Dear Patient: Five Things I’d Like You To Know About Your Insurance

Dental insurance can be a huge asset in making dental treatment feasible for a patient. Unfortunately, patients are less likely to understand their dental insurance benefits than their medical. While medical insurance covers most or all of the necessary procedures with only an initial deductible or minor co-payments, dental insurance operates off of a very low annual maximum that is often insufficient to cover the patient’s dental needs.

Why is this important to talk about? Almost every day I talk to a patient who has avoided the dentist for 5, 10, or even 15 years because of a lapse in dental insurance. These patients are often the ones that excitedly return for a cleaning and exam thinking they can finally bring their mouth back to health now that they have a new insurance plan. Unfortunately, these are also the patients that usually present with multiple dental problems and extensive treatment needs.

When these patients are handed a treatment plan costing several thousands of dollars for root canals, crowns, restorations, etc., and only the first thousand of it is covered by insurance, it’s like a punch in the gut. This can lead to some pretty tough emotions—denial, anger, even depression. The dental office is often the heel of the anger and depression. So patients, here are a few things I’d love to explain to you about your insurance benefits.

1. Your insurance company is a business. A well-run business makes more money than it spends.

In the insurance company’s ideal world, everyone would just have dentures. That way, your employer would still provide insurance, but no one would need any procedures. The insurance provider would continue to collect money, and you wouldn’t use any of your benefits.

Keep your teeth! They are wonderful, beautiful teeth. Just make sure to make regular appointments so we can keep them that way.

2. Just because your insurance doesn’t cover it, doesn’t mean you don’t need it.

I understand that your insurance company covers the amalgam restoration at 100% and the composite restoration has a co-pay, but pleeeeease give me a few seconds of your time to explain the differences between the two. There are benefits to treatment options that are not covered, or not covered fully, that I’d like you to understand before you make a decision about your dental health. When you lock yourself into the mentality that you must stay within your benefits and annual maximum, you can avoid necessary treatment and create a snowball effect of future, more expensive dental problems.

Dental insurance is made to cover tune-ups and oil changes for your mouth with the occasional tire rotation. Sometimes the engine or alternator goes, and you have to dip into your pocket a little deeper than you’d prefer.

3. The negotiated rates we are accepting from your insurance provider often barely cover our costs.

I know dental procedures can be expensive. It gets me down when my patients think the money from those procedures goes directly into my wallet. Patients are less likely to let me know when their tooth hurts or schedule an appointment when they know a tooth needs treatment.

I know I can seem pretty glamorous with my white coat and all, but I promise I’m not ordering procedures to get my hands on your money. After I sterilize the instruments I’m going to use, have the room disinfected and set up for your appointment, take the time to calm your fears and get you comfortable before starting, administer anesthetic, complete the procedure, give you post-op instructions and explain your prescriptions (all while paying an assistant, front desk staff, and the electric and rent to provide you with the space to accomplish all of this), the profit margin is far lower than you might think.

When the economy goes south, finances more easily trigger patients’ emotions. We get that. We try to keep our costs at the lowest level possible while still providing you with the highest quality dental work.

4. A good dentist won’t plan treatment with your insurance coverage in mind.

If I did, I would be forced to misdiagnose, under-diagnose, and recommend inappropriate treatment options. I became a dentist to provide excellent care to my patients, not to be at the mercy of a company who could care less about my patients. I’ll do everything I can to allow you to maximize your insurance benefits, but I can’t alter your treatment needs based on your insurance plan.

5. Our office is not in cahoots with your insurance company.

I can’t begin to tell you how much easier our office would run if we didn’t deal with them at all. We work with them on your behalf, and only for your convenience and benefit. We aren’t holding late night meetings with your provider figuring out how to nickel and dime you from both ends. In fact, most of our encounters with them are explaining why they should pay for something they are trying not to.

Those are five things that will make your life easier as you try to fit dental work into your budget. I hope you will find them useful and they will lead you to happy teeth!

Courtney Lavigne, DMD

Fixing What Isn't Broken

My fiancée’s mother is a consultant to high-risk schools in southeast Michigan, and her job requires many hours of computer work. Computer work did not fall within her job description back when she was still a classroom teacher, so she never became a computer expert. Like many in her generation, she can use computers when she needs to, but learning new tricks takes her a long time. For years, she had an old, gigantic HP laptop, complete with 17” monitor and a battery that lasted all of twenty minutes. She frequently lost work when her laptop power cord fell out and her battery quickly died. She always found reasons not to bring along that eight-pound behemoth when visiting schools. Every time I saw her doze off while waiting for her computer to boot up, shut down, or even open Microsoft Word, I would ask why she didn’t just buy a new one. “It’s not broken,” she’d say, “and they’re expensive.”

All told, she had literally spent hours waiting for her computer to do what she asked it to do. There is never enough time in the day, so why let precious minutes slip away waiting for technology to keep up? Every year, computers get faster, internet bandwidth gets expanded, and new technologies emerge that can help us work more efficiently. If it has been a few years since your last technology purchase, perhaps it is time to take a look around. Have you heard of Solid State Disk Drives (SSDs)? If you spend a few minutes a day waiting for your computers to boot, shutdown, and open programs or files, you may benefit from the superfast file access of these drives.

Are you still using that old minimize button? Why not invest $150 and have a large second monitor so that you can have all of your windows open at the same time? This small investment can boost your (or your front desk staff’s) productivity exponentially!

Not every productivity boost requires you to write a check. If you find yourself writing the same phrase over and over again, maybe you should investigate text expansion applications that can spit out your favorite phrases when you type a shortcut. For example, typing “drba” could automatically be expanded to “discussed the risks, benefits, and alternatives to the proposed treatment.”

It’s Friday! Think about all of the time that you spent this week waiting for technology to work for you. Where are the bottlenecks that are impacting your efficiency? See where a little investment can yield great dividends and don’t be afraid to make improvements, even if nothing is broken. It took a laptop thief to convince my future mother-in-law to upgrade; what will it take to convince you?

David Coviak

I Am a Female Dentist

Certainly, something comes to mind when you read the following statements:

I am a dentist.
I am female.
I am a female dentist.

What are the first things that you think of when I make those statements? Don’t get me wrong; I am not trying to recreate a women’s liberation movement. I can tell you, however, that I am still fighting my way into the Boy’s Club here. Despite the numbers showing equalized ratios, I have yet to see young male “hotties” hocking the newest dental equipment in journals and at conventions.

I recently saw an advertisement for a golden lead apron, and the very young, female woman model was scantily dressed. Really? Who was that company focusing on for their target market group? Not a mid-30s female dentist, that is for certain. If nothing else, they just lost an educated consumer for life due to their blatantly sexist ad. That is one snippet of the thousands of ads I encounter weekly. If you think that I am exaggerating or blowing this out of proportion, pay attention at your next large state annual session. Just stand in the middle and look around at the vendors. Have you ever wondered why they all seem to have young, attractive women in skirts and heels? Hmmm… A point to ponder.

I expect more from my profession and those who serve it. I have a higher standard for my profession than what I see in the grocery store aisle reading selection. I also know what I have experienced firsthand in my first decade in the profession - some are positives, some are negatives, and some are downright disrespectful.

Positive
I was sought after. My partner specifically wanted to bring in a female associate. He was smart enough to recognize the value that the opposite sex can provide for patient care and practice growth. Often, parents want their child to see the “lady doctor.” I have the ability to connect with patients on a level that many male dentists do not, and there are a lot of patients who desire that connection. There are also instances when, as a business partner, I can relate to the staff easier and interpret the situation differently.

Negative
I feel that some patients seek me out as an easy target. Patients have had a tendency to demand something of me that I know they wouldn’t dare request of my male partner. Fortunately, I have identified those situations now and have less to contend with.

Disrespectful
Let me point out that early in my career I was, without a doubt, more passive and less vocal. I don’t encounter as many issues now, but I still see it happen occasionally. I believe it was my first state annual conference and Tom (now partner, then employer) and I were headed for CE and exhibits. I can recount several instances when I was greeted with “Mrs. Wife, it was nice meeting you.” Reps from large dental companies hadn't made an effort to look at my tag labeling me as a member dentist; they assumed that I was a spouse. Fortunately, Tom handled it well. He told them that I wasn’t his wife but the new doc in the office, and apologized that he didn’t make that clear when they spoke. I have also been mistaken for a team member at a large meeting while our staff was checking in.

It also happens when I call in a prescription for a patient. It often goes something like this:

Me: “Good afternoon, this is Dr. Colleen DeLacy. I am calling in a prescription for Mrs. Jones.”
Pharmacist: “Okay. And your name is?”
Me: “Dr. DeLacy.”
Pharmacist: “Yes. But what is your name?”
Me: “I AM THE DOCTOR.”
Pharmacist: “Oh.”

What do I do with these experiences? Early on, I would become agitated, annoyed, and angered. Now, I make certain a clear correction is made; it usually causes the person in error to become uncomfortable and notably self-conscious. Is it wrong of me to make the correction? Absolutely not. I have completed the same rigorous curriculum, passed the same boards, and deserve the same respect as my male counterparts.

I would have liked to include factual statistics to demonstrate the increasing trend of female dentists, but most resources I encountered were more than eight years old. With more than 37,000 AGD members, I am curious to know how the male to female ratio of the AGD compares to that of the ADA. Please feel free to comment with your input. I am writing this article the week of my own state's Annual Session, and I plan to comment if my experience is vastly different this year.

Until next time…

Colleen B. DeLacy, DDS

Dealing With Dental Trauma

Last month, I saw two teenage patients within the span of two days who suffered injuries from playing baseball—one battled the bat, while the other encountered the ball. Fortunately, neither patient is going to lose any teeth from the injuries. But, both patients had enamel and dentin fractures that could have been prevented by wearing a sports mouth guard.

My experience with these two teens has changed some of the conversations I’m having with other patients, especially teenagers! Never before had I thought to ask a patient if they are involved in sports. Our practice has seen injuries from basketball, football, baseball, softball, skateboarding, and cycling. Now I’m sure to mention this fact to patients as a way to encourage them to wear a soft protective mouth guard when playing sports. I offer to make a sports guard for any patient who wants one to protect for their teeth. Unfortunately, many teens are more concerned with looking cool than with protecting their teeth, so most opt out of wearing a mouthpiece. Even if the patient declines, at least they are informed of the risks.

There are so many things to consider when a patient has trauma to the teeth or mouth, that it can sometimes be overwhelming. How am I supposed to remember all of the components of trauma that we studied in dental school? There is a website I have found helpful when dealing with dental trauma. It has links to select which type of trauma a patient has encountered and directions on how to test, diagnose, and treat the injury. I’ve clicked through several of the pages, and the information seems to be accurate and evidence-based. You will obviously still want to use your own knowledge, discretion, and clinical judgment. Check the site out and let me know if you think it is as helpful as I do: www.dentaltraumaguide.com.

I hope you are having a pleasant (and trauma free!) spring.

Elizabeth Cranford, DMD

Themes From a Different Place

In this, my third blog, I want to cover a variety of different subjects, keeping it personal.

In Canada, April is Dental Health Month. The Canadian Dental Association does a really great job in getting the message out there and the media, always looking for a good story, pick it up. So the subject of oral health is in the media, usually in a positive light (I know, that is unusual, unfortunately). It offers us an opportunity to share these stories with our patients because, after all, our practice is all about relationships. The efforts of the CDA, as well as a number of great programs by the AGD, really help us spin the positive for our patients.

In the US, April is Oral Cancer Awareness Month, which offers more opportunities to have serious conversations with our patients about oral cancer and overall body wellness. Our patients see us more regularly than any other health care provider, so we are the ‘front line’ for cancer awareness and prevention. The Canadian Cancer Society is celebrating its’ 75th anniversary this month.

For many years, my practice has created fun themes in our office to celebrate different societal occasions such as Valentine’s Day in February, Halloween in October, Christmas/Chanukah in December, and in Calgary, the Stampede in July. We decorate the office and create some frivolity and joy surrounding these celebrations. For Valentine’s Day, we get enough flowers to hand one out to every patient we see the week before and the week after. Everyone leaves with a flower. For Halloween, we decorate the office and have a ‘sweet swap’ where we collect candy to be donated. (We have donated candy to the Women’s Shelter for kids who were unable to be out on Halloween evening). We post photos on Facebook to keep the conversations going and reinforce our relationships with the patients we are privileged to serve.

Last year, we decided to do something every month. For April, we decided to support the Canadian Cancer Society with a significant donation. In return, we got daffodils and buttons, and extras to hand out to our patients. Once again, our patients left with a lovely flower as a gift, as well as a reminder to continue to raise awareness of our need to fight cancer and support research. It’s been a very fulfilling way to give back.

In my last blog, I mentioned side projects that have been a fascinating diversion. One of these was the promotion of a graphic novel written by my brother Allan. Later this month, we will have a booth at the Calgary Comic Expo to promote the book. We will have media interviews and will be exposing the book to more than 60,000 science fiction fans over three days. I helped pay for the artist to create the artwork, and have been learning a ton about the book publishing industry. Don’t a large number of us want to write a book one day? It has been a fascinating diversion in my crazy life.

I also mentioned in that post that I will share how the building of my new office is progressing. At this time, we are still negotiating the details of the lease with the landlord. We have narrowed down the terms of rent, tenant improvement allowance, operating costs, length of term (10 years plus two 5 year options) and exterior signage. Now we have to iron out some final details about parking allowances to account for City of Calgary bylaws, and some landlord responsibilities towards me with respect to moving my office, etc. After a very long time negotiating (eight months), we’re almost there. But the right deal is worth being patient for, as it will take me to the rest of my career and beyond.

Thanks for reading and giving me the opportunity to share.

Warm regards,

Larry Stanleigh, DDS

April is National Oral Cancer Awareness Month

According to SEER, it is estimated that 40,250 Americans (28,540 men and 11,710 women) will be diagnosed with oral and pharyngeal (throat) cancer in 2012. It will kill roughly one person every hour in America (7,850 Americans) this year. Oral cancer kills more people than endometrial, renal, melanoma, and thyroid cancers do; all of which are considered "common cancers." [source] Where oral cancer is located and at what stage it is at when diagnosed have a huge impact on the survival rate. Lip cancer at stage 1 is 96 percent, but tonsil cancer at stage 1 is 56 percent.

We all know that stuff or kind of recall it when we see it. But there are two things that are often reported as facts, which have always bothered me.

1. Oral cancer is strongly correlated to HPV. That’s only partially true. HPV is only strongly correlated to posterior cancers like oropharyngeal and tonsil. I think a lot of dentists believe all oral cancers are increased due to HPV, but that is not the case.

2. The other thing that bothers me is how is the 5-year survival rate for oral cancer is 57 percent if only 8,000 a year die and 40,000 a year get it? If you use the 8,000 and 40,000 figures, the survival rate should be closer to 80 percent. However, “5-year survival rate” simply means “chances of being alive in five years,” NOT that the cancer kills those people. So, the 5-year survival rate of any group of people is not 100 percent. The older the average age of diagnosis, the lower the survival rate will be just because of the older age. But that still doesn’t explain the difference between 80 percent and 50 percent. The median age at diagnosis for cancer of the oral cavity and pharynx is 62 and the average is right around 60. Let’s just use 62 as the starting point. According to Social Security, about 93 percent of 62-year-olds will survive to age 67.[source] But, on average, only about 80 percent of people with oral cancer will survive those five years. That’s when you do not include those directly killed by cancer. That’s a big difference; so either I’m mistaken or misinterpreting something or those with cancer die from other things at an incredibly higher rate than their peers (3x in this example). Which is it?

Bryan Bauer, DDS, FAGD

Noise in the System

Hello again everyone. Happy Spring. It is amazing how fast the time flies. It seems like just a month ago, it was the start of a new year, and now we are almost 1/3 done with 2013.

Did you pay your taxes? I know of several dentists that are in the dog house with the IRS and two that are about to go the Big House. Who in their right mind thinks they will be able to get away with not paying taxes? I don’t like to pay taxes, but I like the repercussions even less.

There was a football coach of a major university that would use the term “noise in the system” when people would criticize the team, a player, or a coaching call. That is how he described all of the outside issues that would distract the team focus. We have so much of that in dentistry.

The noise in the system I have seen comes recently from a friendly MD who likes to get on national TV and tell everyone how bad dental radiographs or amalgams are. These issues distract me and my dental when we have to reassure our patients and undo the myths and ideas that he has put in their heads. I know some of the patients believe me, but others just believe the talking head on TV. It can be draining when I hear about all the “horrible” things the dentist does to you. He is telling viewers what, when, and how their dentists should be treating them! Should it not bother me, or what? All I know is that it irritates the heck out of me most of the time.

Have you heard the commercial on XM radio talking about bleaching your teeth? It says that their system will even bleach crowns, fillings and veneers? What is it? Is this substance some new miracle potion that defies the laws of chemistry and physics? I have to explain when patients give me the third degree about why my stuff is not as good as the stuff on the radio.

“Ohhhh! You want the real good stuff?” Sometimes I just want to hand them a bottle of correction fluid and leave!

Have a good week.

JJ

Committing to Adapt

We all have natural tendencies and preferences; behaving opposite them requires a lot of energy and can wear us down. Imagine what could happen on a road trip where one person enjoys the experience of being on the road while the other just wants to get to the destination.Regular stops for scenery and snacks then become a disaster.

We come across similar experiences every day in our dental practices. Let us assume that you are the quiet, task-oriented person but your patient gets comfortable by talking and expects you to do the same. Or, let us assume the opposite where you are the outgoing, people-oriented person and your patient just wants to get things done and get out. Regardless, it is all about understanding ourselves and others, and adapting.

From the moment our patients begin to interact with us, they give us clues that let us know how they want us to approach them. For example, a patient who answers the health history’s “Yes/No” questions with further explanation could be a detail-oriented one. We’d better not ignore any of the information. Unfortunately, there is no absolute mathematical equation that explains the reasons behind people’s behavior.

I believe that I am naturally an introvert. After a long day of work, I need a quiet break to recharge; a true extrovert prefers to go out and chat with someone. My natural tendencies used to control my behavior. Instead of mingling with my team when I had available time at work, I used to sit in my office and read a dental journal “to become a better dentist.” I was shocked when I learned that our team members felt that I did not care about them. Imagine how my patients felt!

In an effort to become a better patient care provider and dental team leader, I ventured into the world of behavior analysis. I was attempting to understand my own behavior and that of others. For almost a year, I had phone training for half an hour with a behavioral specialist every other week.

The DISC behavioral language worked for me. It simply measures behavior and how we communicate. Behavior is divided into four groups:

1. Those who state more than they ask, and tend to be blunt and to the point. They focus on results and thus need to direct us. They get angry easily, so attend to their needs immediately.

2. Those who tell stories and anecdotes and digress during conversations. They focus on the experience and they need to interact.Give them chance to talk and share your personal stories.

3. Those who ask more than they state and use a slow pace. They focus on listening to understand. Get to know them well on a personal level.

4. Those who like facts and prefer less verbal, more written communication. They focus on gathering data. Be ready to quote research.

Our whole team completed one of these questionnaires to determine each member’s behavioral style. Everyone committed to adapting, including the doctors. Maybe in the future, patients can complete one of these questionnaires so we can serve them better.

Samer S. Alassaad, DDS

Love Me or Leave Me

I think I gave up on wanting everyone to like me a long time ago.

I’m probably a perfectly likable individual, if you ask most people. I’ve got decent table manners, maintain good personal hygiene practices, and can recite scenes from a wide range of romantic comedies from the late 90s with stunning aplomb. But as a dentist, I’ve learned that most of my patients are primed to hate me before I even have a chance to finish introducing myself.

If I had a dollar for every time I’ve heard a patient say, “No offense, but I really HATE the dentist,” to my face, I could probably pay off the student loans of my entire graduating dental school class. My three-year-old niece is harshly reprimanded by her parents for yelling, “I DON’T LIKE YOU!” at the people she feels uncomfortable being around. Why does my largely grown-up, educated patient pool get away with essentially doing the same thing? I don’t walk into my gynecologist’s office and loudly declare my disdain for what she has to do every year to evaluate my reproductive health. And trust me, I’d much rather see a syringe loaded with septocaine coming towards me than a shiny metal speculum ANY day.

When I first came face-to-face with dentist-hate in my pre-doctoral days, I felt compelled to instantly forge a lasting emotional bond with my patients that I genuinely hoped would change their opinion of me and my profession for good. I apologized profusely when they winced in pain upon injection of local anesthetic. I took it personally when someone complained about the cost of dental treatment or made snide remarks about how my livelihood was sustained at the expense of theirs. I desperately wanted them to understand that I wasn’t the enemy, and if they could just find it in their hearts to look past the white coat, they might just see that I only wanted the best for them. I could be their friend.

Nowadays? I know better. I may still be relatively new to this, but it didn’t take long for me to realize that it is far more important for my patients to respect me than it is for them to like me.

And yet, when I take a close look at the evolution of our profession, it becomes increasingly clear that the practice of being “liked” has become inextricably linked to the practice of dentistry. The advent of social media and the Internet forces us to present ourselves not only as healthcare professionals with enough knowledge and experience to be respected, but also as personalities imbued with just the right amount of character and likability that people feel they need to see in order to believe they’ve made a favorable cerebral connection to us.

Both old and new dentists alike seem to be fully cognizant of the paradigm shift in the dentist-patient relationship. Every time I check my email or go online, I’m bombarded with requests to visit my colleagues’ newly minted Facebook and LinkedIn pages and click “Like” or “Endorse” so the entire universe can have visual confirmation of my support for their career achievements and endeavors.

Yelp reviews and star ratings can, in some instances, make or break a dentist’s reputation. Professional consultants may charge exorbitant fees to help make dental practices more accessible and inviting to new patients. I even saw a CE course in a catalog offering to teach dentists how to use Twitter, promising that the acquisition of a skill mastered by pre-pubescent schoolgirls and most of the “Real Housewives” cast members would convince patients that their dentist was worth investing time and money in because he or she clearly had one steady, gloved finger pressed firmly on the pulse of the new millennium in healthcare.

It’s surreal to watch modern dentists’ professional identities slowly spiraling into some bizarre form of commodity fetishism [somewhere, my college friends are squealing with joy at the inclusion of a Marx reference in an essay about the dental profession] in which society can determine our intrinsic value based on how much we appear to be sought after compared to others of a similar composition.

Is there any way to avoid getting sucked in? [Somewhere, the same group of college friends is now snickering most immaturely.] As a new dentist, do I start bribing friends and businesses to follow me on Twitter to make me appear well-liked and well-connected? Should I create fictitious Yelp accounts to write fake 5-star reviews of myself so my colleagues and patients will believe I’m worth my salt?

Wait. I think I finally made the connection to the “seasoned enough” description.

Or do I keep calm and carry on, without ever worrying if my own level of professional likability isn’t meeting the industry standard? My mildly-seasoned suspicions postulate that the answer inevitably lies somewhere in the middle of these two extremes. I should care enough to ensure that my patients perceive me as a warm and trustworthy professional to whom they can openly express their dental concerns without fear of judgment or condescension, but not care so much about their personal opinions of me that it compromises my ability to provide them with the best care possible.

And that’s not to say that I don’t occasionally wonder about those of you who visit The Daily Grind on a regular basis. I don’t write these entries with the specific goal of appealing to any audience in particular, but I always hope that you’ve enjoyed what I had to say, and that maybe, somehow, I’ve connected to you in some way.

After all, I’m just a girl... standing in front of a blog... asking you to like me.

Diana Nguyen, DDS

Spring Cleaning

Spring is here! As I write this entry, I realize that the weather is far too nice to be inside; I’ll make this brief. We often hear the saying “spring cleaning” being thrown around this time of year. It is a reminder to clean up the garage, throw away the junk we’ve collected over the past year, or spruce up the yard. For dentists, it can serve as a reminder to get our house in order. Check your CE credits. Have you fulfilled (and exceeded) your requirements? Run some office reports. Are you on target to reach your goals? Perform staff reviews. Is everyone contributing at their highest levels? Use spring time to make corrections, as we only have eight more months to ensure we have a wonderful 2013.

Jason Petkevis, DMD

Are You Texting Yet?

“Please thank Dr. Alas for remembering my birthday.”

We get this a lot at my office. How do we do it? My office , admittedly, is not the most high-tech office out there. You won’t see it featured in any of the dental publications as “Office of the Year.” We don’t have digital x-rays. We still use paper charts, and you won’t see a Cerec machine anywhere near my office. But the important thing is that my patients view me as being very high-tech and up-to-date.

How do we get so many compliments about our office being high-tech? Get the patient where they are. Literally. If you have not yet begun using text reminders in your office, get ready to make a phone call to sign up.

Using text reminders, you can reach patients on their cell phones while they are at the store, their kids’ school, or the gym. Wherever they happen to be, you are there too! These days, people live their lives staring at their phones. Even while they are sitting in your dental chair! (That is a topic for another blog.) Imagine not having to leave messages on answering machines that may or may not be retrieved.

Let’s assume it is 8:15 a.m., and you have a hygiene cancellation for 10 a.m. How quickly can you fill that? Our record is 30 seconds. Yes, that’s seconds, not minutes. Our average is about 2 minutes. We maintain a list of people who ask us to call them when we have any openings. I’m sure your office also maintains such a list. But rather than making several phone calls chasing people down, we send a group text and the first one that calls back gets the appointment! How long does it take you to fill that appointment?

The use that really gets us the compliments is reminding our patients about their appointments. We remind our patients two weeks before their appointment and then again two days prior to their visit. We used to send postcards to remind patients of their hygiene appointments. The cost of the texting service is offset by no longer purchasing and mailing postcards. With postage rates so high these days, the service pays for itself with the savings in postage.

Instead of having the patient fill out a postcard after each recall appointment, we make their six month appointment in our regular practice management software. That’s it! Two weeks prior and then two days before their appointment, the computer automatically reminds them!

How does all of this work? The texting computer program connects to your practice management software automatically. It gathers the appointment times and sends each patient a text reminder. On the patient’s end, they can press ‘yes’ to confirm or ‘no’ to let you know that they’ll need to reschedule. All of this happens automatically. You receive an email letting you know the patient’s choice. If they need to reschedule, you simply text them back from your computer to find a more convenient time.

The best endorsement this system has received is from my front office manager. She has jokingly (I hope, told me she would quit if I ever got rid of this service. After more than 30 years, she swears that this is one change that has been a quantum leap in making her job easier.

Finally, the computer sends a patient a message on their birthday. Patients love this feature. It surprises me still that patients call us up and say, “Please thank Dr. Alas for remembering my birthday.”

Do your practice a favor and start texting!

Andy Alas, DDS

Vertical Bitewings

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

Infection Control

A few days ago, I received an email titled: “Every dentist should know.” I opened the attachment and there it was: the story of Dr. Wayne Harrington of Tulsa, Oklahoma, being investigated by the state dental board, the state bureau of narcotics, and the federal drug enforcement agency. The Tulsa Health Department has warned 7,000 patients of his that they may have contracted HIV, hep B or hep C from his procedures due to poor sterilization practices. During the investigation, they found numerous issues in that practice that had to be addressed. (ABC News, Mar. 29, 2013)

Another email followed with the same title, this time with an article speaking about an incident in the St. Louis area in 2010 where 1,800 veterans were put at risk of HIV and other diseases form dental tools that had not been properly sterilized between patients.

My whole body shivered for a moment. All I could think of was where my own limits would be on this issue. Sometimes, I think all human beings are capable of the same actions and what separates us is our limits, our tolerances, and our control levels. I wondered what situation I would have to be where I decide that the value of practicing with poor sterilization would be greater than putting 7,000 patients at risk of contracting a lifelong infection. I couldn’t find where that limit would be for me or for anyone. This was some of the most disturbing news I have ever read about in my field (it was quite a shocker to read the responses to it, as well).

As a way to prevent this, some suggest patients ask their providers what their sterilization practices are and demand explanation. Have we really come to the point where we need our patients to keep an eye on us so we can “do no harm?” Is it not the very essence of every healthcare professional to do no harm? This is not the responsibility of the patient. Patients shouldn’t be going around interviewing dentists to find the ones who practice good infection control! It upsets me to see how one person’s madness has created a situation where distrusting your dentist is being advertised and normalized.

I wondered how this issue could be dealt with in-house. Maybe there should be higher restrictions on licensing renewals and more stringent training required. This episode was unbelievably large in scale, and I doubt that there are any more like it. However, not everyone practices very strict infection control fully; it is assumed that if the bulk of it is practiced, attention to detail is not necessary. I disagree. I think it’s the details that make the bulk work properly.

This is an incredibly sad situation. My heart goes out to every person who was exposed because of one person’s lack of responsibility. This is a good time to reflect on the issue and evaluate our own personal commitment to our patients and make adjustments if we need to. However small, these adjustments will make a big difference in one person’s life and that makes them worth doing.

Mona Goodarzi, DDS