The loss of adult Denti-Cal, an overall drop in adults seeking dental care, the decline in the economy and real estate market, increased regulatory compliance, reduced reimbursement rates...these are just some of the challenges dentists face in their dental practices. At what point do members consider changes in how they practice or ask for help to make changes in their practices? What kinds of changes should they consider? How do they implement these changes and still maintain practice production and income? CDA has heard from members, those seeking assistance and those who offer up their own experiences.
As part of a four-part series, CDA is profiling members who have taken different approaches to how they practice. This article is the first part of the series. Each dental practice is unique so it is important to recognize that not all solutions will work for all dentists, but these are examples of the creativity and determination of dentists as they face changing landscapes.
This is the account of Janice Scott, DDS, a dentist who practices in Stockton with a diverse population, including low-income patients. During the last five to 10 years, she has made several changes in her practice to become more efficient. She made these changes after seeking advice from practice consultants and colleagues. Scott still participates as a contracted provider with a dental plan and doesn't intend to change that status, but does believe the steps she has made to become more efficient in her practice will help her address the challenges of the changing landscape of dental plan practices and the potential effects of health care reform.
Approximately half the patients in Scott’s practice are covered through dental plans, and the other half are uninsured (private pay). Scott said she believes her fee reimbursement rates are generally on the low side because she practices in Stockton. Because of this, she decided she had to work more efficiently to cover her costs.
Ten years ago she attended a C.E. course on glass ionomers and realized that the material could be used as a cost-savings agent for her as well as her patients who could not afford other fillings. Scott has used glass ionomers ever since as a temporary means for caries control and a way to help her low-income patients get healthy over the short-term and come back to her practice at a later date when they can afford the permanent restoration.
Scott’s realization that glass ionomers helped make her practice more efficient in terms of insurance reimbursements and patient satisfaction, led to more strategies.
One of those strategies included looking at the cost of supplies and price matching them. Scott says dentists should shop around more because she has found ways to reduce costs while not reducing the quality of the materials she uses. She said she avoids using the same company for all of her materials simply because of familiarity or convenience. Some materials take less time on certain surfaces and dentists don’t always have to charge based on fee schedules, Scott said.
“There are times when I have reduced a filling from a two-surface to a one-surface because the access was fairly easy and didn't take as long as a traditional two-surface restoration,” Scott said. “This results in a cost benefit to the patient so their recalls might be more manageable from a financial perspective.”
Another strategy Scott has implemented is hiring a hygiene assistant, which allows an increased level of productivity because there is more help with sterilization. The hygiene assistant helps relieve some of the pressure on the practice’s hygienists, which, in turn, helps with appointment times, patient flow and the amount of quality time that can be spent with each patient.
Scott also makes sure she takes plenty of time with each patient to discuss his or her oral health. This boosts patient satisfaction and encourages them to make sure they keep up with their routine appointments. If a patient comes in with a broken tooth, for example, Scott said she takes full-mouth X-rays and probes before she makes a recommendation on treatment. When patients understand what the dentist wants to do and why they want to do it, then they are more engaged in maintaining their oral health, she said.
A practice may need to consider hiring an associate in the future as the dental insurance industry changes, Scott said. If an owner dentist decides to go that route, she said they should consider expanding their hours of operation; opening their office earlier and staying open later, and possibly even opening on Saturdays to accommodate patients’ working schedules.
“If you add another associate or partner to your practice, you are leveraging your fixed costs and you will realize a drastic reduction in overhead. It does not take double the staff to add just one other dentist. Sometimes it only means adding one more assistant and their billing generates enough to cover their cost and then some,” Scott said. “This can be huge in reducing overhead and being able to survive these economic times and reducing reimbursements. If you have more than one associate, it may mean extended hours, but it’s not that any one dentist works harder or longer, it’s just that you may increase your billings because you (in this case your associate) have become more accessible to your patients.”
Having the right staff in place also is crucial, according to Scott. She worked with a consultant for almost five years to help mold her team into what it is today. She said she tries to avoid reducing staff pay or benefits. When Scott gives a patient a discount she always takes it out of the profits of the business and not from staff reductions. She said she thinks of her staff as family and as a result, they work harder, which increases production, patient satisfaction and efficiency.