Mark Doherty DMD MPH

Lynda Riddle DDS

Best Practices in Safety Net Dental Practice Management

What Does Success Look Like?

• What do we seek to accomplish in our dental programs ?

• A Vision remains just that until we attach Goals and Timelines ?

• Use Outcomes to prove we are making our patients and programs Healthier?

The Ideal Dental Practice• Affordable to Patients

• Measureable and Meaningful

• Sustainable

• Quality Managed …..CQI and QA

• A Nice Place to Work

IOM: Advancing Oral Health

IOM’s “Advancing Oral Health in America”

• Organizing Principles for a New Oral Health Initiative– Establish high level accountability– Emphasize disease prevention and oral health promotion– Improve oral health literacy and cultural competency – Decrease oral health disparities– Explore new models for payment and delivery of care– Enhance the role of non-dental health center professionals– Expand oral health research and increase data collection– Promote collaboration among private and public stakeholders– Measure progress toward short and long-term goals – Advance goals to be consistent with Healthy People 2020

Best Practices?Mission- Finance- OH Outcomes

They help us maintain control of our operations and systems and eliminate chaos.

Establish a culture of…..Management• Safe• Efficient• Effective• Equitable• Timely• Patient Centered• Predictable

Data

– Shows you right where the practice is – Gathered through the “planned and

ongoing generation of reports” – Choosing the right Data to collect is vital – The HealthCare Connections Experience

Evaluation Data GatheredGross Charges

Net Revenue

Expenses (Direct and Indirect)

Total Number of Visits

Revenue per visit

Cost per visit

Number of Completed Phase 1 Treatments

Number of Unduplicated Patients

Number of services by ADA code

No-Show Rate

Emergency Rate

Number of New Patients

Goals and Accountability• Create goals based on baseline data

collected, benchmarks and experience

• Create a culture of accountability• Regular meetings to report on progress

• Trust-resolve conflict-commitment –accountability-success

• The HealthCare Connection Experience

Best Practice:

Best Practice: Managing No-Shows

• Create policy with teeth

• Present to board, to staff and to patients

• Distribute and enforce it consistently

• Track No-Shows going forward: document success/failure

Best Practices: Managing No-Shows

• Other potential strategies for managing no-shows:– Have patients sign the no-show policy: place in chart– Provide reminder messages for upcoming appointments– Schedule appointments no further out than 30-45 days– Schedule one follow-up appointment at a time– Don't schedule follow-ups for emergencies on the day of

emergency treatment– Have new patients come in before they are given a new

patient visit to register etc,

• The HealthCare Connections Experience

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• Create a policy that defines a “true emergency”– i.e. pain, infection,swelling,bleeding, fever and trauma

• Implement the emergency policy, and stick to it• Develop a system that cares for true

emergencies while preserving regularly scheduled appointments

• Ensure that staff is trained to triage emergency patients

• Develop a list of questions to ask patients

Best Practice: Managing Emergencies

– Why Manage Emergencies? Control – Defined schedule for emergency care with

understanding that the efficient handling of emergencies results in increased potential to finish patients treatments who have regularly scheduled appointments

– Preserves the integrity of the appointment for patient who has made regularly scheduled visit

Managing Emergencies cont.

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Documenting the number of emergency visits helps the practice understand:– % of overall visits that were

emergencies– Demand for emergency care– Impact of emergencies on the

dental practice– Control or chaos?

• The HealthCare Connections Experience

Managing Emergencies cont.

Best Practice: Scheduling• Allows us to predict and control volume for each

day in practice• Allows us to create designated access for

patients in focus groups such as children, pregnant females, HIV, homeless…..

• Allows us to provide care to focus groups that are beneficial to practice i.e. children

• Provides continuity of care for patients receiving services that require multiple visits.

SchedulingSome factors that affect scheduling policies:• Demographics and needs of the patient population• How far in advance appointments are scheduled• Appointment lengths• Number of appointments available

• The creation and use of designated access

• The stated outcome and financial goals of the practice

Scheduling Best Practices• Schedule appointments no further out than 30-45 days

• Use designated access• Schedule appointments one at a time

– Exception: patients undergoing complex procedures that require multiple visits to complete

• Determine basic appointment length by service provided: 30-45-60 minutes– Additional 10-15 minute increments for procedures requiring

additional time

Best Practice: Management of Self-Pay Patients

• Elements of a good Self-Pay Management Policy:– intelligent crafting of Sliding fee scale that is mutually

beneficial to practice and patient– Education of the patient related to the importance of

their financial contribution i.e. nominal fee or co-pay – Friendly customer service yet firm with SP policy – Policy defining the maximum amount of money owed

to the practice by a patient at which time treatment is postponed

Managing Self-Pays and Co-Pays

• Established, posted policy for self-pay patients• Co-pays always collected at the time of the visit• Give the right message and the same message

to all• Educate patients and staff about the value of

care provided at Usual and Customary fees • Policies drive expectations• Lack of policies leads to failure

Key Elements to Effective Self Pay Management

• Communication and Education

• Developing and implementing sound policies

• Creating scripts• Establishing Accountability• The HealthCare

Connections Experience

Quality Care

Quality Assurance

Are we doing things right?

Quality Improvement

Are we doing the right things?

• Personal OH care in context of family, culture and community• Primary OH Care is an entry point into the larger HC system• Primary OH Care incorporates needs, risks, strengths,

resources and cultures into clinical practice. • Clinical• Financial• Social• Educational

I. Quality of Care

Quality • The degree to which health services for

individuals and populations increase the

likelihood of desired health outcomes and are

consistent with current professional knowledge.

Doing the right thing for the right patient at the right time in the right way to achieve the desired health outcomes

Partnering to Strengthen and Preserve the Oral Health Safety Net

2400 Computer Drive, Westborough, MA 01581 Tel: 508-329-2280 Fax: 508-329-2285 www.dentaquestinstitute.org

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