In Lean Times, Remember the Rule of 33
Recently, I received a phone call from a dentist who was considering cutting one of her hygienist’s hours and instituting an assisted hygiene program. Between her two hygienists, the practice was averaging six cancellations and/or no-shows per day. Understandably, this doctor was extremely concerned. There were a variety of factors contributing to this office’s situation, but “word on the street” is that more than a few practices have seen hygiene holes skyrocket, which makes this a good time to revisit a few of the fundamentals of successful hygiene departments.
In 95% of the practices that McKenzie Management works with, hygiene alone is losing $35,000-$150,000 annually – and that number has likely gone up over the past 12 months. This says nothing of the thousands of dollars in additional dentistry that also disappears, all because patients aren’t in the chair.
To maximize the effectiveness of your hygiene department, follow the Rule of 33. This means that the hygiene department is expected to produce 33% of the total office production, not including doctor's exams. Each hygienist provides 33% of their production in periodontal procedures such as 4910, 4342, and 4381. And the hygienist’s compensation should be no more than 33% of his/her production. If the hygienist receives a guaranteed salary, the expectation must be that she/he produces three times his/her wages. If the hygienist is paid $40 an hour and the cost of the prophy, not including the doctor’s exam, is $80, the hygienist is making 50 cents on the dollar, well above the 33% benchmark. In some cases, fees are too low.
To determine where you stand on the Rule of 33, retrieve the production analysis reports from the practice's management software prior to your monthly meeting and report the results to the team. Next, take a good hard look at recall. Oftentimes when hygiene salaries outpace production, it’s because no one is paying attention to recall. Doctor and staff are lulled into complacency by the appearance of full schedules rather than the reality of last minute cancellations and no shows.
I know that many of you are all too familiar with this scenario: It’s 9 a.m. on Monday morning, and Jane the hygienist is having coffee and perusing the supply catalog because nothing else was on her schedule at this hour. On Wednesday afternoon, she’s organizing magazines in the reception area. Obviously, Jane is not as busy as she should be. And sitting around waiting for patients is every bit as agonizing and stressful for most hygienists as it is for most dentists. It’s time to face the reality of recall. The recall duty is the “red-headed step child” of practice management systems. It is commonly tossed aside, disregarded as a nuisance, and all but forgotten, but it is critical to the financial health of the practice and the financial health of the hygienist.
Part of the problem is that dental offices will blindly rely on six-month scheduling, sending the recall system into autopilot. The lack of accountability typically results in high cancellations and appointment failures. Practices using this technique squeeze out only about 76% patient retention and, if that weren’t bad enough, they have a nearly 50% higher loss of patients than similar-sized practices that do not pre-appoint. The patient base goes down; the overhead goes up.
Integrate a new system. At the next appointment, the hygienist should clearly explain the need for follow-up prophies and exams to the patient. Ask the patient to address the envelope in which their recall notice will be sent. The hygienist writes a personal message to the patient on the professionally written recall letter, noting something specific relating to that patient’s dental needs. Also included in the mailing is an educational brochure relating to the patient’s condition.
If you pre-schedule patients for their six month appointment, the office absolutely must confirm all appointments using not only the telephone but also email confirmation and/or text messaging. Most patients today would much rather receive an email or text message than a phone call. Moreover, they are far more likely to respond promptly if communicated with using these common everyday technologies.
A successful recall system helps patients to secure the dental care they need in a timely fashion – one of the primary responsibilities of your practice. Next week, who’s dropping the ball on recall?
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