve the goals.
First, review your employee gross wages for the past 12 months and your net collections. Gross Wages / Net Collections = Gross Wage Overhead. Salary standard in the industry is 19–22% of net collections for a general practice. In most cases, you can now establish what your collection goal needs to be for the next 12 months, assuming that no drastic changes are planned for staffing, new facility, etc. (Remember that practice management overhead is not the same as what your accountant calculates.)
Let’s say that your Gross Wage Overhead for your team is at 24% and you want it to be 20%. First, determine what your production adjustments were for last year. These are adjustments that reduced your patient fees such as employee discounts, insurance adjustments, senior citizens courtesies, etc. If your adjustments were 20%, you will need to divide your collection goal by the inversion of 20%, or 80%.
Because your Schedule and Hygiene Coordinator schedule to a production goal and not a collection goal, this step must be performed to correctly calculate your daily goal.
Determine what your hygiene goal should be based on one of two factors:
Keep in mind that the more they produce the less the doctor needs to produce!
Monthly Gross Production Goal – Monthly Hygiene Goal (daily ?? x number of days worked) = Doctor Monthly Goal. Divide the Doctor Monthly Goal by the number of days worked = Doctor Daily Goal.
This math can be done on a yearly scale if you prefer not to re-calculate the goals every month. I would recommend that you calculate it yearly to save time and avoid changing the daily goal each month.
What Dr. Lewis Learned:
Once the goals are in place, it is a matter of establishing system goals in order to achieve the production and collection goals. Here are some examples:
How Does This Apply To You?
Doctor, as the captain of your ship, it is important to know where you are sailing and how you are going to get there. Setting daily, monthly and yearly goals are critical to mapping a successful course. You must have a trained crew that understands what they need to do every day. Recognition for a job well done is invaluable to the morale of the office and encourages teamwork for meeting common goals.