Off the Charts: Dental Chart Audit by Dr. John A. Wilde

Completing a thorough chart audit can help recover and retain missing patients

by Dr. John A. Wilde

Crushing debt that plagues some practitioners and the agonizing events of 2020 have sounded a clarion call to the prudent that it is no longer advisable to settle for just getting by. It’s far wiser to maximize achievements in these uncertain times because—trust an old codger here—as bad as things are, they can always get worse. But if one is already aggressively pursuing conventional practice-building strategies and refuses to assume further capital outlays, what viable options exist? If having more active patients would prove beneficial, a chart audit (CA) system can assist the motivated to accomplish their goals.

Where are your patients?

Patients mysteriously drop through the cracks and disappear even in the bestmanaged offices. A CA begins with a systematic review of files to identify everyone not already scheduled in treatment or recall. (The effort must proceed methodically in alphabetical or numerical order as multiple staff may be involved, and at least in our three-doctor office, the process continued in perpetuity.) We wanted to contact every unscheduled patient, address any problems or misunderstandings discovered during their interview, then reestablish a relationship and schedule an examination. We also seized this chance to demonstrate our concern and commitment to achieving and retaining patients’ optimal oral health.

Experts claim the expense of acquiring new patients averages $150–$300 each, while the cost of reactivating someone who’d previously chosen your office is but a slight increase in payroll. Call it five bucks. Because only effort and commitment are required, one can start instantly. And not only does a CA fill hygiene’s schedule, overdue patients also frequently have outsized restorative needs.

The proper chart audit

Let’s consider how best to accomplish our objective.

1. Find a leader. I believe the dentist must provide an overarching practice vision and refine systems to achieve their goals. While a doctor leading by example is laudable and their apparent support essential, I wouldn’t suggest they vanguard this time-intensive task. One champion must be appointed to coordinate and monitor all CA activity. He or she must understand human behavior, possess organizational ability, have outstanding communication skills and work effectively with others.


2. Develop effective dialogue (and use magic words!) Before calls begin, CA staff must review each patient’s record. Note data both personal (all teammates contributed chart notes on things like vacations, new babies or grandbabies, pets, etc.) and professional (date of last visit, bleeding gums, headaches, past problems, cautions or other pertinent events). Calling without first gathering such information becomes a form of aversion therapy doomed to failure.
   
   Once forearmed, a typical call might go: “Good evening, Tom. This is Carol from Dr. Wilde’s office. How are you?” After some polite conversation, such as asking how big that puppy is now, Carol states, “Dr. Wilde asked me to call. He reminded me of the awful toothache you’d suffered. It’s been 22 months since we’ve seen you, and he is concerned. During your last examination, he’d noted some gum bleeding and marked an area where decay might be developing on an upper right molar. Are you having any pain or problems?”
   
   I’ve italicized the “magic words” and although I’m not sure why they work, many years of experience have proved their effectiveness. Develop a precise dialogue, then role-play until everyone is comfortable expressing similar content, but in a manner uniquely their own.
   
   Asking patients if they have questions or concerns can identify past misunderstandings, giving us an opportunity to right perceived wrongs. Discussing such unfortunate incidents during staff meetings helps improve our office. We noted any relevant information in the patient records. If they’re seeing another provider, a determined effort is made to discover a specific reason why. The record of every patient who leaves our office is placed on my desk. Most depart over insurance or payment related issues that I can’t affect, but if I’m unclear about their motives, I’ll call and ask. The cause of their leaving can provide a tremendous wellspring of information to help us grow. This can be uncomfortable, but author and speaker Jeff Olsen claims, “Successful people do what unsuccessful people are not willing to do.”
   
   As my conversation ends, I’ll thank them for allowing us an opportunity to serve and assure them they are always welcome to rejoin our happy dental family. Many chagrined patients have returned, often after discovering that not all providers are genuinely painless.


3. The system. Our office employed expanded hygiene with two operatories, one front desk employee and a full-time chairside dedicated to assisting our hygienist. No loss leader, hygiene profit usually exceeded $10,000 per month. We compensated each team member based on a percentage of hygiene production. The first week we implemented the system, their output (and thus compensation) immediately increased by 25% and never declined. Open time became anathema, with frantic efforts made to fill it. The difference was motivation, because now they were paid for working, not attending, just like me. And also, just like me, they thought earning more was better. Because I never used a CA without expanded hygiene, I can’t estimate how it affected our results, but people must somehow become incentivized to implement any successful system.
   
   One can tailor the level of time and effort to each office’s needs, but we required all three front office staff and our hygiene assistant to average five CA calls per day for a total of 100 per week. They could work calls in as time allowed or accomplish them in 30 minutes at the day’s end. I allocated overtime pay as needed. Measured behavior improves, so a monitor displayed in our lab listed daily calls made by each CA member and the number of patients they’d scheduled. I’d comment on this data frequently, offering encouragement and praise liberally. (Don’t kid yourself. Any undertaking to which the dentist lacks genuine commitment will fail.)
   
   We also held a monthly CA party during which five volunteers (because we had five phone lines) worked exclusively on calls from 5 to 7 p.m. This evening gathering provided doctors and hygienists, who directly benefit from full schedules, an opportunity to demonstrate support. I paid salary and provided a meal, we celebrated each appointment raucously and a cash bonus was awarded for first, second, and third most scheduled patients. It was a hootenanny!

This information should be sufficient to allow anyone who so desires to begin a chart audit program. However, as Thomas Edison stated, “There is far more opportunity than there is ability.” Or, as Winston Churchill more amusingly put it, “Men occasionally stumble over the truth, but most of them pick themselves up and hurry off as if nothing happened.”

Information not acted on is merely entertainment, but a chart audit presents an opportunity for colleagues determined to excel. I would suggest any practice not fully scheduled or that desires to maximize productivity implement a CA. I wish godspeed to the doughty few who will incorporate this concept into their commitment to excellence. Success doesn’t occur by happenstance but is the residue of wisdom and hard work.