I just received a call from the front desk staff member that works for a long-term client. She wanted to know how to improve her recall for hygiene. They were using Eagle Soft, and the doctor wanted to know what reports to use, and if they could improve their recall strategy. This front desk person had worked there 2 years and was following the directions given her by the previous person who occupied her job. She said they were prebooking 90 percent of their hygiene patients and using a contact resource management software (CRM platform) to use emails and texts (Demand Force, PMG Lighthouse 360, etc.) then using the computer to generate recall cards at the due date. If the patient failed to show, they would send another card or text at 1, 2, 3, and finally 12 months. Guess what: Very efficient but terribly ineffective. They were doing everything wrong for the right reasons. They had a strategy, but it just was not working. They had a protocol that just did not give them the results they should expect. What do you do if your strategy doesn’t work? Act quickly to adapt and try something else. Don’t just continue to mindlessly repeat the same thing over and over and expect a different result. About this time, many of you are already forming the dreaded excuse: “Yea but, it’s different here or so and so does it this way and they have a great practice”. We call this chasing the “commonplace” instead of using common sense to solve blockages in your practice. At this time in dentistry, we can ill afford to spend time and energy doing things that do not yield the results we want. In this case, they were doing what they always did. We have to go to a results-based strategy. If we can get the result that we want, then we are operating the correct strategy. If not act quickly and change what you are doing. Recall is the life blood of the practice. 67% of all the dentistry you will ever do in your office comes from hygiene recall.
In this case, I asked them to give me numbers so I could verify exactly where they were and what real challenges they faced. I would bet that they have no idea of where to look and how to verify the percentage of patients on recall. This office used Eaglesoft, and they need to look at their Patient Analysis Report. Dentrix would have been their Practice Statistics Report. Every software except Open Dental will have a pre-collated report you can pull up without having to go to 7 different areas to track down the needed numbers. Your goal would be to have 100% of your patients in your recall system and a protocol to reactivate anyone who falls out of compliance. This is fundamental practice management and a necessary habit to develop in a well-run dental office.
Let’s start from the beginning. She asked: “What reports should we run?” My answer was: “Only the ones you use”. Don’t assume that just because your computer is capable of rearranging numbers into countless reports that you should print or try to use them all. Always begin with the end in mind. What are you going to do with the report? You may find that a computer might not be the best go-to strategy. Maybe in this case we need a little old school as well a pinch of advanced technology.
Let me give you the answer by the numbers:
Pre-book at least 90% of your recall patients. It is best to do this chair side if you have computers in the operatory. Who best to re-schedule the patient than the person who just worked on them? It may take a longer or shorter amount of time for the next appointment. No one needs exactly a one-hour recall appointment. They might need 60 minutes, but some could need 50 or even 40. But the hygiene schedule should always be engineered to use the exact amount of time that you need. Not a default of “everyone gets a one-hour appointment”. Scheduling chairside by the person that just worked on the patient ensures that the proper time is reserved for the next appointment. It eliminates one hand off when dealing with the patient and therefore will eliminate one possible error at the front desk. It’s sad, but the average dental practice only has about a 42% recall. This strategy should be used for any appointment. You goal is to never let a patient leave the office without a future appointment. It might only be an appointment for a phone call, but no one leaves without an appointment.
Real quickly, open your office schedule and look out somewhere between 3-5 months in the future and look at several days. In each hygiene column for that day, how many appointments are there? I wager that it won’t be 7 or 8. It’s more likely to be 4 or less, and your hygienist would insist that she prebooks 90% plus of your hygiene patients for recall. That’s just “spit balling” it, but it is a true picture of a common problem in our offices.
Only pre-book 70% of any day in the future with 6 month recalls. We need that 30% of open appointments for new patients and follow up treatment like soft tissue appointments. Nothing is worse than working with a patient to understand a soft tissue problem, and have them accept treatment recommendations, only to find that you cannot see them for 4 weeks. You tie urgency to the treatment and now you cannot get them in quickly. Boom: Cancelations and No-Shows skyrocket.
Another reason revolves around marketing for new patients. You spend all that money, and they call to make an appointment and you don’t have a place to put them for 3 weeks. More CA/NS. We cannot be productive in hygiene by just having 8 recall patients per day. We need room for substantial cases like new patients, quadrants of sealants, soft tissue management cases, and impressions for TAP and snore guard appliances. If you are with me so far, you are thinking: “He says we have to prebook 100% of our patients for recall, but he also said you only prebook any one day to 70%”. Yep, you got it. Your next thought will be “That doesn’t make any sense. If I only prebook 70% in any one hygiene column, where do the other 30% go if I reschedule them?” Great question. They go in another column. A column that you don’t even have a hygienist to work yet. In that way you are reserving time for substantial cases on the hygiene schedule knowing all along that as this day looms closer and closer, you will need to hire another hygienist. Look at this way. The average hygienist can only see about 650 patients a year if she sees them twice a year, does some scaling and root planing, and has the average number of new patients per month (20-30 new patients a month for an average practice). Now follow the numbers. If you are an average practice, you will have about 30 new patients a month. That is 360 new patients a year. If we really inspired our new patients and they all came back in six months, you would need to hire another full-time hygienist every two years because you will have added 720 new patients during that 24-month period. For the sake of argument let’s say you do average 30 new patients a month, 360 new patients a year. You’ve been doing this for 5 years, but you only have one hygienist. Take a moment and think hard. The answer is that you have more patients leaving your practice than you have coming in. If you didn’t, there wouldn’t be any room for new patients. You have the front door of your practice open, but you also have a larger back door open just as wide or wider. This is a huge problem for the average practice. A dead man walking scenario. Things are so bad that not only do you not see the problem, but the problem is robbing you of consistent growth and profitability. Good practices consistently grow in production, profitability, and new patients every year.
Understand “peak demand times”. Capacity is being able to deliver a service when the patient wants to have it delivered. Make sure you make a note and give this your highest priority while linking this to our previous discussion on recall. Any front desk person can tell you that patients want to come in early or late. About 7-9 AM and 3-6 PM. We call these peak demand times. Those are everyday during the week, Monday-Friday (not Monday-Thursday). You can also add all day Saturday to the list of peak demand times. Monday, Friday, and Saturday are your best days. Whoops, it just happened again. I heard grumbling from the “Yea buts” as they repeat some inane, made-up statistic, because they heard from someone else that “appointments on Saturday never work”. You would be, once again, incorrect. Saturdays are great because no one wants to go through a weekend with a tooth ache. It’s also great for hygiene because no one wants to take off a day to get their teeth cleaned. Wait, someone at the back of the room just yelled out that no staff member wants to work Saturday. That’s cute, but once again you are wrong. We had a doctor that worked Wednesday, Thursday, Friday 8-5, and Saturday 8-1 for a total of 30 hours a week. He would easily produce over $100,000 a month not including the hygiene production. He (and his two assistants) had half a day Saturday off, plus all day Sunday, Monday, and Tuesday off. There was not one team member that worked that schedule that would ever want to go back to a Monday-Thursday schedule. Add to that, this doctor saw a majority of the new patients because those hours were the most convenient for the majority of consumers in our area. I could go on and on, but for the moment, let’s stop paying any attention to the nay sayers and take a look at this with no false notions and really delve into why each and every one of these suggestions fly in the face of common place things we see in a majority of practices. No one wants to start the week with a toothache or go thru a weekend with one. Everyone wants to come in on Saturday, so they won’t have to take off from work, and expose themselves to the risk of another layoff. This is “consumerism”. With this in mind, when we pre-book our patients of record, we should try to encourage them to take non-peak demand times. These recall patients already love and respect you. The new patients do not have this trust or bond to the office. If you use marketing to attract new patients, you must have peak demand times open. No peak demand times, no marketing. A rule to live by: You must be able to get a new patient in for their appointment during a peak demand time and within 4-10 days (not workdays, but 4-10 days from the time they call).
Use the Hygiene Report Card to create more value for the hygiene appointment. It is not “just a cleaning”. This card, developed by hygiene consultant Annette Ashley Linder, goes a long way toward helping patients understand what is done during the appointment. It is included below for your use. Keep in mind that we are not keeping this in our records. It is given to the patient to take home in order to create a better understanding and appreciation for the value of a hygiene appointment. I have included a copy of the Hygiene Fitness Report below. Don’t miss it.
Have the patient address their own hygiene recall card in the operatory while waiting for the doctor to check. NOTE: We have patient 6 month recall cards that we use as an adjunct to a CRM platform using emails and texts. We have the patients address this card to themselves and it is placed in a file with four weeks for each month. Everyone opens their mail over the trash can. When they see their own handwriting, they are sure to stop and look at what it is. At least it will be read.
Have the front desk place this card in a 52-week file. Two weeks before the appointment the front desk will send out all of the recall cards. Simple system with 52 slots for the cards.
Four days before the appointment use your CRM software to send out a text asking for conformation.
24 hours before the appointment: They get a call to remind and confirm the appointment.
Use oversize full color cards for recall. The larger the better. Less chance of being misplaced or slid into a magazine or other mail at the post office. Make sure the card is full color with great graphics to make it stand out in a stack of their mail.
Address correction requested. This should be printed under where the postage goes on any mail used to contact your patients. This will ensure that if the patient has moved and forwarding mail has expired, the Post Office will return the card or letter with the correct address. How stupid is it to keep sending correspondence to someone who does not reply if you do not even know if it is reaching them. This assures you will have an updated patient address along with your computer database being consistently updated. If they have moved, stop sending the cards. If you have the incorrect address, change it. Keep your database up to date on phone numbers, email, and addresses. This is gold in your office. Protect and develop this patient list.
Have the hygienist write a personal note to the patient on the recall card at the same appointment. STOP and REREAD This. This is the foundational can’t miss trick in setting up a recall system. This will tie your patient to your practice. Six months later they receive the card and can’t believe that the hygienist actually remembered about their niece and cheerleading (as an example). See, they think the note was added two days before the mailing. This will go a long way in eliminating CA/NS. If they do fail to show up, make sure to call them. Please reread this and pass it on to your hygiene department and front desk recall person.
If they have failed to respond to the recall cards, text, and phone call, you will need to craft a reactivation letter. The letter should be in an envelope with only your return address on it, and address correction requested (not your practice name). The address should be handwritten (they will open this before a typed letter address). The letter should be crafted to reactivate a lost patient. I would include an offer that would be impossible to ignore. Something like a cleaning, x-rays, exam, and consultation for $50-$60. You need to tell them that you know what a financial challenge the economy has been, how difficult it is to stay on budget, and just outline that it has been ____ months since their last cleaning and at that time they needed _________________ (treatment). You need to mention about how much worse putting off treatment can be, and close with the offer. Sign the letter and place a PS that says something like: If you still feel like you cannot budget your dental care, at least come in and let us take a couple of x-rays and do an exam for $1 so you do not let anything get out of hand. The only other thing you can do to make the letter get opened is to make it lumpy. I once put a single piece of sugar free gum in the envelope and started off by saying “Here’s a sweet deal”. We need to be very proactive about getting these patients back in the fold. Keep in mind that the number one reason people fall off their recall is that something bad happened. We don’t know what, but we need to assume that something went wrong, or they didn’t like something the last time they came in.
The reactivation card should be followed by a call from the office one week after it is sent. The calls are done every day first thing. All you have to do is ask if they received the letter. If yes, then ask if they would like to take advantage of the offer. If they say they did not receive the letter, then make sure the address you have is correct, thank them, and send another letter to be followed one week later with a call.
Tie urgency to any treatment and do a great handoff to the next staff member. Whether it is hygiene or doctor treatment, we need to perfect a script that ties urgency and importance to the recommended treatment plan.
Always keep in mind: You can’t get better giving patients what they do not want. If you are not growing (increased CA/NS, and decreased NP, and Doctor and Hygiene production is down) you are not inspiring your patients. Your systems will ultimately determine the number and variety of patients you will be able to inspire. Nothing is sacred when it comes to systems. Everything needs to change and keep up with current conditions. Make changes to get the results you want.
If you have any questions about hygiene or any other system, give me a call on my cell at 972-523-4660 and let us help you have your best year yet.
Michael Abernathy DDS
[email protected]
Just copy and paste from this link to view the Hygiene Fitness Report referenced above.
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