The Indisputable Missing Link: What’s Not in Your Computer Management System

Against an impressive backdrop of computer hardware and software designed to support virtually every activity of a dental practice, it seems inconceivable that, at the dawn of the third millennium, any vital informational tool might be in short supply. Yet most practices do share a certain deficiency in that area. Alas, despite the information bytes that surround us within an ever-expanding realm of computer technology, we’re frustrated time and again by a lack of knowledge.


When you stop resisting the urge to focus on what’s not in your computer management system, you’re bound to notice that there is an eerie disconnect between information and knowledge, between data and know-how. Can it be that when 2 similar machines—the computer and the human brain—are practically joined at the synapse, there can be such a breach between the availability of all this information and the wherewithal to put it to use? 

Apparently so. While the digital android can yield mega amounts of information about your practice, it still requires the human gray matter to point it in the right direction, determine what information it should extract, interpret the results, and figure out how to best apply them to benefit the practice. There’s the catch.

A LITTLE SPORT IN THE INFORMATION AGE
If you were to watch a basketball championship (or whichever professional sport you prefer), you’d need only look at the score to see who’s ahead. But what about all those stats they keep flashing on the screen in front of you when a player is positioned at the foul line, for example? If you’re a casual fan like me, you automatically dismiss those stats as information you don’t need to know. For the diehard sports fan, however, such stats typically explain why one team is beating the living daylights out of the other. And taking it a step further, those same statistics are key to why and when the coach makes certain calls.


As the name implies, the right “coach” can take players with talent and turn them into champions. Phil Jackson, who coached the Chicago Bulls to 6 NBA championships in 8 years, said, “You have to be a salesman and get your players, particularly your leaders, to believe in what you’re trying to accomplish.” That certainly goes for the dental practice, too. Everyone on the team needs to not only have the final score in mind, but know exactly who is responsible for doing what, how that will affect the outcome, and have the right training to handle the ball in their court. 

The real problem, though, is that often coaches and their players—dentists and staff—don’t know what it is that they don’t know. In point of fact, last fall, my consultants and I developed tests to assess the dental business knowledge of dentists, office managers, and business staff for our Center for Dental Career Development. We posted these tests on our Web site (dentalcareerdevelop.com), and invited dental professionals to take the tests, submit them to us, and we’d send back the results. Over the several months since, we’ve all been bowled over when tallying up the scores. Only 6% of respondents have gotten every question correct! And believe me, these are not difficult questions. Here are a couple of examples... 

  • The doctor’s per hour goal to reach $72,075 per month, working 4.5 days a week, 8 hours a day, is $500 per hour. True or false?
  • We need to add a day of hygiene when our schedule is booked out farther than 4 weeks. True or false?

See what I mean? The first question was taken from the test for dentist and office manager; the second, from the test for business staff. In either case, there’s nothing beyond what should be known by these individuals. Again, the difficulty is that dental personnel often don’t know that such information can be computer-generated, nor what kind of report to initiate, nor what information they’ll need to extrapolate to answer the question. Such a lack of knowledge is what tends to keep a practice in the minor leagues. That said, you face an imperative to narrow the gap between the information that can be generated by your computer and utilizing that information for the good of the practice. Which brings us to the t-word: training.

FACT-FINDING MISSION
From past experience, I know that you get a little nervous about the time and cost of training. You don’t need to get the jitters just yet, but you might as well face the fact that one way or another, you’re going to be picking up the tab on this. You can either pay for training and reap its benefits, or put up with the cost of incompetence and naiveté. Considering the choice, let’s look at some of the facts about 4 key areas typically lacking in computer/management knowledge.

Scheduling
You and your scheduling coordinator know, in theory, that the scheduling coordinator should be scheduling to production goals, but might not have any idea how to go about it. Let’s say you did $850,000 last year and want to grow by 15% this year. That means you’d need to do $127,500 more, for a total production of $977,500. Now, figuring that hygiene (by industry standard) should be 33% of that production, or $322,575, that would leave $654,925 for you, doctor, to produce. Working 48 weeks a year, 5 days a week, that breaks down to a scheduling goal of $2,729/day for doctor production. Once this goal is entered into the computer system, each day will be scheduled to meet the goal—by precisely allocating time units to doctor time, assistant time, hygienist time, and chair time—instead of your scheduling coordinator just filling in spaces in some vague hope that it will meet some hazy target range. So far, so good, right?


Now, a word about the Tickler File Report. Everyone knows that when there is a cancellation, it should be filled from the Tickler File. But many schedulers will automatically go to the file’s short call list instead of the main file. Why? Because it’s easier to fill the time slot. But because the short call list is made up of patients who already have appointments, it’s like robbing Peter to pay Paul—not adding any production to the schedule. Using the main file, then, is the preferred way to fill the cancellation. 

But there’s more to it than that. Most schedulers, after filling the cancellation, will go on to something else, leaving the same 75 or so patients on the Tickler File Report that have been there for the past 2 months. Instead, the scheduler should make a minimum of 5 calls a day to get these people off the report and onto the schedule. In doing so, the scheduler needs to be aware of any trend developing. Are there people needing specific treatment who are either not making appointments, not showing, or canceling? If they’re new patients who aren’t showing up, perhaps you need to evaluate what is being said to them. When notes are made in the computer, it is easier to identify trends that might be putting a damper on the practice; for example, a lack of availability during early morning, evening, or Saturday work hours, or something as simple as no place to park. Software technology allows for such observation, which makes it easy to remedy a potentially difficult situation.

Production
What about an analysis of production by procedure code, by producer? This is one of your computer’s most valuable reports, despite the fact that most hygienists have never seen this report, nor have many dentists. Imagine how helpful it would be to track what you’ve done, how much you’ve done, and where you are in relation to this time last year. Again, it’s a way to observe trends. How many molar root canals have you done this year compared with last year? How many units of crown and bridge did you do on an average per day in the last 6 months? How many comprehensive exams are you doing, and where are they coming from? The Provider Production Summary sure could shed some light on your practice. Wouldn’t it be terrific if someone in your office could run it every so often?


Another amazing tool for production is the Unscheduled Treatment Plan Report, a true mirror of the practice. How much in treatment dollars has remained on this report over the past 12 months? In order to figure out what you can do as a team to get unscheduled treatment off the report and onto the schedule, it would be helpful to be on the lookout for trends. Is there a particular type of treatment not being considered by patients? How are treatment plans being presented? By whom? Are fees too high? Are there financing options offered such as Care Credit? 

By the way, on the subject of Care Credit, your staff needs to be aware that alternative financing is not only for patients facing extensive/expensive treatment. It can also be like divine intervention for patients who have long-running account balances, to say nothing of what such intervention can do for your cash flow.

Hygiene
A recall report of patients due to return over the past 12 months reveals 432 patients. That’s 25% of your patient base. Are they retainable? Sure, but the longer they’re overdue, the more limited is your chance of retaining them. Is there a correlation between patients who haven’t come back and any unscheduled treatment plans? How many patients were due to return and how many actually did? This overdue recall report can also be used to measure incoming versus outgoing patient flow. To measure incoming patient flow, run production report for ADA code No. 00150—new patient exam. Be sure to use the same date range specified on the overdue recall list. Patients not retained must be counted as outgoing patient flow.


Analysis of production by procedure code for each hygienist should be analyzed monthly and given to each hygienist. Typically, they have no idea what they have done; no idea they are taking bitewings on only 25% of their patients instead of 50%; no idea if they are coming anywhere near the industry standard of 33% perio; nor any idea if hygiene is, in fact, producing 33% of total practice revenues. Such knowledge can certainly represent the difference between struggling to stay alive and thriving.

Cash Flow
Accounts Receivable reports are very revealing. They show us how much money is owed by the patients and/or the insurance companies. But if the practice is producing $50,000 a month and there is $10,000 in the “current” column or $45,000 in the current column, what does that mean? Or if the percentage of accounts receivable over 90 days shows 5% or 25%, what does that mean? The questions can be unending, such as...

  • Should I run the accounts receivable report with or without credit balances? What’s the difference?
  • How much was given in adjustments last month/year that could have been practice revenue?
  • How much should we be producing and collecting every month?

As we all know, however, it’s not the question that presents the problem. No, the problem is when staff members don’t have the knowledge to even formulate the question or be aware that there’s more to what they’re doing than they might have thought. Yup, that old t-word, training, is rearing its head—for good reason.
Beyond accounts receivable, your computer software can help staff improve cash flow by improving over-the-counter collection. For example, with a couple of clicks, your business staff can see not only today’s treatment—complete with tooth numbers, surfaces, and ADA codes—but today’s charges, previous balance, copayment or deductible, remaining third-party benefits, and expected third-party payment. Once business staff learn how to generate and use this information, they can be much more in command as they ask your patient for payment.

CONCLUSION
If I’m right and the indisputable missing link is knowledge, just imagine the difference that the right training could make in your staff and in your practice. But before you make any radical changes, you’ll need to keep in mind what coach Jackson said about being a salesman and persuading team members to buy into what you’re trying to accomplish.


Priority one, then, is for each individual on your team to understand how getting up to speed in certain areas will not only help the practice, but ultimately enhance their job security and career options. Of course, this assumes that you can communicate what is expected of both the computer management system and the employee. If that’s going to present a problem, doctor, instead of making excuses, get yourself some training and make things happen.


Ms. McKenzie is a certified management consultant, a nationally known lecturer, an author, and a consultant to the Council on Dental Practice of the ADA. She is president of McKenzie Management, which provides in-office analysis of the business, clinical, and hygiene department, and offers a full line of educational management books, audiotapes, and videos. She is also founder of The Center for Dental Career Development in La Jolla, Calif, which provides advanced dental business education to dental professionals such as office managers, scheduling and financial coordinators, treatment and patient coordinators, and dentists. Additionally, McKenzie Management’s 23 years of experience and expertise are now available via the Internet at practicemanagement-online.com, which provides monthly monitoring of the practice and business staff by skilled, online management consultants. To receive Sally McKenzie’s Weekly e-Motivator newsletter, which provides targeted management tips, or Sally McKenzie’s Monthly Industry Best’s newsletter, call (877) 777-6151 or visit mckenziemgmt.com, practicemanagement-online.com, or dentalcareerdevelop.com.