Steps to Reduce Broken Appointments in Your Practice
Many patients don’t think twice about calling your practice to cancel their appointment a mere few hours before they’re supposed to be in the chair. They don’t understand what that does to your day or how putting off care can negatively impact their oral health – but of course you do.
Educating patients and showing them the value of the care you provide will go a long way in reducing these costly last-minute cancellations and no-shows. And when I say costly, I’m talking about tens of thousands of dollars in lost revenue every year. Don’t believe me? If your practice averages two cancellations/no-shows a day at a value of about $100–$125 each, you’re losing more than $40,000 a year – not to mention the thousands of dollars in lost production you never even had the opportunity to diagnose.
Now that I have your attention, there are other steps you can take to significantly reduce broken appointments in your practice. Read on for my advice.
“Mrs. Green, you’re scheduled for a one-hour appointment with Dr. Clark at 10 a.m. on Thursday September 23rd. If for any reason you can’t keep this appointment, please call our office at least two days in advance so another patient can see the doctor at that time.”
Confirm Every Appointment
Put a List Together
Make a Note of Unreliable Patients
Not sure how to handle this conversation? Here’s an example of what to say:
“Mrs. Green, we seem to be having trouble coordinating a time that works for your schedule and ours. I don’t have any appointments available at this time. However, I do have all your information and will contact you when there is an opening.”
Don’t Depend on Pre-Appointing Alone
Develop a Policy
Last-minute cancellations and no-shows are production killers. They do nothing but wreak havoc on your day and cost you money. Following these steps will help reduce broken appointments in your office, alleviating unnecessary stress and helping you grow practice revenues.
For additional information on this topic and more, visit my blog: The Lighter Side
Interested in speaking to me about your practice concerns? Email firstname.lastname@example.org
Don't Forget the Fluoride
Most offices provide fluoride treatments for children, and most insurance carriers will cover this procedure either once or perhaps twice annually for patients up to and including age 11 (some including age 12). Most parents understand and value the protection fluoride offers their children’s teeth and are happy this service is available.
Less well known is the value fluoride has for an aging population. As more and more people enter their “golden years”, the need for fluoride increases. Gingival decay, coupled with recession, can result in gumline decay that can be a real problem for an increasing number of patients.
How can we incorporate fluoride treatments into our regular adult prophylaxis treatments? Do older patients understand and value this service? Does insurance cover fluoride for adults? What about prescription fluoride toothpaste? How do we explain to resistant patients the need for adult fluoride?
Let’s look at a few ideas:
Adult patients need to understand the reasons we might recommend office fluoride or home prescription fluoride toothpaste. They may associate fluoride treatments with children, or they may assume that since they are older, fluoride will not do any good. A good way to approach your explanation is to follow the tried and true “Show-Tell-Do” format.
Patients need to see the areas that could benefit from fluoride. This can be done with an intra-oral camera and photos on a treatment room monitor, or with a simple hand-held mirror. Select a tooth with an area of recession and point out the difference between the enamel covered surface of the crown and the cementum covered root. Often a receded area is somewhat concave and may present with already decalcified or dark “spots”. It is easy to show that the root surface is softer and is already showing “destruction” as compared to the crown of the tooth.
Patients understand that enamel is hard and the roots of the teeth less so. Now we can tell them what can be done to protect these “at risk” root surfaces. We can go over sulcular brushing, with either a hand brush or mechanical, explaining the damaging effects plaque, bacteria and subsequent acidic bacterial byproducts can create, and we can explain that fluoride can provide a protective surface to give extra fortification. If the patient has an actual cervical decay, showing this can be very effective.
Some patients will be resistant to hearing about fluoride. They will say they are “too old” to worry about decay, and amazingly, some will say that if they get “cavities” they will just have that tooth removed! Luckily, this type of thinking is on the wane. In addition, there is still a small population of patients who believe fluoride is “poison” and they are already being poisoned in their water, etc. Unfortunately, persons who have these opinions are not likely to change their minds. It is still worthwhile to explain, but keep a low expectation.
Patients who accept that they can benefit from fluoride can be offered a fluoride varnish applied at the end of their prophy or perio maintenance appointment and/or a prescription fluoride toothpaste for home use. There are numerous brands and flavors of varnish to choose from depending on the preference of the hygienist. Most are easy to apply and are not displeasing esthetically for the patient.
The dentist’s exam should be performed prior to the application of the varnish, as it can obscure the surfaces of the teeth visually. Patients should be cautioned not to eat or drink for at least 30 minutes after application. Home fluoride toothpaste should be dispensed with detailed instructions. These toothpastes should be kept away from children. A pea-sized amount can be used on a soft bristle brush each time the patient brushes. Other types of toothpastes should not be used interchangeably. For best results, brushing and flossing should be performed as the last activity of the evening before bed, so the fluoride can remain in place through the night.
If fluoride is to be incorporated efficiently into the hygiene appointment, it is important to allow enough time to do so. If the patient has not had fluoride previously, time to explain how and why must be provided. An appointment of 40-50 minutes will not allow for an adequate explanation. If the hygienist is rushed, he or she will not be able to help the patient understand and the patient will likely refuse.
Patients who have already agreed to fluoride can typically be accommodated in a 50-minute time period. However, the dentist must be ready to perform the exam in a timely manner prior to the application of the fluoride. As always, good communication between the hygienist and dentist is vital. If a hygienist is waiting for the dentist exam before placing fluoride and then must apply the fluoride and do the room turnover, the schedule will suffer.
There is often no insurance benefit for fluoride for adult patients. So, in addition to helping patients understand the clinical need for the treatment, the cost must also be explained. Some insurance may apply for fluoride varnish for patients who have had documented cervical restorations. Mentioning this in the narrative on the insurance claim may help. There is typically no insurance coverage for prescription fluoride toothpaste.
The application of fluoride is good for our patients and good for the office bottom line. Providing enough time for patient explanations and the actual treatment is key.
Carol Tekavec RDH is the Director of Hygiene for McKenzie Management. Interested in knowing more about how to improve your hygiene department? Email email@example.com.
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