By The McGill Advisory, August 2022
According to the American Dental Association (ADA), dental care has been the most neglected health care service during the pandemic. That’s largely due to the COVID-19 shutdown, missed or canceled appointments, and poor oral hygiene at home. With the pandemic now easing, patients are clamoring for hygiene services, increasing current demand.
Meanwhile, the American Dental Hygiene Association (ADHA) reports that approximately 5% of dental hygienists left the workforce during the pandemic. Recent record-high inflation has spiked the cost of living, prompting a growing number of hygienists to come out of retirement and back into the workforce. Still, there remains a shortage of hygienists willing to work, making attracting new hires and retaining existing hygienists a top concern for most doctors.
Since many new patients enter the practice through the hygiene department, this shortage affects not only hygiene but also doctor production. Below are eight tips to boost capacity and increase hygiene department efficiency and productivity for a more profitable practice.
1. Boost capacity – Expand your productive capacity by recruiting new hires (full- or part-time). Be proactive by contacting all licensed hygienists in your market area after obtaining a zip code list from the state board, offering a referral bonus to your staff, contacting your supply rep and local dental/hygiene society for leads, offering free CE hygiene programs to attract potential new hires, and monitoring the ADHA job board.
2. Block appointments for soft-tissue management (STM) – Periodontal disease is one of the most dangerous and underdiagnosed dental problems. According to the CDC, nearly half of adults over 30 have some form of periodontal disease, and that increases to 70% for those over 65. In its early stages, periodontal disease can cause bleeding but can quickly degenerate into loss of bone and teeth if it’s untreated. More importantly, the related bacteria can enter the bloodstream increasing patients’ risk of heart attack, stroke, diabetes, COPD, Alzheimer’s, and other ailments. Many practices don’t treat all the STM they diagnose, due to a lack of time in the hygiene schedule for the longer appointments required. As a result, they end up treating patients that need it the least (patients with good oral hygiene), rather than those who need it the most (STM patients). That’s why we recommend blocking one STM appointment per hygienist per day to ensure time in the hygiene schedule to treat them.
3. Block appointments for new patients – New patients are the lifeblood of your practice’s growth. Many practices are operating below optimal capacity because new patients first enter through the hygiene program and can’t get an appointment due to an overcrowded schedule. Since most doctor production comes from new patients, this stifles practice growth. Again, make sure you’re treating the patients that need it the most by blocking at least one daily hygiene slot per hygienist for new patients. Make sure that all hygienists are trained to point out potential dental problems shown on the x-rays or intra-oral image that the doctor will need to diagnose and treatment plan.
4. Adjust the appointment duration – Upon reopening, many practices increased all hygiene appointments to 75-90 minutes each in response to the more extensive cleanings required for patients with poor oral health. Unfortunately, this temporary measure has become permanent in some practices, unduly limiting their productive capacity. Now that patients have likely gone through 2 hygiene appointments since reopening, this temporary scheduling protocol should end. Rather than schedule the same amount of time for each patient, scheduling should be based on the clinical requirements for each patient, which vary. For example, child hygiene visits may require only 30 minutes each, the average adult may now need only 45-50 minutes each, and difficult patients or STM cases may require an hour or more. This ensures the visit will be long enough to properly assess, treat, and educate the patient without wasting your, or their, time.
5. Adjust appointment intervals – Far too often hygiene appointments are automatically set at 6-month intervals, based on insurance coverage. Unfortunately, this common practice clutters up the hygiene schedule, again guaranteeing you’re treating those that need dental care the least rather than the most (those patients with soft-tissue or periodontal problems). Rather, appointment intervals should be based on the patient’s clinical need. For example, patients with “A” oral health should be scheduled for 9-12 month intervals, those with “B” oral health should be scheduled for 6-9 month intervals, while those with average or below average oral hygiene should continue on with the standard 6-month appointment intervals.
6. Maximize efficiency – Make sure your practice is using the “interruptible hygiene check” concept where the doctor can check the patient at any time during the appointment, rather than having to wait for the hygienist to complete their work. This avoids delaying the hygienist and optimizes efficiency. Interchangeable operatories are another hygiene efficiency strategy. Furthermore, hygienists should be trained to be friendly, but not overly talkative, which reduces productivity. Also, assistants should perform child prophys to the full extent allowed by state law to maximize efficiency. Finally, the hygienist should schedule all recall appointments chairside. This ensures that the patient is actively involved in the scheduling process, creating ownership and accountability, which will lower the broken appointment and cancellation rate.
7. Proper coding and billing – Make sure all hygiene procedures are properly coded and billed. For example, many hygienists perform STM services, but charge these out as routine prophys, receiving only 30-40% of the appropriate fee as a result. Furthermore, we’ve seen numerous cases where fluoride services and the doctor exam fee aren’t charged out at all. Finally, have the hygienist enter the services provided and appropriate codes chairside, to ensure that all procedures are properly coded and billed.
8. Reduce loss from broken appointments and cancellations – This loss can be minimized through appointment reminders and confirmations sent by text in advance of each hygiene appointment. When broken appointments or cancellations do arise, make sure that each hygienist has a “call” list to help fill holes in the schedule for maximum productivity.
Author: The above article was reprinted with permission from The McGill Advisory, a monthly newsletter with online resources devoted to tax, financial planning, investments, and practice management matters exclusively for dentists and specialists, published by John K. McGill & Company, Inc. (a member of The McGill & Hill Group LLC). Visit www.mcgilladvisory.com or call 888.249.7537 for further information.