One thing that most dental professionals will agree on is that it takes more overhead and effort to actually see a patient in the office than it did in recent months and years prior to COVID-19. In many cases, more money is spent on infection control and personal protection equipment (PPE), and more time is allowed on the schedule not only for procedures, but also between patients.
This is our new reality, and it’s creating a renewed awareness of our overhead as well as the value of our chair hour. Now, we must take a close look at whether how we are spending our clinical time is really worth it.
In essence, we must place a higher value on our chair time and our schedule to maintain or regain our profitability. And while we are in the business of taking care of patients, profitability is the key to staying in business so we may continue to take care of patients.
Crunching the Numbers
Where do we begin in the process of achieving high-value scheduling? We start outside of the appointment book. We must know our numbers. We need a deep dive into our income and expense statement to analyze what we must collect, per hour, to obtain our desired profitability.
If we have a fee for service practice, this is fairly straightforward. We look at our current overhead, determine what our desired salary is, and factor in the additional overhead (direct costs such as supplies or lab fees) to hit that desired goal, and then we set our production goals accordingly.
If our goal is to collect $1,000,000 per year and our collections are at 98%, then we would divide $1,000,000 by 98%. Our production goal would be $1,020,409 for the year, and then we would break that down by department and by chair. The math there is fairly simple.
But if we have a preferred provider organization (PPO) practice, we must know our true break-even. This is not the break-even where you as the owner get your salary. This is your true cost break-even before you are paid. Next we divide that break-even figure patient hour by department and by chair.
Then, we look at that break-even per chair hour. For example, in a general practice, we would evaluate our average treatment rendered, in hygiene and operative, in an hour. For example, in the hygiene department this might be:
- An adult recare visit with a periodic evaluation, prophy, and bitewings
- A child recare visit with a periodic evaluation, prophy, and bitewings
- An adult new patient visit with a comprehensive evaluation, cleaning, and full-mouth x-rays
In operative, this might be:
- A single crown
- A pair of three-surface posterior composites
- A pair of two-surface anterior composites
Setting Goals
Once we select the procedures for our break-even review, we bring our time and our fees into the equation. For the amount of time that we spend per appointment type, can we exceed our break-even per chair hour? If the answer is no, we have two choices.
One is to figure out how to go faster. In many cases, practices may already be close to their maximum speed clinically on how quickly they can handle appointments. The alternative is to make decisions to begin to minimize the practice’s dependency on PPO plans, beginning with the worst reimbursing plans.
Next, we can look to scheduling for high value by identifying, based on our collection’s goals, what our production goals should be per day and be sure that our production goals reflect our net production (PPO fee for that plan) to ensure the greatest accuracy.
In other words, if our full fee for a crown is $1,200, yet our fee schedule fee is only $900, we must have our practice management software set to show us net and not gross production for the treatment plans with PPO Involvement.
Now, look at each individual doctor’s goals. If he or she desires a collections goal of $6,000 per day for their operative procedures, then he or she would need to be scheduled, at a 98% net collections rate, to $6,123 in “net” production. To hit that consistently, his or her operative schedule should be pre-blocked for 80% of that goal, or roughly $4,900 in pre-blocked appointments.
Scheduling Your Day
Once you have a production goal, you must decide how many pre-blocked appointment slots are needed per day and where they should be. In most practices, this is three or four high-value production appointments per doctor per day.
When considering where to place pre-blocks, in addition to your own personal preferences for when you are at your best as a provider, set yourself up for success by bookending those pre-blocked appointments.
Bookending means starting at the beginning of the day and scheduling toward lunch. Then at lunch, move toward the beginning of the day. After lunch, move toward the end of the day, or at the end of the day move back toward lunch.
In other words, avoid randomly starting a pre-block at a time like 9:30 am where you are having to juggle what you can place on the schedule before or after those pre-blocks. Many doctors have two stair-stepped operative pre-blocks first thing in the morning and two in the afternoon, starting right after lunch.
Putting It All Together
Now is the time when focus and verbal skills really come into play for everyone on the team. When offering appointments to patients, we want to market the next available high-value appointments to patients with those types of procedures.
This is involves training the team to say, “Mrs. Smith, we happen to have an appointment available tomorrow morning at 8 am if that would work for you to come in for your crown appointment.”
For high-value types of operative procedures, we are always offering those next available high-production appointments, unless the doctor has indicated that there is a reason to wait.
High-value scheduling is a process that begins with knowing our numbers, making fact-based short-term and long-term decisions regarding PPO involvement, setting goals, and sharing those goals with the team. Then we must craft our ideal schedules in operative and hygiene and include our teams in the process.
Once the entire team is on board with what our ideal schedule should look like, it takes a continued focus and awareness to know when the next available high-value openings are. The team should work together ongoingly to master the verbal skills to consistently and enthusiastically suggest those open appointments to our patients as convenient opportunities.
Dentistry is essential, and so is the entire team’s understanding of high-value scheduling so we can keep our patients healthy while also achieving a healthy bottom line.
Ms. Reed is a coach, speaker, and author of Growing Your Dental Business. She also is president of the Dental Coaching Institute and coaches dentists and team leaders on implementing systems and standards that drive consistent and predictable revenues. She graduated from Harding University in 1990 with a BBA in management. She has been named a Leader in Dental Consulting by Dentistry Today from 2007 to the present. She is a member of the Academy of Dental Management Consultants the American Association of Dental Office Management as well. She can be reached at penny@dentalcoachinginstitute.com or at (888) 877-5648.
Related Articles
The Dentist as CEO, Leader, and Coach
The One Thing to Avoid During COVID-19
