It's office autopsy time! Kiera shares the story of a practice that recently discovered $2.5 million going unnoticed. She talks about the doctors and their (very) busy schedules, the need for an additional hygienist, and what the cold, hard numbers told this practice about next steps.

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Transcript:

Kiera Dent (00:01 )

Hello, Dental A Team listeners. This is Kiera. And today I am excited. I was just in a practice and we were going through a lot of really fun things. And whenever I come from an office, I get so excited to come back and chat with our podcast family of things that you and your practice should and could be doing. I was told when I was in this office, this is the Dental A Team magic where we physically fly to your practice. We work with your teams. We work with you as a doctor. We uncover hidden pieces that maybe you didn't even know to bring to a call.

 

I think it's so magical to be able to do this for practices. And so today is a little office autopsy of finding $2.5 million left behind on the table in ways that you would never expect. Sound interesting? Well, I hope you're ready because I wanna take you through and uncover hidden little cashflow pits that you might not even be looking at. So number one, we decided to go through...

 

because this doctor is so busy. So many of you tell me I'm so busy, Kiera, my schedule is jam-packed, and I say congratulations, but what is the cost of that? So for example, if you have your hygiene department, you should be looking at your active patient base. So an active patient base for a general dentist should be 1,500 patients as an active patient for one doctor. High end, like where you can kind of get by is 1,900, but beyond that, that's very high. And we're talking 12 months and 18 months. So take a look at both of those numbers.

 

and just look to see where are you at. So this practice, they have about 4,500 active patients with two full-time doctors. They're at capacity. So what's happening is we have options. We can add more hygiene, but then that's going to have our doctor to hygiene, AKA our exams at the wrong amount. What's happening is they're dropping periopatients because they don't have space for their...

 

Regular prophy patients, then they're diagnosing SRPs, but they have nowhere to put them for six months. They're pushing new patients out for four to five months. So we did a little bit of fun math and we didn't even, this is just gonna be some hypotheticals, but I think for you just to hear like, what are some of the things that actually can hurt your practice and how much are you leaving on the table when we do things like this? So for this practice, when we went through and we looked at it, we thought, all right, let's take an average prophy and whatever it is for you.

 

Maybe it's 150 up to 200 for an average prophy. We're talking prophy, x-rays, cleanings, or just even prophy and an exam. How much is that for you and your practice? Now, look to see how many active patients you have. If we've got 4,500, well guess what? You get a double that because those patients are coming in two times a year. So have fun with those numbers. We divide that by 12. We look at how many patients we're seeing per day. Now that doesn't necessarily mean how many you are, but that's how many you're going to need to see.

 

Then we look to see how much hygiene we have right now today to see, we actually have enough hygiene spaces for it? But let's not forget that we also have to add new patients because in addition to our active base, we are constantly adding more patients. Yes, we are losing some patients, but my hope is that you at least are adding more than we're losing. So we've got to look at those two together and see how much time we actually have in a week, in a month that we need to be seeing patients. This is gonna then show you your gap. So for this practice, they had over 200 appointments

 

that they were short every single month. That's at a minimum. So clearly they're ready to bring on another hygienist. This was great numbers to see, do I bring on a hygienist? Do I not bring on a hygienist? But the problem is they're already at five hygienists with two doctors. You can start to do the math. So it's like, well, great. Well, we're not diagnosing perio either. So options are we could bring on a sixth hygienist and that hygienist would just do SRP. That doesn't mean just that person, but we'd have eight hours of SRP in a given day.

 

spread across all the hygienists. That means we don't increase our exam numbers, but we do increase our number of perio. We do increase our number of hygiene spots. That's going to help in some instances. But even if we fix that problem, remember we still have all these patients that we're not seeing. So this practice right now, they told me, hey, Kiera, we're pushing our patients out about eight months is where we've got to put them. We can't see them on the six month mark. We've got to push them to the eight month. So I did the math and I was like, okay, average pro fee is going to be about $150 per patient.

 

but you gotta take all those patients that would be seen in one month and we times that by 150. Now, I understand this is very loose math, but it gives a good idea because think about it, those patients, if we saw them every six months, that's money from insurance and also from seeing them on a regular schedule, plus not just that, but patient care. We see them on the six month interval, but these ones we're not seeing every six months, we're seeing them every eight months. So that means there's two months that we're missing out on opportunities to see them.

 

So when we did the math, it averaged out to about $450,000 with this patient base annually, just of miss hygiene. And that was only on one month. If you want to do it on two months, which is realistically what it would be, that's almost a million dollars worth of revenue, just in hygiene miss opportunity. That's fascinating to me. This is why I think a consultant is so powerful because we come in and we do crazy numbers like this and we look at your numbers and we look at where you're at. And it really gives you the confidence to know, can I bring on an associate? Can I bring on more hygiene?

 

I feel like this, what does the number and the data suggest? So just looking at that, I was like, a simple fix is bring a hygienist in, let's have our perio go up. And then also we need to bring a doctor in for whether it's full time or not. So we ran scenarios of if we brought a doctor in, if we added more hygiene, if we had our doctors do this, what do we need to do? How do we keep our doctor to hygiene ratio running all these scenarios to then say, my gosh, this really would help our practice out.

 

And when I think about this and I think about practices for us, are you looking at numbers and metrics like this? Are you calculating the cost of missed appointments or not scheduling our hygiene patients back? Not to mention that we're certainly not doing 30 % of our patient base as perio. What these hygienists are doing is they're seeing that they need perio, but they don't have space to put them. So they don't want to have the conversation. This is no knock to a hygiene team. Several hygienists do it because I'm going to tell you, you've got this awful disease.

 

but then I'm not actually going to be able to get you in for X number of days, weeks, months. That feels really, really, really hard to try and convince a patient of this. So what do we do? We clean it out and we say, you know what, we're just gonna get it next time. But next time then fumbles and then we gotta have these conversations. Then we don't wanna have these conversations. We're constantly looking at like, we're just punting the ball down the line. So what do we need to do on this? What are the scenarios in this option? How much money is being left behind, but also how much patient? And this is great.

 

Other options that we considered are, we cut insurances? Because, hey, if we've got this many patients, what if we cut out our lowest producing insurance that pays us