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The three most common battles between front office and back office

Dayna Johnson


The battle of the appointment book
Scheduling is a chess game. It takes skill and planning to make just the right moves so that, at the end of the day, you’re not in checkmate with the entire team backing you into a corner, and you wondering what you did that caused total chaos. The schedule is the one thing in the dental practice that affects every team member, but running it properly is often not taken seriously. The problems I find in the dental practices I work with are completely fixable, with a little planning.

    ➢ Front office: “Too many people are scheduling appointments, and my appointment book is a mess.”

My first response to this is, “Well, it’s not your appointment book. It belongs to the entire office, but you can take back control of it.” I think it’s a good thing to have clinical teams that can multitask and schedule appointments; they just need direction. You, as scheduling coordinators, need to tell them what can be scheduled where. The clinical team does not have time (or the visual skills) to look over four to eight columns of treatment rooms to see if patients are scheduled in the appropriate place. Map out the appointment book for your clinical team so they can schedule an appointment easily and correctly.

Most practice management software has a way of preblocking areas of the appointment book so that the team can quickly see open spots that fit the parameters of an appointment they need to schedule. Some examples for preblocking are emergency time, crown seats, ortho checks, and other nonproductive appointments. These nonproductive appointments are important to block time for because they should not be scheduled in high productive time blocks. If a clinical team member does not know where to schedule a crown seat, he or she will just stick it wherever … and you know that will cause a problem between the front office and the back office. If you map out your appointment book and your clinical team sticks to the plan, you will not hear, “She just didn’t schedule that there, did she?” in your office anymore.

    ➢ Back office: “All the front office is concerned about is production, and I need to get this patient in this week.”

This is a tough one because you are responsible for taking care of your patients’ needs and making sure the office reaches its production goals. Like I said, it’s not your appointment book; it belongs to the entire team. This applies to the clinical team as well. If you have a patient in your chair who requires an appointment this week and there is not a preblock that fits your needs, then it is up to you to talk to your scheduling coordinator. If you and your scheduling coordinator can look at the appointment book together and she understands the importance of scheduling the patient in this week, then the two of you can come up with a solution together. The scheduling coordinator can make adjustments in her goals for the rest of the month to make up for the disruption in her initial plan.

There will always be exceptions, even when you have your schedule mapped out. When the front office and the back office can discuss it, the magic can happen and the teams can schedule together harmoniously.

The battle of the hand-off
The patient hand-off at the front desk sets the patient’s expectations for the next visit. The hygienist or clinical assistant has just spent an hour or so with the patient and is the keeper of the information. This information must be transferred to your front office, so please don’t send your patient up to the front desk alone.

    ➢ Front office: “It drives me crazy; they just drop off the patient and I have no idea what to schedule or what we did today.”

Unless the clinical team is checking out the patient in the treatment room, collecting money for today’s visit, reviewing treatment plan estimates for the next visit, and scheduling the next appointment, there needs to be a systematic approach to passing the patient off to the front desk. The front office needs the information not only to take care of the patient’s needs, but also so patients can hear that everyone is communicating the same information.
• What did you do today? — The front office needs to know what procedures were done so they can create the insurance claim, add any necessary attachments to the claim, and collect the patient’s portion of the appointment.
• What is next? — Are you referring the patient to a specialist? Does the patient have a new treatment plan that needs to be reviewed? Does the patient just need his or her next hygiene visit scheduled?
These two pieces of information are critical for a proper hand-off between the front and back office. Even though we all know this is important, this is where one of the most frequent missteps occurs in the dental practice. Don’t keep the front office guessing. How can we fix it?
• Use patient routing slips — Now, if you know me, you know that I am not a big fan of using paper; however, a patient routing slip can be a very useful tool. It can be a great nonverbal way of communicating these two critical pieces of information to your front desk, especially if the clinical team member is running late and can’t spend a lot of time at the front desk. On the Patient Route Slip from the Dentrix software, the procedures that were scheduled today are listed, as well as the patient’s current treatment plan so the provider can easily circle what was done and then number the treatment plan. The front office quickly knows what was done today and what is coming next in the order of the treatment plan.
• Verbal hand-off — A verbal hand-off is great because the patient can hear the communication between the treating provider and the front office person. The patient can observe the transfer of information and know that it was communicated accurately. But since there is nothing written down, the front office team member must have a good memory or may need to write the information down on a piece of paper so she can take care of the patient’s scheduling.

    ➢ Back office: “I don’t have time to fill out a routing slip; the front office can read the chart and get the information.”

Wouldn’t you like to avoid getting that note slipped under the bathroom door that reads, “Did we take X-rays today?” I’ll say it again — please don’t keep the front office guessing. If there were X-rays on the appointment for today and the front office doesn’t read it in your note, they will question it. It is the front office’s job to make sure all those details are addressed so that nothing is missed. Let’s avoid those questions by communicating the details with our front office team during the hand-off, even if it takes an extra one or two minutes.

The battle of treatment planning
If you’ve read any of my treatment planning articles or watched the video interview http://bcove.me/p4e9tjrk I did with DentistryIQ.com, you know I feel very strongly that there needs to be clear expectations set in the office about who enters the treatment plan, who presents it, and who schedules it. Let’s review a couple of typical scenarios.

    ➢ Front office: “They bring the patient up to the front and say, ‘Ms. Taylor is ready to schedule her crown’ and walk away. Then I open up the treatment plan and there’s nothing there. It’s so frustrating.”
This is a common problem among dental offices. At your next team meeting, talk about these issues. Here are my recommendations.

• Who should enter the treatment plan procedures? — The person who is in with the doctor during the exam should be the one entering the treatment plan into the patient chart. It is the doctor — and the doctor alone — who has the credentials to diagnose. Since a diagnosis needs to be attached to the procedure code on the treatment plan, this is the most efficient way. If you leave this up to your front office, they will inevitably need to hunt down the doctor for the diagnosis, so it’s best to do it right the first time.
• Who is responsible for presenting the treatment plan? — She who schedules the appointment reviews the treatment plan and fees and makes the financial arrangement. In my opinion, if the patient doesn’t have a financial arrangement, the patient doesn’t get in the appointment book. If you’re squeamish about discussing fees, then leave it up to your front office.
• Who schedules the treatment? — If you know that the patient has a firm financial arrangement, and your appointment book is mapped out so you know an appropriate place to schedule, then go for it! I’m a huge fan of cross-training and multitasking if it is within your security rights at your office.

    ➢ Back office: “I don’t have time to treat my patient, write up my clinical note, turn my room over, and enter the treatment plan.”

You might not like this answer, but you better find time. According to a 2007 ADA study on malpractice claims among dental providers, lack of treatment planning documentation was the No. 1 error. Writing up the treatment plan with the diagnosis is one of the most important clinical charting requirements. You’re putting your office and your doctor at risk when you neglect to make this a priority.
How can your team assist you with making sure the patient’s treatment plan gets documented?

• Have someone turn over your room for the next patient or seat your next patient if the patient is already in the office.
• Call the front office to help with periodontal charting if you’re running behind during your hygiene visit.
• If the doctor is available, ask him or her to enter the treatment plan into the patient chart. It is OK to delegate to the doctor; he or she wants to help but just needs to be asked.
• If you’re using computers in your office, try using a voice-activated charting system such as Dentrix Voice Pro.

When there is turmoil between the front office and the back office, your patients can feel it. They can sense the frustration and see it on your face when you’re disappointed in one of your team members. Work on these issues during team meetings and create systems in your office that address these issues. Set standards in your office so that patients walk away feeling like your office is a well-oiled machine.

Editor's Note: Dayna will be presenting a free webinar for the American Association of Dental Office Managers (AADOM) on Wednesday, October 3, at 1 p.m. Eastern/10 a.m. Pacific. The webinar is titled, "You're Too Busy for Busywork!" To register for the free webinar, or get more information, please click here.

Author Bio
Dayna Johnson, founder and principal consultant of Rae Dental Management, helps dental offices improve patient care, increase collections, and reduce staff headaches by implementing efficient management systems. With 19 years’ experience in the business and technical side of dental offices, Dayna’s passion for efficient systems is grounded in both personal understanding and professional expertise. She can be reached at dayna@raedentalmanagement.com, or visit her website at www.raedentalmanagement.com. If you’re a Dentrix user, you can check out her blog with front office tips and ideas at http://thedentrixofficemanager.blogspot.com/.

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