Scheduling for Success in Managed Care

Maximizing appointments and using multiple columns to block them can help reduce the stress of maintaining profitability

Richard P. Gangwisch, DDS

Managed care is here to stay and, unfortunately, so are low reimbursement rates. If you are going to provide managed care, it will be difficult to remain profitable unless you work out of more than one chair. Efficiency is paramount in being able to keep your head above water. Simple math will tell you that if you are receiving fees that are 50% below what you normally charge, you will have to do twice the amount of work to maintain your current level of profit. Therefore, if you are going to accept dental insurance, it is highly recommended that you have multiple chairs and a dental assistant for each scheduled treatment room.

Working this way will require you to increase your productivity by developing your clinical efficiency. There are many ways to do this. For starters, you can delegate everything that your state board will allow and get used to doing quadrant dentistry. But to truly increase your productivity, you need to maximize the work that you accomplish during each appointment and schedule appointments in a way that optimizes your clinical efficiency.

Maximize Your Appointments

For any individual patient, try to combine as many procedures as you can into each appointment. Reducing the total number of appointments will greatly increase efficiency. Think about how much time it takes to wait for a patient to rinse and get up out of the chair, dismiss him or her with postoperative instructions, thoroughly clean and disinfect everything in the operatory, seat the next patient without running down the hall, discuss the weather and the impending treatment, and then give a slow, painless anesthetic injection to get the ball rolling again. Whew! That takes almost half an hour, and during that time, that chair is not making any money for you.

What if you are in the middle of excavating for a restoration and you end up staring at the pulp? If the schedule permits, go ahead and perform the root canal treatment at that time. There is quite a bit of time saved by not having to temporize the tooth and bring the patient back for a subsequent visit. And after performing the root canal, try to incorporate delivering the crown into the same appointment if you are equipped to do so. This can save you a significant amount of time and can also make the patient more willing to have the procedure performed. How many times have you done a root canal and then had the patient not show up for the crown appointment? Because the tooth is no longer hurting, skipping the crown can appear to be an enticing way to save money.

If a patient has a need for multiple crowns, consider doing the preparations for as many of them as possible during the same visit. The time savings are enormous. You can use the same set of impressions for all of the crowns, the temporary restorations can all be constructed at the same time, and the crowns can be fabricated by the laboratory all at once and seated in one subsequent appointment. For most patients, the biggest hurdle to pursuing such treatment is financial limitation. Consider offering third-party financing options to help patients cover the costs. You can even offer to discount the crowns because it will not cost you as much to do them all at once. A little extra incentive can go a long way.

When treating dental insurance patients, you can't afford to spend as much time on small talk as you can with your fee-for-service patients. They are paying you less than what you charge for the services they are receiving, so efficiency is key to maximizing profit. If you have visited your physician lately, you have probably noticed that he or she is much less chatty than in the past due to the need to meet production goals. You also don't have the luxury of setting time aside for hygiene exams for patients on dental insurance. Those exams should be shoehorned in between other tasks. For example: numb a patient, perform a hygiene check, prepare a crown or filling, perform a hygiene check, acquire a working length radiograph for a root canal, perform a hygiene check.

Optimize Your Schedule

To schedule for success, I recommend that you utilize multiple columns in your appointment schedule, with each column representing a treatment room. Use the first column for more complex procedures, such as crown and bridge work, cosmetic dentistry, implants, root canal treatments, and surgeries. In the second column, schedule less time-consuming but still doctor-intensive procedures, such as fillings. And finally, the third column should be used for treatments that can be performed with minimal doctor time or mostly by assistants. Common procedures that lend themselves nicely to the third column include denture delivery and repairs, crown seatings, clear aligner progress checks, teeth bleaching, extractions, and consultations.

By utilizing the column approach, you can be assured of having a very productive and profitable day without becoming overwhelmed. If possible, always keep an extra chair unbooked to use for overflow or emergency appointments. This will help you to better stay on schedule. Emergency patients can be extremely appreciative that you were able to get them in on the same day, and many of them can become lifelong patients and be great referral sources.

Generally, try to keep the first column open mainly for full fee-for-service patients. If that column isn't fully booked in the week ahead, then consider filling it with insurance patients. It's also a good idea to keep some open slots in the second column for full fee-for-service patients as well; you don't want them to have to wait for an appointment. This process can be likened to how services are provided at a professional sporting event. At halftime, you'll notice that the bathroom lines are significantly shorter near the box seats when compared with those near the upper deck. Insurance patients will get the same high-quality service from you, but they may have to wait a little longer for an appointment than patients who are paying your full fees.

Consider pre-blocking a first column patient appointment for a full day at least once per month. Reserve this for a very complex restorative or cosmetic treatment that will probably last most of the day. This way, a patient with a big case who is eager to proceed doesn't have to wait a long time for an appointment. Patients who wait too long can get cold feet. If this all-day appointment isn't filled with 2 weeks to go, then open it back up for normal first column appointments.

Profit With Less Stress

The decision to provide managed care can have many different effects on a practice. Some dentists who do so will have to improve their clinical efficiency in order to achieve a level of productivity that is sufficient to maintain their current levels of profit. Maximizing the work that is accomplished during appointments and scheduling them in a manner that optimizes practice efficiency can help dentists reduce the stress of maintaining profitability in managed care, even in the face of historically low reimbursement rates.

About the Author

Richard P. Gangwisch, DDS, a master of the Academy of General Dentistry and a diplomate of the American Board of General Dentistry, is a clinical assistant professor at the Dental College of Georgia at Augusta University and practices in a Heartland Dental-supported office in Lilburn, Georgia.