Continuing Education (CE) for Orthodontists
The continuing education article below is available to orthodontists and general dental practitioners who perform orthodontics.
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Educational aims and objectives
This article aims to discuss the benefits of technology and outsourcing to help gain more time to connect with patients.
Orthodontic Practice US subscribers can answer the CE questions by taking the quiz to earn 2 hours of CE from reading this article. Correctly answering the questions will demonstrate the reader can:
- Understand technologies that can alleviate stress for the team.
- Realize the need for financing options.
- Realize the significance of connecting with the modern patient.
- Realize how to safely connect in a COVID-19 and post-COVID-19 climate.
- Recognize the importance of having a dedicated insurance professional to facilitate patients’ understanding of procedures and coverage.
JoAn Majors shows how technology and outsourcing help practices communicate with patients and improve in financial matters as well.
JoAn Majors, RDA, CSP, discusses how technology and outsourcing can improve efficiencies during COVID-19 times and beyond
Recently on a call, a team member explained, “I don’t have the time to chat with my patients. With reviewing a screening form, recording temperature, timing CaviCide™ spray for 3 minutes (wipe), plus 3 more minutes, plus a 60-second (or two 30-second) rinse(s) with hydrogen peroxide before treatment, I can easily lose several minutes per patient.” With all of the new sanitizing and PPE tasks to remember to keep patients safe in the dental office with efficient practice and patient management systems in place, efficiencies can still be achieved to save time and to use the time that is allotted more efficiently. During this period when dentists and teams need to rethink time-management protocols, it is the perfect time to embrace what technology and outsourcing can do to help gain that time to connect with our patients.
With all of the stressors that are a part of daily office life during the COVID-19 reopening, instituting even more office management protocols probably would be an unpopular announcement too. Inspirational speaker Tony Robbins says, “People will do more to avoid pain than they do to gain pleasure.” It is important for the team to understand that even the most remarkable technologies will have a learning curve, and everyone needs to be patient because learning new skills will increase the whole team’s long-term success. The learning curve or time lost because of COVID-19 changes can be transformed into a benefit when life is made easier in the long run because of the new methods.
After the frustrations of lockdowns and social distancing, people are craving connection more than ever. Reopening the office was therapeutic for many dental professionals and teams. We would have liked to greet our patients back with a hug or have more time to connect with in-depth conversations during this stressful period, but post-COVID-19 office procedures with less touch and less teeth (smiles covered by masks more often), resulted in more intentional interaction and increased focus. Technology efficiencies can help the team move from transactional to transformational. The communication that goes with these technologies is as significant as the technology or service itself.
Efficiency No. 1
The COVID economy — financing options are no longer optional in today’s climate
When possible, consider the money issues that face patients in the COVID-19 economy before it becomes an issue that affects treatment acceptance. It is advantageous to offer some third-party financing with one of the many companies available. The inability to provide some payment options today can be a real barrier to treatment. According to an August 8th report from CNBC, 32% of Americans were behind on mortgage payments.1 Patients are deciding whether they should pay their mortgage that is already several months late or take their child or even themselves to the dentist. The “want to” types of treatment have also been affected by this change in our economy. The ADA News reported an ADA Health Policy Institute poll in April, which stated, “The volume of total collections is down significantly with 82% of respondents saying collections were less than a quarter of what is typical in their practice.”2
Patients have options for financing dental treatment.3
- Traditional third-party financing: When patients use their own credit cards, the practice can receive payment within 48 hours. The practice pays average credit card fees of up to 3%.
- Dependent third-party financing: The dental practice partners with a third-party provider. The dental office has zero liability if the patient defaults. The dentist can offer terms and conditions and payment plans that increase case acceptance. Advantages to choosing this type of plan are the practice gets paid up front and doesn’t take any risk for nonpayment, and the practice can increase case acceptance by introducing more favorable terms.
- In-house financing: Patients set up a payment plan with the practice. In this scenario, the practice holds the risk for nonpayment.
- Hybrid financing: Patients sign a legal financing agreement and are charged interest and an intermediary administrates the program. The doctor is not fully paid up front, but the deposit usually is equal or greater than the bottom line costs of the treatment plan.
Making it easier for someone to pay can be easier with many incentive plans offered by outside financing companies during this time. Rates are temporarily lower, and these companies can provide alternative payment methods. Lending Tree®, Compassionate Care, Partial.ly, and CareCredit® are just a few of the companies that can fulfill this need. Since each office’s needs differ, research companies such as these should discuss which one would provide the most beneficial plans and can best support your team.
Many team members are not aware that an outside financing company has data accessible for new and existing patients before they get in the chair. In my office during the COVID-19 crisis, we were only allowed to see emergency patients on 2 days; some new patients were so grateful to find a dentist at all. With limited availability, same-day dentistry for emergencies was and still can be efficient. Prequalification functionality is often built into these platforms, so both the doctor and patient will know the amount of funding available. Having this ability to access the available credit with the name and phone number of a new patient can be extremely helpful. On the CareCredit dashboard, we could easily see the funds obtainable before the patient arrived in our office, which increased productivity and improved customer service. Saving time that way allowed us to be more efficient. We knew how to respond regarding financing when the patient said, “It’s tough for us right now because my spouse didn’t work during the pandemic shutdown.”
In one of the last articles written by Sally McKenzie, an incredible dental colleague, mentor, and management professional, she shared, “payment plans enable your practice to schedule the number of appointments required to complete treatment, not the number patients can afford. This means patients will be less likely to cancel at the last minute or not show up at all, reducing broken appointments and all the trouble they bring.”4
Efficiency No. 2
COVID-19 concerns about spreading germs — reducing surface “touch” and increasing “staying in touch”
Adopting a healthier “touch it once” mindset is more serious than ever in today’s practice. With all the fear of spreading these germs with a sneeze or droplets, why in the world would we still have multiple people touch paper? The CDC website FAQ about transmitting COVID-19 through the mail, packages, or surfaces with the virus on them, notes: “It may be possible that people can get COVID-19 by touching a surface or object that has the virus on it and then touching their own mouth, nose, or possibly their eyes, but this is not thought to be the main way the virus spreads.”5 Touch may not be the “main” way the virus is spread. Still, it presents a possibility that can be avoided while creating a time-saving efficiency for our teams and all patients. A better, safer way to obtain all of the necessary information is through electronic submissions. Consider paper referrals and the possibility of how referrals or film X-rays or printouts can be lost in the mail, misfiled, or lost in a patient’s or parent’s car on the trip to the office. However the information goes missing, it still causes unnecessary wasted time for the referring dentist, the treating specialist, and the patient, who may have to spend extra time in the office or be reappointed because of the missing information.
Having digital records management saves time for your front office and the referring dentist. The outgoing phone call to the referring office takes time and touch. The other office needs to answer the phone and research the missing file — more time and more touch. The investigation continues — did the form get scanned into the practice management system before the patient left? If not, where is it now? The front office person not only has to interrupt her tasks to check, but also may have to ask the assistant or even interrupt the doctor. In these already challenging COVID-19 times, offices should help team members touch fewer surfaces while maintaining more connection with the patients’ records as efficiently as possible.
Office software such as LOOP and OneClick can help with this issue. I’ve used the latter as a clinical assistant in the front office. The patients have appreciated that I was able to sit with them chairside and tell them that I will click on the “easy” button and give them a “jump-start” to whom the doctor would recommend as the best “specialist” in the community. At that time, I am able to electronically send the patient’s X-rays, details for the evaluation, and medical history. From that management system, the referring dentist can keep up with the patient’s treatment and progress as well. As soon as I send the information, our patient can receive a text message from the specialists’ team momentarily and begin the process to move the patient through the office’s care cycle and let the administrative team know a referral has taken place. The only surface touch that is needed is for my keyboard. No duplication of effort is needed. If the administrative team members want or need to know more, they can access the dashboard and check it out.
With products like this for referral and lab prescriptions, the office has the opportunity for less confusion and, more importantly, today, less contact via the phone and paper. The fewer times we can touch a piece of paper or the phone for that matter, the better and more efficient we are. Also, with this additional time, dentists and teams can serve patients better and connect by listening to their concerns.
Efficiency No. 3
COVID-19 protocols and patient communication requiring consistent communication
Selecting a reminder system that serves the patient’s needs and the practice’s desires for communication and efficiency is more important than ever. There are many companies that can fulfill that need such as Solutionreach, Lighthouse 360, and WEAVE. It is important to have a flexible system, and in the case of our office, WEAVE works best for us. Today in our practices, we are overloaded with multiple dashboards for identifying various clinical and business aspects. Finding a system that can create multiple efficiencies while meeting your desires and budget is essential. As a soft skills specialist, our most important need was the ability to customize the many messages we need to disseminate as well as to share new COVID-19 protocols. Efficiency is paramount; we needed to know all of the information about who is calling and connect with a patient as quickly as possible while matching his/her patient picture with the name. Even when the employee or dentist is not working from the office, this function allows the owner and team to be and look very efficient. With all of this information, I have the opportunity to take customer service a step further when I can say, “Ms. Jones, would you like to go ahead and schedule Susan’s appointment too? She is due next month, and I can take care of the balance from your husband’s appointment now too.” All this can be achieved by viewing the same app or pop-up window.
The communication system in our office is set up to begin with a 2-week phone call before any appointment if the patient has not been in since the pandemic. This allows the staff to make patients aware of our new protocols and keep them safe. It also gives us the necessary time to replace a patient appointment if they had concerns and opted to wait. (This is very helpful with senior patients.) Then we send customized text messages at 7 days, 4 days, 2 days, and 2 hours before their appointment, allowing us to be more efficient in many ways. According to a survey of 750 healthcare professionals and their clients commissioned by WEAVE, 73% of healthcare practices say that personalized communication increases response rates and performs better. The survey also states that over half of these practices indicated that it is easier to reach clients with a text than a phone call.”6
The app also gives us the opportunity for attaching the ADA screening form, communicating about our Open Chair FeeSM for a missed appointment, and send a reminder about our curbside check-in.
The curbside check-in, sent the same day, generates a message that appears at the top of the patient’s text messages and allows the patient to type a quick message letting us know they have arrived. Then based on our appointment flow, we text when the patient can enter for his/her appointment. We also have a follow-up message thanking patients for their trust and helping our small business survive. This aspect of personalization is appreciated and receives some of the best replies.
With concerns about touching money, credit, or debit cards during the COVID-19 crisis and even after, sending a link for patient payment offers more safety. We ran multiple communication types during the pandemic through our system, communicating in both email and text.
We learned over time that the old 5-digit messages are often ignored. Now during an election year, when everyone is inundated with unsolicited texts, it is even worse; I reply STOP on those immediately! So that the messages are taken more seriously and not just deleted, our messages derive from our actual phone number.
We love that our patients even respond to our birthday message (now revolving around COVID-19 and a distant hug), and those messages can be changed yearly. Many patients perceive that the message is straight from the doctor and respond. The ability to listen to those messages at home during COVID-19 also was a game-changer. The missed-call text and our ability to quickly see the patient’s response message are how we gained so many new loyal patients. Many said they could not get anyone in other offices to return their call. Allowing someone on the team to rotate to watch the app each day also gave a few hours of work to team members who had requested more hours.
Now at the end of the year, we will launch a campaign through the system for “Use it or Lose it” benefits, and then “Are you dreaming of a white Christmas?” whitening special. A reminder system needs to do more than remind to be considered efficient and effective for today’s discriminating buyer.
Implementing any new technologies has a learning curve. Before implementing a new system, do some research by asking colleagues on message boards or calling other dentists to see which system has worked for them.
Keep in mind that you’ll need to be discreet and adhere to HIPAA regulations with messages to your patients. For years we were warned about leaving personal patient information on a recorder that someone other than the patient might hear. Even though you are texting their personal device, it’s a good idea to keep messages generic in nature that shouldn’t violate HIPAA laws. If you are texting with a patient, and money or other personal matters that could be of concern come up, consider saying, “Ms. Jones, I can call you about this, or you can give me your permission to communicate this type of information here by text.” Clarity is never a mistake when communicating with patients.
Efficiency No. 4
Insurance time crashers —understanding the scalability and profitability of outsourcing specific tasks
Outsourcing these tasks does not replace team members; it replaces team members’ non-connecting tasks so that they can still be essential and efficient and help our practices to survive. For example, private or small group practices need a strong team for insurance benefits and billing issues — tasks that can take much time and effort because patients need to be educated on the difference between dental benefits and medical insurance.
Mouth Healthy, a website of the American Dental Association notes that “An annual maximum is usually $1,000 or $1,500 and has not changed much in the last 50 years,” and that the time it takes to speak to a person about a specific procedure takes a lot of time.7 Years back, when a plan covered 50% of three crowns, the time that it took to explain and process the insurance form was more feasible. Today, the cost of technology and PPE makes this function quite different. Patients often do not realize how little their dental insurance will cover. And with the perio rules and coverage for other procedures changing regularly, patients need someone to make the connection with them and spend the time to plan their care within or in spite of their insurance plan. Consider orthodontic treatment and how some still perceive this as a “want to” rather than a “need to” service. A team member can create value by communicating one-on-one how significant a patient’s occlusion is to his/her long-term dental health. Speaking with a patient in the office rather than wasting time on hold with the insurance carrier will reap far better results. Patients must discuss and understand the possible risks and consequences of delaying or not accepting a treatment recommendation, but that communication must be delicately delivered, taking time and focus.
There has never been a better time to consider sharing seasoned insurance professionals’ cost as an outsource to your team. The assistant that loves to coddle and care for that frightened patient may not effectively also play the role of the detailed individual needed to file claims correctly. Some assistants want to be patient-facing, while other team members enjoy battling it out on the phone with an insurance company’s representative in a back room with no patient inter-action. Outsourcing to a dedicated insurance professional offers an opportunity to ease the workload of those who need that time to connect with patients. With most practices experiencing shutdowns because of COVID-19 exposure or losing team members who are concerned about returning to work, having greater insurance returns can increase revenue and reveal the underlying plan details that can trip up the patient and cost money.
A recent article in Becker’s Hospital Review, “Outsourcing is Exploding in Healthcare – Will the Trend Last?” shares this key point: “When the functions are outsourced, systems have access, through the vendors, to the most up-to-date technology for data collections and analysis without investing in capital.”8 Most of us can’t afford someone of this experience for less than about $15 to $16 an hour. The private practices recognize the scalability and affordability of the big groups and DSOs having a dedicated team with many of these services. There are so many, including Medusind, eAssist, Dental Hero, Dental Claims Support, and Peak Professional Partners, to name a few. It is an efficiency that can have an immediate impact on the bottom line and the sanity of your team.
Running a dental office has always been a complicated combination of catering to patients’ needs, providing excellent clinical care, and discovering the most efficient ways of helping patients navigate their financial choices while keeping the profitability of the office. COVID-19 times have made it even more necessary to find efficiencies through technology and expert third-party options. All of these choices will create a smoother workflow even after the crisis has abated.
Technology and outsourcing are very helpful in communications during COVID-19 times, and JoAn Majors also believes that soft skills can also be a tremendous asset. Read her article, “Soft skills can help you deliver tough news to your patients and their parents,” here: https://orthopracticeus.com/soft-skills-can-help-you-deliver-tough-news-to-your-patients-and-their-parents/.
- Adamczyk A. 32% of Americans had outstanding housing payments at the beginning of August. CNBC Make It. https://www.cnbc.com/2020/08/06/32-percent-of-americans-had-outstanding-housing-payments-at-beginning-of-august.html. Posted August 6, 2020. Accessed October 19, 2020.
- Carey M. HPI poll examines impact of COVID-19 on dental practices. ADA News. https://www.ada.org/en/publications/ada-news/2020-archive/april/hpi-poll-examines-impact-of-covid-19-on-dental-practices. Posted April 1, 2020. Accessed October 19, 2020.
- Sadusky A. The Dental Drilldown: Patient financing programs 101. Dental Economics. https://www.dentaleconomics.com/practice/patient-communication-and-patientfinancing/article/16385045/the-dental-drilldown-patient-financing-programs-101. Published January 1, 2019. Accessed October 19, 2020.
- McKenzie S. 7 ways to increase cash flow in your office. Dentistry IQ. https://www.dentistryiq.com/practice-management/financial/article/14183768/7-ways-to-increase-cash-flow-in-your-office. Published September 21, 2020. Accessed October 19, 2020.
- Centers for Disease Control and Prevention. Frequently Asked Questions. https://www.cdc.gov/coronavirus/2019-ncov/faq.html#Spread. Accessed October 19, 2020.
- Weave. Doing Business in the New Normal: A Weave Guide for Healthcare Practices in the Age of Social Distancing. https://www.getweave.com/ebook-weave-got-this. Accessed October 19, 2020.
- Mouth Healthy. Common Dental Benefit Terms: What They Mean and Why They Might Come with a Cost. https://www.mouthhealthy.org/en/dental-care-concerns/common-dental-benefit-terms. Accessed October 16, 2020.
- Becker’s Hospital Review. Outsourcing Is Exploding in Healthcare — Will the Trend Last? https://www.beckershospitalreview.com/hr/outsourcing-is-exploding-in-healthcare-will-the-trend-last.html. October 4, 2013. Accessed October 19, 2020.
This article is intended to provide general information and is not intended as legal or financial advice.
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