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Dental Consultant Advice: Hygiene Production Keys

Your hygiene department can make or break your practice, yet most hygiene departments underproduce.

Here is a list of the top five concerns I've heard and questions I've been asked over the years.

1. What percentage of production should come from hygiene?

The "industry standard" is 30% to 35%; however, the percentage of a practice's production that comes from hygiene will vary, as dentists have different treatment protocols, and their definition of "ideal dentistry" and "ideal hygiene care" will vary. As an example, I have one client who produces $5,000 a day and whose hygienist produces $1,200 a day. Another client produces $2,200 a day and has a hygienist who produces around $1,000 a day.

So what is a good amount of production for a hygienist? The answer should be based on what a practice generally delivers and its fee schedule. For example, offices that do scaling and root planing (SRP) on a more frequent basis will have higher hygiene production averages. This, of course, depends on the doctor's viewpoint on what the hygiene department should deliver. So depending on the type of hygiene a practice delivers, I look for what a practice can optimally do based on the type of services it offers.


2. What counts toward hygiene production?


Everything billed in hygiene except, for the most part, the exam.


Sometimes there is an "exam debate" as to what counts toward hygiene production. This is because of codes that only allow the exam to be submitted if the dentist does the examination/diagnosis unless state law, such as in Colorado, says otherwise. This really only matters if you pay or pay a bonus based on production. As long as the benchmark for the compensation/bonus is consistent and fair, it doesn't much matter, except it would be nice if hygienists were acknowledged for what they actually produce.


3. What should open hours be?


“Are you adding new hygiene days to your schedule?”


Open hours in hygiene are a chief concern. Let's do some basic math: Say you're getting 30 new dental patients a month. That's 360 new dental patients in a year, which means a possible 720 hygiene appointments.

Are you adding new hygiene days to your schedule? If not then there are big, gaping holes in your recare system that a city bus could fall through.

4. Salary or commission?

Base pay plus commission seems to be the best and most popular system. This protects the hygienist if the front desk drops the ball on the schedule but also gives the hygienist a reason to go the extra mile. Commission kicks in when production exceeds three times base pay. Also if the day does fall apart, or there's an open hour, the hygienist on base pay can be put to work calling overdue patients or handling other necessary tasks. However, doing so won't fly when a hygienist is paid on commission only.

How a three-times bonus system is worked out:

Calculate the daily average production for the hygienist over the past three months (or longer).

The minimum calculation is three times the pay. Example: Daily pay is $250 x 3 = $750 = Minimum daily baseline.

At the end of the month, multiply days worked by the minimum daily baseline. Example: 16 days x $750 = $12,000 = Minimum monthly baseline.

Assuming production is higher than the minimum monthly baseline, there will be a bonus. Subtract baseline from total production for the month. A quick example would be if the production for a month was $14,000 and the baseline was $12,000, then there's a $2,000 difference.
Multiply the difference by 30% (adjust up or down as you see fit) to arrive at the actual bonus for the month. Using the example above, $2,000 difference x 30% = $600 bonus.

5. Which codes?

Periodontal maintenance (code D4910), of course, follows SRPs. It is not preventive care but aftercare. However, sometimes patients are billed for a prophy (code D1110) when in fact what they received was a D4910 or some other aftercare treatment. If this is happening in your practice, there is likely a significant loss of production.

Sometimes this occurs as that's the way it's always been done in a practice, or because the hygienist or front-desk person does not know how to comfortably explain the differences in the treatments to a patient. The team member opts for the path of the least resistance so as not to upset or lose the patient.

For this reason, it is vital that your hygienist and front desk team be able to comfortably educate patients on the necessity of regular periodontal maintenance visits and how that is different from a prophy. This is done using effective case presentation techniques. Start by role-playing with your hygienists to see how well they can educate patients on the differences. It can be a real eye-opener.

Keep track of your hygiene numbers, and using incentives and proper coding will help achieve the mission of efficiently delivering the best possible hygiene care to all your patients.


 

Kevin Tighe, Cambridge Dental Consultants, Senior Consultant, got bitten hard by the business and marketing bug during long summer days working at his dad's Madison Avenue ad agency. After joining Cambridge as a speaker in the mid-1990s, Kevin went on to become Cambridge’s senior consultant and eventually CEO. Cambridge Dental Consultants is a full-service dental practice management company offering customized dental office manuals. Frustrated? High overhead? Schedule a chat with Kevin at 

Dental Consultants Tip: D1110 vs. D4910
Dental Consultants Tip: Calling Patients

 

What Does A Dental Consultant Do? Charge?

Many dentists will tell you dental consulting works. If dental practice management firms had no worth or benefit they could not stand up to harsh economic realities for long. What a veteran dental consultant brings to the table are systems and protocols successfully implemented in other practices that have been improved and tweaked over many years. Top dental consultants talk and network with each other. They pay attention to what works and what doesn't work across all dental practices.

Marketing & New Patients

Practice management consultants generally have little marketing training or background. 

Note: Cambridge'a consultants are Certified SEO and Ad Words Specialists

Dental Office Systems

Key systems dental consultants implement:

  1. New Patient Phone Call
  2. Insurance Processing
  3. New Patient Experience and Patient Education
  4. Financial Arrangements
  5. Scheduling
  6. Confirmation
  7. Unscheduled Treatment Followup
  8. Reactivation
  9. Huddle
  10. Stat Monitoring
  11. Daily and Weekly Checklists
  12. General Policy Manual

Your Staff

You will not get much ROI from your dental consulting if your staff do not have your back. You do not beed a team of cheer leaders jumping up and down with enthusiasm, but you do need staff who are smart and take some pride and ownership in what they do. If there is more than the usual drama in your practice that needs to be sorted out before you will get any real results.

Staff Accountability 

What gets monitored gets done.

The "big" obvious numbers are important to monitor, but when you look at them they are typically already "in the books". You want your team to concentrate and be accountable daily on the "small" stats that bring about the "big" stats. How many practice owners know how many calls were made to unscheduled patients each day or overdue re-care or inactive patients? Many dentists vastly underestimate how much daily "outflow" is needed to keep a schedule full. How may dentists know what % of slots were open in their hygiene schedule each day? How many know how many NP calls there were yesterday, who scheduled and if they end up showing up? More importantly how many staff know considering it's their job to do?

The only way to monitor what gets done is with daily stats especially for your weak areas. For example, one employee should be specifically responsible for calls to patients who are unscheduled, overdue re-care or need reactivation. Other staff can and should help in coordination with the accountable employee, but that employee accountable reports daily on a spreadsheet like this: 1. # of calls or personal texts sent 2. # of contact
3. # of appointments with name and date 4. # of arrivals

It is the employee who is either making themselves valuable to you or not. If they are doing so, dismissing them will never enter your mind. On the other hand, if they are not making themselves valuable, you will be doing them and yourself a favor by giving them the opportunity to find a practice or other employment that is a better fit for them.  

Leadership

What most practice owners are missing is not how to book an appointment but how to be effective leaders. The best systems in the world are useless if the staff do not comply. Good leaders know how to get staff to willingly follow through and comply. Agreement among all team members is key. Your written office policies should contain those agreements and should answer most questions staff come up with. Doing so will save you much time and simplify the management of your practice. Staff non compliance is a sure sign of poor leadership. The primary reason practices underperform is staff non compliance.  Key traits of leaders. All it takes is discipline: 

  1. Always keep a cool head especially when "under fire"
  2. Realize that all mistakes are an opportunity for you and your staff to learn.
  3. Set a good example.
  4. Always be learning.
  5. Take care of yourself.
  6. Fight the impulse to address multiple issue at the same time. Frantic activity creates spotty results.

Cost

$35.000.00 is the average fee for a one year program with dental practice management companies you are likely familiar with. For those companies that require you and your staff to travel to their facility or seminar you also need to add in the cost of travel, staff pay and lost production from time away from your practice. 

Questions You Should Ask

  1. Do you and/or your staff have to travel or does the consultant come to you?
  2. Is the program mostly one on one consulting versus seminars or courses with multiple clients in attendance? There are advantages to both.
  3. If the dental consulting is one on one who will actually deliver the consulting? I recommend knowing who your specific dental consultant will be prior to signing on the dotted line.
  4. Is program based on a specific dental practice management system? You want to avoid cookie-cutter programs. Ensure the program will be tailor-made to fit your practice's specific needs.
  5. The cost (including travel expenses and downtime) is certainly not the only factor, everything else being equal, it is still a major factor to consider. It's unwise to pay too much, but it's worse to pay too little.

If you do a little homework it should be fairly easy to pick a reputable consultant that is a good fit for you and your practice.