New patients scheduled versus show rate. New patients are a lifeblood of any practice, and a growing practice needs at least 25 new patients per month for each provider. Scheduling new patients and maximizing the percentage that actually show up requires diligence from the staff. If the show rate is weak, evaluate the new patient call. Low scheduling suggests need for improvement in external marketing as well as improvement on internal referral. How’s word-of-mouth treating you? It’s the best source of new patients, so keep that quality-of-care high!
Doctor efficiency. This key number is a reflection of several systems and operations metrics. Team tracking of anticipated production to start each day, as well as actual production achieved by end of day, gives you the numbers; divide actual production by anticipated production to get a percentage, with the target of 100% meaning planned production was met. If well under 100%, review reasons for cancellations and no-shows, and check your confirmation protocol. Often there may be a treatment plan acceptance issue. One fix: rapid response with the short call list. If above 100%, this means your schedule may be unnecessarily open if you have time for that much unscheduled treatment. Worse, cramming too much into a daily schedule causes mistakes on anyone’s and everyone’s part due to hastened corner-cutting, leading to breakdown in systems for collections and treatment plan counseling, among others. Overall quality of care is also reduced.
Assistant treatment plans. Between 30% and 40% of total production comes from the doctor’s treatment rooms during exams or with add-on treatments. If your treatment plans are low, production will be low—you eat what you kill!
Assistant treatment plan acceptance rate. Again, you eat what you kill, so you’re looking for 46% to 50%. Proper procedures for treatment plan presentation and promotion, with handing off to office staff for scheduling, must be followed to ensure continuum of care. Before dismissing the patient, assistants need to review the next visit’s plan to close the loop.
Total treatments scheduled. If not actually scheduling at least 50% of planned treatments, look into how your office presents and closes the deal. Effective presentation promotes the best choice, but it is the patient making the choice. So… is the connection with the patient effective, with understanding of their values, concerns, and time issues? Remember that they will agree with the person in the lab coat most of the time, but without that honest rapport, and understanding, the patient is unlikely to show up.
Scheduling of unscheduled treatments. How is the follow-up for those treatment plans still up in the air, or things in the pre-authorization stage? About 10% of production should come from this area; if this is low, make sure staff is regularly working on this with pre-authorization work or follow-up calls to patients with unscheduled treatment plans.
Actual Hygiene Production. Hygiene services should account for about 30% of total production, so review marketing and planning for adjunctive services (night guards, whitening, perio program, etc.) as well as yearly perio charting is this number seems low.
Hygiene treatment plans. A typical dental office will plan double the amount of hygiene treatment they typically end up scheduling.
Hygiene treatment plans scheduled. About 65% to 70% of total production is scheduled out of hygiene exams, so scheduled hygiene treatment should exceed 50% of planned treatment in their rooms. Hygienists should be assessing, and then suggesting to the provider, any potential oral issues (which is not the same as diagnosis). They may also present possibilities to the patient, smoothing the way for the dentist during the exam to piggyback off that and suggest a treatment strategy. With multiple professional opinions in play, treatment plan acceptance rates go up.
Hygiene treatment plan acceptance rate. With the aforementioned percentages of the total production in mind, set a monthly goal of 70%. To increase diagnosis and treatment planning, thorough exam and comprehensive treatment planning is essential. But the exam time is very limited. To improve efficiency and decrease missed conditions, the hygienist plays a huge role.
Are your hygienist assessing and suggesting oral conditions to assist in comprehensive diagnosis and minimize time spent in the exam room (not to be confused with diagnosing). Hygienist spend a lot of time in the mouth before you come in for an exam. They are highly qualified to evaluate the mouth and less likely to miss conditions such as, bleeding gums, vertical fractures of teeth, marginal discrepancy around crowns, abfractions, abrasions, mucogingival defects, heavy frenums, tooth mobility, furcations, present fistuals, wear facets, broken cusps, marginal discrepancy, and separation of a restoration from the tooth. Let's match up the condition with a diagnosis with a treatment. The hygienists should present and hand off their findings of conditions to the Dentist during the exam. It helps keep the exam short, validates to the patient that two people saw this problem in their mouth, allows for a discussion of the condition/problem. Conditions are also referred to as signs and symptoms.
Condition-Diagnosis-Treatment
- Bleeding gums-periodontal disease-SRP
- Vertical fractures-incomplete or complete fracture of clinical crown-crown
- Marginal discrepancy around crowns-marginal decay/open crown margin-crown replacement
- Abfractions, abrasions-occlusal disease, bruxism, clenching, TMD-nightguard, orthotic, TMD Treatment, Botox
- Mucogingival defect-active frenum-frenectomy fistula-apical abscess-root canal
- Wear facets-bruxism, lateral interference, hyperocclusion-crown, nightguard, or occlusal equilibration
- Broken cusp or missing cusp- complete cusp fracture-crown
- Marginal discrepancy and separation of the restoration from tooth-open restoration margin, recurrent decay-direct restoration
Hygiene reactivation. Regular cleanings keep the patient visitation cycle in motion. Given a goal of 98% hygiene efficiency with 2% fallout, fill those slots with regular reactivation calls to patients who have fallen away, so that they don’t get lost. Because you want to strike while the iron is hot, reactivated patients should be scheduled as soon as possible; consider adding hygiene hours if you have no place to put reactivated patients.
Value of scheduled hygiene reactivation. With 2% fallout to be recovered, the minimum dollar value to be reactivated (the goal)is the number of patients you need to reactivate times the value of the average visit.
Office expenses. With the national average being 65%, good offices run at 60% (a good goal) and the best run at 50%. Reducing expenses and keeping them down is an obvious way to increase profits. Add increased production, and you have a heavier cash flow.
Pre-payments. A good goal is 10% of monthly production taking the form of prepayment of the patient’s expected portion, ideally during scheduling to ensure their commitment, reduce no-shows and accounts receivable, and maintain a healthy revenue stream.
Team-based referrals. Your office staff should be eager to refer patients to the practice. It is a reflection of their confidence in the level of care provided. If you do not see the team referring to you, reflect on your practice philosophy, office morale, and your role in the success of the practice.
Scoreboard + Incentives. The trick is to give the team a scoreboard with incentives that drive them to constantly evaluate their own performance, working to hit these specified goals that promote practice health. A financial incentive plan with total office bonuses (divided by the number of employees in some equitable way) for meeting these goals can bear fruit if consistently monitored, and are worth the money because they help focus everyone’s attention on maintaining good practices rather than fixing what isn’t working.