Is This Blunder Costing You Thousands of Patients?
I recently had a conversation with Dr. John. Like many dentists over the last several months, he’s experienced some challenging times. But one thing that Dr. John firmly believes is that his practice is not losing patients. He is living in a fantasy. But Dr. John, a sole practitioner, is not alone in his delusions; he is like 78% of the 128,000 general dentists in the United States. The vast majority of solo practitioner practices are losing more patients than they are bringing in, and many of them scoff at such a notion. Holes in the schedule: “it’s the weather.” Lower production: “it’s the economy.” Fewer hygiene days needed: “it’s the hygienist.” And the excuses go on - seldom will they acknowledge that they are losing patients.
We work with doctors every day who have been in practice for 15 to 30 years yet can’t quite explain why they are still solo practitioners. Some dentists have had 2,000 to 3,000 people come through their offices and never return. The harsh reality is that you are losing more patients out the backdoor than you are gaining new patients coming in the front door. Dentists commonly believe that patient records in the computer or in the files constitute active patients. In actuality, only those patients that have been in the practice for a hygiene recall appointment in the past 12 months can be counted as active patients. The recall system, or lack thereof, is a huge factor in patient attrition.
Yes, patient retention will vary from practice to practice, but it’s essential that you understand where yours falls. The loss of non-retained recall patients per month cannot be anymore than 50% of the 00150’s or new patients per month.
Patient retention is measured monthly by taking the recall patients due for the month and dividing into the recall patients treated for the month. So, at the first of the month you run a recall report of patients due for the month. At the end of the month, you will generate a production report and total the amount of perio maintenance plus periodic exams which should equal the amount of recall patients treated for the month. Remember, a hygiene patient who receives a quadrant of root planing is not a recall patient.
Next, take a good hard look at recall. It is the most important system in the practice for ensuring patient retention - and it’s also the most ignored system in the practice. How do you know if your recall system is weak? Look at the number of hygiene days. If they haven’t increased in the past 12 months, the practice is losing patients. In addition, the schedule has open time slots, however the schedule looks full because the practice schedules patients six months out. Moreover, no one on the business team is responsible for ensuring that the hygiene schedule isn’t riddled with holes or following-up with past-due patients.
Too many dental teams take it for granted that the patient will return, but when they don’t, no one follows up with them to get them back on the schedule. Pre-scheduling three and four month recall is reasonably effective. But the six month recalls are not. It is essential that if you pre-schedule patients six months in advance you educate the patients, and the business staff must follow-up with patients on the phone. Too often, it’s the follow-up that falls down.
In addition, when the patient is in the chair, communication between the doctor, hygienist and patient must reinforce the need for ongoing care. Most patients don’t think they need to go to the dentist every six months, and many dental teams are not particularly effective in convincing patients otherwise. It’s not uncommon for the dental team to refer to the hygiene appointment as a routine checkup, thereby trivializing the importance of care delivered and confirming the patient’s misperceptions.
An effective recall system includes other key components as well. The practice should be actively educating the patients. Professional recall notices should be used. The patient can be involved in the recall process by personally addressing the envelope that they will receive in the mail with their recall information and informational brochures. A business employee needs to follow up with patients to ensure that they will keep their recall appointments. In addition, the hygienist should be scheduled to meet specific production goals and there should be no more than .5 openings in the schedule on any given day.
Are You As Good As You Say You Are?
Case Study #231
Dr. Barbara Cross
On the questionnaire that our clients complete prior to the initial visit by the consultant, it is not uncommon for one of the requests to read something like this: “Need you to motivate my staff.”
Gosh, I wish I had such powers over people, but motivation must be self-induced. I can shine the light down the path, provide toolboxes, and be a great cheerleader but motivate, I can’t. This same request was made by Dr. Cross when I visited with her. “I feel like my team is in a rut. We are doing the same things over and over again and not making any significant changes for improvement. They need to be motivated.”
So let’s see what is really going on in Dr. Cross’s office.
Practice statistics at the time of my visit:
The actual dollar amount is not significant for this article. It is important, however, to note that the practice is not growing financially. Several statistical indicators illustrate that the practice has areas that need improvement.
Step #1 – This Is A Business
After revealing all my practice concerns with Dr. Cross, it was time to share my findings with the team during the presentation. Recognizing that numbers, calculations, percentages, and projections are not always everyone’s strong suit, I attempt to make my information as understandable as possible. My goal is to impress upon Dr. Cross’s team that the practice is a business. No, we don’t sell tires or clothes and our “customers” don’t walk out of our “store” with bags full of purchases. However, the practice is still a business with business concerns such as overhead, profits, losses and the need for accuracy.
Accuracy is important in all phases of the business. The patient’s demographic information must be correct in the computer in order to generate accurate statements, insurance claims and reports. The patient’s clinical information must be charted accurately by the doctor, hygienist and assistants to avoid potential errors today and in the future.
Step #2 – Analyze The Business For Strengths And Weaknesses
Now that Dr. Cross and her team understand all that must be taken into consideration when running a profitable business, information must be acquired, reviewed and analyzed and decisions must be made in order to turn the business around and make a profit. The following topics were discussed:
Fortunately, her practice was not suffering from a lack of new patients. Two years ago she had made the leap to digital radiography, thus eliminating patient paper records, and the practice had undergone a complete “makeover” last year so these topics were seen as strengths.
Step #3 – Who Can Do The Job?
As a team, and along with my guidance, Dr. Cross and her team evaluated the weaknesses of the practice. They established production goals based on where they wanted the overhead to be in 12 months in order to receive a salary increase; discussed more profitable ways of scheduling; steps that could be taken to improve patient retention; and developed a periodontal program to better serve their patients.
These discussions evolved into Job Descriptions for the team: a Clinical Coordinator to manage the expenses of the dental supplies, a Financial Coordinator, Schedule Coordinator and Hygiene Coordinator to manage the various tasks in the business area of the practice. Each Coordinator was assigned very specific tasks in order to reach specific goals they established. Now the fun begins!
This is where the tough get going or the going gets tough. Remember I mentioned that many wonderful team members understand numbers, goals and targets. Other team members can remember every patient’s name, their pet’s name and their telephone numbers. What a gift when used in the right “department” of the business.
Dr. Cross had three wonderful business team members. Due to lack of job descriptions, they all did everything and yet no one did anything specifically. It was due to no fault of theirs – the doctor never learned in dental school how to run a “business.” Fortunately, however, she knew enough to see that something needed to be fixed, she just didn’t know what it was or how to fix it!
Step #4 – Is The Right Person In The Right Position For The Job?
After spending less than six months working with the three wonderful people in the business department of Dr. Cross’s practice, it was very obvious to the three of them that each had their own strengths and weaknesses. Unfortunately, their own titles and job descriptions did not fit their strengths. They were not achieving their goals, Dr. Cross was not happy, and the entire team was suffering as a result.
The solution? Match up the strengths of the team members with the job description that works best for them. The Schedule Coordinator and the Hygiene Coordinator swapped places. They realized that one of them was more task-oriented and one multi-tasked much easier and enjoyed the “organized” chaos that can take place in the “hot seat.” The Financial Coordinator recognized that she was not a “numbers” person, which is so very crucial for her position. She elected to attend hygiene school so she could work more closely with the patients, which was her strength.
As the owner of your “business” there are times when it can be very difficult to make the right decision for the entire team and for the business. Analyze your practice to determine your strengths and weaknesses, review the job descriptions of your team and confirm that you have the right people in the right places - everyone will be much happier as a result!