Written by Christene Bernhardt Tuesday, 30 November 2004 19:00
During the observation portion of an in-office consultation, I witnessed the business administrative staff member leave her post on numerous occasions to track down the appropriate clinical person who could answer questions concerning the treatment of patients. Obviously, this lack of knowledge was frustrating for the business staff while sending a strong message of inefficiency and confusion to the patient who was waiting.
To determine the cause of this time-wasting activity, I evaluated the quality of the clinical team’s treatment planning documentation and immediately found the cause of this problem. The treatment plan was grossly inefficient in providing the comprehensive information needed for effectively servicing all aspects of the patients’ needs as treatment unfolds. The treatment plan consisted of a list of procedures only, and the crucial supporting facts were delivered, in part, by verbal discussion when the patient was dismissed. This scenario is an invitation to make mistakes and sets the stage for inefficiency.
An effective treatment plan provides a comprehensive overview of the treatment planned for the patient after the consultation. It serves as a major communication tool between the clinical and business administrative staff to ensure that everyone is informed of the status of the plan before treatment and while it is rendered. In addition, it is the nucleus of information necessary for all other systems to function successfully. Scheduling, financial arrangements, and insurance processing are compromised when treatment planning is insufficient.
Computer-generated treatment plans are the norm in most practices today, and can be highly effective if fully utilized. Unfortunately, many software programs that provide effective treatment plan capabilities are not used to full potential due to lack of understanding and/or training regarding how to maximize this system. If the treatment plan provides comprehensive information, 14 objectives will be accomplished. Many quality software programs will generate all or most of these objectives.
THE 14 OBJECTIVES OF THE EFFECTIVE TREATMENT PLAN
(1) Provides a record of the treatment diagnosed and recommended.
(2) Outlines the sequence in which the treatment is to be rendered.
(3) Gives the units of time needed for each appointment and assigns doctor and assistant time needed to support effective scheduling.
(4) Provides a record of appointments given.
(5) Identifies all services to be postponed to a future date and notes the time frame for follow-up.
(6) Provides a record of the fees quoted for each procedure.
(7) Indicates that a financial agreement has been made and provides a brief description.
(8) Provides the treatment information needed to support insurance processing, such as date of missing teeth, age of a prosthesis, and notations that support the need for treatment.
(9) Provides a record of alternative treatment, which could be a single procedure or a complete alternative treatment plan.
(10) Identifies treatment to be referred to a specialist.
(11) Indicates, at a glance, treatment progress: what has been completed and what remains to be rendered.
(12) Provides immediate attention to medical alerts.
(13) Provides a section for comments that is connected to the procedures to be rendered.
(14) All of the above is available with minimal screen changes.
Before purchasing, evaluate the system’s ability to provide all 14 of the objectives. Programs can also vary greatly on the number of steps required to accomplish these key points. An unfriendly system often encourages underutilization followed by the sacrifice of one or more objectives.
STEPS TO ACCOMPLISHING THE 14 OBJECTIVES
Since software programs vary in protocol, the following outlines the most frequently available approach to implementing the 14 objectives.
Objective No. 1: Recording the Recom-mended Treatment. All comprehensive programs provide an efficient method of entering the recommended treatment directly into the patient’s file. This information becomes a permanent part of the record and can remain solely in the computer records as part of a paperless system. It can also be printed to serve as a hard copy for the chart or printed for use with patient interaction during the consultation. Most programs will give you the option to customize your treatment entry, which is a huge time saver. For example, if you frequently recommend a core buildup with a porcelain-fused-to-metal crown, you can create a pre-set icon that automatically combines these 2 procedures, reducing the number of entries required.
Objective No. 2: Sequencing of Treatment. Treatment entered in the presenter can now be organized into appointments and prioritized by assigning a number (1, 2, 3) or letter (a, b, c). Some systems have the ability to assign a color to each priority for visual clarity.
Objective No. 3: Assigning Units of Time Per Appointment. Most programs have the ability to assign the appropriate number of units to each procedure. Once a procedure is entered, the system can identify the time needed. When you are ready to schedule, create an appointment and click on the procedures to be performed. If the time frame assigned needs adjusting, a simple click-and-drag can accomplish this.
Objective No. 4: Recording the Appointment Dates Given. Once the patient is scheduled—and with a single click of the mouse—a walkout statement can be generated that lists all upcoming appointments for the patient and family. This informative statement also outlines the treatment rendered, fees charged, and payments made. It also provides a family balance and an estimate of the insurance benefits.
Objective No. 5: Record-ing Services to Be Rendered in the Future. Enter all treatment in the treatment plan regardless of when it is to be rendered. Treatment postponed for the future can be easily identified by assigning the letter w (wait) in the presenter. Assigning a color to future treatment is also helpful in making sure it is clearly identified. Include a short message in the presenter notes that specifies when this treatment is to be completed. This information will print on the treatment plan.
Objective No. 6: Record-ing the Estimated Fees for Each Procedure. All comprehensive programs have the ability to attach the fee to each procedure. Multiple fee schedules can be entered in the system, which ensures the treatment plan reflects true collectable production and reasonably accurate insurance estimates.
Objective No. 7: Documentation of the Financial Agree-ment Made. Most software programs can generate an agreement for the patient to sign once the financial agreement has been reached. A signed agreement is crucial in successfully collecting a comprehensive treatment plan. When collecting for smaller procedures at the time of treatment, the walkout statement is extremely efficient.
If the patient is insured, the system automatically calculates the estimated benefits and the patient’s portion, provided the correct data was entered into the insurance plan’s coverage table. Attention to detail when setting up this system can save you literally hundreds of hours.
When utilizing the treatment plan printout to discuss finances with the patient, it is important not to itemize insurance benefits by procedure. Provide a total of the estimated benefits only. Itemizing benefits encourages a selective “menu attitude.” Decisions concerning individual procedures should not be influenced by insurance coverage. Most software programs allow you to block this itemization so that the printout reflects only the bottom line.
Objective No. 8: Recording Supportive Insurance Infor-mation. Notations pertaining to treatment that insurance companies often request are entered directly into the treatment plan notes. These notations streamline the communication between the clinical and the business administrative team and enhance efficiency in processing claims by eliminating the “scramble” for details later.
Objective No. 9: Recording Alternative Treatment. Enter all treatment options in the treatment plan. For example: Treatment choices are implant and crown, fixed bridge, or partial denture. In the presenter, highlight the procedure to be included in the first option group and assign an option number (O-1). Repeat this process with the remaining options (O-2, O-3). You can now print the alternatives as a group or as a separate report, depending on the software capabilities.
Objective No. 10: Record-ing Treatment to Be Referred. When referring interrupts treatment, a note can be entered in the treatment plan and a priority assigned for this need. The dental software program should allow you to track the status of all patients who have been referred. Many programs pro-vide a field in the patient’s file to track all specialty referrals; this information is sent to a database, which can provide a report showing all referral activity for any given time frame.
Objective No. 11: Acknowl-edges Completed Treatment. A quality software program allows you to review treatment status from several perspectives:
(a) treatment to be done (printed in red);
(b) treatment completed (printed in blue); and
(c) treatment completed at another office (printed in green).
A click on the appropriate checkmark button in the treatment plan allows you to designate the view you desire.
Objective No. 12: Acknowledges All Medical Alerts. Once the medical alert has been noted in the treatment plan, the system will flag all pertinent situations that relate to the alert. For example, all appointments needing premedication will be flagged, allowing you to see that attention is needed.
Objective No. 13: Recording Comments Related to Treatment. Most software programs allow you to add comments and additional information directly into the treatment plan or treatment notes. This ability sets the stage for a paperless approach, or a hard copy can be printed for the chart.
Objective No. 14: Recording With a Minimum of Screen Changes. Most reputable software programs require as little as 2 to 3 screen changes to complete the 14 objectives. One module should manage the patient’s demographic and financial information. Another module should manage all clinical information. Control-ling the number of modules utilized should be a major factor in selecting a software program.
TREATMENT PLAN ENTRY IN TREATMENT ROOM VERSUS BUSINESS OFFICE
Treatment plan entry in the treatment room during the examination, by the clinical assistant or hygienist, is obviously the most time-efficient and effective approach. However, some practices do not have the finances, space, and/or staffing for this option. Therefore, a manual form designed to accomplish the 14 objectives must be completed by the clinical team and sent to the business staff for computer entry.
It is essential that all treatment plans, regardless of size, be entered in the computer immediately following the consultation. This vital step ensures that all diagnosed treatment is monitored in relation to completion and eliminates the need to perform a labor-intensive chart audit. Many important management reports are generated from this input.
TRACKING OUTSTANDING TREATMENT
One of the most beneficial elements of the computer-generated treatment plan is the system’s ability to provide a quick overview of all outstanding diagnosed treatment by patient and/or procedure. Utilizing the computer tickler system to tie a time frame for follow-up reduces a large and overwhelming computer-generated list to a manageable daily task. Patients with unscheduled treatment are entered in this system by date for followup. If the system is checked daily and the appropriate action taken for each patient, cracks close that patients tend to slip through, which is an en-hancement to patient care.
MONITORING SUCCESS OF TREATMENT ACCEPTANCE
With the input of all treatment plans, assessing the average value of the new patient will be easily obtainable and crucial to evaluating the success of your treatment consultations. Approximately 50% of production should be generated from new patients. Therefore, the number needed to obtain this goal depends on the average value. If improvement is needed, tracking your progress will be effective only if all treatment plans have been entered.
A well-managed, highly efficient practice relies on the comprehensive information provided through effective treatment planning. Computer-generated treatment plans are successful only if the 14 key points of information are included within the plan. Major systems such as scheduling, financial agreements, and insurance processing fail if adequate information is not provided through the treatment plan.
Successful interactions with patients at the time of the consultation rely heavily on having adequate information at your fingertips. The treatment plan is truly the foundation to all communications that must occur during the patient’s experience, and ensures that every team member has clear and easy access to the status of each patient as treatment unfolds.
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