Scheduling and Treatment Planning
for Fun and Profit
Preston Lovelace, JD, MS
Patient scheduling and treatment planning are two foundations of dental practice management that are conceptually simple; consequently, they are rarely focused upon in dental school. The nature of clinical education is such that most students complete a minimum number of each type of procedure, rather than taking individual patients through the entire continuum of care. This tends to minimize the time spent generating complete treatment plans; instead, students spend their time getting informed consent for one treatment, and then providing that treatment. In addition, students rarely use more than one operatory to treat multiple patients simultaneously, making efficient scheduling a secondary consideration.
In practice, thorough treatment planning is the most important thing a dentist can do to maximize efficiency, and minimize liability, in the office. A complete treatment plan is the first piece of a complete patient record, which can (and will) be scrutinized by patients, attorneys, state dental boards, and/or the DEA. A treatment plan should be generated by the dentist during or soon after any new patient exam. It should include 1) the procedure(s) needed, 2) the time required for each procedure, 3) cost of the procedure, 4) the order of treatments in the plan. Most dental software packages allow for default settings by procedure code to be entered, automating much of the work. Once a treatment plan is entered, it can be used by the staff to gain informed consent for the procedures and schedule the patients for treatment and payment.
The second benefit of a treatment plan is that it clearly communicates the needs of the clinical side of the dental practice to the business side, so that clinical time can be efficiently scheduled. Since almost every dental practice has multiple operatories, it is necessary to use block scheduling and divide patient visits into “provider time,” “assistant time,” and “combined time.” When block scheduling, divide the time available in each operatory into 10 or 15 minute segments. I strongly recommend using 10 minute increments of time. 10 minute increments yield 2 more blocks of time per hour of day than 15 minute increments, allowing more flexibility in scheduling across multiple operatories. “Provider time” is time the dentist spends with the patient (giving the injection, doing the root canal). “Assistant time” is time the patient spends occupying an operatory without the doctor present (seating the patient, radiography, waiting between injection and numbness). “Combined time” is time both the assistant and doctor spend together with the patient. if the doctor has more than one assistant, it can be ignored.
Almost every practice management software package is capable of designating provider and assistant time by procedure. However, it is important to customize these times to the individual doctor’s needs. New dentists are still climbing the learning curve, so procedure times may need to be apportioned more generously than a dentist with 5 or 10 years experience. If you don’t know what to set for each procedure, make your best guess. An educated guess is better than the one made by a receptionist or IT guy. Time yourself the next time you perform the same procedure and adjust accordingly. Also, these parameters can be adjusted for each individual appointment if a particular case requires more time.
If you are a dentist who wants to give two treatment plan choices to a patient (not recommended), make sure your staff deletes the unused treatment plan from the computer to avoid future confusion over excess unscheduled treatment plans.
Once the treatment plan is entered and procedures are properly split into provider and assistant time, the front desk can now fill in the schedule like a puzzle. The doctor can only be in one place at a time, but the assistant(s) can be in adjoining operatories prepping the next patient or dismissing the last one. By subdividing the appointments into smaller increments, the amount of down time experienced by the dentist is minimized. The rest of the office is scheduled around the highest value employee, maximizing income production. Appointment coordinators should schedule long appointments in one operatory, and multiple shorter ones in the other(s) (see figure). During short downtimes, like waiting for an injection site to become numb, the dentist can be doing hygiene checks or other short procedures.
In the illustration on page 23, the red is ”provider time” and the yellow is “assistant time”. The patient coordinator has scheduled three procedures in room one for the dentist from 8 to 9, 9 to 10 and 10 to 12 (red). But the dentist has free time in room one from 8 to 8:10, 9 to 9:30, 10 to 10:20, and 11:40 to noon (yellow).
The patient coordinator may then put a patient requiring 30 minutes of provider time in room two. When the doctor finishes in room one at 8:50, he moves to room two. While the assistant is dismissing the patient, cleaning the operatory, and seating the next patient in room one, the doctor sees the patient already seated in room two and does the 30 minutes of dentistry required. When he finishes that patient in room two, room one already has a patient seated. In the example below, the second patient in room two required 20 minutes of the assistant’s time (possibly for radiographs and/or an impression for a temporary prior to the doctor’s arrival).
The doctor then sees his third patient (the second patient seated in room one) for 30 minutes. In the example below the next patient is seated in room three. Actually, two operatories would be adequate for the schedule below. The third operatory is only used when the first two rooms both have patients seated, and there is still open ”provider time”. The doctor would spend 20 minutes with the patient in room three while the patients are dismissed and seated in room one.
The doctor would be occupied with the 5th patient of the morning for 90 minutes. Since all of this time requires the doctor to stay with the patient, no patient is placed in the other rooms. Ten minutes before the ”provider time” ends with this patient, the assistant would be seating the patient in room two or three (three in this example). Please note that the seating of a patient in the next operatory overlaps with the last portion of the ”provider time”, not the dismissing time or assistant time.
In this example, the doctor performs 3 hours and 50 minutes of dentistry in a four hour period without keeping patients waiting and without double booking his time. If the scheduling coordinator is just “filling the rooms” when scheduling appointments, you may find yourself booked for 7 hours of dentistry on some mornings due to inadvertent double booking. On other days, you may find yourself idle because the majority of the work is “assistant time” and not ”provider time”.
Last, but not least, if the “provider time” in room two or three requires 10 more minutes than the assistant time in room one allows, the scheduling co- coordinator will need to add a 10 minute space to room one to not overbook the doctor.
Is there ever a time for double booking? Yes! Double booking is done early in the morning and immediately after lunch if (and only if) you are in a practice which caters to a clientele who misses appointments regularly. When double booking, the idea is to have enough ”provider time” to compensate for those who fail to keep their appointment.
Although the concept behind scheduling is simple, it is not second nature and must be taught to all of your staff. If treatment planning is the map that runs the office, scheduling is knowing whether to turn right or left in following the map.
Some final details to consider when scheduling are the concepts of an average day and prioritized scheduling. When a practice first starts and the appointment book is empty, there is no need to prioritize appointments. This gains importance as patient load and appointment scarcity increases, because high value procedures take priority over low value ones. If your production goal is $500,000 and you intend to work 48 five-day weeks, you need to produce just under $2,100 per day worked.
This requires a few big procedures per day along with some new patient and some shorter appointments. Therefore, once a sufficient patient load has been reached, the most desirable appointment blocks (usually early mornings and late afternoons) can be reserved for high dollar procedures until roughly a week beforehand. Leaving the most desirable and easiest to fill appointments open for large procedures minimizes the time between treatment acceptance and performance of the treatment, giving the patient less time to change their mind. If a patient is forced to wait many weeks for a high value appointment, they may choose to spend their money elsewhere. If a reserved block remains empty a week beforehand, it can be broken up and filled with multiple low value appointments. By blocking out time for high value, longer procedures, the front desk can ensure a consistent work load for the office and avoid “slow” or “hectic” days.
As Lewis Carroll once wrote, “If you don’t know where you are going, any road will take you there.” With thorough treatment planning and efficient scheduling, a dental office can establish strong lines of communication among team members, keeping everyone’s attention on a common goal and avoiding stagnation in the practice. ■
Preston Lovelace, J.D., M.S. is a practice transition specialist with ADS, a company with independent practice brokers, appraisers, and consultants nationwide. His company, ADS Lovelace and Associates, serves Louisiana and Mississippi. He received his M.S. in Chemistry and J.D. from the University of Illinois. He is a member of both the Louisiana State Bar and U.S. Patent Bar. Preston can be reached at 225-614-7700 or at PLovelace@gmail.com. For more information on ADS, visit www.adstransitions.com