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Published by Viva Concepts, 2018-05-21 19:57:32

California Dental Care: Case Study

Office Observation Case Study Implementation

Hello Dr. Patel,
It was my pleasure visiting your office.
Your office is one of the best set up offices in terms of flow lines that I have seen. I have been in literally thousands of offices and your planning of the flow lines is extremely well thought out and is set up nicely for future growth and expansion.
I obtained excellent information during my visit and I have laid out an overview of the primary focus and/or direction for expansion of California Dental Care.
The production of your facility has a capacity for an annual production exceeding 7M to 8M in revenue. The office has daily and monthly goals as seen at your morning meeting.
The accomplishment of expansion has to be envisioned so the staff understand how the practice can gradiently achieve the goal. A breakdown of “Departmental Income” is easily understood and brings about agreement. As a starting point any goal is achieved on gradients so I have arbitrarily chosen the first goal of 5 million as the first step in expansion.
Revenue Centers Orthodontics
The orthodontic department should easily have an annual revenue goal of $1M. This needs a breakdown working backward from the overall goal.
The average orthodontic case is approximately $5,000. With a $1M goal this requires about 200 to 220 orthodontic starts per year, or about an average of one new start per day is needed, which on an annual basis is about
Hygiene Department
The hygiene department currently has two full time hygienists. An average daily production of $1500 per day is easily achievable.
The current situation needs resolution due to low production and high cancellation rate, both easily resolved.
With an average of 70 new patients per month, the practice will add a minimum of 1 full time hygienist per year.
Hygiene Metrics
The benchmark daily production for a hygienist for the dental industry averages $1,500 per day. The average full time hygienists works 4 days /wk X 50 weeks/year = 200 working days.

Annual revenue/hygienist/year = 200 days/yr X $1,500 production/day = $300,000/yr. The objective over the next 3 years is to add a full time hygienist (4 days per ) per year. At 72 patients per month (fee for service & PPO type patients):
Hygiene Growth
Califonia Dental Care averages 72 non-medical patients per month (PPO and Fee for service). With an average of 8 patients per day, every month the practice has approximatelyn 9 full days of hygiene.
9 days
19 days
45% loss of database
5 days
9 days
5 days
5 days
9 days
45% loss of database
1 Full time hygienist added/year
Currently 2 full time hygienist + 3 added hygienist in the next 3 years will give 5 full time hygienist.
Annual Hygiene Department Revenue = 5 hygienist X $300,000/yr = $1.5 Million/yr. Current average monthly Hygiene Revenue: $30,000/mo. = $360,000/year
Increase of hygiene over next 36 months: Approx. $1.2 million.
Operative Department
Note: The operative department revenue includes Perio, general operative and oral surgery. These can be listed separately as income centers but for purposes of the expansion plan they are grouped together as an overall revenue department.
The production of the operative department is calculated based on an Average Transaction
Value for a multi-disciplined practice that offers services of general dental procedures (including implants, prosthetics and cosmetic veneers), endodontics, periodontics, oral surgery, pedodontics and orthodontics.
The annual ATV (Average Transaction Value) for a multi-disciplined practice ranges from
$1,800 - $2,100 per patient.
At 72 new patients per month the practice will see 864 New Patients per year. Operative Annual Revenue: The annual revenue goal = 864 X $2,000 = $1.73M/year

The above Departmental Revenue is as follows:
(Perio, Oral Surgery, Endo, Pedo)
Orthodontics: Hygiene: Medical:
Total Revenue
$1M $1.5M $0.3M $5.2M
Hygiene “Wellness” Implementation Actions
Information was obtained regarding the Department of Hygiene to give an assessment of current actions being done and what should be done to improve both efficiency, production and primarily retention of patients.
The current operating method of the Hygiene Department is summarized below for purposes of improving and coordinating a more ideal method within this department:
New Patients
Situation #1: Many or most new patients are seen by the New Patient Coordinator who performs an excellent indoctrination of the office. She as well takes x-rays and has a warm dialogue with each new patient.
Most new patients are not receiving their cleanings on the day of their initial appointment. This alone is a severe complexity that will result in the following:
• Difficulty in getting the patient to return.
• It lowers the monthly hygiene department revenue as the new patients are scheduled into the future, and
• Patient experience is lowered as they are expecting to receive their cleaning on the initial visit.
Situation #2: There is a non-optimum situation on the volume of cancellations which itself
precipitates frustration with the hygienists and scheduling personnel.
There are several main causes of cancellations. Foremost is an unstable hygiene department,

which include:
• Frequent change of hygienists due to turnover of staff.
• Patients are scheduled with a different hygienist than their “own” hygienist.
• Little to no dialogue from the hygienist to the patient regarding cancelled appointments. In other words, if cancellations are not talked about then the cancellation rate increases dramatically.
• Patient Education that explains WHY recall visits are important for the patient...their dental work goes to a minimum; gum disease and future dental work are dramatically reduced and in many cases, disappear.
• A poor reminder system for their upcoming appointment.
• Little or no contact with the patient database (i.e. Happy Birtday, Happy Holiday, Happy New Year, etc.) Personal contact is slowly lost due to no emotional connection.
Reminder System
In obtaining information while at the office, the following reminder system is currently being done:
Every new and returning patient receives a series of 4 emails:
Email #1: “Save this Date” email is sent to the patient with the date of their hygiene visit, stating “save this date.”
Email #2: An email is sent 7 days prior to the schedule visit as a reminder Email #3: An email is sent the day prior to the patient’s scheduled visit Email #4: An email is sent 3 hours prior to the patients visit
Text Messages
Every new and returning patient for hygiene receives 4 text messages, in addition to the above- mentioned emails:
Text #1: Text #2: Text #3: Text #4:
Sent 7 days prior to visit Sent 3 days prior to visit Sent the day prior to visit Sent 3 hours prior to visit

Phone Call Confirmation
In addition to the emails and text messages above, the patients receive a phone call to confirm their appointment. According to the scheduler/confirming person in the call center, she receives mostly phone message recordings but some do pick up.
Resolution for the Above-mentioned Situation #1 and Situation #2
• All hygiene appointments Hygienist “A” for Patient “A” are only schedule to see Hygienist “A”
• Immediately change the New Patient visit to include the X-rays, exam and cleaning on first visit.
• All hygiene visits must include a “cancellation dialogue” which is given to each patient when handed their appointment card. Additionally, a “Hygiene Appointment Cancellation Policy” is framed and visibly posted on the wall so the patient can see it. (Sample Attached)
• The cancellation dialogue given, right when the appointment card is given to the patient, would be something as follows:
“Okay Ms. Jones, my pleasure seeing you this visit. Here is your appointment for
your next “Wellness” visit... it is on (day, date and time). We will send you a text message reminder which looks like this (the hygienist has a picture of a cell phone that shows the text message they will receive). Simply type a “C” and this tells us that your appointment time is fine and you can make the appointment. If something comes up and you cannot make your appointment, simply type a “N” and this tells us “No, I need to reschedule.”
“As you know, I’m in charge of our Hygiene Wellness Program and our goal for you and every patient is to educate you to eliminate future dental work for a lifetime.
“It is very important to let me know at least 3 to 4 days in advance if you can’t make your appointment so I can rearrange my schedule. If 3 or 4 patients forget to let me know it becomes extremely challenging to fix the schedule. I would sincerely appreciate if you could help me if you need to change your appointment.
“Thanks so much in advance...I’m looking forward to your next visit...we’re on our road to achieve Wellness!”
The above “cancellation dialogue: takes less than a minute or two. The dialogue is said at a speed that the patient can receive it easily. The largest error is saying this dialogue too fast, which results in losing its importance and impact.
Streamline Hygiene Confirmation System:
1. Modify your Text message to say:
This message is to confirm your hygiene visit on day_____, month______ at _____

time. Please reply by typing a “C” to confirm your appointment. If you cannot make your appointment just press the phone number to call our office to reschedule your appointment.
Note: Change your texting message to as close as possible to the above.
2. 3.
4. 5.
Verify the phone number being used belongs to the patient you are setting the appointment for.
Set your Revenue Well text dates for TWO alerts.
Alert #1: Five days in advance of the appointment. Set this at 12:30pm. Alert #2: 1-Day prior to appointment. Set this at 12:30pm.
Email: Send the email the day the appointment is made that says, “Save this Date.”
Send no other emails. In cases where the office does not have the patients cell number, then emails replace the Alerts as described in point (3) above.
Phone Confirmation: Phone confirmations are used if there is no reply from the
first text. Allow 48 hours for a text message to be answered before calling. This means phone confirmations are made 3 days prior to the patient’s visit. Call again 2 days prior to the appointment. If no reply, then rearrange the hygiene schedule to fill the missing appointment.
The above is a guideline and procedure to diffuse multiple texts, emails and phone calls which are irritating to any consumer.
As mentioned above, the Hygienist is “prepping” the patient on receiving text messages in her “cancellation dialogue” when she makes the appointment.

Actions for Implementation Case Study
California Dental Care is on a Case Study with Viva Concepts. It is a wonderful journey in education to establish practice growth through Hygiene Retention. The Department of Hygiene is the focal point of expansion as this is the only part of the business that deals with retention of consumers.
As such, there is training of staff, specifically the hygiene team and scheduling/confirming personnel.
The initial actions to begin improvement of this Department:
1. New Patients same day cleaning: Immediately transition all new patients for cleanings
the same day as Millie’s indoctrination, x-rays and exam. I believe new patients currently are scheduled on a separate “New Patient” column? This was mentioned when I visited the office so if this is the case, then change this over and place them right in the hygiene schedule for that day.
2. Modify the Hygiene Patient Confirmation System: As described above, put your texting/email and phone confirmation system in place so it is simplified. Concurrently, the hygienist implement the “Cancellation Dialogue” as covered above.
3. Set up an time that works for the Hygiene Team (both hygienists) as well as the Confirming/Call Center staff member (Lindsay?, not sure) for an Orientation at Viva. Call the Viva Office and ask for Diana, she is the Training Coordinator for Case Studies.
This initial orientation requires 1⁄2 day, about 4 hours and they are scheduled on Thursday, Friday or Saturday. It can be in the morning from 9:00am to 1:00pm, or in the afternoon from 1:00pm to 5pm.
The orientation will give a complete overview of the courses and actions that will be done over the next 12 months...which will give a “road map” as well as a schedule to allow for future planning both for the office and their personal commitments.
The practice has a great team and your Hygiene Team leader...well, I think she’s a 10 and she’ll l take your department of hygiene to all new levels.
Looking forward to seeing them at Viva! My Kindest Regards,
Greg Hughes, DDS CEO Viva Concepts

Mission Statement
(framed in each Hygiene Operatory)
Displayed one on top the other, clearly visible for patients to see.

Cancellation Policy
(framed in each Hygiene Operatory)

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