Historically, dental hygiene has been seen as a loss leader. In many practices, the dentist charges nominal fees for a “cleaning,” and uses the examination as an opportunity to find needed treatment, and that’s where the real production gains come in.
But it doesn’t have to be this way. If you treat that department like a business within a business, it can be and is a profit center for the practice. Dental hygienists are an integral part of of the healthcare team as they connect oral disease with systemic diseases and partner with patients toward their optimal oral and overall health. They are healers and practice builders.
But how do you make that happen? Buy a bunch of new equipment? Give out big raises to elicit harder working hygienists? Neither are necessary. Most of what you need is already in place, you just need a new strategy. Read on to learn how you can start getting the most out of your hygiene department.
Learn where your current hygiene department stands
Dentists and hygienists do not enter the field of dentistry because they love numbers and tracking performance reports. However, knowing your Key Performance Indicators (KPIs) are important because they help to improve patient care, manage costs, and ensure optimal practice performance. Understanding a small number of KPIs on a weekly, monthly, and annual basis will tell most dentists and dental hygienists what they need to know and exactly how they and the practice are performing.
There are many KPI’s you could track within your practice, but when it comes to dental hygiene, Aligned Dental Partners views these as most critical:
- Production- Gross & Net: Think of production as the amount of care provided to your patients. The only way we can track how much care you’ve provided is by codes billed and the dollar amount for each of those. Hygienists should produce at least 3 times what they are paid. So someone who makes $50 an hour and works 8 hours, should produce at least $1,200 a day.
- Reappointment: This is how many patients are reappointed for their next appointment, before they leave the office and is the single most important way to ensure that the practice will continue to thrive and grow. This should be 90% or more.
- Perio percentage: This is how many of your visits include periodontal services. This target range is 40-60%.
- Fluoride varnish ratio: This is how many of your appointments include a topical fluoride application. With tooth decay affecting 90% of the population, this ratio should be 70% or more.
Understanding the numbers and identifying strengths and areas of opportunity as a clinician will enable your hygienist to be the hygienist your patients deserve. Metrics can be intimidating, but when hygienists understand them, they can be harnessed to propel a career to new heights.
Clinical alignment between the doctors and hygienists
Do you have an established agreement as to what periodontal health looks like in your practice? How you identify it, how you talk about it with patients, and how you treat and manage it. Having clinical alignment in place is critical. It ensures the entire clinical team, including dentists, hygienists, and even assistants, are following the same standards of care, treatment protocols, and diagnostic criteria, leading to consistent quality patient care across the entire practice.
So often the hygienist is working hard but calling it a prophy. They do not feel comfortable telling their patients bad news. They would rather take on the burden of doing a difficult procedure in just a few minutes and call it a prophy than tell a patient the truth about his or her condition. This is unfair to the patient who is not being told about their true condition and is also unfair to the practice missing out on the higher fees that come from using the proper codes. With agreed upon clinical guidelines in place, treatment recommendations are based on patient assessment findings, using established communication skills that can help to navigate sometimes difficult conversations successfully.
If practice and patient care philosophy has not already been defined, include your team on the development. This can be achieved through team-wide ongoing professional development that helps to ensure everyone is updated on the latest clinical practices and guidelines. Involving them in the education required for your practice’s clinical alignment increases employee engagement and ownership as well as fosters a collaborative environment. When a practice shares a set of common values and beliefs, everything else will come easily.
Practice-wide policies and protocols in place
While clinical policies are vital to actual patient care, operational policies and procedures are just as important. Everyone on the team should know your policies for scheduling and at least have a moderate level understanding of your financing policy and insurance reimbursements. How does the team handle patient warm ups and handoffs that guarantee information is passed all the way from doctor/hygiene exam back up to the business team? Having these in place ensures that everything is being done the same way throughout the company. All of these tie together and integrate the clinical side with the operational side.
Updated fees
If you’re like most dentists, you don’t routinely raise fees. Many will skip doing this for years in fear of upsetting patients then will resort to trying to play catch up or make up for lost years of no fee increases, putting them at risk for making those steep increases they wanted to avoid in the first place. Keeping fees set at one rate for too long ultimately results in both increases in your overhead ratio and diminishing profits. Year after year, this can dramatically hurt your bottom line. Aligned Dental Partners recommends evaluating your fees yearly, including hygiene fees. Oftentimes, even when restorative fees get updated, hygiene fees tend to stay the same due their high visibility. Your fee schedule should accurately reflect the quality of care provided in your practice. There is a great deal of value behind what the hygienist does and with value comes cost. Don’t undervalue the service your hygiene team is providing.
Speaking of value
Much of what is recommended to patients are problems they are not aware of. The burden lies with the hygienist to bring awareness to the issue and to establish the value in the recommended treatment. A common mistake hygienists make is that they try to use education to convey the importance of what treatment the patient needs. But we all know that education does not always motivate patients to accept treatment. We know smoking is bad, so why do we, as a society, still do it?
People make buying decisions based primarily on value. The hygienist can start to build value from the 1st moment they meet the patient by seating the patient on time, listening to their chief concern, and asking questions to gauge their emotional motivators. Once the hygienist understands the patient’s motivators and has started building trust, he or she can tailor the treatment presentation based on what they have learned. The 3 key components to presenting treatment is identifying and communicating the following:
- Problem- Show and explain to the patient what you are seeing using visual aids and simple, concise language. “You have an active bacterial infection called gingivitis that is causing your gums to be swollen and bleeding…”
- Consequence- Explain the consequence of inaction tied to the patient’s emotional motivator. Don’t’ skip this part- this is where we build urgency! “…I’m concerned because if we do not treat this now it will worsen, become painful, and more expensive to treat later…”
- Solution- Offer the recommended treatment. “…I recommend Gingivitis Therapy which will help to reverse the effects that your gingivitis has caused. I have time today to start this treatment.”
In a typical 60-minute appointment, both time and the patient’s attention span are limited so we need to make the most of both. Listening to the patient, asking questions, speaking confidently, and eliminating “wiggle” words such as a little, maybe, possibly will go a long way. Bleeding is bleeding and decay is decay- don’t undermine your own message.
Use your technology
Unless you’ve been living under a rock the last few years, we’ve all witnessed the explosion of new technology. It’s enabling dentists and dental hygienists to provide more efficient and effective treatments to their patients. From portable digital X-rays to handheld lasers the size of a pen to online appointment booking, technological advancements have transformed the way dental care is delivered and managed, making it more accurate, safe, and patient-friendly.
As mentioned earlier, hygienists have to make the most out of their 60-minute appointment. While there are many exciting and valuable technologies out there, here are 3 technologies that are making the biggest impact:
- Intraoral cameras: Simply put, “every patient, every visit”. These images allow our patients to see what we are seeing, improve provider credibility, help with dental benefit claim denials, and increase treatment acceptance rates. If your hygienist does not have their own dedicated intraoral camera, buy them one today.
- Artificial intelligence: It’s a tool that, when used in conjunction with clinical experience and judgement, helps to automate the process of diagnosing caries and periodontal disease. It can help to create consistency among providers and prevent oversight as well help the patient understand what we are seeing through colors rather than the grayscale that radiographs offer. Only a dentist can diagnose and a hygienist can co-diagnose, but AI can make it easier to know where to look.
- Lasers- They are small, affordable, easy to use and can be used to treat periodontal issues, inactivate oral lesions, desensitize root surfaces, and other beneficial procedures. After the initial cost of the purchase of the laser then training & certifications for your team, this tool becomes an add back that facilitates ongoing income and elevates patient care.
This is truly the age of technology, so why not use these tools to your advantage?
To effectively increase dental hygiene production, a new strategy and mindset must be created. Many dental practitioners don’t like thinking about dentistry, and dental hygiene in particular, as a business due to fear of being accused of overdiagnosing and overtreating. In reality, it is a business. If we don’t treat it like a business, we won’t be in business very long. When dental hygienists adopt a new mindset around proactive treatment and understand the levers to pull to improve performance, they can run the hygiene department as a wellness center and a business within the business. When we do this, the patients, the practice, and the practitioners all win.
By Noura McClure CRDH, BS
