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The real “bottom line”: Patient well-being and practice finances can exist in harmony

July 23, 2018
Dental hygienists are usually employed by dental practices, and dental practices have to make at least some profit to stay open, attract talented professionals, and stay up-to-date. But it can be tempting to view a practice's bottom line as an enemy of patient care, and understandably so. Julie Whiteley, BS, RDH, says that when these needs are properly balanced, they can actually work in concert with one another.

Recently, a fellow dental hygienist asked a question that sparked much conversation and debate. Should it be our production numbers or the numbers of lives we are able to touch that measure us? My feeling is that these two measures are not mutually exclusive and, in fact, work in concert with each other.

The reality is that we work in a business with expenses and overhead. Also, remember that not all of the money produced will be collected. Consider offices that are in network with insurance plans. The amount collected will be significantly less than what is produced. Insurance companies base the percentage that they cover based on their fees (called usual and customary fees), not your office fees. For example, say a prophy in your office is billed out at $100. The insurance company may reimburse on their fee of $80, and contracts may require the office to write off the difference. There is also the issue of uncollectable debt; some patients unfortunately don’t pay for services rendered.

In order for patients to have the best possible care, the practice must have the resources to provide the appropriate equipment and to attract the most talented staff. Additionally, patients should have a proactive versus a reactive dental team who take the time to educate and inform on customized treatment plans that are in their best interest.

This statement is not to be interpreted that we over treatment plan or suggest services that are not necessary. As a passionate clinician with a focus on quality and ethical patient care, that is something I could never support. Consider these statistics from the AAP though: an estimated 47.2% of American adults over 30 have periodontitis, and it affects 70.1% of people over 65. When we think of the amount of perio treatment in our office, are we proactively treating disease? Are we watching and waiting? Are we sometimes doing what I like to call “the prophy in disguise,” where we are doing localized perio therapy, but coding it as a prophy?

The best practices and most successful hygienists understand how to provide patient-centered quality care in a profitable practice. In those cases, it’s a healthier patient, a healthier practice, and a healthier hygienist.

Basic industry standards for hygiene

  • 30% of total office production should generally come from the hygiene department.
  • 30% of your hygiene services should be D4000 codes (therapeutic, not preventative).
    • Of those, consider how many are maintenance cases versus active therapy. Are your maintenance patients truly maintained?
  • A hygienist’s production should be about three times their hourly wage including benefits.

Situations that can affect these numbers

  • The doctor produces in large volume or performs a lot of cosmetic or implant cases. This high production could decrease the hygiene percentage related to total production.
  • Hygiene fees are too low compared to restorative fees. Some offices are hesitant to increase hygiene fees for fear of patient complaints.
  • Consider the number of hygiene columns to doctor columns on the schedule. If there is a large number of hygienists and only one doctor, the hygiene percentage of total production could be significantly higher than 30%. Also, consider a doctor who has lower production compared to hygiene due to openings in the restorative schedule and/or the majority of treatment consisting of services that are billed at lower fees.

Other considerations

  • Appointment blocks must allow time to build relationships and educate patients, but time is precious and limited. The most successful offices allot appropriate time for each patient, and the most successful hygienists use that time well. There is a difference between sheer speed and maximizing the time to the best advantage of the patient and the practice.
  • Consider the impact of downtime. One hour of open hygiene time per day, assuming $150 average hourly production, equates to $3,000 per month ($36,000 per year).

Important to know the numbers, but let care be your guide

  • Build trust and solid relationships with an understanding of the patient’s goals, dental IQ, and barriers (real and perceived). Stay curious, open, and without judgment. Have conversations with the patient versus lectures.
  • Educate patients so they have the knowledge to make their own decisions.
  • Recommend the proper treatment for the patient without judgment or assumptions—be proactive and prevention focused. Don’t upsell or overtreat.
  • Create value for the patient at every appointment. Educated patients who see the value in what we do understand the importance and show up for appointments. They are also more likely to accept necessary treatment.
  • Code for what you do and inform before you perform.
  • Keep your knowledge base current, including proper coding. Codes are not insurance based—they are ADA based—and we are legally bound to code for what we do.

The bottom line is that when we offer our patients compassionate, thorough care with a focus on education and prevention, we help guide them to needed treatment.

The relationships we create are based on mutual understanding, respect, and educating on the importance of appropriate treatment. When we successfully do this, we add value to the office and positively impact the lives and health of the patients entrusted to our care. With this approach, the numbers fall into place as a secondary benefit of doing the right thing.

Julie Whiteley, BS, RDH, is certified in human resources. She holds degrees in business administration and dental hygiene and has worked extensively in both fields. She is on the faculty of Massachusetts College of Pharmacy and Health Sciences University in Boston. Julie bridges her knowledge and experience from business, clinical hygiene, and teaching to deliver information and programs that enhance dental practices. Contact her at [email protected].

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