Best Practices in Safety Net Dental Practice Management
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Transcript of Best Practices in Safety Net Dental Practice Management
Mark Doherty DMD MPH
Lynda Riddle DDS
Best Practices in Safety Net Dental Practice Management
What Does Success Look Like?
• What do we seek to accomplish in our dental programs ?
• A Vision remains just that until we attach Goals and Timelines ?
• Use Outcomes to prove we are making our patients and programs Healthier?
The Ideal Dental Practice• Affordable to Patients
• Measureable and Meaningful
• Sustainable
• Quality Managed …..CQI and QA
• A Nice Place to Work
IOM: Advancing Oral Health
IOM’s “Advancing Oral Health in America”
• Organizing Principles for a New Oral Health Initiative– Establish high level accountability– Emphasize disease prevention and oral health promotion– Improve oral health literacy and cultural competency – Decrease oral health disparities– Explore new models for payment and delivery of care– Enhance the role of non-dental health center professionals– Expand oral health research and increase data collection– Promote collaboration among private and public stakeholders– Measure progress toward short and long-term goals – Advance goals to be consistent with Healthy People 2020
Best Practices?Mission- Finance- OH Outcomes
They help us maintain control of our operations and systems and eliminate chaos.
Establish a culture of…..Management• Safe• Efficient• Effective• Equitable• Timely• Patient Centered• Predictable
Data
– Shows you right where the practice is – Gathered through the “planned and
ongoing generation of reports” – Choosing the right Data to collect is vital – The HealthCare Connections Experience
Evaluation Data GatheredGross Charges
Net Revenue
Expenses (Direct and Indirect)
Total Number of Visits
Revenue per visit
Cost per visit
Number of Completed Phase 1 Treatments
Number of Unduplicated Patients
Number of services by ADA code
No-Show Rate
Emergency Rate
Number of New Patients
Goals and Accountability• Create goals based on baseline data
collected, benchmarks and experience
• Create a culture of accountability• Regular meetings to report on progress
• Trust-resolve conflict-commitment –accountability-success
• The HealthCare Connection Experience
Best Practice:
Best Practice: Managing No-Shows
• Create policy with teeth
• Present to board, to staff and to patients
• Distribute and enforce it consistently
• Track No-Shows going forward: document success/failure
Best Practices: Managing No-Shows
• Other potential strategies for managing no-shows:– Have patients sign the no-show policy: place in chart– Provide reminder messages for upcoming appointments– Schedule appointments no further out than 30-45 days– Schedule one follow-up appointment at a time– Don't schedule follow-ups for emergencies on the day of
emergency treatment– Have new patients come in before they are given a new
patient visit to register etc,
• The HealthCare Connections Experience
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• Create a policy that defines a “true emergency”– i.e. pain, infection,swelling,bleeding, fever and trauma
• Implement the emergency policy, and stick to it• Develop a system that cares for true
emergencies while preserving regularly scheduled appointments
• Ensure that staff is trained to triage emergency patients
• Develop a list of questions to ask patients
Best Practice: Managing Emergencies
– Why Manage Emergencies? Control – Defined schedule for emergency care with
understanding that the efficient handling of emergencies results in increased potential to finish patients treatments who have regularly scheduled appointments
– Preserves the integrity of the appointment for patient who has made regularly scheduled visit
Managing Emergencies cont.
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Documenting the number of emergency visits helps the practice understand:– % of overall visits that were
emergencies– Demand for emergency care– Impact of emergencies on the
dental practice– Control or chaos?
• The HealthCare Connections Experience
Managing Emergencies cont.
Best Practice: Scheduling• Allows us to predict and control volume for each
day in practice• Allows us to create designated access for
patients in focus groups such as children, pregnant females, HIV, homeless…..
• Allows us to provide care to focus groups that are beneficial to practice i.e. children
• Provides continuity of care for patients receiving services that require multiple visits.
SchedulingSome factors that affect scheduling policies:• Demographics and needs of the patient population• How far in advance appointments are scheduled• Appointment lengths• Number of appointments available
• The creation and use of designated access
• The stated outcome and financial goals of the practice
Scheduling Best Practices• Schedule appointments no further out than 30-45 days
• Use designated access• Schedule appointments one at a time
– Exception: patients undergoing complex procedures that require multiple visits to complete
• Determine basic appointment length by service provided: 30-45-60 minutes– Additional 10-15 minute increments for procedures requiring
additional time
Best Practice: Management of Self-Pay Patients
• Elements of a good Self-Pay Management Policy:– intelligent crafting of Sliding fee scale that is mutually
beneficial to practice and patient– Education of the patient related to the importance of
their financial contribution i.e. nominal fee or co-pay – Friendly customer service yet firm with SP policy – Policy defining the maximum amount of money owed
to the practice by a patient at which time treatment is postponed
Managing Self-Pays and Co-Pays
• Established, posted policy for self-pay patients• Co-pays always collected at the time of the visit• Give the right message and the same message
to all• Educate patients and staff about the value of
care provided at Usual and Customary fees • Policies drive expectations• Lack of policies leads to failure
Key Elements to Effective Self Pay Management
• Communication and Education
• Developing and implementing sound policies
• Creating scripts• Establishing Accountability• The HealthCare
Connections Experience
Quality Care
Quality Assurance
Are we doing things right?
Quality Improvement
Are we doing the right things?
• Personal OH care in context of family, culture and community• Primary OH Care is an entry point into the larger HC system• Primary OH Care incorporates needs, risks, strengths,
resources and cultures into clinical practice. • Clinical• Financial• Social• Educational
I. Quality of Care
Quality • The degree to which health services for
individuals and populations increase the
likelihood of desired health outcomes and are
consistent with current professional knowledge.
Doing the right thing for the right patient at the right time in the right way to achieve the desired health outcomes
Partnering to Strengthen and Preserve the Oral Health Safety Net
2400 Computer Drive, Westborough, MA 01581 Tel: 508-329-2280 Fax: 508-329-2285 www.dentaquestinstitute.org
A PROGRAM OF THE