BEST PRACTICE ACADEMY: BUILDING A SUSTAINABLE DENTAL PROGRAM

Alabama Primary Health Care Association

February 19, 2019

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Pre-Training Evaluation & Training Materials

Before we begin, please fill out the pre-training evaluation and download

some of the materials we’ll be using today

• Pre-Training evaluation: https://www.surveymonkey.com/r/ALPRE19

• Training materials: https://www.dentaquestinstitute.org/learn/online-

learning-center/resource-library/alabama-pca-training-2019

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Who We Are

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Who We Are (Cont.)

The DentaQuest Partnership for Oral Health Advancement, a not-

for-profit organization, engages in grantmaking, research, care

delivery improvement programs, and collaborations that

transform the current broken system to achieve better health

through oral health.

We are passionate and committed to revolutionizing oral health by implementing meaningful change strategies to create an effective and equitable system that results in improved oral

health and well-being of all.

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Focus Areas

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SNS has worked with over 500 dental programs

in 45 states & DC

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Oral Health Value-Based Care Training Program

Our new Oral Health Value-based Care Training Program will focus on

educating, enabling and empowering oral health stakeholders, including

payers, contractors, dental practices and providers, around value-based

care in oral health and what they need to know to successfully transform

when the opportunity presents itself.

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Today’s Presenters

Da-Nell

Pedersen,

Strategic

Communications

Manager

Danielle

Apostolon,

OHVBC

Training

Specialist

Kelli Ohrenberger,

Manager of

Interprofessional

Practice

Caroline

Darcy,

Technical

Assistance

Project

Manager

Tess Draper,

RDH, Clinical

Integration

Trainer,

DentaQuest

Care Group

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Today’s Objectives:

After this training, participants will:• Identify essential components to developing a business plan for FQHC dental

programs.

• Establish key dental policies and procedures for managing an efficient and effective FQHC dental program.

• Measure dental program capacity and understand its impact on access to care.

• Set realistic and achievable financial and productivity goals.

• Continuously monitor dental program performance.

• Develop a strategic scheduling template to maximize access, improve oral health status outcomes and dental program financial viability.

• Develop effective policies and procedures for managing broken appointments and emergencies.

• Develop strategies to achieve integrated care.

• Develop an understanding of how interprofessional practice leads to integration and coordinated care.

• Develop an improvement plan for success.

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Today’s Agenda

Laying the Groundwork for Financial Sustainability in the Dental Program

Developing Financial and Productivity Goals – Demo of Tools

Break

Strategic Scheduling

Lunch

Comprehensive Health Center Integration to Improve Overall Health

Break

Managing Chaos

Group Activity – Creating the Improvement Plan for Success

Closing/Wrap-Up

LAYING THE GROUNDWORKFOR DENTAL PROGRAMFINANCIAL SUSTAINABILITY

Alabama Primary Health Care Association

February 19, 2019

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Junior Accountant, Computerized Bookkeeping, LLC

Accounts Payable Supervisor, W.B. Mason

Senior Project Manager, Safety Net Solutions, 2008-2018

Oral Health Value Based Care Training Specialist Present

Danielle Apostolon, B.A. Business

Management

Oral Health Value-Based Care Training

SpecialistDentaQuest Partnership for Oral Health Advancement

Member, American Association of Public Health Dentistry

Associate Member, Association of State and Territorial Dental Directors

Member, National Network for Oral Health Access

Associate Editor, Safety Net Dental Clinic Manual

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What is Sustainability?

(Financial) sustainability is the ability to

generate resources to meet the needs of the

present without compromising the future

This Photo by Unknown Author is licensed under CC BY-SA-NC

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Importance of Sustainability

• Grant funds are never sufficient

• The resources allows us to hire and keep good providers

and staff

• Meet increasing operational costs due to increased

demand for services

• Expand the services we provide

• How we are reimbursed may change

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It all depends where we

start…

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MEDICAL DENTAL

Are Different!

Different Care Plan and Different

Business Plan

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Medical

20% of clinic volume

80% of visits = varied

80% of visits = longer

80% of billing varied

80% of visits treatment

80 % of RVU different

0% of governance is designed around dental

EDR silo

Not familiar with dental model

Lack of confidence

80% of clinic volume

80% of visits = similar

80% of visits = shorter

80% of billing similar

80% of visits diagnostic

80% of RVUs similar

100% of governance is designed around medical

EMR silo

Familiar with medical model

Confident leadership

Dental

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Key to Success for Creating a

Sustainable Business Plan

• Defining your capacity

• Setting access goals, responsibilities, timelines

• Having the right policies for “everything”

• Using data to evaluate quality and provider

productivity outcomes

This Photo by Unknown Author is licensed under CC BY-SA-NC

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What Does Success Look Like?

Provide access to care

Generate enough revenue to cover expenses

Provide high quality dental care that is

appropriate, cost-effective, and is what our patients

want

Manage the chaos and achieve smooth patient

flow throughout the work day

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What Does Success Look Like?

Promote continuity of patient care

Collaborating with others in the community to

meet patient needs

Meet all regulatory requirements and standards

of practice

Happy, healthy patients and staff!

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Create the Business Plan

• Target Population

• Service delivery model

• Types and #’s of providers and staff

• Services

• Number of chairs

• Hours of operation

This Photo by Unknown Author is licensed under CC BY-SA

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• Number of visits

• Number of unduplicated patients

• Number of new patients

• Procedures by ADA code

• Procedures per visit

• Broken Appointment rate

• Emergency rate

• Gross charges

• Total expenses

• Net revenue

• Collection Rate

• Expense per visit

• Revenue per visit

• Aging report past 90 days

• Payer and patient mix

• % of completed treatments

• % of children needing sealants who received sealants

• HRSA Sealant metric

Data to Evaluate Program Performance

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2,500-3,200encounters/year/FTE dentist

2,700 encounters/year with 1,100 patient

base/dentist

1.7 patients/houror 13.6 patients/day/dentist

Access Benchmarks

2.6 Visits/Year/Patient

2 Chairs/dentist (3:1 is ideal)

1.5 Assistants/dentist (1 DA per chair is ideal)

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1,300-1,600encounters/year/FTE hygienist

230 work days/year (or 1,600 work hours/year after

holidays and vacations)

2 ADA coded servicesas the diagnostic part of a recall or comprehensive visit (exam, FMX)

1.2patients/hour/hygienist

or 10 patients/day/hygienist

5 days/week x 46 weeks = 230 work

days/year

Access Benchmarks

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15% Broken Appointment Rate

<10% Emergency Rate

33% Comp TX. Plan is Fair

#New Patients = #Completed Treatment

Plans

Access Benchmarks

Booking out 30-45 days

Designated AccessScheduling

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$200 average cost per encounter (UDS 2017)

330 Allocation = Average of 15%

Gross Charges =

>$500K-$600K per dentist per year

% of total A/R due past 90 days =

10-15%

95% Collection Rate

Financial Benchmarks

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$40Nominal fee

3 Slide Categories100-199% FPG

Full Fee Schedule70-80% of UCR

Financial Benchmarks

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2017 Alabama UDS Numbers

• 319,327 unduplicated FQHC patients

• 91.59% accessed medical services

• 18.01% accessed dental services (57,517 patients; 115,002 visits)

• 2,797 visits/year/FTE Dentist

• 764 visits/year/FTE Dental Hygienist

• 2 visits/year/unduplicated dental patient

• Average cost/visit in dental = $140 per visit

• Sealant metric average = 48.53%

Source: https://bphc.hrsa.gov/uds/datacenter.aspx?q=tall&year=2017&state=&fd=

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Capacity=Quality

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Defining Capacity

• We are limited by our structure

• Chairs-Rooms-Operatories, Dentists,

RDHs, DAs, Staff, Hours of Operation

• Our structure determines our capacity, not our hearts

• We cannot be all things to all patients

• We only have 20% of the capacity of Medicine

• Understanding and defining capacity is essential to the creation of

the dental business plan

• We need to decide WHO gets the care by creating priority

populations

Equitable, quality care mandates that

we work within our capacity

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Benchmark Guide

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Example

Staff and Operatories:

• 2 FTE General Dentists

• 3.0 FTE Dental Assistants

• 1 FTE Hygienist

• 5 Operatories

• Each Dentists works out of 2 Ops

Hours:

• Monday through Friday 8:00-5:00 (1 hour lunch)

• 8 clinical hours per day

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Determining Capacity Goals Based

on Our Structure

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# of

Providers

# of total

clinical hours

worked

x recommended

# of visits/

clinical hour

Potential

Daily Visit

Capacity

Mon. 2 16 1.7 27

Tues. 2 16 1.7 27

Wed. 2 16 1.7 27

Thurs 2 16 1.7 27

Fri 2 16 1.7 27

Potential Weekly Capacity = 135 Dentist Visits

Actual

Visits

% of

Capacity

Achieved

20 74%

26 96%

19 70%

18 66%

10 37%

*At least two operatories and 1.5 dental assistants

Setting Productivity/Access Goals: Visits

Potential vs. Actual – FTE Dentists

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# of

Providers

# of total

clinical hours

worked

x recommended

# of visits/

clinical hour

Potential

Daily Visit

Capacity

Mon. 1 8 1.2 9

Tues. 1 8 1.2 9

Wed. 1 8 1.2 9

Thurs 1 8 1.2 9

Fri 1 8 1.2 9

Potential Weekly Capacity = 45 Hygiene Visits

Actual

Visits

% of

Capacity

Achieved

7 77%

8 89%

6 66%

7 77%

6 66%

*Benchmark of 1.2 is ideal for a practice with a patient mix of both adults and children

Setting Productivity/Access Goals: Visits

Potential vs. Actual – FTE Hygienists

WHY?

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GOAL CALCULATION TARGET

Visits/Day 27 Dental Visits + 9 Hygiene Visits = 36 visits

per day *same for each day

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Visits/Week 135 Dental Visits + 45 Hygiene visits = 180

visits per week

180

Visits/Year 180 weekly visits x 46 weeks = 8,280 Visits 8,280

Dental Visits Based on Capacity

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Only fill in peach

colored cells Provider Type

General

Dentist A

General

Dentist B

General

Dentist C

Pediatric

Dentist Resident RDH A RDH B

Visit per Hour Benchmark 1.7 1.7 1.9 1

Daily Clinical Provider Hours 7 7 8 7 Monday 46 50 4

Visits 11.9 11.9 0 15.2 0 7 0

Daily Clinical Provider Hours 7 7 7 Tuesday 30.8 32 1.2

Visits 11.9 11.9 0 0 0 7 0

Daily Clinical Provider Hours 7 7 7 Wednesday 30.8 33 2.2

Visits 11.9 11.9 0 0 0 7 0

Daily Clinical Provider Hours 7 9 7 Thursday 34.2 35 0.8

Visits 11.9 15.3 0 0 0 7 0

Daily Clinical Provider Hours 7 7 7 Friday 30.8 32 1.2

Visits 11.9 11.9 0 0 0 7 0

Daily Clinical Provider Hours 4 4 Saturday 10.8 11 0.2

Visits 6.8 0 0 0 0 4 0

Weekly Visits per Provider 66.3 62.9 0 15.2 0 39 0 Weekly Visit Goal 183.4

Enter number of

weeks/year 46

Yearly Visit Goal 8436.4

Daily Provider Visit Goals Clinic Productivity Goals

Day of the Week Daily Visit Goal Actual Visits Variance

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

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# of

Providers

# of total

clinical

hours

worked

x recommended

# of visits/

clinical hour

Potential Daily Visit

Capacity

Mon. 2 16 1.4 22

Tues. 2 16 1.4 22

Wed. 2 16 1.4 22

Thurs 2 16 1.4 22

Fri 2 16 1.4 22

Potential Weekly Capacity = 110 Dentist Visits

2 Dentists each working out of 2 Operatories with 1 dental assistant

Model 1

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Potential Weekly Capacity = 135 Dentist Visits

2 Dentists each working out of 2 Operatories with 1.5 dental

Model 2

# of

Providers

# of total

clinical

hours

worked

x recommended

# of visits/

clinical hour

Potential Daily Visit

Capacity

Mon. 2 16 1.7 27

Tues. 2 16 1.7 27

Wed. 2 16 1.7 27

Thurs 2 16 1.7 27

Fri 2 16 1.7 27

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Cost of Adding Dental Assistant

$16/hour x 40 hrs = $640/week

Fringe benefits @ 25% = $160

Total cost = $800/week

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Additional 25 Visits per week

• 20% Self pay visits = 5 @ $40 = $200

• 65% Medicaid visits = 17@ $135 = $2,295

• 10% Commercial Insurance = 3 @ $165 = $495

• 5% Homeless (Free Care) = $0

• Total Revenue = $2,990 - $900 (cost of adding a Dental Assistant)

Weekly profit = $2,090

Yearly profit = $108,680

Increases access by providing nearly 1,150 additional visits for the year!

Cost vs. Benefit of Adding Dental Assistant

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Dental Procedures

Benchmark for Procedures per Visit: 2.5

Total the number of procedures by ADA code and divide that by the total number of yearly visits

• Total annual visits = 3,600

• Total procedures by ADA/CDT code = 4,000

• 4,000/3,600 = 1.1 procedures per visit

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Scope of Service Benchmarks

Service Type Procedure Codes % of

Total

Diagnostic D0100-D0999 (excluding

D0140)

30-40%

Preventive D1000-D1999 25-35%

Restorative D2000-D2999 18-25%

Endodontics D3000-D3999 1-2%

Periodontics D4000-D4999 2-5%

Removable Prostho D5000-D5899 1-3%

Fixed

Prosthodontics

D6200-D6999 <1%

Oral Surgery D7000-D7999 5-10%

Emergency D0140, D9110 2-6%

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What Happens at the Visit

TimeProviders level of competency

Patient need

Patient tolerance

Reimbursement

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Balancing the Mission and Margin:

Expenses Revenue

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Define what Financial Success Looks Like:

• Create a profit?

• Break even or zero variance?

• With grants or without grants?

• Willing to accept a loss? If so how much?

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Net Revenue

Goal Calculation Target

Revenue per

Year

Break Even: Total direct

and indirect expenses

for the year

$1,000,000

Revenue per

Week

$1,000,000/46 weeks $21,739

Revenue per

Day

$1,000,000/230 clinic

days

$4,348

Revenue per

Visit

$1,000,000/8,280 $121

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Individual Production Goals

Provider FTE Gross

Charges

Net

Revenue

(60%)

Annual

Days

Worked

Charges/Day Revenue/Day

Dr. D 1.0 $541,667 $325,000 230 $2,355 $1,413

Dr. G 1.0 $541,667 $325,000 230 $2,355 $1,413

Total

Dentist

2.0 $1,083,333 $650,000 460 $4,710 $2,826

RDH 1.O $291,667 $175,000 230 $1,268 $761

RDH 1.0 $291,667 $175,000 230 $1,268 $761

Total

RDH

2.0 $583,333 $350,000 460 $2,536 $1,522

TOTAL $1,666,666 $1,000,000

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Predictability is Key

Ability to predict expected reimbursement based

on:

• Payer Mix

• 3rd Party insurance reimbursement

• Sliding fee discounts and nominal fees

• Visits

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Impact of Payer Mix on Sustainability

7,500 visits

35% Medicaid =2,625 visits x $100 = $262,500

55% Self-Pay/SFS =4,125 visits x $30 = $123,750

10% Commercial =750 visits x $125 = $93,750

Total revenue = $480,000

Total expenses = $500,000

Operating loss = ($20,000)

7,500 visits

40% Medicaid =3,000 visits x 100 = $300,000

50% Self-Pay/SFS =3,750 visits x $30 = $112,500

10% Commercial=750 visits x $125 = $93,750

Total revenue = $506,250

Total expenses = $500,000

Operating surplus = $6,250

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Average Reimbursement by Payer Type

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Financial Projections Projected Visits

Actual Visits

Difference -6500

Patient/Insurance mix: Yearly visits

Percent Medicaid -

Percent Self Pay -

Percent Commercial Insurance -

Percent Other -

Total 0% -

Reimbursement Rate (per visit): Yearly Revenue

Medicaid -$

Self Pay -$

Commercial Insurance -$

Other -$

Total Projected Revenue -$

Total Expenses

Projected Bottom Line -$

Payer Mix Tool

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Common Problem Areas:

• Unfavorable Payer Mix• Working under or over capacity• Lack of goals and accountability

• High broken appointment rate

• Scheduling issues (types of patients)

• Insufficient support staff (dental assistants)

• Staff turnover

• Equipment issues (chairs, outdated, missing, broken)

• Lack of EDR/PMS (or not being fully utilized)• Billing and collections • Fees are set too low • Other

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VALUE-BASED CARE

Future of Oral Health Payment and

Care Delivery

58

Cost of Healthcare

2017 U.S.

Healthcare Costs:

3.5 Trillion/

22% of GDP

U.S. spends

6-11% more on health

than other countries

The U.S. is ranked

37th in health

outcomesby the WHO

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30% of Health Care Resources are Wasted

Source: Institute of Medicine Report – The Healthcare Imperative

Unnecessary Services

$210 Billion

Fraud

$75 Billion

ExcessiveAdministrative Costs

$190 Billion

Inefficiently Delivered Services

$130 Billion

Prices That Are Too High

$105 BillionMissed Prevention

Opportunities$55 Billion

= 1 Billion

60

30% = $37.2Bthat could have been spent

on care

30% = $4.47Bthat could have been spent

on care

2016 Dental Expenditures =

$124B2016 Medicaid Dental Costs

= $14.9B

Oral Health Care Dollars Wasted

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Access to Care

Environment

Genetics

Health

Behaviors

Influence on

Health

10%

20%

20%

50%

Access to Care

OtherHealth Behaviors

National Health Expenditures$3.5 Trillion

88%

8%

4%

Health Status: Determinants of Health

and Health Care Expenditures

Source: Centers for Disease Control and Prevention, University of California at San Francisco,

Institute for the Future, http://www.cdc.gov/nchs/fastats/health-expenditures.htm

62

Value-based healthcare is a

healthcare delivery model in which

providers are paid based upon

making patients healthier while

reducing costs of care.

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The fact that an alternative payment model

is different from fee-for-service does not

necessarily mean it is better.

www.chqpr.org/downloads/WhyVBPIsNotWorking.pdf

DESIGN

64

Fee-For-Service What Works What Does not Work

• Providers are only paid when

they provide a service

• Pays for more care when patients

need it (volume)

• Payment does not depend upon

variables the provider can’t

control

• Predictable payment, Providers

know what they will be paid

before they provide a service

• Care is not linked to quality or

results

• Care provided is not predictable

• Cost of care can exceed the

payment for care

• No fees for many needed

services

• Costs for care are not predictable

or comparable

www.chqpr.org/downloads/WhyVBPIsNotWorking.pdf

65

Pay-For-Performance

What Does not Work

• P4P services provided may not

be the ones that a particular

patient needs

• Payments may not be enough

to cover the costs of care

• There may be needed services

that are not covered by the P4P

plan

• Costs for care are not

predictable or comparable

• Providers still have to deliver

services to be paid. P4P is

just an adjustment to FFS

provided

• Providers could get paid less

for treating patients with

greater needs

• Providers could get paid less

for things they can’t control

www.chqpr.org/downloads/WhyVBPIsNotWorking.pdf

66

OHVBC is Not:

• Simple

• One size fits all

• Guaranteed to work

• Going away

• Instant

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Opportunity to be at the Table

and not on the Menu

68

Domains of VBC

• Leadership, Vision and Will

• Structure, Systems and Operations

• Care Pathways and Provider Buy-In

• Data and Analytics Technology and

Personnel

• Financial Viability

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QUESTIONS/DISCUSSION

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DEMONSTRATION OF TOOLSFinancial & Productivity Goals

Payer Mix

71

Open the Financial and Productivity Goals Tool Excel

spreadsheet (1st tab – Productivity Goals Exercise)

Using the Productivity Benchmark Guide & Data Sheet for

Financial and Productivity Goals Exercise (both in

word), we are going to identify the following

productivity goals:

• Visits per day

• Weekly visits per provider

• Visits per week

• Visits per year

Creating Capacity and Productivity in Access Goal

72

Financial and Productivity Goals Tool

1st Tab

73

Sample Data

74

Financial and Productivity Goals Tool

2nd Tab

Instructions Description of Goal Variables Goal

Enter total indirect and direct expenses

from the profit and loss statement the

most recent fiscal year Yearly Revenue Goal -$

Enter number of weeks/year Weekly Revenue Goal #DIV/0!

Enter Number of Clinical Days per Year Daily Revenue Goal #DIV/0!

Total Projected Yearly Visits will

automatically fill in from the

Productivity Goal Sheet Revenue Per Visit 0 #DIV/0!

Goal 1: Break Even Goal without Grants

Refer to the 3rd Tab “Profit and Loss Statement” for

expenses

75

Payer Mix Tool

Financial Projections Projected Visits 6500

Actual Visits

Difference -6500

Patient/Insurance mix: Yearly visits

Percent Medicaid -

Percent Self Pay -

Percent Commercial Insurance -

Percent Other -

Total 0% -

Reimbursement Rate (per visit): Yearly Revenue

Medicaid -$

Self Pay -$

Commercial Insurance -$

Other -$

Total Projected Revenue -$

Total Expenses

Projected Bottom Line -$

Payer Mix Tool

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SCHEDULINGFORSUCCESSAlabama Primary Health Care Association

February 19, 2019

78

Learning Objectives

• Provide information on the basics of successful dental

scheduling

• Discuss the common scheduling pitfalls

• Provide guidance in effective scheduling for various

provider types

• Talk about how to schedule new adult patient visits

• Discuss strategies for overcoming schedule busters

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Works directly with safety net dental programs to provide technical assistance, coaching & motivation

Presents at national conferences on various practice management subjects

Member, National Network for Oral Health Access

Caroline Darcy

Project Manager of Technical Assistance

DentaQuest Partnership for Oral Health

Advancement

Associate Member, American Association of Public Health Dentistry

Bachelor of Arts degree from Emmanuel College in Boston, MA

80

Guiding Principles

The dental schedule should be used to achieve three key

strategic objectives:

1. Maximum access to care for patients

2. Improved oral health status for patients

3. Financial viability of the dental program

81

Maximum Patient Access

• Our mission is to provide care to disadvantaged patients who have difficulty getting care elsewhere

• A certain number of our appointments can be designated for our priority populations

82

Improve Oral Health Status:

Completion Of Phase 1 Treatments

What is Phase 1 Treatment?

Diagnosis and treatment planning, preventive services, emergency treatment, restorative treatment, basic (non-surgical) periodontal therapy, basic oral surgery, non-surgical endodontic therapy and space maintenance and tooth eruption guidance for children

83

Why Track Phase 1 Treatment Completion?

• Important quality metric

• Promotes continuous coordinated care

• Enables balance of new and existing patients

84

Financial Viability

• Net revenue = total direct and indirect expenses

• Patient revenue plus grants/other

85

Define The Scheduling Process

• What will be the start & end times for appointments each

day?

• How many appointments per day?

• What is your capacity each day?

• Who is needed in each appointment?

• What types of appointments can be double-booked?

• What are the appropriate apt lengths for various visit

types?

86

The Schedule Process (Cont.)

• How do we best use our available operatories?

• What is your ideal patient mix? (new patients, emergencies,

priority populations, etc.)

• How far out should we schedule our apts?

• Who is authorized to schedule appointments?

• Be strategic about who can schedule appointments

• Providers should always be working to the top of their

licenses

87

Common Scheduling Pitfalls

• Scheduling appointments out too far

• Scheduling multiple appointments for patients

• Putting too many new patients into the schedule

• Appointments that are too long or too short

• Not using provider time strategically

• Not being strategic about how and when to double-book

• Open time in the daily schedule (10 minutes here and

there adds up!)

88

Common Scheduling Pitfalls (Cont.)

• Hygiene appointments in the

dentists’ schedules

• Not maximizing the potential of

auxiliary staff with expanded

functions

• Not identifying our priority

populations

• Not using designated access to

preserve appointments

89

Defining Program Capacity

• Capacity is finite

• Capacity = structure and resources

90

# of

Providers

# of total

clinical hours

worked

x recommended

# of visits/

clinical hour

Potential

Daily Visit

Capacity

Mon. 2 16 1.7 27

Tues. 2 16 1.7 27

Wed. 2 16 1.7 27

Thurs 2 16 1.7 27

Fri 2 16 1.7 27

Potential Weekly Capacity = 135 Dentist Visits

Actual

Visits

% of

Capacity

Achieved

20 74%

26 96%

19 70%

18 66%

10 37%

*At least two operatories and 1.5 dental assistants

Setting Productivity/Access Goals: Visits Potential

Vs. Actual – FTE Dentists

91

# of

Providers

# of total

clinical hours

worked

x recommended

# of visits/

clinical hour

Potential

Daily Visit

Capacity

Mon. 1 8 1 8

Tues. 1 8 1 8

Wed. 1 8 1 8

Thurs 1 8 1 8

Fri 1 8 1 8

Potential Weekly Capacity = 40 Hygiene Visits

Actual

Visits

% of

Capacity

Achieved

7 87%

8 100%

6 75%

4 50%

6 75%

Setting Productivity/Access Goals: Visits Potential

Vs. Actual – FTE Hygienists

92

GOAL CALCULATION TARGET

Visits/Day 27 Dental Visits + 8 Hygiene Visits = 35 visits

per day

35

Visits/Week 135 Dental Visits + 40 Hygiene visits = 175

visits per week

175

Visits/Year 175 weekly visits x 46 weeks = 8,050 Visits 8,050

Determining Annual Potential Visits

For The Dental Program

This shows how to take the daily visit capacity and determine weekly

and annual goals for the dental program.

46 weeks is the standard number of weeks we use in a health center

year to account for holidays, vacations and other office closings

93

Priority Populations

• Children

• Pregnant women

• Patients with chronic diseases such as diabetes, heart

disease and HIV/AIDS

94

Designated Access

• The daily schedule ensures access

for all patients

• But a certain number of

appointments are reserved

• These reserved appointments

can’t be filled with other patient

types until the day before

95

Financial Goals

• Gross charges

• Net patient-generated revenue

• Bottom line (revenue after

expenses)

96

Daily Revenue Goal

• Gross Charges – Contractual Adjustments = Adjusted Net Revenue

97

Determining The Daily Revenue Goal

Total direct and indirect expenses ÷ Number of clinic days per year = daily net revenue goal to break even

For example:

Total expenses = $950,000

5 days per week x 46 weeks = 230 clinic days per year

$950,000 ÷ 230 = daily net revenue goal of $4,131

98

Common Staffing Benchmarks

• General dentist, 2+ operatories, 1.5 assistants = 1.7 visits/hour

• General dentist, 1-2 operatories, 1 assistant = 1 visit/hour

• General dentist, 3+ operatories, 1 EFDA and 1-2 assistants = 2.5

visits/hour

• 4th year dental students = 0.5 visit/hour

• GPR Resident, Q1 = 1 visit/hour

• GPR Resident, Q2 = 1.2 visits/hour

• GPR Resident, Q3 = 1.5 visits/hour

• GPR Resident, Q4 = 1.7 visits/hour

• Hygienist, 1 operatory, unassisted = 1 visit/hour (typically, unless lots

of kids)

• Hygienist, 2 operatories, assisted = 1.5 visits/hour

99

Scheduling For Dentists

• Minimum of two operatories and ideally two assistants

• Staggered appointments in two columns (possible use of 3rd

column for overflow)

• Define workflow for each standard visit - where and for how

long the dentist is needed

• Line up the blocks so the dentist’s time is maximized

• Consider each dentist’s individual characteristics but aim for

standardization

100

Sample Template, Dentist

Morning Schedule: Afternoon Schedule:Time Op1 Op2

Op3 (Overflow for

emergencies)

8:00 Emergency

8:10

8:20

8:30

8:40

8:50

9:00

9:10

9:20

9:30

9:40

9:50

10:00

10:10

10:20

10:30

10:40

10:50

11:00

11:10

11:20

11:30

11:40 Emergency

11:50 HOLD

12:00

12:10

12:20

12:30

12:40

12:50

Time Op1 Op2Op3 (Overflow for

emergencies)

1:00 Emergency

1:10

1:20

1:30

1:40

1:50

2:00

2:10

2:20

2:30

2:40

2:50

3:00

3:10

3:20

3:30

3:40

3:50

4:00

4:10

4:20

4:30

4:40 Emergency

4:50 HOLD

5:00

Intake10-minute appointments for medical hx review, blood pressure, etc.

Operative

40-minute appointments for Fillings/extractions. Can expand to 60 minutes for more procedures

Anesthesia

First 10 minutes of operative appointment, if anesthesia is provided, where the dentist might be available for a brief side-booked appointment (eg, denture try-in, suture removal) or to provide a POE or LOE

Lunch 30 minutes

Color Code:

101

Scheduling For Hygienists

• Easiest schedules to fill; hardest to KEEP full!

• Broken appointments can wreak havoc

• Limit 6-month recall appointments

• Limit new patients in the daily schedule

• Develop tasks for hygienists whose patients fail to show

102

Assisted Hygiene

• Requires two operatories and dedicated hygiene assistant

• Hygienist can see 1.5 patients/hour or 12-13 patients in an 8-

hour day

• Assistant facilitates visit

• Eliminates RDH waiting for dentist to do exam

• Must rigorously manage broken appointments

• Must have demand for hygiene

103

COMPARISON:

Unassisted Vs. Assisted Hygienists

Unassisted

Hygienist

Assisted

Hygienist

Visits/hour 1 1.5

Visits/day 8 12-13

Visits/week (factors in

25% BA rate)

30 45

Revenue ($140/visit) $4,200 $6,300

Salary costs (includes

22% fringe)

$1,464 $2,149

Net revenue after salary $2,736 $4,151

Annual net revenue $125,856 $190,946

104

Sample Template, Assisted Hygiene

Time Room 1 Room 28:00 greet, seat, update, BP (Patient 1)

8:10 x-rays

8:20 Prophy greet, seat, update, BP (Patient 2)

8:30 OHI review, disclose, anesth

8:40 OHI/dentist exam SRP (one quad)

8:50 Unseat patient/clean OP

9:00

9:10

9:20 greet, seat, update, BP (Patient 3)

9:30 Prophy Unseat patient/clean OP

9:40

9:50 greet, seat, update, BP (Patient 4)

10:00 Unseat patient/clean OP Prophy

10:10

10:20 greet, seat, update, BP (Patient 5)

10:30 x-rays

10:40 Prophy OHI/dentist exam

10:50 Unseat patient/clean OP

11:00 Greet, seat, update, BP (Patient 6)

11:10 OHI/dentist exam Prophy

11:20 Unseat patient/clean OP

11:30 Greet, seat, update (Patient 7)

11:40 Sealants x 4 OHI/dentist exam

11:50 Unseat patient/clean OP

12:00 Unseat patient/clean OP

The Result: 7 patients in 4 hours! Patients have the same amount of time in

the dental chair, the work is just redistributed to provide more access.

105

Scheduling Adult New Patient Visits: Reasons

For Not Breaking Visits Up

• Can be red flag for insurance audits

• Not patient-focused care

• Clogs the schedule

• Harder to complete treatment on existing patients in a

timely manner

106

Rationale For Breaking Up Visits

• Oral health status unknown

• How much calculus in the mouth?

• May not be able to complete exam until calculus removed

• Not enough time to do all required work in one visit

107

Recommendations

• Follow the template faithfully

• 60 minutes with hygienist

• Practice policy: as much care as possible in time allotted

• Document why if patient needs separate exam visit with the

dentist

• PSR first and comprehensive periodontal exam if indicated

• Pilot, test and tweak as necessary

108

Document The Scheduling Process

• Create a formal scheduling policy

• Include scheduling templates as attachments

• Review the policy with entire staff

• Train staff how to use the templates

• Monitor, provide feedback and tweak as necessary

109

Schedule Busters

• Last minute cancellations & No-shows

• Late patients

• Too many emergencies/walk-ins

• Too many new patients

• Overbooking

• Logjams at check-in or out

• Providers who fall behind

• Not enough support staff

• Wrong appointment types

• Wrong appointment lengths

• Insufficient Instruments

• Technology issues

110

Strategies For Resolving Schedule Busters

• Attack broken appointments

• Be strategic with double-booking

• Control emergencies/walk-ins

• Limit new patients

• Revisit capacity

• Resolve logjams at check-in/out

• Determine why providers/practice fall behind

• Ensure sufficient instruments

• Tackle technology issues

111

QUESTIONS/DISCUSSION

112

ORAL HEALTHINTERPROFESSIONALPRACTICEAlabama Primary Health Care Association

February 19, 2019

114

Project Manager, Safety Net Solutions, 2008-2014

Senior Project Manager, Interprofessional Practice, 2014-2018

Manager, InterprofessionalPractice, 2019

Kelli Ohrenberger, M.A. Integrated Marketing

Communication

Manager, Interprofessional PracticeDentaQuest Partnership for Oral Health Advancement

Member, American Association of Public Health Dentistry

Member, National Network for Oral Health Access

Member, National Rural Health Association

115

Registered Dental Hygienist, Private Practice, 2009

Dental Hygiene Team Manager, Clinica Family Health, 2009-2018

Clinical Integration Trainer, Dentaquest, 2018

Tess Draper, RDH, BS Dental Hygiene

Clinical Integration TrainerDentaQuest Care Delivery

Member, American Dental Hygiene Association

Member, National Network for Oral Health Access

116

Agenda

1.) Why Interprofessional Practice?

2.) What are the challenges?

3.) How does IPP fit into my organization?

4.) Resources

117

WHY INTERPROFESSIONAL PRACTICE?

118

INTEGRATED CARE• An interdisciplinary approach to health

care that incorporates specific

procedures of other disciplines into daily

practice.

COORDINATED CARE• Using a continual care pathway approach

that allows the patient easy navigation

and understanding their needs within the

health care system.

INTERPROFESSIONAL PRACTICE

HIT &

Telehealth

Patient

Engagement

Referral & Case

Management

Population &

System Analysis

Clinical

Integration

Risk Stratified

Care

119

“Healthcare is an exercise in

interdependency- not personal heroism... a

need for greater teamwork and to ask,

what am I part of?”

- DON BERWICK

President Emeritus and Senior Fellow, IHI

120

Why Oral Health Interprofessional Practice?

• Health

• Practicality

• Financial

121

Health Benefits: The Oral Systemic Connection

122

Patient-Centered Benefits to IPP

-Dr. Don Berwick, IHI [NOSORH Annual Session 2016]

123

Practical Benefits of IPP

• The people who are at highest risk for dental disease

have the greatest difficulty in accessing care (lack of

access points, lack of insurance, out-of-pocket costs,

etc.)

• The public health infrastructure for oral health is

insufficient to address the needs of disadvantaged

groups

• Integration of oral health into medical care expands the

potential for high-risk individuals to have access to care

that halts and even reverses dental disease, avoiding or

reducing the need for expensive treatment

124

Benefits of Interprofessional Practice

• Referring to oral health providers that medical providers

know (and vice versa)

• Quick access for medical patients with acute oral health

situations (and for dental patients with potential medical

issues)

• Warm hand-offs and curbside consults

• More effective chronic disease management

• Preventive oral health care and effective self-care

strategies extended to medical settings

• More reimbursement options now (e.g. 40 states

reimburse non-dental professionals for fluoride varnish

applications)

125

Schneider EC and Squires D. N Engl J Med 2017; 377:901-904. /

Schneider et al. Commonwealth Fund, 2017

126

©2004 by American Academy of Pediatrics

Predicted, dentally related, cumulative costs

according to age of first preventive visit

Savage M F et al. Pediatrics 2004;114:e418-e423

127

WHAT ARE THE CHALLENGES?

128

Timeline of Current Dental Model (Surgical Care Model)

19101840 1945 1970

129

What’s the current state of affairs?

Medical and dental professionals are trained separately and then they practice how they are trained - separately.

The “hidden curriculum” about oral health in medical training:

• Oral health means teeth

• Teeth are the domain of dentistry

• I know very little about teeth

• Dentists know little about the rest of the body

• Why are you (dentist) asking me about something related to teeth?

• Why is this patient coming to ME about their mouth?

• Why can’t I get a dentist to see this patient?

Dr. Mark Deutchman, University of Colorado – School of Medicine

130

What’s the current state of affairs?

Medical and dental professionals are trained separately and then they practice how they are trained - separately.

The “hidden curriculum” about oral health in dental training:

• Oral health means dental care

• Teeth are the domain of dentists

• I do not see a need to know about treating systemic diseases

• Physicians consider us as an inferior “doctor”

• Surgical intervention gets me to graduation & pays the bills after

• Why is this patient coming to ME about their health?

• Team, what team? I’m holding my own suction over here.

131

Barriers to Integration/Collaboration

Medical and Dental Professionals:

• Educated separately

• Licensed separately

• Regulated separately

• Practice independently

• Non-integrated benefits/insurance programs

• PCPs see the mouth as the property of dentists

• Sharing of information rarely occurs

• Seen by the public as separate

• Oral Health Training for health professionals has been sparse to non-existent

132

• Education and training for

PCPs- must see the

mouth as an integral part

of the body

• Training for general

dentists to treat small

children, pregnant women

and patients with other

health issues

• Patient communication –

low literacy, culturally

appropriate education

materials

• Policies defining key

processes

• Case management

system

• Designated access

appointments

• Time availability in

medical

• User-friendly CRA tool

• Reimbursement issues

• Services not co-located

Challenges

133

Barriers to Integration/Coordination (Medical)

Time• No time built into physician visit for the oral health component

Comfort• Many PCPs uncomfortable with the mouth, due to lack of oral

education and training

• Lack of comfort with caries risk assessment, anticipatory guidance, screening

Reimbursement• Lack of incentive to provide dental services because PCPs do not

get reimbursed for all procedures they can perform

Referrals• If there is no place to refer patients when a dental problem is

found…. why find the problem?

134

135http://www.michigan.gov/documents/mdhhs/Oral_Health_Assessment_of_BP-

Diabetes__Report_Feb_2017_550635_7.pdf

136

HOW CAN ORAL HEALTH IPP FIT INTO MY ORGANIZATION?

137

138

Oral Health at Well Child Visit

• Review medical/dental histories

• Perform Oral Health Evaluation (HEENOT) Document findings and management plan, including referrals

• Fluoride administration (SDF to be explored)

Oral health – Risk based instruction

• Conduct counseling to decrease or maintain low oral health risk (risk factor identification)

• Set self-management goals

• Follow up and develop referral plan

Oral Health at Well Child Visit

• Review medical/dental histories

• Perform Oral Health Evaluation (HEENOT) Document findings and management plan, including referrals

• Fluoride administration (SDF to be explored)

Oral health – Risk based instruction

• Conduct counseling to decrease or maintain low oral health risk (risk factor identification)

• Set self-management goals

• Follow up and develop referral plan

Measurement Concepts

Fluoride

Application *

Self-Management

Goal Setting

Oral Health Evaluation

(Risk Assessed)

Referral Initiated Referral Completed

MORE Care Pediatric Pathway

139

Creating an Interprofessional Oral Health

Network

140

Levels of Integration and IP Practice

Boynes SG. Finding Meaning with Interprofessional Practice, Part I. Dental Economics. September, 2015.

141

Medical-Dental Integration: Colorado FQHC

Recommendation/Goal

AAPD recommends 1st dental

visit by age 1.

Minimize need for pediatric

dental OR services.

Reduce dental caries

Clinic in 2011

Average age of new pediatric

dental patient = 4YO.

Average age of pediatric

dental OR case = 4YO.

Average patient’s dental

treatment plan included

treatment for 10 cavities.

142

Medical-Dental Integration: Colorado FQHC

143

Medical-Dental Integration: Colorado FQHC

• Co-located dental hygienists into primary care clinics

• Dental screening, fluoride varnish, self-management

goals

• Dental home established with dental hygienist unless

immediate need is with dentist

– Keep healthy teeth out of the limited dental chairs

– Provides access to children needing treatment

144

Medical-Dental Integration: Colorado FQHC

Lessons learned:

• Develop systems that develop productive relationships

• Champion relationships first

• Partnership for whole body care

• Culture shift

• What did we do to make it work?

• Medical champions

• Systems to help you do this

145

RESOURCES

146

Resources:

https://www.denta

questinstitute.org/

rural-ipp

https://www.hrsa.

gov/sites/default/

files/hrsa/oralhea

lth/integrationofo

ralhealth.pdf

http://www.qualish

ealth.org/sites/defa

ult/files/White-

Paper-Oral-Health-

Primary-Care.pdf

http://www.nnoha.

org/nnoha-

content/uploads/2

015/01/IPOHCCC-

Users-Guide-

Final_01-23-

2015.pdf

147

Tools for Success and Communication

148

QUESTIONS/DISCUSSION

149

MANAGING CHAOS:EMERGENCIES ANDBROKEN APPOINTMENTS

Alabama Primary Health Care Association

February 19, 2019

151

Learning Objectives

• Understand the negative impact of

emergencies and BAs on the practice

• Learn strategies for managing emergencies

• Learn strategies for reducing BAs

152

MANAGINGEMERGENCIES

Emergency care is

important but capacity

must be managed

153

Why Does it Matter?

• Dental ER or Dental Home?

• Unpredictability

• Reimbursement

• Disruption

• Patient/Staff Satisfaction

154

Operational Emergency Department

• Quantify demand for emergency care

• Develop system to meet demand

• Create an emergency policy and triage tool

155

Quantify Demand

• Average Per Day

• Reality vs. Perception

• Tracking

156

When Demand Exceeds Capacity

• Patients of record

• Patients in service area

• Waivered patient policy

• Are all area safety nets doing their part?

157

Have a System in Place

• Where do emergencies fit?

• Who will provide care?

• What care will be provided?

• Morning huddle

158

Beware of Walk-Ins

159

The Role of Triage

• What constitutes an emergency?

• Who decides?

• Objective criteria

160

Ask the Patient MUST BE SEEN

TODAY!See tomorrow or this

week

See when available

“On a scale of 1

to 10 how badly

are you hurting?”

Pain level 7 to 10 Pain level 4 to 6 Pain level 3 or below

“How long have

you been

hurting?”

This level for a

week or less This level of pain for a

month or less Had these symptoms for

over a month

“Describe the

type of pain or

discomfort you

feel.”

Throbbing Broken tooth, lost a filling Chip tooth, broken filling

“How are you

sleeping at

night?”

Keeps me awake

at night Able to sleep with

medication Able to sleep

“What occurred to

make the tooth

begin to hurt?”

Unknown or bit

down on

something hard

Bit down on something or

other cause Sweets; candy causes it to

hurt

“Have you

noticed any other

symptoms?”

Fever and

swelling ------ ------

Two or more

checkmarks in this

section results in the

patient needing to be

seen today

Three or more checkmarks in

this section results in the

patient needing an

appointment this week

Three or more checkmarks in

this section results in the patient

being given the next available

standard appointment time

Sample Triage FormPatient Name: ___________________________________ Date: _____________________Last Dental Visit: ________________________ Location of Pain: Bottom left, Bottom right, Top left, Top right________Patient Address: __________________________________ Contact Number: ____________________________________

161

Definitive vs. Palliative Care

• Definitive whenever possible

• Time

• Impact on BAs

• Patient/provider satisfaction

162

Have a Policy

• Define it all

• Share with staff

• Communicate to patients

163

REDUCING BROKENAPPOINTMENTS

Broken Appointment

Rate Goal: 15%

164

165

Broken Appointments

#1 cited problem for all safety net dental clinics!

5 Key Areas Negatively Impacted:

Access to Care

Oral Health Outcomes

Staff Satisfaction

Patient Satisfaction

Financial Sustainability

166

Why Does This Matter

• Lost productivity

• Lost revenue

• Wasted chair time

• Diminished access

• Incomplete treatment

• Chaos/unpredictability

• Staff/provider frustration

• Patient frustration

167

Factors Likely to Increase BA Rates

• No policy

• Policy weak or not enforced

• No understanding of why keeping appointments matters

• Misinterpretation of governance related to no-shows

• No culture of accountability (staff or patients)

• No consequences for broken appointments

168

Broken Appointments Defined

No-Show:A patient is scheduled for an appointment and they do not show up for that appointment.

Late Cancellation:

A patient cancels an appointment less than 24 hours prior to the start of the appointment.

Late Arrival:A patient does not arrive by 10 minutes after the start of their appointment.

169

Managing Most Likely to “No-Show”

New Patients

Recare Visits

• Require new (non-emergent) patient registration prior to scheduling 1st appt.

• Limit the number of new patients/day

• Book new patient visits within 2 weeks

Emergency Follow-up

• Teach patients to value the hygiene visit

• Consider moving to a “designated access” 2-5 week schedule for hygiene patients

• Require emergency patients who need follow-up care to call to schedule their next visit

170

Punishment vs Consequences

EVERY time the policy is breached:

• Call, letter, document/flag account

STRIKE ONE • Reminder and (only) warning

STRIKE TWO• Consequence occurs; requires a

proactive response from patient

STRIKE THREE• Strongest consequence

implemented by dental staff

171

“Proactive Response” Consequences:

Broken Appointment

Retraining Session

Write a Letter to the

Dental Director1. Explanation

2. Understand the impact

3. Promise never again

172

Stronger Consequences

Dismissal letter

• 30 days of emergency

care access

Same-Day-Only Scheduling Status

• Quick call lists

• Patient required to call

173

Less Favorable Consequences

Charging for No-Shows

• Rarely works

• Can’t charge Medicaid

patients

Double-Booking

• Feast or famine

https://www.medicaid.gov/medicaid/benefits/downloads/policy-issues-in-the-delivery-of-dental-services.pdf (see question 11a)

174

Source: http://www.aapd.org/media/Policies_Guidelines/D_DentalNeglect.pdf

Considerations For Children Under Age 18

175

Strategies for Success

Provide reminder messages for upcoming

appointments

Text/e-mail plus phone

48 hours in advance

What if: Non-working numbers

What if: Voice mail

176

Strategies for Success

• 30-45 days out

• One appointment at a time

• New (nonemergent) patients register in advance

• Limit appointments for multiple family members

• Ask emergency patients to call for follow-up

appointment

• Limit new hygiene patients

• Use alerts to warn schedulers

177

The Five Best Practices

• Strong policy with clearly communicated consequences

• Consistent enforcement

• Patient education

• Culture of accountability for patients and staff

• Track and evaluate BA rate

178

CDT Codes

D9986: Missed

Appointment

D9987: Cancelled

appointment

D9991: Dental Case Management – addressing appointment compliance

barriers

179

BA Rate Calculation

• The number of broken appointments ÷ number of

scheduled visits

• Scheduled Visits = number of visits + number

broken appointments MINUS number walk-ins

180

BA Rate Calculation

20 visits

5 broken appointments

2 walk-ins

Scheduled Visits = number of visits (20) + number broken

appointments (5) MINUS number walk-ins (2) = 23

Math: the number of broken apts (5) ÷ number of scheduled

visits (23) = 22%

181

QUESTIONS/DISCUSSION

CREATINGTHEIMPROVEMENT PLANAlabama Primary Health Care Association

February 19, 2019

183

The Improvement Plan (IP)

184

Recipe to a Successful IP

Identify and state the Problem or Problems

Apply Strategies to address each of the problems

Define the Actions Steps to execute each strategy

Assign a Person or Person’s responsible

Attach Due Dates

Set goals and performance Metrics

185

Step 1: Identify the Area in Need of

Improvement

• Observation

• Data

• Staff Meetings

• Patient Satisfaction Survey

• Environmental Changes

• Organizational Changes

186

Examples

• The broken appointment rate is 30%

• Providers are working late and somedays do not get a lunch break

• High number of walk-ins and emergencies

• Patients have been complaining about the long waits

• Providers feel burnt out

• Patients cannot schedule an appointment for at least another 3

months

187

Step 1: State the Problem

The no show rate is 30%

No-shows and last-minute cancelations are negatively impacting access

to care and productivity. The policy is not consistently enforced.

• By reducing the no-show rate the practice can increase revenue

and decrease chaos and stress for dental staff. A major impact will

be an increase in the percentage of patients who complete their

phase 1 treatment within 12 months.

188

Step 2: Identify Strategies

Revise and distribute a strong, no-tolerance Broken Appointment policy

to establish accountability with the patient and staff. Post signs

prominently within the practice explaining the policy.

Flag patient charts of those who breach the policy and send letters

reminding those patients of the policy they agreed to abide by.

189

Step 3: Create Action Steps

1. Revise the current policy

2. Obtain Board approval

3. Educate staff and patients about the new policy

4. Require all new patients to sign the policy

5. Monitor the BA rate and access policy after 3 months

190

Step 4: Assign Due Dates & Responsibilities

Action Steps Due Date Person(s) Responsible

Revise the current policy 6/30/17 Dental Director and Practice

Manager

Obtain Board approval 7/15/17 Dental Director and CEO

Educate staff and patients about the

new

8/1/17 All staff

Require all new patients to sign 8/30/17 Front Desk

Monitor the BA rate and access policy

after 3 months and report to leadership

Ongoing Practice Manager

191

Step 5: Set a Target Goal for the Metric

Current BA rate = 30%

Year 1: 20%

Year 2: 15%

Every quarter the broken appointment will be monitored to ensure:

• Policy is effective

• Everyone is consistent with enforcing the policy

• BA’s are being documented accurately

192

Step 6: Execute and Monitor Results

• Create Buy-In and Accountability among staff

• Collect data to monitor result; have a measurable goal for everything!

• Regular meetings to discuss the progress in executing the actions

steps

• Discuss barriers that arise

• Brainstorm ways to overcome barriers as a team

• Celebrate successes

• Recognize and award staff

• Coach and offer feedback when there are setbacks

193

Resources

• Improvement plan template

• Best Practice Manual

• Tools to create goals

• Sample policies

• DQI Resource Library

• Online Learning Modules

194

Next Steps

Utilizing the Best Practice Manual and Improvement Plan Template

1. Download the Best Practice Manual (pdf)

2. Download the Improvement Plan Template (Word)

3. Identify 1 area for improvement that your clinic can work on in the

short term (next 3 months)

4. Decide on at least 1 strategy

5. Create specific actions steps for each strategy

195

CLOSING/WRAP-UP

196

Sample Policies & Tools

• Dental Policy & Procedure Manual Template

• Sample Clinical Protocols

• Sample Dental Job Descriptions

• Sample Broken Appointment Policies

• Scripting for CHC Dental Staff

• Profit & Loss Budget Variance Tool

• Sample Scheduling Policy

• Sample Emergency Policy

• Sample Quality Assurance Policy

• Dental Clinic Performance Monitoring/Tracking Tool

• And much, much more!

https://www.dentaquestinstitute.org/learn/safety-net-solutions/sns-sample-

policies-and-tools

197

Online Practice Management Courseware

• Developing Billing Excellence

• Fee Schedules, Sliding Fee Scales, & Management of the

Self-Pay Patient

• Safety Net Dental Program Finance and Productivity: Your

Mission and Your Margins

• Front Desk Customer Service

• The Front Desk: Creating Your Dream Team

• Managing Chaos in the Dental Program

• Scheduling by Design

Free continuing dental education credits!

https://www.dentaquestinstitute.org/learn/online-learning-center/online-

courseware/safety-net-dental-practice-management-series

198

Additional Online Learning Center Resources

Other Learning Modules/Online Courseware

• Disease Management Series

• Special Topic Series (e.g. Payment Reform in Oral Health)

Resource Library

• Best Practices Manual

Dental Caries Management Virtual Practicum

Instructional Webinars

PrevenTips Videos

https://www.dentaquestinstitute.org/learn/online-learning-center

199

Sign-Up for DQP News

Click here to sign up for DentaQuest Partnership news and updates

200

Post-Training Evaluation

Link to Survey: https://www.surveymonkey.com/r/ALPOST19