The 5 things you need to make assisted dental hygiene work in your practice
There’s no doubt that an efficient, motivated and educated dental hygiene department can work wonders for improving your practice’s treatment of periodontally challenged patients. Recently, much has been written about assisted dental hygiene, and the benefits it provides both to the patient and the dental office. This article will touch on the five things that you must have to make it work at your location. The following is a written collaboration between this dentist and his primary hygienist, and how they came about creating a successful assisted dental hygiene program for their beachside office in Florida.
Although the concept of assisted dental hygiene is relatively simple to understand, the major stumbling block is the execution of the program, and the combination of five key factors to ensure its success. A combination of the right people, office design, and proper fees will go a long way in making sure that an assisted dental hygiene program works in your office setting. The following five factors are a must for a successful assisted hygiene program.
1. The right assistant
For this program to work, the dentist must be willing to commit the resources of a chair side assistant solely to the hygiene department. Depending of the amount of office hours worked per week, a chair side assistant with excellent skills can handle up to a maximum of two hygienists in a daily schedule, regardless of how many patients are booked per day. Duties would include taking and developing films, setting up and breaking down rooms, oral hygiene instructions tailor made for each patient, and scheduling the next preventive maintenance visit. If the office has Digital X-Ray Systems and computerized treatment room capability, the assistant must have had adequate training in that aspect also.
A certified dental assistant (CDA) would be the logical choice for this position, as most state practice acts allow that assistant to perform the “rubber cup” supra-gingival part of the periodontal maintenance appointment. After reporting her clinical findings to the former patient, committing that patient to the agreed upon future maintenance interval, leaving the assistant to formally dismiss and escort the patient out of the treatment room, the hygienist then moves on to the next patient
In our office, we have been able to retain some of our assistants who have been accepted into the local dental hygiene program as the dental hygiene (DH) assistant, and that has been a “win-win” for both parties. Their confidence level treating patients gradually grows, as they get further into their dental hygiene training, and is a wonderful adjunct to the formal classroom training they receive in school. The other alternative would be to formally post the position as an assistant to the dental hygienist, or move someone that is currently chair side with the dentist, who enjoys the challenges and rewards of dental hygiene.
The DH assistant must have good time management skills, anticipating the flow of the hygiene schedule, and must be able to effectively communicate with the dental hygienist to ensure a smooth “handoff “ of the patient. Our patients readily accept this arrangement, because they have been aware of the dental hygiene team from the start of their treatment, and are aware of the expanded duties that our assistants have.
2. The right dentist
Dentists considering incorporating the assisted dental hygiene concept in their offices should review their state’s list of delegable duties that a CDA or hygiene assistant is allowed to do to more fully utilize their skills, and further help the hygienist. Dentists must be good delegators, respect the skills the hygienist possesses, and facilitate the delegation of duties from them to the hygienist.
Furthermore, the dentist must be knowledgeable in all the advances made in the area of periodontal preventive maintenance, including thorough periodontal tissue records, initial perio therapy, and standards of care when it comes to radiographs, diagnosing of periodontal disease, and the proper coding for each periodontal condition and procedure. There are many excellent continuation education soft tissue management programs available, and bringing the entire dental team to a program will go a long way in having staff commitment to assisted dental hygiene.
The dentist must also have good time management skills, as the exams done by the dentist on the patients will come during an ebb in his or her schedule, which we call an “interruptive hygiene exam.” Again, our patients have grown accustomed to my coming in during any phase of the hygiene appointment, since I mainly am doing a review of planned treatment, and looking for restorative needs. Our hygienist will review at that time her findings up to this point in the treatment, and can readily check with me later if she detects any other oral condition she feels I need to review. This also has the effect of keeping the hygiene schedule running smoothly, as hygienists don’t need to come down the hallway to inform the doctor they are done, and having to wait until completion of a procedure. In a two hygienist office, that is a common occurrence unless interruptive exams are done.
Finally, the dentist must be supportive of the hygiene team, and be patient as the formation of the team takes place. The process is no different than the training and nurturing of a good dentist-assistant team!
3. The right staff
All members of the staff must be on board for the concept of assisted dental hygiene. The other staff members must recognize that a dental hygienist is a very important part of the production in the office, and egos must be parked at the staff entrance for this to work smoothly.
A good management rule of thumb is that fully 35 percent of practice production comes from the hygiene department, and that can only be achieved with everyone’s cooperation and support. It is critical to make everyone understand that the success of the practice is linked to performance and pay, and all parts come together for future financial gain to all members of the staff.
Since all offices will have occasional staff members ill or out of the office, cross training between front office and clinical staff is a must to smooth out the rare day when the assigned dental hygiene assistant is unavailable, since the schedule will be booked accordingly. The situation with an absent team member should be handled in the same way as if a doctor’s assistant was not available.
4. The right office design
An often overlooked aspect of the assisted dental hygiene program is a good patient flow that is a product of excellent office design. Ideally, a single dentist with two hygienists would use six treatment rooms, since all three providers would work out of two rooms. All the rooms should be identically configured, and stocked for all procedures. Since some offices would lack space, consideration should be made to have “hygiene only” or “dentistry only” days, so that assistants can maintain an adequate patient flow by preparing rooms in an alternating fashion. Small pieces of equipment may have to be purchased, such as an additional Dental Alginate Mixer and an Dental Ultrasonic Scaler are present in all rooms where those procedures will be anticipated. A small but efficient dental lab will need to be equipped to process Dental Tray Materials, diagnostic models, etc., and the entire dental team needs to be trained in how to do those procedures.
Our office does new patient exams at the first visit with a dental hygienist and assistant present. Since the first impression of an office after the initial phone call is the treatment room, I urge doctors to ensure that the “new equipment” be delegated to the dental hygiene area where the new patient will first be seated, and any computerized equipment if allocated should primarily be located in those rooms. You only get one chance to impress, and the treatment room should be friendly, inviting, and impressive.
A frequently overlooked spot is the area immediately adjacent to the front desk/payment counter. Your office plan should include a private treatment presentation room, and this underutilized area should be where your new patients fill out their confidential patient information. A warm greeting, and a private room to discuss patient medical and dental histories goes a long way in making that person feel special, and the initial blood pressure recording can be done there by front office staff prior to the patient heading into the treatment area. This has the effect of heading off potential medical conditions that will need telephone follow up before treatment is initiated.
5. The right compensation plan
Prior to determining compensation, a thorough review of your fee schedule is in order, as it will dramatically impact the production and compensation of the dental team. Also, assisted dental hygiene would be very difficult to introduce if the practice has a large mix of capitation or managed care plans, due to a tendency in those plans to heavily discount preventive services. Collections in the high 90-percent range is a must if you will compensate your hygienist on a production basis, otherwise your cash flow will be diminished due to a lag in payment. Our office does not take insurance assignment, so adequate funds are there to compensate our hygienists properly.
Assisted dental hygiene is a very lucrative situation for a hygienist when compensated on a production only basis. A good range of salary would be in the 30 percent to 35 percent of production area, with the actual figure depending on other benefits offered by the practice, and the overall clinical experience of the hygienist. Once this program is established, the hygienist will benefit from all future fee increases in the fee schedule. Credit is given for all radiographs, bleaching cases, Pit and Fissure Sealants, and the only items exempted would be actual hygiene aid devices such as Electric Toothbrushes, Home Desensitizing Agents, etc.
If you have a hygienist who is currently in a salaried or hourly position, there may be some reluctance to “take the plunge” to a production only compensation situation, but our hygienists are pleased with the existing program in place, and easily reach their production goals.
Another practice management rule of thumb is that the hygiene department should be producing at least three times the actual compensation, and this is automatically achieved when compensation is linked to the formula above. Anticipated lag times in the schedule is taken without pay by our hygiene staff, giving them a well deserved rest with their families. Compensation by the current formula gives them the freedom to choose that!
Hygiene assistants can look forward to the same time off if they desire, as it is in the best interest of the office if everyone can take time off to do whatever interests them. Flexibility in vacation/personal time is a must for this to work.
In summary, many criteria must be in place for assisted dental hygiene to work for your office. All the pieces must be carefully constructed to take advantage of a wonderful opportunity to make dental hygiene and the delivery of preventive dental treatment a rewarding one, both financially and professionally.