Thinking Outside the Chair: How Your Hygienist Can Help Drive Revenue

Driving the growth of a business isn’t just reserved for the dentist. Your dental hygiene department can be the source of untapped revenue potential.

“In most offices, the dental hygienist does 8 scaling and root-planing appointments a day–if the patients actually show up,” says Roger Levin, founder of the Levin Group, a dental consulting firm.

A practice that focuses only on the mechanics of tooth cleaning substantially underutilizes the training, dedication, and insight offered by most hygienists, he believes. Reworking the hygienist’s role in a practice “can be an annual increase of $100,000 to $200,000 in practice production. It is very significant,” he says. Other major benefits to be realized include substantially improved care for patients and greater job satisfaction for the hygienist.

“Hygiene is a business within a business. It is the cauldron from which dentistry comes from, unless it’s a new-patient exam,” says Deborah Dopson-Hartley, RDH, who was a dental hygienist for 35 years and now operates a consulting and training business in New Jersey. “Every patient, unless it’s an emergency, touches the hygienist. So you can see the strength and power of the hygienist, not only in production but in terms of marketing and sales.”

Found Opportunities

Levin estimates that most dentists spend 4.5 minutes on the average dental hygiene check, which contrasts with the hour that hygienists spend. With time to look closely at what’s happening in the patient’s mouth, the hygienist is better positioned to identify treatment options. “This is not about identifying unnecessary treatment,” Levin stresses. “This is about identifying necessary treatment.”

For a practice to realize the full potential of the hygiene department, Dopson-Hartley recommends that 85% of production should be generated through the dental hygienist, who touches every tooth in the mouth and can more readily identify potential health issues for the dentist to diagnose. “It is our job to find the problem,” she says. Then, the hygienist must sell the patient on the idea of treatment, that is, to help the patient understand and accept why treatment is necessary. “A hygienist should be able to turn very complex language spoken by the dentist and dental assistant into words that a patient can understand,” she says. “Then we can promote what the dentist had diagnosed. Nobody calls up the office and says, ‘Can I have a cavity filled?’ They call for a cleaning. The hygienist becomes the provider for the provider.”

Patients often turn to the hygienists and ask if they really need the treatment that the dentist recommended. This is an opportunity for the hygienist to promote treatment, Dopson-Hartley says.

Currently, 71% of American dental practices do not perform annual full-mouth periodontal charting, according to research by the Levin Group Data Center. As a result, some dental problems are not being identified and opportunities for increased production and revenue are being missed. Because initial periodontal therapy typically involves all four quadrants of the mouth, it means four separate appointments, all billed under an insurance code that differs from simple prophylaxis and has a distinct fee level. Many of those patients also should change to a more frequent cleaning schedule, usually three to four times a year, rather than twice.

Missed Connections

High no-show and cancellation rates can sap the profitability of the average hygiene division. A rate lower than 1% is optimal, according to practice-management experts, but some practices may see it be as high as 4% to 5%. To help drive down the rate, an education program should be implemented, which should clearly communicate to patients the expectations that they must keep their appointments for maintaining their teeth for life and general health and provide ample notice of unavoidable cancellations as a courtesy to the staff and other patients. Dental offices may want to consider not recalling chronic offenders.

More to Consider

Dentists can amplify the power of the hygienist by considering the following suggestions. Dental practices should ensure that hygienists have ample opportunities for taking professional continuing education (CE) courses. Taking the minimum mandatory number of CE classes isn’t sufficient. Treatment options can be explained well only if the hygienists fully understand them and feel enthusiastic.

Also, create management systems that illuminate the hygiene department’s expenses and revenues, including both direct production revenue and sales and referrals that will help to build the practice. Establishing sales goals and projections also can be useful and provide motivation. The entire practice team should be taught to see the hygiene division as a crucial component of the business.

When the practice becomes sufficiently busy, add a dental-hygiene assistant to the team, rather than hire another hygienist. An assistant can help with cleaning; preparing rooms, radiographic machines, and other equipment; scheduling appointments; and educating patients–all at a fraction of the hygienist’s annual salary. This can increase the productivity of the hygienist by as much as one-third.

“If my appointment book isn’t full, then the dentist’s book isn’t full. Most patients in my chair should be returning for cavities, restorations, and other services,” Dopson-Hartley notes.