Dismissal – Whose Job is It Anyway?
“Mrs. Jones, did doctor
happen to mention what he was charging you for today’s procedure?”
Yes, you read that line correctly. The employee is asking
the patient how much she should be charged. Believe me; I’ve
seen this scenario play out more often than you care to know. The
front desk employee is trying to dismiss a patient, but the employee
does not know what the charge is for the visit,
nor does she know exactly what procedures have been performed, and
it’s likely she doesn’t know if the patient is to be
scheduled to return.
before you start rattling off a string of negative comments about
the incompetence of the front desk employee think about the check
out procedures in your office. Do you make certain that
you and your assistant complete all of the necessary paperwork on
a patient before you send them to the front desk? Do you have a
clear standard operating procedure for patient
dismissal in your practice?
often Ms. Front Desk is twisting in the wind. She waits, watches,
and hopes that the chart is going to come sprinting to the front.
It isn’t. Once the chit-chat time is exhausted, Ms. Front
desk makes a final attempt to actually take care
of the patient. She politely excuses herself and goes ripping through
the office in search of necessary documentation
to actually do the job you’ve hired her for.
should patients be dismissed in your office? Read on.
Near the end of the procedure when the doctor is finishing the restoration,
checking the contacts with dental floss, and checking the occlusion
with articulation paper, the dental assistant should rise from her
chair and remove her gloves and log today’s procedures
in the patient record. (Logging into a computer terminal
instead of a paper record would be ideal.)The assistant confers
with the doctor to ensure that she is documenting the correct information.
For example, “Doctor, was that an MO on #30 that we did for
Mrs. Jones today?” The assistant also asks if Mrs. Jones needs
to come back, reiterating the next step on the patient’s
doctor confirms or corrects the statement and dictates to the assistant
any other information that he/she would like documented in the progress
notes. In some states, the dentist is legally required to
sign off on the entry. Other states only require that the
assistant initial the entry. The doctor also indicates the next
step in the treatment plan. “We’ll need to see Mrs.
Jones again for 3 units on #14.” The doctor will then explain
to Mrs. Jones that at her next appointment they will be treating
the tooth on the upper left side.
patient record and charge slip are complete. At that point the assistant
leaves the operatory and seats the next patient in the next chair.
The dentist finishes up with the patient, says goodbye, then moves
on to the next treatment room to administer the anesthesia.
Oftentimes when patients beat their charts to the front desk it
is because the dentist has given the patient the signal to flee.
He/she removes the bib and adjusts the chair –
the universal signals that this appointment is over and the patient
can leave. When the dentist finishes he/should thank the patient,
leave the bib on and explain that the assistant will be right back
to dismiss them.
assistant returns, provides necessary post-op instructions, explains
what the doctor did, raves about the quality of
the doctor’s care. She then removes the bib from the patient
and uprights the dental chair. With patient chart and necessary
paperwork in hand, the assistant escorts the patient to the front
desk. Her attention remains focused on the patient.
The assistant hands the records to the front desk and thanks the
simple procedure ensures that the focus is always on the patient,
and no longer will the front desk staff have to walk away from their
jobs to finish yours.
you have any questions or comments, please email Sally McKenzie
in having Sally speak to your dental society or study club?
Gingivitis Contribute To Systemic Disease?
Review of the Literature
Dr. Allan Monack
Hygiene Clinical Director
Physicians and dentists have become increasingly aware of the link
between gingival inflammation and increase risk to cardiovascular
disease, stroke, and low birth weight. There is growing evidence
that other health problems are influenced by periodontal disease.
What are the pathways that influence the systemic disease process?
The July supplement issue Vol. 25 of the “Compendium
of Continuing Education in Dentistry” lists four
systemic dissemination of locally produced inflammatory mediators,
provocation of an autoimmune response, and aspiration or ingestion
of oral contents into the gut or airway.
It is possible that oral biofilms serve as a reservoir for respiratory
pathogenic bacteria. (1) It has been shown that lung function
is reduced by periodontal disease. Patients with more attachment
loss tended to demonstrate less lung function than patients with
less attachment loss.(2)
Adverse Pregnancy Outcomes
There is evidence that gingival inflammation influences the birth
process. It is believed that chronic infections stimulate the inflammatory
process. This causes inappropriate levels of prostoglandins and
TNF-a, which can cause uterine contractions and promote preterm
birth. Recently, periodontal pathogens, such as Fusobacterium
nucleatum, originating in the gingival sulcus have been found in
the placenta. (3) It is possible that these bacteria enter the bloodstream
thru the periodontium to directly effect premature birth.
Periodontal diseases are associated with an increase in C-reactive
protein (CRP) levels. CRP has been shown to be a more predictive
marker for acute coronary events than are low-density lipoprotein
(LDL) levels. (4) Periodontal pathogens such as P gingivalis have
fimbriae that allow it to attach to host epithelial and endothelial
cells. (5) and produces proteases that degrade collagen. (6) These
and other pathogens may contribute to the development of artherosclerotic
lesions when they enter the bloodstream thru the diseased periodontal
pocket. Mattila et al (7) examined patients with acute myocardial
infarction. Their study showed that poor oral health correlated
directly with coronary heart disease (CHD). A National Health and
Nutrition Examination of nearly 10,000 individuals indicated a 25%
increased risk of CHD. (8)
periodontal inflammatory process has been shown to release cytokines.
These in turn are linked to the formation of polymorphonuclear (PMN)
leukocytes. PMN can cause oxidation of LDL, which stimulates production
of fibroblast growth factor, which is linked to the formation of
a bulge of the luminal wall of the cardiovascular arteries. (9)
The increase in CRP also contributes to vascular damage in the brain,
leading to strokes. This direct result to the inflammatory process
causes blood vessels to dilate and become more permeable. The result
is increased blood flow and plasma leakage into the surrounding
It is imperative that dentists communicate the seriousness of periodontal
disease. It has been demonstrated that inflammation caused by periodontal
disease affects the systemic health of your patients. Monitor and
treat early signs of periodontal disease and you can help REDUCE
THE RISK of life threatening disease for your patients.
1.Scannapieco FA, Periodontal Inflammation: From Gingivitis to Systemic
Disease? Compendium Vol. 25 No.7.16-25
2.Scannapieco FA, Ho AW. Potential associations between chronic
respiratory disease and periodontal disease. J perio 2001:72:50-56
3.Han YW, Redline RW, Li m, et al. Fusobacterium nucleatum induces
premature and term stillbirth in pregnant mice: Infect. Human. 2004:72:2272-2279
4. Glurich I, Grossi S, Albini B, et al. Systemic inflammation in
cardiovascular and periodontal disease. Cin. Diagn.Lab Immunol.
5.Dan BR, Burks JN, Seifert KN, et al. Invasion of endothelial and
epithelial cells by strains of Porphyromonas gingivalis. FEMS Microbiol
6.Holt SC, Kesavalu L, Wailer S, et al. Virulence factors of Polhyromonas
gingivalis. Periodontol. 2000. 1999:20:168-238
7.Mattila KJ, Nieman MS, Valtonen VV, et al. Association between
dental health and acute myocardial infarction. BMJ. 1989:298:779-781
8. DeStefano F, Anda RF, Kahn HS, et al. dental disease and the
risk of coronary heart disease and mortality. BMJ. 1993:306:688-691
9.Anayeva NM, Tjurmin AV, Berliner JA, et al. Oxidized LDL mediates
the release of fibroblast growth factor-1. Arterioscler Thumb Vasc
10.Sbordone L, Bortolaia C. Oral microbial biofilms and plaque-related
diseases: microbial communities and their role in the shift from
oral health to disease. Clin. Oral Investig. 2003:7:181-188
you have any questions concerning your hygiene program submit them
to me at firstname.lastname@example.org
and I will answer them in future articles.
in having Dr. Allan Monack speak to your dental society or study
DOES YOUR OVERHEAD
You Scheduling…By ACCIDENT?
is not enough to be busy, so are the ants. The question is, what
are we busy about?”
Henry David Thoreau
Belle M. DuCharme
RDA, CDPMA, Director
The Center for
Dental Career Development
Center for Dental Career Development, I teach a course that
enhances the skills of Scheduling Coordinators. I feel, after my
35 years in dental offices and my experience with doctors and staff
at The Center, that formal business training for
a Scheduling Coordinator is a must. The job description of a scheduling
coordinator includes duties of a receptionist,
but by no means is the person responsible for “making your
day” just a “receptionist”.
In smaller practices that see less than twenty patients
a day, the Scheduling Coordinator is
the Financial Coordinator. Not only does she have to create
the day she must see that you get paid for that
day. In either situation, your Scheduling Coordinator needs
to understand the “background and figures” that determine
how the schedule should be created.
Let’s compare two women from two different practices a thousand
miles apart. Jane was hired a month ago as a Scheduling Coordinator.
Her office had McKenzie Management’s consultant
in last year to analyze the office systems and give recommendations
for improvement. All systems were in place and the office was running
smoothly and profitably. Jane had a written job description and
a clear idea as to what she expected from our training session.
The office was seeing an average of thirty three new patients a
month and the office was meeting or exceeding production and collection
goals each day. How do I know? She brought the reports with her.
I was able to train her more effectively knowing the production
per hour goal. Why is that important for a Scheduling Coordinator
to know? The business side of dentistry has overhead to meet monthly
and without an actual number to work with, scheduling is
by chance. The stress of a $500 day and the stress of a
$5,000 day can cause a practice to be “manic depressive”
as you ride the roller coaster of chance.
came in for the Scheduling Coordinator course with an unclear job
description. Her office did not have McKenzie Management
in for consulting services. She had a title of Business Administrator
on her business card, yet a written job description listed her as
Manager of Production. She was instructed by her
employer to speak to other employees about behavior issues only
to be told, “You are not my boss.” This issue was distracting
her from her main position of Scheduling Coordinator.
over the reports, I noted that the new patient average for the year
was only six patients a month. The schedule for the doctor was routinely
booked out eight weeks or more with no open time
reserved for new patients. They had recently decided to stop pre-booking
hygiene appointments due to the frequency of cancellations and failed
appointments yet they were unable to appoint new patients because
the doctor was booked solidly for eight weeks or
more. New patients were seen on a cancellation base only. This is
very poor customer service and is the reason they could see only
six new patients a month. I asked Martha what the production per
hour goal was for her office. She replied, “ I don’t
know, Dr. L asked me to pick a figure that sounded
good.” After showing her the overhead figures and how to calculate
production per hour based on fees and the amount of time doctor
needs per procedure, she became enlightened and had a new
found sense of ownership of what she was doing for the
practice. She left here far more confident than when she arrived.
you would like more information on how your systems, and the performance
of your employees can reach peak levels. Call us at 1-877-777-6151.
M. DuCharme, RDA, CDPMA
YOU LIKE TO HAVE
Exceptional Front Office Employees?
look forward to each new day with my team, and what we
will accomplish today that will create the tomorrow that
I want. I am happy because I feel in control again. I
am happy because I understand my and my team’s role.
I am happiest to have my feelings of fear, for the future
of my practice, diminishing daily and being replaced by
am looking forward to having my finger on the pulse of
my practice again. Thank you McKenzie Management.
WANT TO BE
Insurance Coding Handbook
manual is an office essential!
Much more than just codes and definitions, this manual helps you
speed up insurance reimbursement, reduce requests for "more
information" and decrease payment delays! Additionally, under
the provisions set by the HIPAA Act, all dental offices and insurance
carriers that transmit health information electronically must
use the current version of dental procedure codes found in this
Handbook. Also, you will receive information on treatment estimates
and how to talk to patients about insurance.
*Good Through 11/20/04
Missed Past Issues of Our e-Management Newsletter?
What is the best approach to take with patients who need to come
in for recall but they owe us money?
First of all, don’t avoid contacting the patient. Confront
the patient but have as much information about the patient’s
payment as possible. For example, let’s take a patient who
has dental insurance and their coverage will pay 100%. State the
facts to the patient, i.e., you have a balance, you’ve been
paying your commitment, we appreciate it, you’re due for this
service, your insurance should pay 100% so you shouldn’t be
incurring any additional charges to your account, let’s schedule
let’s approach the situation where the patient will be responsible
for paying and there is an existing balance.
“Mrs. Richmond? Hi, this is Carol from Dr. Thompson’s
office. I wanted to let you know you’re due for your periodic
oral health exam and professional teeth cleaning. Because you have
an existing balance of $320, we will expect you to pay for the service
when you come in, which would be $125 or would you rather we keep
checking your account status and notify you once your account has
been paid in full?”
This shows consideration on the part of the office rather than being
inconsiderate by not addressing the patient’s financial concern.
this answers your question.
OUT OF YOUR
Center for Dental Career Development
Business Education for Dental Professionals
Pearl Street, Suite 201
La Jolla, CA 92037
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