This one time …

I have a very strong love-hate relationship with dental insurance companies.  On one hand I am very happy that dental insurance exists but on the other, I’m not certain that it is as effective as it could be – most patients are better off with a dental discount plan in place of dental insurance but that’s a topic for another day.  This is a day-day struggle for me in clinical practice and I imagine many of you can echo my same discontent.

Recently, I have completed several narratives (additional documentation in order to have a filed claim processed and paid) requesting the start and stop time of treatment – most recently treatment that was completed six months ago – SIX. MONTHS. AGO.  But Amanda, don’t you have electronic documentation of the patient’s appointment – and of course, the answer is yes.  However, therein lies my question:

Does the amount of time an appointment is “scheduled” for determine the quality of care during said appointment?

Have any of you wondered the same thing?  Maybe you work in a group practice with 3 or 4 other dental hygienists or you are a DDS and you work with 2 or 3 associates – while the appointments are all “scheduled” for 45-60-90 minute intervals, the actual amount of time it takes you and your peers to complete the necessary treatment likely varies; and depending upon your veteran status, it may vary significantly.

Here are five things that are likely going through my head as I begrudgingly comply with the request in an attempt to help patients get their dental benefit::

I. I am a veteran clinician.  I have almost 11 years chair-side clinical dental hygiene experience.  When I graduated, a prophylaxis took close to 90 minutes – newbs 😉  Now, on a given day with a recare patient, I can complete the same treatment in 30-45 minutes.  In hygiene school we were given 3.5 hours to complete the necessary paperwork, an incredibly thorough head & neck exam both intra- and extra- orally, dental hygiene therapy, and patient education – that’s the short list.  After 11 years, if I still need 90 minutes – I’m doing it wrong.

II. There have been so many new and amazing advances in dental hygiene toys; I mean tools 🙂 (they are actually called instruments but that didn’t have as nice a ring) – titanium hand scalers, air polishers, ultrasonic units, fluoride varnish, and digital radiology to name a few.  Part of the reason the appointments don’t take as long is due to these advancements.  If these tools aren’t getting better and it takes me the same amount of time or longer – I’m wasted my resources.

III. Comprehensive dental diagnosis and patient treatment planning – that’s a mouthful.  More and more frequently offices are scheduling their new patients for initial appointments that give them the opportunity to more accurately diagnose the true periodontal status of their newest patron.  These appointments vary in time and treatment (in our office we take a PANO at no charge, an FMS or BWX and PAs, complete periodontal charting including recession/furcation/mobility – all the good stuff – and a Comprehensive examination) but ultimately provide a very dental  clear picture.  Why does this matter you ask? For the purpose of this post, it matters because the clinician knows what they’re up against when the patient returns for the diagnosed treatment.  We can have the appropriate armamentarium ready, our game faces on, and because repetition is the mother of study, we’ve learned something new from the last time that enhances the current patient experience.

IV. Newsflash: people HATE coming to the dentist.  How do I know this? Because no less than 8 times a day am I informed that people don’t like me, or my boss, or my place of employment.  It hurts – We give people bad news – it’s expensive – they had a bad experience in the past – you name it, we hear it.  Part of our job is give the patients the best experience we can as fast as humanly possible because no one wants to be at the dentist and they certainly don’t want to be there for hours.

V. The “schedule” is arbitrary.  It is a guide to tell you an approximate amount of time that is generally required for each patient.  Some take more; some take less.  You can’t actually predict how much time every patient in your schedule is going to need, who’s going to be on time or late, and if you get an emergency put in your schedule.  Most of the time we make educated guesses (history repeating itself) and get things right but sometimes patients need more or less – and we just can’t know until the patient is in our chair.  So when you ask me SIX MONTHS later how long their appointment took, to be quite honest, your guess is as good as mine.

Don’t get me wrong, I fully support checks & balances systems.  They are incredibly important in accountability – especially when accountability is related to patient care.  However, I am no where near convinced that the amount of time it takes me determines my effectiveness.  You want to know if you’re reimbursing for quality and not quantity?  Request pre- and post- operative BWX and/or IO photos or biologic testing are my go to options.  Those will show the measure of quality care that was provided; not the amount of time spent in the chair.

  • Post-operative BWX are an AMAZING tool in accountability because you can VISUALLY see if you removed the deposits – even after 11 years I still take them on almost every NSPT patient (and the occasional Gingivitis).
  • I would love LOVE L.O.V.E. to be able to submit before and after photos – I love them, patient’s love them, and insurance companies should be requesting them.
  • Do yourself a favor and check out OralDNA.  This salivary testing option is inexpensive and can be an excellent tool to show patients what can’t be seen: the BILLIONS of bacteria that cause their periodontal status to be less than ideal – mind blown.

So what do we do as providers? I wish I had the answer.  Sadly, we created this paradigm; not us exactly but the clinicians that came before us.  And I get it: you want patients to like you, you don’t want to give them bad news, and you certainly don’t want them to complain about billing (which is, of course, solely the fault of the dental provider) – I’m not blaming you  because I am you.  I have felt those same things every day – sometimes multiple times a day.  We can only hope that going forward every patient will do everything will say and insurance companies will pay for all our claims … 😀 Until that time, we keep fighting the good fight.

Do you have any other non-time related checks and balances that you use in your practice? I’d love to hear about them!


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