“Ummm, well, all of them I think…Very healthy—I mean, we provide the highest quality of care, and I just took a class on case presentation and cosmetic braces. Not only that, I have several professional affiliations. I’m an occlusion expert and mount all of my models. We even do root canals and implants on our patients! Our case acceptance rate is 20% higher than the average 40% acceptance rate at most practices. AND we have complimentary hot towels. And we’re not one of those unethical corporate chopshops. And we don’t advertise because it is unprofessional. So, I guess pretty healthy, right?”
Usually people give an answer like the one above, but it still doesn’t answer the simple question “How healthy are your patients?”
This simple question is at the heart of everything in our professional practice. Oral disease is chronic and can’t be cured. With good professional partnership, the disease can be controlled and health can be maintained. Trying to sell any other version of this reality to the people we serve is nonsense. So if you are caring for 1,000 people in your practice, how healthy are they?
If you can’t provide an answer to that question, it means one of two things—you either don’t care or you have no means of classification. For me, not having a way to answer this question bothered me during the early years of my career. I always felt that so much emphasis was being placed on everything except the sole purpose of our profession’s existence, and I wanted a method for evaluation. Dentistry is reduced to a short term sales transaction by so many in and around our profession these days. So this is the grouping method our practice uses to get to the heart of how and why we team up to serve our community of patients, day in and day out.
Group One: Emergency
These are the patients that show up once every two or three years and need something pulled, root canaled, or filled. They have not had an overall exam in our office in the last two years. This doesn’t mean they’re a bad person. We’re here for these patients, and when they are ready for a comprehensive exam, we will be here for them so they can start to avoid big expensive advanced disease problems.
Group Two: Remedial
This is for the patients who have been in for a checkup in the last two years and are content to just “get a cleaning” or “whatever insurance covers.” They typically express a desire to not fix something if it isn’t broken, meaning if they can’t physically feel something that’s painful or broken, they’d rather not address it. It almost feels as if they look at your office like an auto repair shop—oil changes and breakdowns are the reason they seek you out. These patients always get an opportunity to understand what health is and their disposition in relation to health. They often have non-painful acute or chronic disease. We have offered them a short- and long-term plan to address that disease. They are not currently interested in considering long-term health or proactive care.
Group Three: Progressive
These are patients who have shared with us what’s important to them. They have a short- and long-term plan for health that is consistent with what’s important to them. Patients in this group are actively partnering with us and progressing toward health.
Group Four: Stable
As mentioned earlier, we give all patients a short- and long-term plan. The short-term plan addresses disease that is immediately threatening what’s important to them. Actively progressing tooth gum and bite disease that will have expensive, painful and long-term consequences for the patient if not addressed as soon as possible. This is what we call “Now” care when treatment planning. The long-term plan includes what it is going to take to keep the patient healthy for the long run. Patients in group four have received the care they need to complete the short-term plan and are now stable. Beyond needed dental care, we have also worked with them to acknowledge other challenges to long term health, including self care, chronic systemic disease problems, etc.
Group Five: Complete
A patient isn’t going to die or have systemic risk from missing a lower first molar in the next two years. However, if what’s important to that patient is keeping the rest of their teeth, then replacing that tooth is a big deal in the long run. If they don’t, we know it will lead to a domino effect that will result in even more edentulism. So this is the group of people who have no outstanding short- or long-term treatment. We have completed our plan to get this patient to health. In our practice, we feel it is not only our job to get them to health but also to partner with them to do everything we can to help keep them there.
Dental insurance does not pay us to classify the health of our patients. Consultants wouldn’t like the challenge of trying to figure out a black-and-white case acceptance percentage for your practice. And it’s pretty impossible to link daily diagnostic and production quotas. In fact, there is (sadly) no direct incentive for you to care about the actual health of your patients. Accordingly, you might chalk this up as a frivolous exercise. That is fine if you think the current system is working for you and our community. But the evidence is mounting that it isn’t.
Only 36% of adults had a dental visit last year and only 18% of uninsured adults saw a dentist. Caries is still the world’s most prevalent chronic infectious disease and untreated periodontal disease is on the rise. More and more kids’ only professional dental visit is in a van outside their public school. We regularly evaluate every tooth’s five clinical surfaces and probe six different places along the gumline of each tooth and record these findings diligently so why not group their relative health? And we dentists are not knocking it out of the park either—dentists’ incomes have been relatively stagnant since 2009. Given this health classification system is not perfect but neither is dentistry. Our career is an endless navigation of imprecise problems and even less precise solutions. So why not apply our discretion to the level of health of our patients as well?
Quantifying health has other benefits that may not be obvious at first glance. First, it helps simplify an otherwise complicated and abstract goal for our team—creating health for our patients. Very simply, we want to welcome patients in group one and eventually move them to group five over time. And then we want to keep them there. That informs everything else we do in our practice. For example, how we talk to different patients as we talk to patients, according to their unique disposition. Most of all, it helps us understand how well we are doing as a team. If all of our patients perpetually stay in groups one, two, and three, then we may not be doing a very good job of communicating with patients. Or maybe we need to work harder on helping them overcome the challenges that are holding them back from progressing toward health- affordability, time, or anxiety. Maybe our scheduling or reminder system needs some work.
It is also a not-so-subtle reminder that there is a great deal of care that our patients need in order to fulfill what’s important to them.
You might find that focusing on health may actually have more impact on your practice’s bottom line than the meaningless quotas. If you have questions or comments about how to rate the health levels of your patients, let us know. If you like this idea, pass it on to a colleague and we’ll start quantifying the health of our community together.
Take Care and keep growing.