Practice management1 /certified fixed orthodontic courses by Indian dental academy

PRACTICE MANAGEMENT

INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com


PRACTICE MANAGEMENT


METAMORPHOSIS OF
DENTISTRY


Traditional dentistry has changed
dramatically over past 25 years. More
challenges face a dentist today than even
before. Now dental practice management
has got great impact by the following
factors.


These factors are;--------

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
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The greatly increased consumer
awareness
The impact of insurance carriers
New dental delivery system
The prevalence of extensive advertising
The dental malpractice crisis


PRACTICE MANAGEMENT INCLUDES
PATIENT MANAGEMENT
DENTAL STAFF MOTIVATION
FINANCIAL MANAGEMENT
MARKETING
LEGAL CONSIDERATION


PATIENT
MANAGEMENT


The first phone call


It is the first physical contact ,the patient has with our
personnel and our office and therefore an aura of
pleasantness and concern must be established. Can
be of two types in nature

Typical phone
call

Emergency phone call
e.g.. Fracture of teeth,
traumatic injury


Receptionist is the person who makes the
first office contact on phone, so these most
important auxillaries should have following
qualifications;-----------



Dental auxillaries experience
Good telephone voice
Physical appearance - according to what our
patient will accept and be pleased with.


Therefore a receptionist should be trained
for the following;--------
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
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Phone must be answered promptly.

Answer with pleasant and concerned voice.
A monotone should be used.
Listen carefully and obtain all the information
before closing the conversation.
Never discuss fee or financial arrangements over
the phone.
Always close the conversation in a pleasant and
concerned manner.

IMPROVING TELEPHONE
MANAGEMENT



No of telephone lines sets or an answering machine
will depend on the following factors
No of outgoing
calls

Size of our
practice

No of patient
seen per day

No of
phone call
received
per day


THE ART OF DENTAL EXAMINATION





This simply means being through.
A complete and thorough examination will not only
enable us to deliver the best possible treatment but
will also help to prevent the practice of malpractice
suits.
Before going to actual art of examination following
things should be performed.


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Actual examination should follow after the
consultation which should be extra oral and
intra oral.
Consider every aspect of dentistry when
examining the patient.
Expertly record the results of the consultation
and examination.
Inform before you perform.


Medical
consultation
patient
identification

medical and
dental history
Consult with
other dentist in
case of referral


ANXIETY AND PAIN CONTROL



Pain control of the dental patient is still one of
the pressing needs of our profession.
APPROACHES

Spoken words
(hypnosis,biofeed
back)

Drugs

Pharmacological and verbal





Verbal techniques capable of altering body functions
when used by skilled dentist. They can induce state of
relaxation ,sedation, analgesia, amnesia and are very
helpful in post operative pain control
LIMITATION
TIME CONSUMING

LEVEL OF
PATIENT
CONTROL NOT
PREDICTABLE


PHARMACOLOGICAL MEANS




Widely used through different routes
We are a pill oriented society so oral
medication probably will be the most
acceptable form of premedication.


ORAL PREMEDICATION

Relaxation of patient
before his arrival to
dental clinics

More dentistry
can be
performed at one
visit.

Diazepam is most commonly used.

MAXIMUM DENTISTRY IN MINIMUM
VISITS



Generally the patient would like the
treatment to be completed as
painless and comfortably as possible
and quickly and efficiently and with
the least expenditure of time effort
and money.


Followings should included
in the practice


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A complete examination, detailed diagnosis, and
treatment plan and time for each appointment as
well as in between the appointments should be
established before the starting of the treatment.
Plan , present ,and schedule the case.
Separate the treatment visits completely from
the payment arrangements.


Orthodontic management of
medically compromised patients


Orthodontic procedures generally
perceived to be among the least invasive
and physiological benign of any in the
dentistry. However it must be evaluated
for potential risk for medically
compromised patients and orthodontists
must be comfortable with being able to
identify patients at risk and to treat them
appropriately.

Major risk for medically compromised
orthodontic patients associated with
bacteremias, are caused by
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

Band placement and band removal.
Bleeding and infection cause by mucosal
and gingival irritation.
Ability of patients with some conditions to
tolerate treatment.


management
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Communication with patients physicians.
Aggressive pretreatment and intratreatment oral
hygiene maintenance.
Prudent use of prophylactic antibiotic therapy.
If diagnosis of leukemia or aplastic anemia is
made, removal of existing orthodontic appliance
is mandatory to minimize the risk of gingival or
mucosal irritation ,bleeding or infection.
Elastomeric modules are preferred to wire
ligatures.





It has been suggested that orthodontic
induced external root resorption occurs
with greater frequency in patients with
asthma than in nonasthma population.
Therefore it would seem prudent for
orthodontist to disclose the increase risk of
root resorption to patients before initiating
the treatment.

LEGAL
CONSIDERATION




Legal ramifications of the some of the clinical
situations that arise in the dental practice of dentistry
and practical approaches and solutions to these
problems should be familiar to dentists
LEGAL
CONSIDERATION

CONTRACTS AND
GUARANTEES
ABANDONMENT AND
TERMINATION OF
TREATMENT

FRAUD AND
MISREPRESENTATION

INFORMED
CONSENT

ABANDONMENT AND TERMINATION
OF TREATMENT




Dental abandonment is somewhat similar to
abandonment of a child by a parent.
Once a dentist undertakes the treatment it is
important to complete the treatment to a
point at which patient is not left in a
precarious position e.g.. Not placing a
permanent restoration after caries removal
on the tooth.



Termination of treatment can be done in
case of chronically complain about their
perception of out come, uncoperation or
constantly break appointments, by
sending a letter by certified mail with
return receipt requested.


CONTRACTS AND GUARANTEES




Many dental malpractice suits are
brought against a practitioner based on
contract, so some knowledge of the
general concepts of contract law is
essential to avoid these situations.
Generally a contract is considered as an
written document , however in many
situations a legal contract is formed orally.





On this basis practitioners are advised to be
very careful in conversation to their patients
They should not promise or guarantee any
thing .
Try not to admit fault when problem occur and
think carefully before not charging a patient
for an additional procedure that might become
necessary.




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When performing orthodontic treatment stress
the need for co-operation in determining the
final result.
We should speak about improvement not
perfection.
Discussing the need for patient cooperation for
home care and keeping appointments
Staff should also be instructed to be very
careful about importance of not making
promises or statements that may provide a
basis for future liability.


INFORM CONSENT



SHOULD CONTAIN----

Procedure explained in simple terms

Information of any and
all risks

Treatment alternatives with their
associated risk and risk of
non
treatment



In case of minors a legal ,valid consent
should be taken from parents before
treatment. However in case of extreme
emergency, dental care can be rendered.
The children with certain level of financial
success and are capable of decision
making can give their consent
themselves.

FRAUD AND MISREPRESENTATION




A dentist should be honest in filling out forms
and making insurance reports which represent
an affidavit of truthfulness by us.
It is necessary to resist temptation to alter
treatment reports just to take advantage of
insurance policy provisions , because once
caught it costs more to defend ourselves, our
reputation and our livelihood.


Sexual harassment :an issue in orthodontic
office
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

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According to Nolo Press of Berkeley,California
sexual harassment results from a misuse of
power rather than from sexual attraction.
Unwelcome sexual advances ,request for such
favors considered as harassment when:-Submission to or rejection of such conduct by an
individual is used as the basis of employment
decisions affecting such individual.
Such conduct has the purpose of or effect of un
reasonably interfering with an individual work
performance or creating a hostile or offensive
work environment.





The orthodontist or staff members should be
very careful about being with a patient in the
office alone or even in a part of office out of
sight and out of ear shot.
Always make sure that another adult is in the
office when you are with the patient or parent
to avoid such circumstances.






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A more worrisome situation in the orthodontic
practice is an allegation of sexual harassment
against the orthodontist by a young or adult
patient of opposite sex.
If such complaint were made such an allegation
would go to the state dental licensing board for
review .
A written office policy may be good way to put
these issues out for everyone in the office.


FINANCIAL
MANAGEMENT


FINANCIAL CONSIDERATION






It is important to ascertain who, is responsible for
treatment.
In a situation involving long term treatment ,such as
orthodontic care in which the fee is paid periodically
over a long period of time, it is essential that every
specific financial agreements be made.
Consent should contain


Consent of
either
competent
parent or wise
to have signs
of both

ORTHODONTIC
CONSENT

Mode of payments


Total cost

Determination of orthodontic fee






Establishing a fee that both orthodontist and the
parent feel good about, can be difficult. A fair fee
is what the doctor and the patient agrees is fair.
The price of almost any product or the fee for
almost any service depends upon a no of
considerations other than the cost to produce it.
Ultimately the price is determined by a sufficient
number of people who are willing to pay and by
the desired profit of the producer.







The orthodontist who invests years and large
sums in education and in establishing and
building a practice, starts a career years later
and dollars behind.
It is strange fact that experience is not highly
valued in determining the orthodontic fee and the
fee of most experienced orthodontists are
only10% higher than the fee of brand new
orthodontist.
As patient have no real way of judging
competence in advance, so they judge us by
peripheral factors. e.g. Recommendation by
dentist and First impressions of the office, doctor
and staff.





Orthodontic fees must be increased
regularly to at least equal the increase in
orthodontic price index, in terms of
increased costs of material, staff, and a
host of other overhead items.
Some patients value the service more
than the fee while people who do not
know the value of service can only
concentrate on the size on the fee.




Earlier (before 1950) when no of orthodontists
were few.
The orthodontic economic equation:

fee x case load – expenses = profit .



which emphasis on more cases starts at low
fees.
As the no of orthodontists increased there after,
supply caught up with the demand and so fees
need to be raised.


PAYMENT ARRANGEMENTS



A financial arrangement is an agreement between
two parties in which one party will perform a given
treatment for a specific fee and other party
(patient) will accept this obligation and will pay in
prescribed manner.


No arrangement at
all

Pay as you go

TYPES OF FINANCIAL
ARRANGEMENT

Bank loans
In office budget
installation plan

Patient
payment
booklet

THIRD PARTY AND YOU




The payment of dental fee by the patient through
health insurance organization—is known as third
party.
A knowledge of insurance policies is necessary

To alert the dentist to the
potential problems with the
procedures and the
terminology being used

To offer specific basic
guidelines as to how to
proceed with third party
Plans


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TERMINOLOGY

Generally insurance and terms are defined by the
insurance carrier
The most important terms used now these days
include
Prior authorization
UCR fee concept
Participating contracts
Fee itemization
90th percentile
Peer review

PRIOR AUTHORISATION




It is basically a listing of procedures, item by
item with procedure code as sanctioned by
ADA.
A general policy of an insurance company is
that they usually do not dictate the care but
rather offer payment for a lesser service which
lead to following difficulties


•Moral and ethical dilemma of doing or not doing
his best for patient Health.
•Places a dental subscriber in a doubt if his or
her dentist is telling the truth about best care
available.
•Patient may think that service might be
detrimental to his own health.


PARTICIPATING CONTRACTS



It is legal contracts between a dentist and a
insurance carrier. In this type of agreement
insurance carrier decide to pay appropriate
payment in full for certain plans and gets
the right to enter dentist office and review the
records.




Basically the purpose of such type of
contracts is to allow insurance
company to take list of contracted
dentist to the purchaser and to sell both
you and your care skill and judgment. So
before indulging in such type of
agreement a lawyer consultation is
necessary.


UCR CONCEPT OF FEE






Usual fee— means that usual fee charged to
most patients by a given dentist for a given
procedure.
Customary— fee charged by dentists of similar
experience and background in a given
geographical area .
Reasonable— a fee is reasonable if it meets
the above two criteria or if it is justifiable
considering the special circumstances or the
particular patient in question.



Each dentist should carefully examine the
strength and weakness of UCR before
signing a contract with insurance
companies and to decide who will get
benefit, the patient ,the dentist or the
insurance company.


Reimbursement of dentist by
insurance companies
Participating and non participating
dentist
A participating dentist is defined as
any duly licensed dentist with whom
insurance company has a contractual
agreement to render care to covered
subscribers.

Participating dentist




According to this concept the insurance
company gives 90th percentile of fee as
payment in full, and only fee of the high priced
top 10% will be cut. This concept sounds fare
but in case of inflation a request of new filing
should be made to the insurance company.
Company will have the right for post treatment
inspection of randomly chosen patients to
monitor the quality of care.

Non- participating dentists




They are paid considerably lower
percentile often 50th percentile.
However they do not need to prefile their
fees and are not subject to fee audits.


MARKETING





Marketing is a process that enables us to
better understand the needs and wants of
our patients.
It is about listening and learning from our
patients as a way to improve the care we
provide.






The word marketing has caused discomfort and
alarm among some dentists due to the stigma
attached to dental advertising.
Here it is important to draw a distinct line
between advertising and marketing which are
quite different and require a different approach in
patient education.


Offering or promoting a service or product
usually new or out of the ordinary that we
want our consumer to receive.
ADVERTISING
MARKETING
Offering or promoting a service or
product that consumer already perceive
as desirable. It is giving them some thing
they already want or enjoy.

Before we introduce our marketing plan
,we should understand the following:-



The strength of practice —market those
services we deliver best with an eye for
those services that are unique and special
to differentiate our practice from others.
The weakness of your practice -we can
use our dental staff team, third party
aides, to assist ,find, and correcting the
weakness.

Some other factors which should also
be taken into consideration are



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Geographical area
Demographic area
Psychographic area
Budget
Ideally 5% of the collected revenue should
be put back into our marketing program.






Due to increased dental manpower, changing
disease patterns (most important a major
decreased in the dental caries incidence in the
young population), cost containment policies by
business and government and the rise of
consumerism have placed more emphasis on
the field of marketing
Marketing techniques

INTERNAL
MARKETING

EXTERNAL
MARKETING

INTERNAL MARKETING


These are the marketing techniques used within the
practice to keep established and new patients
active and to motivate them to become enthusiastic
referral sources, before employing internal
marketing technique three important trends of the
society should be well known to the dentist

Self help
movement

Information
based society
High
tech/high
touch


Teaming up patients to
teach them preventive
techniques and
maintenance of good
oral hygiene at home

Stressing
personal service
and caring
attitude in
addition to latest
dental
technology

INTERNAL
MARKETING
TRENDS

Provide accurate information on
dental health to the patient

The first step
–our staff

Patient
perception

The first
impression

INTERNAL
MARKETING
Case
presentation

Knowing our
patients

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Learn all the methods of pain control and utilize
the most advantageous to make patient
comfortable during the long appointments.
Organize the procedures, set up staffs and
office to cut down on all make ready and put
away procedures.
Four handed dentistry should be practiced
Plan the entire course of treatment to
completion.
Deliver what you promise,
use
appointment book to plan treatment and to
complete the treatment in the shortest possible
visits.

STEPS IN EXTERNAL
MARKETING
DEFINITION

BUDGET

DISCUSSION

RESEARCH

MEDIA
PLANNING


TARGET
MARKET

SET
GOALS

PRACTICE
EXPANSION






Any business may reach a saturation point beyond
which productivity can not increase without additional
capitalization.
In a dental practice the expansion may be directed
towards the purchase of equipment ,the addition of
personnel ,or both..
PATIENT
ACTIVITY IN
CLINICS

FINANCIAL
CONSIDERATIONS

PRACTICE
EXPANSION

Transitional office design






A orthodontic office should be designed to allow
some flexibility for secondary working chairs for
expansion of the practice.
A new office may be ideal for a particular stage
in a practice but no one should expect a design
to hold up for 30 years.
Due to changing nature of our profession and its
technology, more than one office may be
required during an orthodontic career.

Grading of an orthodontic office based on external
and internal feature.
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External feature(1)—community demographics -moderate to
high income level, proximity to high growth
areas, shopping centers, hospitals and referring
dentists.
(2)attractiveness of office building —includes
inviting curb appeal, visibility to drive by traffic,
adequate convenient parking.
(3)signage —personal sign instead of common
marquee, high quality design and easy observed
at right angle to the traffic.

Internal feature





Reception area —warm ,friendly décor, generous
seating, fully visible to secretary, at reasonable
distance from appointment desk.
Office design that creates a feeling of space –
wide hallways, abundance of windows and
skylights ,and liberal use of glass panels and
windows between work zones.


features of excellent Operatory




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Exceptional atmosphere in open bay.
exciting exterior view if possible or
interesting wall treatments.
Should be equipped with well organized
and up to date equipment.
Digital patient records that allow
convenient access to treatment history
without paper charts.

STAFF
MANAGEMENT






It is difficult for dentists to practice dentistry
and handle the administrative issues at the
same time. Doing so leads to decreased
production and increased stress.
Any practice will reach a certain point at
which the dentist no longer can continue to
monitor ,control and watch everything.


Leverage in dentistry






Leverage is the ability to grow the business or
practice through other people. It is not the same
as delegation.
Delegation is having other people perform
specific tasks. with delegation a dentist might
assign a specific task to a dental assistant.
A dentist should spend approximately 98% of
their time in direct patient treatment to be
productive , based on the model of dental
practice. this leaves a little time to act like as
company (DENTAL CLINICS) CEO who is
focused on strategy and direction.



this is the point at which a legitimate office
manager (front desk staff members) needs
to be put in place who handles all human
resources and staff management
functions, controlling all financial
parameters of the practice and setting
policy for practice often with the approval
of the dentist.


MOTIVATING THE DENTAL STAFF






It has been said many times that the greatest
frustration that we face in running our office is
managing tension with and among our staffs.
We need to discuss not just the dental office but
business in general in order to prepare ourselves
for successful practices in the year ahead.
Motivation of dental staff can be brought about by

OVERVIEW AND
SELF ASSESSMENT

MOTIVATING
TOOLS


Bonus system

Continuing education

MOTIVATING TOOLS

Retreat

Staff
meetings

EMPLOYER—EMPLOYEE
CONSIDERATIONS




Hiring in general is regulated by various laws
on both the national and state level. If not
followed dentist may be leaving himself
open to law suit or regulatory hearing.
Although rule varies from state to state
generally it is unlawful to discriminate in
hiring employees based upon race, religion,
national origin, sex, age ,or disability.



Discharge of employee—written attendance,
punctuality ,records of probationary periods
job assessment and evaluations should be
made. One should also record the all
warnings, disciplinary actions ,and negative
evaluations to justify our discharge.


RECENT ADVANCES IN
DENTISTRY

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OFFICE DESIGNING
INTERNET
3D IMAGING IN ORTHODONTICS


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Improper design and shortage of chairs can limit
the options for association.
So the floor plan for a new office can be
designed to allow some flexibility for secondary
working chairs in case a associate is added
later.
By taking advantage of modern time and motion
concepts we can easily increase the no of
patients by 10 per day and still reduce stress in
the office.

Effects of square footage on
practice expansion
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



Smaller office (2000square feet or less)—not
profitable for two orthodontists, new growth will
require expansion.
Medium size office(2500-3500 square feet)—
minimum 5 to 6 chairs, profitable practice for 2
doctors
Larger offices(4000 square feet or more)
-minimum 6-8 operatory chairs, provide greater
flexibility for remodeling to accommodate new
associate.

INTERNET







This new era of computer technology will be an
enormous part of our practice in the coming
years.
In the relatively near future the internet will
grow in its starring role as an interactive
television/audio medium, allowing dentistry
some great opportunities to raise awareness.
These technologies will be helpful for
Computerization of scheduling, progress notes,
insurance claims, telemarketing, radiography
and other form of communication.

3D IMAGING IN ORTHODONTICS


It is a set of anatomical data that is collected
using diagnostic imaging equipment,
processed by an computer and then displayed
on a 2D monitor to give the illusion of depth.
The depth perception causes the image to
appear in 3d.



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

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APPLICATION IN ORTHODONTICS
Pre and post orthodontic treatment assessment
of dentoskeletal relationship and facial aesthetics
3D treatment planning and 3d soft and hard
tissue prediction.
3D fabricated custome made archwires,3d facial
skeletal and dental records can be used for in
treatment planning, research and medico legal
purposes .


MODEL
CONSTRUCTIO
N

VISUALIZATION

3d
imaging,mand.motion.
facial animation,
functional information

Image and data
refinement,registration,int
egration.

DIAGNOSIS
AND
TREATMENT
PLANNING

ANALYSIS
finite element
analysis, material
selection

TREATMENT
Treatment option, definitive
treatment, computer assisted
therapy, treatment results.


BOUNDARY
CONDITION

References:---

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

Roger levin---Leverage in dentistry—Journal of
American Dental Association—2005 January,
vol-136,page—87—88.
Christian B.Sager—Balancing team
development in four directions--- Journal of
American Dental association—
2005,December,vol-136,page-1730-1731.
Ronald Inge—The ins and out of dental
insurance-- Journal of American Dental
association—2005 February—vol-136,page-204209.

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Stephen T. Sonis—Orthodontic management of
selected medically compromised patients:
cardiac disease, bleeding disorders and asthma.
—Seminars in orthodontics-vol.10,page-277280.
Redmond et al—one pathway to successful
orthodontic practice-JCO 2005
July,vol.XXXIX.No.7,page,415-419.
Gerald Nelson—Sexual harassment: An issue in
the orthodontic office—Am J
Orthod.1993,october,vol-104,no-4,page-417418.


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Murlidhar Mupparapu et al—Use of a wireless
local area network in an orthodontic clinic- Am J
Orthod 2005 June,vol,127,no-6,page-756-759.
Robert G.Keim et al----Practice success—JCO
2005,December,vol-XXXIX,no-12,page-687—
695.
Donald Poulton et al—Treatment outcomes in 4
modes of orthodontic practice-- Am J Orthod
2005 March,vol-127,page-351-354.


Larry Wintersteen—Marketing with patient
focus-- Journal of American Dental Association
—1997 December –vol-128-page-1657-1659.
 Roger P.Levin —Are you operating at OPC-Journal of American Dental Association—1997
December –vol-128-page-1649-1651.
 Roger P.Levin—Measuring patient satisfaction-Journal of American Dental Association—
2005,march,vol.136,page,362-363.









James Mah—Predictive orthodontics:A new
paradigm in computer assisted treatment
planning and therapy.—Seminars in
Orthodontics,2002,March,vol-8.page,2-5.
The dental clinics of North America—Practice
management-1988,jan,vol-32,no-1.
Rbert A.W.Fuhrmann—3D evaluation of
periodontal remodelling during orthodontic
treatment-- Seminars in
Orthodontics,2002,March,vol-8,page,23—28.


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

David Schwab—Today’s impatient patient-Journal of American Dental Association—1997
Ben Bissell---The challenge of change- Journal
of American Dental Association—1997
Barry Freydberg—Get with the Net--Journal of
American Dental Association—1997 December
–vol-128-page-1654-1656.

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

Warren Hamula—Transitional Office
design: attracting an associate.—
JCO,2002,December.VOL-XXXVI,no12,page-701-706.
Vicki Venn ,Sheila Scott—Insight into the
business of orthodontics—
BJO,1996.August,vol-23,no-3, page,288—
291.

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Practice management1 /certified fixed orthodontic courses by Indian dental academy

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