Every state or national dental meeting has multiple practice management programs on the agenda. Inevitably, these are among the most well-attended seminars at the meeting. The common themes at these courses include improving your recall system, your case presentations, follow-up systems, phone skills, scheduling and marketing. While dentists and their teams leave most of these programs excited for all of the changes they are going to make, the excitement and the follow-through wane over time. Perhaps that is because you don’t leave these programs with any concrete changes to implement or true idea of the financial implications of the suggestions.
The best systems in the world are only as effective as the diagnosis about which the patient was educated. Even the best office manager or schedule coordinator cannot put patients on the books for treatment that wasn’t diagnosed. The goal of this series of posts is to open doctors’ and staff’s eyes to all the dentistry that is right in front of them. The amount of dentistry that is available to do on your current patient pool and the underutilized treatment procedures/codes is astounding. In each post of this series, I will discuss one or two treatments or practice management suggestions that you can utilize the second you put down the article. We will look at the financial implications of each and extrapolate the results over the typical dental career.
Each of the tips will be accompanied by clinical photos or case reports to support the concept. The goal is that every idea turns into a win-win situation. It is amazing how thorough, thoughtful dentistry not only turns out to be best for the patient, but also adds to the production of the practice. I will discuss concepts that benefit the patient, protects the dentistry you perform, and enhances everyone’s quality of life by decreasing patient chair time and adding to your bottom line.
Let us begin with your hygiene department and available treatment that can be produced. In the vast majority of practices in the United States, patients receive prophylaxes twice a year. In the typical practice, dentists perform radiographs once a year. What form do these radiographs take? If yours is like most practices, you perform four horizontal bitewings that look something like this:
This is the classic four bitewing series, ADA code D0274 . What do you notice as you look, however, at this next series of radiographs?
Here we see anterior teeth and we can see much further apically. This is the seven vertical bitewing series. This series not only helps us examine the upper and lower anterior teeth, but also shows us the crestal bone in much greater depth and detail. Compare the vertical bitewing of the #3 and #30 areas to the horizontal radiographs of the same area. It is clear how deep the periodontal defect is. You cannot appreciate this on the horizontal bitewing.
This series of radiographs is better for the patient, as it gives us more diagnostic information. It turns out that we can charge (and insurance pays) more for this series of radiographs. This is the definition of a win-win situation: better diagnostic information benefits the patient’s oral health and a greater fee benefits the practice. Let us examine the immediate impact of the implementation of seven vertical bitewings on your practice.
My calculation is based on the following assumptions: eight hygiene patients a day (we will assume ½ of the patients in a typical day are due for radiographs), 200 hygiene days a year, and a fee difference between four bitewings and seven vertical bitewings of $30. You can, of course, plug your own numbers into this equation:
4 (one half number of hygiene patients a day)
x 200 (hygiene days a year)
x $30 (fee difference between 7 VBWs and 4 BWs)
$24,000 increased production by converting to 7 vertical bitewings
By simply changing your recall protocol so that you take seven vertical bitewings instead of four bitewings, you can easily generate an extra $24,000 in production per year, based on this example. This doesn’t even take into consideration the difference in diagnostic information and increased treatment you will find during your exams. This calculation is based on conservative assumptions. For many of you, the increased production can be much greater. Extrapolated over the average 35-year career of a dentist, this could result in an extra $840,000 in production. This is certainly a nice start for a comfortable retirement.
This is the first of a number of suggestions that I will present over the coming series of posts. Next month, we will step back and start where all patient relationships begin: the new patient experience. We will discuss how to maximize this critical event and make it more financially productive by decreasing the lost overhead of new patient no-shows. As we progress through the series, I will speak about specific treatments, under-utilized ADA codes, and missed diagnoses that will add production and profitability.
Until next time, open your eyes to the possibilities.
Christopher J. Perry MS, DMD, FAGD