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BEST PRACTICE ACADEMY: BUILDING A SUSTAINABLE DENTAL PROGRAM
Alabama Primary Health Care Association
February 19, 2019
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Pre-Training Evaluation & Training Materials
Before we begin, please fill out the pre-training evaluation and download
some of the materials we’ll be using today
• Pre-Training evaluation: https://www.surveymonkey.com/r/ALPRE19
• Training materials: https://www.dentaquestinstitute.org/learn/online-
learning-center/resource-library/alabama-pca-training-2019
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Who We Are
4
Who We Are (Cont.)
The DentaQuest Partnership for Oral Health Advancement, a not-
for-profit organization, engages in grantmaking, research, care
delivery improvement programs, and collaborations that
transform the current broken system to achieve better health
through oral health.
We are passionate and committed to revolutionizing oral health by implementing meaningful change strategies to create an effective and equitable system that results in improved oral
health and well-being of all.
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Focus Areas
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SNS has worked with over 500 dental programs
in 45 states & DC
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Oral Health Value-Based Care Training Program
Our new Oral Health Value-based Care Training Program will focus on
educating, enabling and empowering oral health stakeholders, including
payers, contractors, dental practices and providers, around value-based
care in oral health and what they need to know to successfully transform
when the opportunity presents itself.
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Today’s Presenters
Da-Nell
Pedersen,
Strategic
Communications
Manager
Danielle
Apostolon,
OHVBC
Training
Specialist
Kelli Ohrenberger,
Manager of
Interprofessional
Practice
Caroline
Darcy,
Technical
Assistance
Project
Manager
Tess Draper,
RDH, Clinical
Integration
Trainer,
DentaQuest
Care Group
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Today’s Objectives:
After this training, participants will:• Identify essential components to developing a business plan for FQHC dental
programs.
• Establish key dental policies and procedures for managing an efficient and effective FQHC dental program.
• Measure dental program capacity and understand its impact on access to care.
• Set realistic and achievable financial and productivity goals.
• Continuously monitor dental program performance.
• Develop a strategic scheduling template to maximize access, improve oral health status outcomes and dental program financial viability.
• Develop effective policies and procedures for managing broken appointments and emergencies.
• Develop strategies to achieve integrated care.
• Develop an understanding of how interprofessional practice leads to integration and coordinated care.
• Develop an improvement plan for success.
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Today’s Agenda
Laying the Groundwork for Financial Sustainability in the Dental Program
Developing Financial and Productivity Goals – Demo of Tools
Break
Strategic Scheduling
Lunch
Comprehensive Health Center Integration to Improve Overall Health
Break
Managing Chaos
Group Activity – Creating the Improvement Plan for Success
Closing/Wrap-Up
LAYING THE GROUNDWORKFOR DENTAL PROGRAMFINANCIAL SUSTAINABILITY
Alabama Primary Health Care Association
February 19, 2019
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Junior Accountant, Computerized Bookkeeping, LLC
Accounts Payable Supervisor, W.B. Mason
Senior Project Manager, Safety Net Solutions, 2008-2018
Oral Health Value Based Care Training Specialist Present
Danielle Apostolon, B.A. Business
Management
Oral Health Value-Based Care Training
SpecialistDentaQuest Partnership for Oral Health Advancement
Member, American Association of Public Health Dentistry
Associate Member, Association of State and Territorial Dental Directors
Member, National Network for Oral Health Access
Associate Editor, Safety Net Dental Clinic Manual
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What is Sustainability?
(Financial) sustainability is the ability to
generate resources to meet the needs of the
present without compromising the future
This Photo by Unknown Author is licensed under CC BY-SA-NC
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Importance of Sustainability
• Grant funds are never sufficient
• The resources allows us to hire and keep good providers
and staff
• Meet increasing operational costs due to increased
demand for services
• Expand the services we provide
• How we are reimbursed may change
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It all depends where we
start…
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MEDICAL DENTAL
Are Different!
Different Care Plan and Different
Business Plan
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Medical
20% of clinic volume
80% of visits = varied
80% of visits = longer
80% of billing varied
80% of visits treatment
80 % of RVU different
0% of governance is designed around dental
EDR silo
Not familiar with dental model
Lack of confidence
80% of clinic volume
80% of visits = similar
80% of visits = shorter
80% of billing similar
80% of visits diagnostic
80% of RVUs similar
100% of governance is designed around medical
EMR silo
Familiar with medical model
Confident leadership
Dental
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Key to Success for Creating a
Sustainable Business Plan
• Defining your capacity
• Setting access goals, responsibilities, timelines
• Having the right policies for “everything”
• Using data to evaluate quality and provider
productivity outcomes
This Photo by Unknown Author is licensed under CC BY-SA-NC
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What Does Success Look Like?
Provide access to care
Generate enough revenue to cover expenses
Provide high quality dental care that is
appropriate, cost-effective, and is what our patients
want
Manage the chaos and achieve smooth patient
flow throughout the work day
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What Does Success Look Like?
Promote continuity of patient care
Collaborating with others in the community to
meet patient needs
Meet all regulatory requirements and standards
of practice
Happy, healthy patients and staff!
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Create the Business Plan
• Target Population
• Service delivery model
• Types and #’s of providers and staff
• Services
• Number of chairs
• Hours of operation
This Photo by Unknown Author is licensed under CC BY-SA
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• Number of visits
• Number of unduplicated patients
• Number of new patients
• Procedures by ADA code
• Procedures per visit
• Broken Appointment rate
• Emergency rate
• Gross charges
• Total expenses
• Net revenue
• Collection Rate
• Expense per visit
• Revenue per visit
• Aging report past 90 days
• Payer and patient mix
• % of completed treatments
• % of children needing sealants who received sealants
• HRSA Sealant metric
Data to Evaluate Program Performance
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2,500-3,200encounters/year/FTE dentist
2,700 encounters/year with 1,100 patient
base/dentist
1.7 patients/houror 13.6 patients/day/dentist
Access Benchmarks
2.6 Visits/Year/Patient
2 Chairs/dentist (3:1 is ideal)
1.5 Assistants/dentist (1 DA per chair is ideal)
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1,300-1,600encounters/year/FTE hygienist
230 work days/year (or 1,600 work hours/year after
holidays and vacations)
2 ADA coded servicesas the diagnostic part of a recall or comprehensive visit (exam, FMX)
1.2patients/hour/hygienist
or 10 patients/day/hygienist
5 days/week x 46 weeks = 230 work
days/year
Access Benchmarks
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15% Broken Appointment Rate
<10% Emergency Rate
33% Comp TX. Plan is Fair
#New Patients = #Completed Treatment
Plans
Access Benchmarks
Booking out 30-45 days
Designated AccessScheduling
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$200 average cost per encounter (UDS 2017)
330 Allocation = Average of 15%
Gross Charges =
>$500K-$600K per dentist per year
% of total A/R due past 90 days =
10-15%
95% Collection Rate
Financial Benchmarks
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$40Nominal fee
3 Slide Categories100-199% FPG
Full Fee Schedule70-80% of UCR
Financial Benchmarks
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2017 Alabama UDS Numbers
• 319,327 unduplicated FQHC patients
• 91.59% accessed medical services
• 18.01% accessed dental services (57,517 patients; 115,002 visits)
• 2,797 visits/year/FTE Dentist
• 764 visits/year/FTE Dental Hygienist
• 2 visits/year/unduplicated dental patient
• Average cost/visit in dental = $140 per visit
• Sealant metric average = 48.53%
Source: https://bphc.hrsa.gov/uds/datacenter.aspx?q=tall&year=2017&state=&fd=
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Capacity=Quality
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Defining Capacity
• We are limited by our structure
• Chairs-Rooms-Operatories, Dentists,
RDHs, DAs, Staff, Hours of Operation
• Our structure determines our capacity, not our hearts
• We cannot be all things to all patients
• We only have 20% of the capacity of Medicine
• Understanding and defining capacity is essential to the creation of
the dental business plan
• We need to decide WHO gets the care by creating priority
populations
Equitable, quality care mandates that
we work within our capacity
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Benchmark Guide
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Example
Staff and Operatories:
• 2 FTE General Dentists
• 3.0 FTE Dental Assistants
• 1 FTE Hygienist
• 5 Operatories
• Each Dentists works out of 2 Ops
Hours:
• Monday through Friday 8:00-5:00 (1 hour lunch)
• 8 clinical hours per day
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Determining Capacity Goals Based
on Our Structure
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# of
Providers
# of total
clinical hours
worked
x recommended
# of visits/
clinical hour
Potential
Daily Visit
Capacity
Mon. 2 16 1.7 27
Tues. 2 16 1.7 27
Wed. 2 16 1.7 27
Thurs 2 16 1.7 27
Fri 2 16 1.7 27
Potential Weekly Capacity = 135 Dentist Visits
Actual
Visits
% of
Capacity
Achieved
20 74%
26 96%
19 70%
18 66%
10 37%
*At least two operatories and 1.5 dental assistants
Setting Productivity/Access Goals: Visits
Potential vs. Actual – FTE Dentists
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# of
Providers
# of total
clinical hours
worked
x recommended
# of visits/
clinical hour
Potential
Daily Visit
Capacity
Mon. 1 8 1.2 9
Tues. 1 8 1.2 9
Wed. 1 8 1.2 9
Thurs 1 8 1.2 9
Fri 1 8 1.2 9
Potential Weekly Capacity = 45 Hygiene Visits
Actual
Visits
% of
Capacity
Achieved
7 77%
8 89%
6 66%
7 77%
6 66%
*Benchmark of 1.2 is ideal for a practice with a patient mix of both adults and children
Setting Productivity/Access Goals: Visits
Potential vs. Actual – FTE Hygienists
WHY?
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GOAL CALCULATION TARGET
Visits/Day 27 Dental Visits + 9 Hygiene Visits = 36 visits
per day *same for each day
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Visits/Week 135 Dental Visits + 45 Hygiene visits = 180
visits per week
180
Visits/Year 180 weekly visits x 46 weeks = 8,280 Visits 8,280
Dental Visits Based on Capacity
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Only fill in peach
colored cells Provider Type
General
Dentist A
General
Dentist B
General
Dentist C
Pediatric
Dentist Resident RDH A RDH B
Visit per Hour Benchmark 1.7 1.7 1.9 1
Daily Clinical Provider Hours 7 7 8 7 Monday 46 50 4
Visits 11.9 11.9 0 15.2 0 7 0
Daily Clinical Provider Hours 7 7 7 Tuesday 30.8 32 1.2
Visits 11.9 11.9 0 0 0 7 0
Daily Clinical Provider Hours 7 7 7 Wednesday 30.8 33 2.2
Visits 11.9 11.9 0 0 0 7 0
Daily Clinical Provider Hours 7 9 7 Thursday 34.2 35 0.8
Visits 11.9 15.3 0 0 0 7 0
Daily Clinical Provider Hours 7 7 7 Friday 30.8 32 1.2
Visits 11.9 11.9 0 0 0 7 0
Daily Clinical Provider Hours 4 4 Saturday 10.8 11 0.2
Visits 6.8 0 0 0 0 4 0
Weekly Visits per Provider 66.3 62.9 0 15.2 0 39 0 Weekly Visit Goal 183.4
Enter number of
weeks/year 46
Yearly Visit Goal 8436.4
Daily Provider Visit Goals Clinic Productivity Goals
Day of the Week Daily Visit Goal Actual Visits Variance
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
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# of
Providers
# of total
clinical
hours
worked
x recommended
# of visits/
clinical hour
Potential Daily Visit
Capacity
Mon. 2 16 1.4 22
Tues. 2 16 1.4 22
Wed. 2 16 1.4 22
Thurs 2 16 1.4 22
Fri 2 16 1.4 22
Potential Weekly Capacity = 110 Dentist Visits
2 Dentists each working out of 2 Operatories with 1 dental assistant
Model 1
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Potential Weekly Capacity = 135 Dentist Visits
2 Dentists each working out of 2 Operatories with 1.5 dental
Model 2
# of
Providers
# of total
clinical
hours
worked
x recommended
# of visits/
clinical hour
Potential Daily Visit
Capacity
Mon. 2 16 1.7 27
Tues. 2 16 1.7 27
Wed. 2 16 1.7 27
Thurs 2 16 1.7 27
Fri 2 16 1.7 27
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Cost of Adding Dental Assistant
$16/hour x 40 hrs = $640/week
Fringe benefits @ 25% = $160
Total cost = $800/week
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Additional 25 Visits per week
• 20% Self pay visits = 5 @ $40 = $200
• 65% Medicaid visits = 17@ $135 = $2,295
• 10% Commercial Insurance = 3 @ $165 = $495
• 5% Homeless (Free Care) = $0
• Total Revenue = $2,990 - $900 (cost of adding a Dental Assistant)
Weekly profit = $2,090
Yearly profit = $108,680
Increases access by providing nearly 1,150 additional visits for the year!
Cost vs. Benefit of Adding Dental Assistant
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Dental Procedures
Benchmark for Procedures per Visit: 2.5
Total the number of procedures by ADA code and divide that by the total number of yearly visits
• Total annual visits = 3,600
• Total procedures by ADA/CDT code = 4,000
• 4,000/3,600 = 1.1 procedures per visit
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Scope of Service Benchmarks
Service Type Procedure Codes % of
Total
Diagnostic D0100-D0999 (excluding
D0140)
30-40%
Preventive D1000-D1999 25-35%
Restorative D2000-D2999 18-25%
Endodontics D3000-D3999 1-2%
Periodontics D4000-D4999 2-5%
Removable Prostho D5000-D5899 1-3%
Fixed
Prosthodontics
D6200-D6999 <1%
Oral Surgery D7000-D7999 5-10%
Emergency D0140, D9110 2-6%
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What Happens at the Visit
TimeProviders level of competency
Patient need
Patient tolerance
Reimbursement
48
Balancing the Mission and Margin:
Expenses Revenue
49
Define what Financial Success Looks Like:
• Create a profit?
• Break even or zero variance?
• With grants or without grants?
• Willing to accept a loss? If so how much?
50
Net Revenue
Goal Calculation Target
Revenue per
Year
Break Even: Total direct
and indirect expenses
for the year
$1,000,000
Revenue per
Week
$1,000,000/46 weeks $21,739
Revenue per
Day
$1,000,000/230 clinic
days
$4,348
Revenue per
Visit
$1,000,000/8,280 $121
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Individual Production Goals
Provider FTE Gross
Charges
Net
Revenue
(60%)
Annual
Days
Worked
Charges/Day Revenue/Day
Dr. D 1.0 $541,667 $325,000 230 $2,355 $1,413
Dr. G 1.0 $541,667 $325,000 230 $2,355 $1,413
Total
Dentist
2.0 $1,083,333 $650,000 460 $4,710 $2,826
RDH 1.O $291,667 $175,000 230 $1,268 $761
RDH 1.0 $291,667 $175,000 230 $1,268 $761
Total
RDH
2.0 $583,333 $350,000 460 $2,536 $1,522
TOTAL $1,666,666 $1,000,000
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Predictability is Key
Ability to predict expected reimbursement based
on:
• Payer Mix
• 3rd Party insurance reimbursement
• Sliding fee discounts and nominal fees
• Visits
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Impact of Payer Mix on Sustainability
7,500 visits
35% Medicaid =2,625 visits x $100 = $262,500
55% Self-Pay/SFS =4,125 visits x $30 = $123,750
10% Commercial =750 visits x $125 = $93,750
Total revenue = $480,000
Total expenses = $500,000
Operating loss = ($20,000)
7,500 visits
40% Medicaid =3,000 visits x 100 = $300,000
50% Self-Pay/SFS =3,750 visits x $30 = $112,500
10% Commercial=750 visits x $125 = $93,750
Total revenue = $506,250
Total expenses = $500,000
Operating surplus = $6,250
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Average Reimbursement by Payer Type
55
Financial Projections Projected Visits
Actual Visits
Difference -6500
Patient/Insurance mix: Yearly visits
Percent Medicaid -
Percent Self Pay -
Percent Commercial Insurance -
Percent Other -
Total 0% -
Reimbursement Rate (per visit): Yearly Revenue
Medicaid -$
Self Pay -$
Commercial Insurance -$
Other -$
Total Projected Revenue -$
Total Expenses
Projected Bottom Line -$
Payer Mix Tool
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Common Problem Areas:
• Unfavorable Payer Mix• Working under or over capacity• Lack of goals and accountability
• High broken appointment rate
• Scheduling issues (types of patients)
• Insufficient support staff (dental assistants)
• Staff turnover
• Equipment issues (chairs, outdated, missing, broken)
• Lack of EDR/PMS (or not being fully utilized)• Billing and collections • Fees are set too low • Other
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VALUE-BASED CARE
Future of Oral Health Payment and
Care Delivery
58
Cost of Healthcare
2017 U.S.
Healthcare Costs:
3.5 Trillion/
22% of GDP
U.S. spends
6-11% more on health
than other countries
The U.S. is ranked
37th in health
outcomesby the WHO
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30% of Health Care Resources are Wasted
Source: Institute of Medicine Report – The Healthcare Imperative
Unnecessary Services
$210 Billion
Fraud
$75 Billion
ExcessiveAdministrative Costs
$190 Billion
Inefficiently Delivered Services
$130 Billion
Prices That Are Too High
$105 BillionMissed Prevention
Opportunities$55 Billion
= 1 Billion
60
30% = $37.2Bthat could have been spent
on care
30% = $4.47Bthat could have been spent
on care
2016 Dental Expenditures =
$124B2016 Medicaid Dental Costs
= $14.9B
Oral Health Care Dollars Wasted
61
Access to Care
Environment
Genetics
Health
Behaviors
Influence on
Health
10%
20%
20%
50%
Access to Care
OtherHealth Behaviors
National Health Expenditures$3.5 Trillion
88%
8%
4%
Health Status: Determinants of Health
and Health Care Expenditures
Source: Centers for Disease Control and Prevention, University of California at San Francisco,
Institute for the Future, http://www.cdc.gov/nchs/fastats/health-expenditures.htm
62
Value-based healthcare is a
healthcare delivery model in which
providers are paid based upon
making patients healthier while
reducing costs of care.
63
The fact that an alternative payment model
is different from fee-for-service does not
necessarily mean it is better.
www.chqpr.org/downloads/WhyVBPIsNotWorking.pdf
DESIGN
64
Fee-For-Service What Works What Does not Work
• Providers are only paid when
they provide a service
• Pays for more care when patients
need it (volume)
• Payment does not depend upon
variables the provider can’t
control
• Predictable payment, Providers
know what they will be paid
before they provide a service
• Care is not linked to quality or
results
• Care provided is not predictable
• Cost of care can exceed the
payment for care
• No fees for many needed
services
• Costs for care are not predictable
or comparable
www.chqpr.org/downloads/WhyVBPIsNotWorking.pdf
65
Pay-For-Performance
What Does not Work
• P4P services provided may not
be the ones that a particular
patient needs
• Payments may not be enough
to cover the costs of care
• There may be needed services
that are not covered by the P4P
plan
• Costs for care are not
predictable or comparable
• Providers still have to deliver
services to be paid. P4P is
just an adjustment to FFS
provided
• Providers could get paid less
for treating patients with
greater needs
• Providers could get paid less
for things they can’t control
www.chqpr.org/downloads/WhyVBPIsNotWorking.pdf
66
OHVBC is Not:
• Simple
• One size fits all
• Guaranteed to work
• Going away
• Instant
67
Opportunity to be at the Table
and not on the Menu
68
Domains of VBC
• Leadership, Vision and Will
• Structure, Systems and Operations
• Care Pathways and Provider Buy-In
• Data and Analytics Technology and
Personnel
• Financial Viability
68
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QUESTIONS/DISCUSSION
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DEMONSTRATION OF TOOLSFinancial & Productivity Goals
Payer Mix
71
Open the Financial and Productivity Goals Tool Excel
spreadsheet (1st tab – Productivity Goals Exercise)
Using the Productivity Benchmark Guide & Data Sheet for
Financial and Productivity Goals Exercise (both in
word), we are going to identify the following
productivity goals:
• Visits per day
• Weekly visits per provider
• Visits per week
• Visits per year
Creating Capacity and Productivity in Access Goal
72
Financial and Productivity Goals Tool
1st Tab
73
Sample Data
74
Financial and Productivity Goals Tool
2nd Tab
Instructions Description of Goal Variables Goal
Enter total indirect and direct expenses
from the profit and loss statement the
most recent fiscal year Yearly Revenue Goal -$
Enter number of weeks/year Weekly Revenue Goal #DIV/0!
Enter Number of Clinical Days per Year Daily Revenue Goal #DIV/0!
Total Projected Yearly Visits will
automatically fill in from the
Productivity Goal Sheet Revenue Per Visit 0 #DIV/0!
Goal 1: Break Even Goal without Grants
Refer to the 3rd Tab “Profit and Loss Statement” for
expenses
75
Payer Mix Tool
Financial Projections Projected Visits 6500
Actual Visits
Difference -6500
Patient/Insurance mix: Yearly visits
Percent Medicaid -
Percent Self Pay -
Percent Commercial Insurance -
Percent Other -
Total 0% -
Reimbursement Rate (per visit): Yearly Revenue
Medicaid -$
Self Pay -$
Commercial Insurance -$
Other -$
Total Projected Revenue -$
Total Expenses
Projected Bottom Line -$
Payer Mix Tool
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SCHEDULINGFORSUCCESSAlabama Primary Health Care Association
February 19, 2019
78
Learning Objectives
• Provide information on the basics of successful dental
scheduling
• Discuss the common scheduling pitfalls
• Provide guidance in effective scheduling for various
provider types
• Talk about how to schedule new adult patient visits
• Discuss strategies for overcoming schedule busters
79
Works directly with safety net dental programs to provide technical assistance, coaching & motivation
Presents at national conferences on various practice management subjects
Member, National Network for Oral Health Access
Caroline Darcy
Project Manager of Technical Assistance
DentaQuest Partnership for Oral Health
Advancement
Associate Member, American Association of Public Health Dentistry
Bachelor of Arts degree from Emmanuel College in Boston, MA
80
Guiding Principles
The dental schedule should be used to achieve three key
strategic objectives:
1. Maximum access to care for patients
2. Improved oral health status for patients
3. Financial viability of the dental program
81
Maximum Patient Access
• Our mission is to provide care to disadvantaged patients who have difficulty getting care elsewhere
• A certain number of our appointments can be designated for our priority populations
82
Improve Oral Health Status:
Completion Of Phase 1 Treatments
What is Phase 1 Treatment?
Diagnosis and treatment planning, preventive services, emergency treatment, restorative treatment, basic (non-surgical) periodontal therapy, basic oral surgery, non-surgical endodontic therapy and space maintenance and tooth eruption guidance for children
83
Why Track Phase 1 Treatment Completion?
• Important quality metric
• Promotes continuous coordinated care
• Enables balance of new and existing patients
84
Financial Viability
• Net revenue = total direct and indirect expenses
• Patient revenue plus grants/other
85
Define The Scheduling Process
• What will be the start & end times for appointments each
day?
• How many appointments per day?
• What is your capacity each day?
• Who is needed in each appointment?
• What types of appointments can be double-booked?
• What are the appropriate apt lengths for various visit
types?
86
The Schedule Process (Cont.)
• How do we best use our available operatories?
• What is your ideal patient mix? (new patients, emergencies,
priority populations, etc.)
• How far out should we schedule our apts?
• Who is authorized to schedule appointments?
• Be strategic about who can schedule appointments
• Providers should always be working to the top of their
licenses
87
Common Scheduling Pitfalls
• Scheduling appointments out too far
• Scheduling multiple appointments for patients
• Putting too many new patients into the schedule
• Appointments that are too long or too short
• Not using provider time strategically
• Not being strategic about how and when to double-book
• Open time in the daily schedule (10 minutes here and
there adds up!)
88
Common Scheduling Pitfalls (Cont.)
• Hygiene appointments in the
dentists’ schedules
• Not maximizing the potential of
auxiliary staff with expanded
functions
• Not identifying our priority
populations
• Not using designated access to
preserve appointments
89
Defining Program Capacity
• Capacity is finite
• Capacity = structure and resources
90
# of
Providers
# of total
clinical hours
worked
x recommended
# of visits/
clinical hour
Potential
Daily Visit
Capacity
Mon. 2 16 1.7 27
Tues. 2 16 1.7 27
Wed. 2 16 1.7 27
Thurs 2 16 1.7 27
Fri 2 16 1.7 27
Potential Weekly Capacity = 135 Dentist Visits
Actual
Visits
% of
Capacity
Achieved
20 74%
26 96%
19 70%
18 66%
10 37%
*At least two operatories and 1.5 dental assistants
Setting Productivity/Access Goals: Visits Potential
Vs. Actual – FTE Dentists
91
# of
Providers
# of total
clinical hours
worked
x recommended
# of visits/
clinical hour
Potential
Daily Visit
Capacity
Mon. 1 8 1 8
Tues. 1 8 1 8
Wed. 1 8 1 8
Thurs 1 8 1 8
Fri 1 8 1 8
Potential Weekly Capacity = 40 Hygiene Visits
Actual
Visits
% of
Capacity
Achieved
7 87%
8 100%
6 75%
4 50%
6 75%
Setting Productivity/Access Goals: Visits Potential
Vs. Actual – FTE Hygienists
92
GOAL CALCULATION TARGET
Visits/Day 27 Dental Visits + 8 Hygiene Visits = 35 visits
per day
35
Visits/Week 135 Dental Visits + 40 Hygiene visits = 175
visits per week
175
Visits/Year 175 weekly visits x 46 weeks = 8,050 Visits 8,050
Determining Annual Potential Visits
For The Dental Program
This shows how to take the daily visit capacity and determine weekly
and annual goals for the dental program.
46 weeks is the standard number of weeks we use in a health center
year to account for holidays, vacations and other office closings
93
Priority Populations
• Children
• Pregnant women
• Patients with chronic diseases such as diabetes, heart
disease and HIV/AIDS
94
Designated Access
• The daily schedule ensures access
for all patients
• But a certain number of
appointments are reserved
• These reserved appointments
can’t be filled with other patient
types until the day before
95
Financial Goals
• Gross charges
• Net patient-generated revenue
• Bottom line (revenue after
expenses)
96
Daily Revenue Goal
• Gross Charges – Contractual Adjustments = Adjusted Net Revenue
97
Determining The Daily Revenue Goal
Total direct and indirect expenses ÷ Number of clinic days per year = daily net revenue goal to break even
For example:
Total expenses = $950,000
5 days per week x 46 weeks = 230 clinic days per year
$950,000 ÷ 230 = daily net revenue goal of $4,131
98
Common Staffing Benchmarks
• General dentist, 2+ operatories, 1.5 assistants = 1.7 visits/hour
• General dentist, 1-2 operatories, 1 assistant = 1 visit/hour
• General dentist, 3+ operatories, 1 EFDA and 1-2 assistants = 2.5
visits/hour
• 4th year dental students = 0.5 visit/hour
• GPR Resident, Q1 = 1 visit/hour
• GPR Resident, Q2 = 1.2 visits/hour
• GPR Resident, Q3 = 1.5 visits/hour
• GPR Resident, Q4 = 1.7 visits/hour
• Hygienist, 1 operatory, unassisted = 1 visit/hour (typically, unless lots
of kids)
• Hygienist, 2 operatories, assisted = 1.5 visits/hour
99
Scheduling For Dentists
• Minimum of two operatories and ideally two assistants
• Staggered appointments in two columns (possible use of 3rd
column for overflow)
• Define workflow for each standard visit - where and for how
long the dentist is needed
• Line up the blocks so the dentist’s time is maximized
• Consider each dentist’s individual characteristics but aim for
standardization
100
Sample Template, Dentist
Morning Schedule: Afternoon Schedule:Time Op1 Op2
Op3 (Overflow for
emergencies)
8:00 Emergency
8:10
8:20
8:30
8:40
8:50
9:00
9:10
9:20
9:30
9:40
9:50
10:00
10:10
10:20
10:30
10:40
10:50
11:00
11:10
11:20
11:30
11:40 Emergency
11:50 HOLD
12:00
12:10
12:20
12:30
12:40
12:50
Time Op1 Op2Op3 (Overflow for
emergencies)
1:00 Emergency
1:10
1:20
1:30
1:40
1:50
2:00
2:10
2:20
2:30
2:40
2:50
3:00
3:10
3:20
3:30
3:40
3:50
4:00
4:10
4:20
4:30
4:40 Emergency
4:50 HOLD
5:00
Intake10-minute appointments for medical hx review, blood pressure, etc.
Operative
40-minute appointments for Fillings/extractions. Can expand to 60 minutes for more procedures
Anesthesia
First 10 minutes of operative appointment, if anesthesia is provided, where the dentist might be available for a brief side-booked appointment (eg, denture try-in, suture removal) or to provide a POE or LOE
Lunch 30 minutes
Color Code:
101
Scheduling For Hygienists
• Easiest schedules to fill; hardest to KEEP full!
• Broken appointments can wreak havoc
• Limit 6-month recall appointments
• Limit new patients in the daily schedule
• Develop tasks for hygienists whose patients fail to show
102
Assisted Hygiene
• Requires two operatories and dedicated hygiene assistant
• Hygienist can see 1.5 patients/hour or 12-13 patients in an 8-
hour day
• Assistant facilitates visit
• Eliminates RDH waiting for dentist to do exam
• Must rigorously manage broken appointments
• Must have demand for hygiene
103
COMPARISON:
Unassisted Vs. Assisted Hygienists
Unassisted
Hygienist
Assisted
Hygienist
Visits/hour 1 1.5
Visits/day 8 12-13
Visits/week (factors in
25% BA rate)
30 45
Revenue ($140/visit) $4,200 $6,300
Salary costs (includes
22% fringe)
$1,464 $2,149
Net revenue after salary $2,736 $4,151
Annual net revenue $125,856 $190,946
104
Sample Template, Assisted Hygiene
Time Room 1 Room 28:00 greet, seat, update, BP (Patient 1)
8:10 x-rays
8:20 Prophy greet, seat, update, BP (Patient 2)
8:30 OHI review, disclose, anesth
8:40 OHI/dentist exam SRP (one quad)
8:50 Unseat patient/clean OP
9:00
9:10
9:20 greet, seat, update, BP (Patient 3)
9:30 Prophy Unseat patient/clean OP
9:40
9:50 greet, seat, update, BP (Patient 4)
10:00 Unseat patient/clean OP Prophy
10:10
10:20 greet, seat, update, BP (Patient 5)
10:30 x-rays
10:40 Prophy OHI/dentist exam
10:50 Unseat patient/clean OP
11:00 Greet, seat, update, BP (Patient 6)
11:10 OHI/dentist exam Prophy
11:20 Unseat patient/clean OP
11:30 Greet, seat, update (Patient 7)
11:40 Sealants x 4 OHI/dentist exam
11:50 Unseat patient/clean OP
12:00 Unseat patient/clean OP
The Result: 7 patients in 4 hours! Patients have the same amount of time in
the dental chair, the work is just redistributed to provide more access.
105
Scheduling Adult New Patient Visits: Reasons
For Not Breaking Visits Up
• Can be red flag for insurance audits
• Not patient-focused care
• Clogs the schedule
• Harder to complete treatment on existing patients in a
timely manner
106
Rationale For Breaking Up Visits
• Oral health status unknown
• How much calculus in the mouth?
• May not be able to complete exam until calculus removed
• Not enough time to do all required work in one visit
107
Recommendations
• Follow the template faithfully
• 60 minutes with hygienist
• Practice policy: as much care as possible in time allotted
• Document why if patient needs separate exam visit with the
dentist
• PSR first and comprehensive periodontal exam if indicated
• Pilot, test and tweak as necessary
108
Document The Scheduling Process
• Create a formal scheduling policy
• Include scheduling templates as attachments
• Review the policy with entire staff
• Train staff how to use the templates
• Monitor, provide feedback and tweak as necessary
109
Schedule Busters
• Last minute cancellations & No-shows
• Late patients
• Too many emergencies/walk-ins
• Too many new patients
• Overbooking
• Logjams at check-in or out
• Providers who fall behind
• Not enough support staff
• Wrong appointment types
• Wrong appointment lengths
• Insufficient Instruments
• Technology issues
110
Strategies For Resolving Schedule Busters
• Attack broken appointments
• Be strategic with double-booking
• Control emergencies/walk-ins
• Limit new patients
• Revisit capacity
• Resolve logjams at check-in/out
• Determine why providers/practice fall behind
• Ensure sufficient instruments
• Tackle technology issues
111
QUESTIONS/DISCUSSION
112
ORAL HEALTHINTERPROFESSIONALPRACTICEAlabama Primary Health Care Association
February 19, 2019
114
Project Manager, Safety Net Solutions, 2008-2014
Senior Project Manager, Interprofessional Practice, 2014-2018
Manager, InterprofessionalPractice, 2019
Kelli Ohrenberger, M.A. Integrated Marketing
Communication
Manager, Interprofessional PracticeDentaQuest Partnership for Oral Health Advancement
Member, American Association of Public Health Dentistry
Member, National Network for Oral Health Access
Member, National Rural Health Association
115
Registered Dental Hygienist, Private Practice, 2009
Dental Hygiene Team Manager, Clinica Family Health, 2009-2018
Clinical Integration Trainer, Dentaquest, 2018
Tess Draper, RDH, BS Dental Hygiene
Clinical Integration TrainerDentaQuest Care Delivery
Member, American Dental Hygiene Association
Member, National Network for Oral Health Access
116
Agenda
1.) Why Interprofessional Practice?
2.) What are the challenges?
3.) How does IPP fit into my organization?
4.) Resources
117
WHY INTERPROFESSIONAL PRACTICE?
118
INTEGRATED CARE• An interdisciplinary approach to health
care that incorporates specific
procedures of other disciplines into daily
practice.
COORDINATED CARE• Using a continual care pathway approach
that allows the patient easy navigation
and understanding their needs within the
health care system.
INTERPROFESSIONAL PRACTICE
HIT &
Telehealth
Patient
Engagement
Referral & Case
Management
Population &
System Analysis
Clinical
Integration
Risk Stratified
Care
119
“Healthcare is an exercise in
interdependency- not personal heroism... a
need for greater teamwork and to ask,
what am I part of?”
- DON BERWICK
President Emeritus and Senior Fellow, IHI
120
Why Oral Health Interprofessional Practice?
• Health
• Practicality
• Financial
121
Health Benefits: The Oral Systemic Connection
122
Patient-Centered Benefits to IPP
-Dr. Don Berwick, IHI [NOSORH Annual Session 2016]
123
Practical Benefits of IPP
• The people who are at highest risk for dental disease
have the greatest difficulty in accessing care (lack of
access points, lack of insurance, out-of-pocket costs,
etc.)
• The public health infrastructure for oral health is
insufficient to address the needs of disadvantaged
groups
• Integration of oral health into medical care expands the
potential for high-risk individuals to have access to care
that halts and even reverses dental disease, avoiding or
reducing the need for expensive treatment
124
Benefits of Interprofessional Practice
• Referring to oral health providers that medical providers
know (and vice versa)
• Quick access for medical patients with acute oral health
situations (and for dental patients with potential medical
issues)
• Warm hand-offs and curbside consults
• More effective chronic disease management
• Preventive oral health care and effective self-care
strategies extended to medical settings
• More reimbursement options now (e.g. 40 states
reimburse non-dental professionals for fluoride varnish
applications)
125
Schneider EC and Squires D. N Engl J Med 2017; 377:901-904. /
Schneider et al. Commonwealth Fund, 2017
126
©2004 by American Academy of Pediatrics
Predicted, dentally related, cumulative costs
according to age of first preventive visit
Savage M F et al. Pediatrics 2004;114:e418-e423
127
WHAT ARE THE CHALLENGES?
128
Timeline of Current Dental Model (Surgical Care Model)
19101840 1945 1970
129
What’s the current state of affairs?
Medical and dental professionals are trained separately and then they practice how they are trained - separately.
The “hidden curriculum” about oral health in medical training:
• Oral health means teeth
• Teeth are the domain of dentistry
• I know very little about teeth
• Dentists know little about the rest of the body
• Why are you (dentist) asking me about something related to teeth?
• Why is this patient coming to ME about their mouth?
• Why can’t I get a dentist to see this patient?
Dr. Mark Deutchman, University of Colorado – School of Medicine
130
What’s the current state of affairs?
Medical and dental professionals are trained separately and then they practice how they are trained - separately.
The “hidden curriculum” about oral health in dental training:
• Oral health means dental care
• Teeth are the domain of dentists
• I do not see a need to know about treating systemic diseases
• Physicians consider us as an inferior “doctor”
• Surgical intervention gets me to graduation & pays the bills after
• Why is this patient coming to ME about their health?
• Team, what team? I’m holding my own suction over here.
131
Barriers to Integration/Collaboration
Medical and Dental Professionals:
• Educated separately
• Licensed separately
• Regulated separately
• Practice independently
• Non-integrated benefits/insurance programs
• PCPs see the mouth as the property of dentists
• Sharing of information rarely occurs
• Seen by the public as separate
• Oral Health Training for health professionals has been sparse to non-existent
132
• Education and training for
PCPs- must see the
mouth as an integral part
of the body
• Training for general
dentists to treat small
children, pregnant women
and patients with other
health issues
• Patient communication –
low literacy, culturally
appropriate education
materials
• Policies defining key
processes
• Case management
system
• Designated access
appointments
• Time availability in
medical
• User-friendly CRA tool
• Reimbursement issues
• Services not co-located
Challenges
133
Barriers to Integration/Coordination (Medical)
Time• No time built into physician visit for the oral health component
Comfort• Many PCPs uncomfortable with the mouth, due to lack of oral
education and training
• Lack of comfort with caries risk assessment, anticipatory guidance, screening
Reimbursement• Lack of incentive to provide dental services because PCPs do not
get reimbursed for all procedures they can perform
Referrals• If there is no place to refer patients when a dental problem is
found…. why find the problem?
134
135http://www.michigan.gov/documents/mdhhs/Oral_Health_Assessment_of_BP-
Diabetes__Report_Feb_2017_550635_7.pdf
136
HOW CAN ORAL HEALTH IPP FIT INTO MY ORGANIZATION?
137
138
Oral Health at Well Child Visit
• Review medical/dental histories
• Perform Oral Health Evaluation (HEENOT) Document findings and management plan, including referrals
• Fluoride administration (SDF to be explored)
Oral health – Risk based instruction
• Conduct counseling to decrease or maintain low oral health risk (risk factor identification)
• Set self-management goals
• Follow up and develop referral plan
Oral Health at Well Child Visit
• Review medical/dental histories
• Perform Oral Health Evaluation (HEENOT) Document findings and management plan, including referrals
• Fluoride administration (SDF to be explored)
Oral health – Risk based instruction
• Conduct counseling to decrease or maintain low oral health risk (risk factor identification)
• Set self-management goals
• Follow up and develop referral plan
Measurement Concepts
Fluoride
Application *
Self-Management
Goal Setting
Oral Health Evaluation
(Risk Assessed)
Referral Initiated Referral Completed
MORE Care Pediatric Pathway
139
Creating an Interprofessional Oral Health
Network
140
Levels of Integration and IP Practice
Boynes SG. Finding Meaning with Interprofessional Practice, Part I. Dental Economics. September, 2015.
141
Medical-Dental Integration: Colorado FQHC
Recommendation/Goal
AAPD recommends 1st dental
visit by age 1.
Minimize need for pediatric
dental OR services.
Reduce dental caries
Clinic in 2011
Average age of new pediatric
dental patient = 4YO.
Average age of pediatric
dental OR case = 4YO.
Average patient’s dental
treatment plan included
treatment for 10 cavities.
142
Medical-Dental Integration: Colorado FQHC
143
Medical-Dental Integration: Colorado FQHC
• Co-located dental hygienists into primary care clinics
• Dental screening, fluoride varnish, self-management
goals
• Dental home established with dental hygienist unless
immediate need is with dentist
– Keep healthy teeth out of the limited dental chairs
– Provides access to children needing treatment
144
Medical-Dental Integration: Colorado FQHC
Lessons learned:
• Develop systems that develop productive relationships
• Champion relationships first
• Partnership for whole body care
• Culture shift
• What did we do to make it work?
• Medical champions
• Systems to help you do this
145
RESOURCES
146
Resources:
https://www.denta
questinstitute.org/
rural-ipp
https://www.hrsa.
gov/sites/default/
files/hrsa/oralhea
lth/integrationofo
ralhealth.pdf
http://www.qualish
ealth.org/sites/defa
ult/files/White-
Paper-Oral-Health-
Primary-Care.pdf
http://www.nnoha.
org/nnoha-
content/uploads/2
015/01/IPOHCCC-
Users-Guide-
Final_01-23-
2015.pdf
147
Tools for Success and Communication
148
QUESTIONS/DISCUSSION
149
MANAGING CHAOS:EMERGENCIES ANDBROKEN APPOINTMENTS
Alabama Primary Health Care Association
February 19, 2019
151
Learning Objectives
• Understand the negative impact of
emergencies and BAs on the practice
• Learn strategies for managing emergencies
• Learn strategies for reducing BAs
152
MANAGINGEMERGENCIES
Emergency care is
important but capacity
must be managed
153
Why Does it Matter?
• Dental ER or Dental Home?
• Unpredictability
• Reimbursement
• Disruption
• Patient/Staff Satisfaction
154
Operational Emergency Department
• Quantify demand for emergency care
• Develop system to meet demand
• Create an emergency policy and triage tool
155
Quantify Demand
• Average Per Day
• Reality vs. Perception
• Tracking
156
When Demand Exceeds Capacity
• Patients of record
• Patients in service area
• Waivered patient policy
• Are all area safety nets doing their part?
157
Have a System in Place
• Where do emergencies fit?
• Who will provide care?
• What care will be provided?
• Morning huddle
158
Beware of Walk-Ins
159
The Role of Triage
• What constitutes an emergency?
• Who decides?
• Objective criteria
160
Ask the Patient MUST BE SEEN
TODAY!See tomorrow or this
week
See when available
“On a scale of 1
to 10 how badly
are you hurting?”
Pain level 7 to 10 Pain level 4 to 6 Pain level 3 or below
“How long have
you been
hurting?”
This level for a
week or less This level of pain for a
month or less Had these symptoms for
over a month
“Describe the
type of pain or
discomfort you
feel.”
Throbbing Broken tooth, lost a filling Chip tooth, broken filling
“How are you
sleeping at
night?”
Keeps me awake
at night Able to sleep with
medication Able to sleep
“What occurred to
make the tooth
begin to hurt?”
Unknown or bit
down on
something hard
Bit down on something or
other cause Sweets; candy causes it to
hurt
“Have you
noticed any other
symptoms?”
Fever and
swelling ------ ------
Two or more
checkmarks in this
section results in the
patient needing to be
seen today
Three or more checkmarks in
this section results in the
patient needing an
appointment this week
Three or more checkmarks in
this section results in the patient
being given the next available
standard appointment time
Sample Triage FormPatient Name: ___________________________________ Date: _____________________Last Dental Visit: ________________________ Location of Pain: Bottom left, Bottom right, Top left, Top right________Patient Address: __________________________________ Contact Number: ____________________________________
161
Definitive vs. Palliative Care
• Definitive whenever possible
• Time
• Impact on BAs
• Patient/provider satisfaction
162
Have a Policy
• Define it all
• Share with staff
• Communicate to patients
163
REDUCING BROKENAPPOINTMENTS
Broken Appointment
Rate Goal: 15%
164
165
Broken Appointments
#1 cited problem for all safety net dental clinics!
5 Key Areas Negatively Impacted:
Access to Care
Oral Health Outcomes
Staff Satisfaction
Patient Satisfaction
Financial Sustainability
166
Why Does This Matter
• Lost productivity
• Lost revenue
• Wasted chair time
• Diminished access
• Incomplete treatment
• Chaos/unpredictability
• Staff/provider frustration
• Patient frustration
167
Factors Likely to Increase BA Rates
• No policy
• Policy weak or not enforced
• No understanding of why keeping appointments matters
• Misinterpretation of governance related to no-shows
• No culture of accountability (staff or patients)
• No consequences for broken appointments
168
Broken Appointments Defined
No-Show:A patient is scheduled for an appointment and they do not show up for that appointment.
Late Cancellation:
A patient cancels an appointment less than 24 hours prior to the start of the appointment.
Late Arrival:A patient does not arrive by 10 minutes after the start of their appointment.
169
Managing Most Likely to “No-Show”
New Patients
Recare Visits
• Require new (non-emergent) patient registration prior to scheduling 1st appt.
• Limit the number of new patients/day
• Book new patient visits within 2 weeks
Emergency Follow-up
• Teach patients to value the hygiene visit
• Consider moving to a “designated access” 2-5 week schedule for hygiene patients
• Require emergency patients who need follow-up care to call to schedule their next visit
170
Punishment vs Consequences
EVERY time the policy is breached:
• Call, letter, document/flag account
STRIKE ONE • Reminder and (only) warning
STRIKE TWO• Consequence occurs; requires a
proactive response from patient
STRIKE THREE• Strongest consequence
implemented by dental staff
171
“Proactive Response” Consequences:
Broken Appointment
Retraining Session
Write a Letter to the
Dental Director1. Explanation
2. Understand the impact
3. Promise never again
172
Stronger Consequences
Dismissal letter
• 30 days of emergency
care access
Same-Day-Only Scheduling Status
• Quick call lists
• Patient required to call
173
Less Favorable Consequences
Charging for No-Shows
• Rarely works
• Can’t charge Medicaid
patients
Double-Booking
• Feast or famine
https://www.medicaid.gov/medicaid/benefits/downloads/policy-issues-in-the-delivery-of-dental-services.pdf (see question 11a)
174
Source: http://www.aapd.org/media/Policies_Guidelines/D_DentalNeglect.pdf
Considerations For Children Under Age 18
175
Strategies for Success
Provide reminder messages for upcoming
appointments
Text/e-mail plus phone
48 hours in advance
What if: Non-working numbers
What if: Voice mail
176
Strategies for Success
• 30-45 days out
• One appointment at a time
• New (nonemergent) patients register in advance
• Limit appointments for multiple family members
• Ask emergency patients to call for follow-up
appointment
• Limit new hygiene patients
• Use alerts to warn schedulers
177
The Five Best Practices
• Strong policy with clearly communicated consequences
• Consistent enforcement
• Patient education
• Culture of accountability for patients and staff
• Track and evaluate BA rate
178
CDT Codes
D9986: Missed
Appointment
D9987: Cancelled
appointment
D9991: Dental Case Management – addressing appointment compliance
barriers
179
BA Rate Calculation
• The number of broken appointments ÷ number of
scheduled visits
• Scheduled Visits = number of visits + number
broken appointments MINUS number walk-ins
180
BA Rate Calculation
20 visits
5 broken appointments
2 walk-ins
Scheduled Visits = number of visits (20) + number broken
appointments (5) MINUS number walk-ins (2) = 23
Math: the number of broken apts (5) ÷ number of scheduled
visits (23) = 22%
181
QUESTIONS/DISCUSSION
CREATINGTHEIMPROVEMENT PLANAlabama Primary Health Care Association
February 19, 2019
183
The Improvement Plan (IP)
184
Recipe to a Successful IP
Identify and state the Problem or Problems
Apply Strategies to address each of the problems
Define the Actions Steps to execute each strategy
Assign a Person or Person’s responsible
Attach Due Dates
Set goals and performance Metrics
185
Step 1: Identify the Area in Need of
Improvement
• Observation
• Data
• Staff Meetings
• Patient Satisfaction Survey
• Environmental Changes
• Organizational Changes
186
Examples
• The broken appointment rate is 30%
• Providers are working late and somedays do not get a lunch break
• High number of walk-ins and emergencies
• Patients have been complaining about the long waits
• Providers feel burnt out
• Patients cannot schedule an appointment for at least another 3
months
187
Step 1: State the Problem
The no show rate is 30%
No-shows and last-minute cancelations are negatively impacting access
to care and productivity. The policy is not consistently enforced.
• By reducing the no-show rate the practice can increase revenue
and decrease chaos and stress for dental staff. A major impact will
be an increase in the percentage of patients who complete their
phase 1 treatment within 12 months.
188
Step 2: Identify Strategies
Revise and distribute a strong, no-tolerance Broken Appointment policy
to establish accountability with the patient and staff. Post signs
prominently within the practice explaining the policy.
Flag patient charts of those who breach the policy and send letters
reminding those patients of the policy they agreed to abide by.
189
Step 3: Create Action Steps
1. Revise the current policy
2. Obtain Board approval
3. Educate staff and patients about the new policy
4. Require all new patients to sign the policy
5. Monitor the BA rate and access policy after 3 months
190
Step 4: Assign Due Dates & Responsibilities
Action Steps Due Date Person(s) Responsible
Revise the current policy 6/30/17 Dental Director and Practice
Manager
Obtain Board approval 7/15/17 Dental Director and CEO
Educate staff and patients about the
new
8/1/17 All staff
Require all new patients to sign 8/30/17 Front Desk
Monitor the BA rate and access policy
after 3 months and report to leadership
Ongoing Practice Manager
191
Step 5: Set a Target Goal for the Metric
Current BA rate = 30%
Year 1: 20%
Year 2: 15%
Every quarter the broken appointment will be monitored to ensure:
• Policy is effective
• Everyone is consistent with enforcing the policy
• BA’s are being documented accurately
192
Step 6: Execute and Monitor Results
• Create Buy-In and Accountability among staff
• Collect data to monitor result; have a measurable goal for everything!
• Regular meetings to discuss the progress in executing the actions
steps
• Discuss barriers that arise
• Brainstorm ways to overcome barriers as a team
• Celebrate successes
• Recognize and award staff
• Coach and offer feedback when there are setbacks
193
Resources
• Improvement plan template
• Best Practice Manual
• Tools to create goals
• Sample policies
• DQI Resource Library
• Online Learning Modules
194
Next Steps
Utilizing the Best Practice Manual and Improvement Plan Template
1. Download the Best Practice Manual (pdf)
2. Download the Improvement Plan Template (Word)
3. Identify 1 area for improvement that your clinic can work on in the
short term (next 3 months)
4. Decide on at least 1 strategy
5. Create specific actions steps for each strategy
195
CLOSING/WRAP-UP
196
Sample Policies & Tools
• Dental Policy & Procedure Manual Template
• Sample Clinical Protocols
• Sample Dental Job Descriptions
• Sample Broken Appointment Policies
• Scripting for CHC Dental Staff
• Profit & Loss Budget Variance Tool
• Sample Scheduling Policy
• Sample Emergency Policy
• Sample Quality Assurance Policy
• Dental Clinic Performance Monitoring/Tracking Tool
• And much, much more!
https://www.dentaquestinstitute.org/learn/safety-net-solutions/sns-sample-
policies-and-tools
197
Online Practice Management Courseware
• Developing Billing Excellence
• Fee Schedules, Sliding Fee Scales, & Management of the
Self-Pay Patient
• Safety Net Dental Program Finance and Productivity: Your
Mission and Your Margins
• Front Desk Customer Service
• The Front Desk: Creating Your Dream Team
• Managing Chaos in the Dental Program
• Scheduling by Design
Free continuing dental education credits!
https://www.dentaquestinstitute.org/learn/online-learning-center/online-
courseware/safety-net-dental-practice-management-series
198
Additional Online Learning Center Resources
Other Learning Modules/Online Courseware
• Disease Management Series
• Special Topic Series (e.g. Payment Reform in Oral Health)
Resource Library
• Best Practices Manual
Dental Caries Management Virtual Practicum
Instructional Webinars
PrevenTips Videos
https://www.dentaquestinstitute.org/learn/online-learning-center
199
Sign-Up for DQP News
Click here to sign up for DentaQuest Partnership news and updates
200
Post-Training Evaluation
Link to Survey: https://www.surveymonkey.com/r/ALPOST19