Seven Ways to Make Your Hygiene Department Profitable
And get educated patients and happy hygienists in the process

Cathy Jameson is the President and Founder of Jameson Management Group, an international practice management and consulting firm focused on building thriving and successful fee-for-service practices. Cathy graduated from the University of Nebraska at Omaha with a B.S. in Education, and from Goddard College with her Master’s Degree in Psychology, concentrating her study in the area of effective management. She combines her practical “take home” management tools with a working knowledge of and a sincere devotion to understanding human needs and human nature. In addition to consulting, Cathy is a well-respected lecturer and author. Cathy can be reached at 580-369-5555.

Let’s look at seven specific ways to make the hygiene department within your practice excellent—a department that helps patients get and maintain a healthy mouth, educates people about the restorative needs in their mouths, and generates a healthy profit margin for the practice.

1. Set production goals for the hygienist.
He/she should be producing at least three times his or her salary. Pre-block the schedule for approximately 1/2 of the production goal in primary appointments. (Pre-block for a minimum of six months and preferably one year if you are advance appointing.)

Primary procedures for a hygienist are any periodontal appointments, sealants, and appointments that include a full mouth series of radiographs or a panoramic radiograph.

2. Integrate a comprehensive, non-surgical periodontal therapy program into your practice.
Many practices are providing non-surgical therapy for their patients and are calling those procedures “adult prophies.” Do not shortchange yourselves. You are providing care that will help a patient move from a diseased state to a healthy state. The treatment for this patient is entirely different than for the patient who is healthy and is coming in for a preventive appointment (which is called an adult prophylaxis).

Spend the time and money necessary to bring your practice current with the latest and greatest in non-surgical periodontal therapy. Learn all aspects of the therapy: how to diagnose, treatment plan, present, file insurance, overcome objections, and treat the disease.

3. Define and implement a job responsibility of “hygiene retention coordinator.”
This wonderful person would have the following responsibilities:

• He/she COULD schedule hygiene appointments, unless you are scheduling at the chair, manually or on the computer.

• Confirm all hygiene appointments.

• Send out notices that confirm all ‘advance-scheduled’ hygiene appointments—after these notices have been cross-checked with the appointment book to make sure that all changes have been noted before the cards are sent out.

• Send out notices to patients who are past due but have, for whatever reason, not scheduled an appointment in their designated month.

• Contact all patients who are past due for a hygiene appointment and schedule these patients for their appointment.

• If unable to reach the patient by telephone, the hygiene coordinator would send a very positive, educational letter to these patients, along with a brochure of some nature, encouraging the patient to contact the office to schedule an appointment.

• Fill any voids in the hygiene schedule.

4. Hire a hygiene assistant.
In most areas of the country, there is a shortage of available hygienists. So, as our profession moves to a mode of more comprehensive hygienic care, we find that the personnel to support that effort are in short supply.

Schedule hygienist time/assistant time into every appointment to maximize the talent of the two fabulous dental professionals. This will provide patients with quality, comprehensive care and effective scheduling that is productive and profitable, with stress control for all people (assistant, hygienist, doctor, and patient).

EXAMPLE—This might be the breakdown of the hygienist’s time and the assistant’s time:

Assistant: Greet, seat, review health history, take necessary radiographs and develop radiographs.

Hygienist: Provide probing, record data, prophylaxis, and fluoride (if appropriate), intra-oral camera if available, discussion/education of possible areas of concern, and involvement with doctor evaluation.

Assistant: Coronal polish, home care instruction, schedule next appointment, complete paperwork and dismiss patient.

There may be several other alternatives. You can see how productive and educational this type of scheduling can be. Obviously, a great hygiene assistant is needed, one whom you believe will give the patient an even better experience because he/she has been with two wonderful professionals.

5. Schedule each patient according to his or her individual needs.
Do not schedule generically—individualize. Let the hygienist determine how much time is needed with each patient.

Use a 10-minute appointment book. The right appointment book will make all the difference in your days. If you are scheduling a hygienist with an assistant, you need two columns, one column per active chair. Your appointment book, whether manual or computerized, should let you schedule hygienist time and assistant time.

6. Study the 1995 CDT-2 codes from the ADA.
Change your previous codes to reflect the current codes as outlined by our association. These codes will be updated again in 2000.

File insurance by code. The ADA does not designate a code unless it is defined as a specific procedure unto itself. In addition, be sure to read the codes specifically and schedule, make financial arrangements, and collect according to the actual procedure being administered.

7. Make it possible for the hygienist to use an intra-oral camera on every patient.
• Use the camera to record any new areas of concern that have arisen since the patient’s last visit.

• Use the camera to redo any photographs of dentistry that has been previously diagnosed but left untreated. Use the intra-oral camera to re-educate a patient about previously diagnosed and recommended treatment may help them make a decision to “go ahead.”

• Show a patient the evidence of periodontal disease: the pockets, the bleeding points, or the inflamed tissue. This will help the patient understand what is happening and encourage them to proceed with a more accelerated mode of treatment.

• Validate the need for and the benefit of co-therapy/home-care.

Forty to 60% of the doctor’s restorative dentistry should be coming directly out of hygiene. Most hygienists tell me that approximately half of their patients need some sort of restorative dental care. Give the hygienist the time to educate patients about the benefits of restoration and to use the intra-oral camera.

Each of the above seven strategies will make a significant difference in your hygiene department’s profitability. However, if you put all seven into place, your hygiene department will thrive. Not only will you have a happy, personally and professionally satisfied hygienist who will be less likely to “burn out” or go somewhere else, but you will also have a hygiene department that will further educate your patients, help them get and maintain healthier mouths, and increase your profitability in the process.