The Dental Billing Podcast

Improving Perio Performance Percentages with Jennifer Lyman RDH (Part 4)

• Ericka Aguilar • Season 8 • Episode 6

Share episode

Can 60% of your dental practice's patients truly benefit from periodontal treatment? Uncover the eye-opening statistics and essential benchmarks we reveal in this latest episode. We dive into the crucial aspects of periodontal care, from understanding the CDC's findings to mastering the formula for calculating your perio performance. We also touch on common pitfalls and the importance of embracing new learning processes and consistent systems. Tune in to hear Jen's expert insights on transforming your practice's periodontal performance.

Accountability and structured protocols are the backbone of effective periodontal care, and this episode leaves no stone unturned on these critical topics. We stress the importance of strict adherence to perio protocols and consistent follow-ups, ensuring that all diagnosed conditions are treated according to standard care guidelines. Learn practical strategies to initiate changes within your practice, overcome scheduling challenges, and manage patient needs with dedicated time slots for SRPs. This episode is a treasure trove of actionable advice aimed at achieving long-term improvements in patient care.

Confidence and communication are pivotal for any dental hygienist, and we highlight their impact on patient care in this episode. Discover how understanding periodontal performance percentages and viewing patient treatment from a holistic health perspective can enhance your practice. We offer practical steps for calculating these metrics and provide invaluable resources for those seeking to improve. As we wrap up, we encourage dental hygienists to stay motivated, emphasizing the power of small steps in achieving significant improvements. A special thanks to Jen for her contributions, and stay tuned for our upcoming discussion on pediatric sleep apnea.

Want to learn Dental Coding and Billing? Join here:

https://tr.ee/efzYrY7mp-

Would you like to set-up a billing consultation with Ericka or Jen? We would love the opportunity to discuss your billing questions!

Email Ericka:
ericka@dentalbillingdoneright.com

Email Jen:
jen@dentalbillingdoneright.com

Perio performance formula:

(D4341+D4342+D4346+D4355+D4910)/(D4341+D4342+D4346+D4355+D4910+D1110)


Want to know what your fee should be for D4346? Send Ericka an email to ericka@dentalbillingdoneright.com


Speaker 1:

Jen, welcome back to the final episode of our four-part series. We have been talking about hygiene and billing and more specifically honing in on what you refer to as hygiene performance. We also refer to that internally as perio percentage performance. Can you remind the audience what your benchmark is for perio performance percentage?

Speaker 2:

Yeah. So my benchmark is 60% of your patient your current patients that you have in your practice should be on the perio side of things and that number a lot of hygienists and a lot of offices will get really nervous about that number. It seems like really high. It's more than half of your patients should be perio. But when you look at the statistics from the CDC, it does say that 60 to 70% of Americans have perio. So if we're treating accordingly and statistically you should be treating about 60% of your patients with that. That does include gingivitis patients and it does include periomyelitis as well as SRP patients. So that's where we're at with that number.

Speaker 1:

And debridement, I think as well, correct?

Speaker 2:

And debridement correct.

Speaker 1:

So what you're saying is it's not necessarily saying that 60% of your patients should have periodontal disease. It just means that there should be some form of treatment related to the disease within 60% of the patient base, correct? Yes, does a limited SRP count for that?

Speaker 2:

It does Yep. So if we're doing limited gingivitis cleaning and then they go back to a prophy patient, that's fine, but we check monthly. So when we do our coaching and everything, we want to check monthly to see where their perio percentage is at, and that can change on a month to month basis, you know. And even demographically, we have some offices that we've talked to that they're like well, our demographic doesn't really see perio, but everyone has perio or some form of perio.

Speaker 1:

We all have something going on in our mouth. I know that even people that have exceptional oral health can still have isolated areas of infection. So, with that being said, you're saying 60% is our benchmark, but we like to see our offices get above 60%. We still want to see that number at a higher percentage. Can you explain again, for individuals who are just listening to this four-part series, what represents perio performance?

Speaker 2:

Like our formula yes For that. Yeah, so we're taking all of your perio patients so limited SRP, full quad SRP, perio maintenance, debridement and gingivitis patients and you divide that number by your total patient base so active patient list and per month. So that gives you your perio percentage and with that, that tells us where you're on track for and that's something that we track each month, like I said, and that will give us your baseline number. Now, usually when we see the first you know meeting that we meet with an office, it's like in the teens, like 15 ish is about where it's at when we see an office over 20%.

Speaker 1:

We are ecstatic.

Speaker 2:

Yes, yeah, and I think we've only seen one that was like over 50, and we're like what are you doing? You know, like you are a unicorn, it was very exciting.

Speaker 1:

It was awesome. But that hygienist who we're actually going to talk about at the end of this episode. She was new to this practice and she's all about perio-conversion, which we'll talk about at the end of this episode. We may have touched on it, I believe, in the last episode, episode three of this series, but we're going to talk about perio-conversion and the things that we can you can implement tomorrow you as the listener to start improving your perio performance percentage by focusing on converting the prophy patients into appropriate gingivitis or perio patients. So, with that being said, what are some of the most common pitfalls you, as a hygienist, see, or blind spots that you see, preventing an office from performing at optimal perioperformance percentage?

Speaker 2:

Yeah, I think there's a couple of big ones. So the first one is hygienists need to be willing to learn and change processes. I know hygiene can get very monotonous. Sometimes we just go and we do our job and we leave, and it gets very tiring, we're exhausted, there's just so much to do and an appointment. But we need to be looking at it from a different lens of how are we caring for these patients.

Speaker 2:

If they go to another office, would they be diagnosed with perio there? That's a huge red flag. If you're looking at this patient from the standpoint of if they left, would they get diagnosed with perio, then you're missing that opportunity right there to care for that patient and ultimately increase your perio percentage. That's number one. Two is not having systems in place. So if we don't perio chart all at the same time, you know, within the same timeframe, if we don't have a protocol in place for when we treat perio, it gets very muddy, it gets very gray between hygienists and especially when you have large practices and we see these numbers that are 15%, it's because there is no systems in place. And even from you know front to back, hygienists come up, give them a route, slip or just say hey, I'm checking out my patient. Now get them scheduled for the next one. Maybe that code was incorrect and we need to have better communication systems to process all of that information and make sure that we have a cohesive team and cohesive billing and cohesive clinical team.

Speaker 1:

In the first part that you just mentioned, hygienists need to be willing to learn. I know that a lot of times it can feel like we have some resistance when we are hired to come in and coach a team to an experienced hygienist who is doesn't feel like he or she needs the help to improve. We've had instances where we've met with hygienists who are instructors at a local hygiene school and they are literally doing bloody pro fees because you and I have looked at their clinical documentation.

Speaker 2:

Oh yeah, we've read the notes.

Speaker 1:

We've read the notes. And what about the perio chart? And these are experienced, seasoned hygienists and we did the training. And then we go back after the training. We've given them all the tools and the needle did not move. That happens sometimes.

Speaker 1:

So I agree with you. It's not that these systems don't work because they do. We've seen it in offices where you know the hygienist is so eager to improve systems that you know your perio performance goes from 15% to 50%. That's amazing, because now we're treating more of what is actually coming into the practice right. So I love that you mentioned and you touched on the fact that sometimes we have to have a hygienist that is willing to learn. Those are some of the blind spots Talk to us a little bit about as we recap through this last part of the series. Talk to us a little bit about some of the things that we can implement or some of the things that we can change, as if you were coaching these offices that are listening to us. So I'm going to throw you in, coach, and let you coach our audience.

Speaker 2:

Okay. So this is something that we do with every practice that I work with. As far as billing, because I am a hygienist, I do kind of see those blind spots, so we try to point that out and coach them along the way to increase reimbursement right and take care of their patients. So I think one of the systems is having a periodontal protocol in place. Now, this is something that can be laminated, this is something that can be bullet points, it can be whatever is easiest for your office and kind of going back to where those hygienists you know are more resistant, it has to work for each office, right, and that's why everything is so individualized. We don't have a one size fits all program, like every office is so different. The way that they want to take care of their patients is different. They have a different standard of care. So that needs to happen with the doctor and the hygienist and then communicate that to the rest of the office.

Speaker 2:

So this is where we stand on perio. This is what we're going to treat. This is when we're going to refer. These are the extra treatments that we're going to do if a patient is X, y and Z in chronic perio, whatever that may be so. There has to be a process and a system, even if it's just one hygienist like offices are getting bigger, so let's start that now. Create that system so that when we do hire hygienists, they set that expectation coming in from the get-go. This is how we treat patients. Are you okay with this?

Speaker 1:

And how we do business in our hygiene department, because, at the end of the day, this is business and I we just met with an office, um not too long ago, the perio office the perio office, right, the perio office.

Speaker 1:

They don't have a hygienist right now. They're currently looking and their fear was do we start this coaching program now or do we wait until we have a hygienist? And you and I both agreed that this is actually a great time to start setting up systems so that when you onboard this hygienist, it is very clear as to the decision-making tracks that are established. You know, this is what a healthy prophy patient looks like. This is what a gingivitis patient looks like. Here's our expectation on treatment. Here's what a periopatient looks like. Here's the expectation of treatment. Here are the appointment protocols. So everybody on the team, as you mentioned, like having that cohesiveness. And it's a very boutique approach because every office has a different standard of care. All in the best interest of the patient. But rather than like you always talk about, you know you have three hygienists and each hygienist has their own protocol.

Speaker 2:

Yep. So it gets so confusing for the patients. You know they go get SRP at one with one hygienist and then they have their second SRP and they're like, oh no, we don't need to do the full quads. That's so confusing for patients. So, and you're in the same office, you know so that that should be communicated. And even we have our offices do a period protocol and then I get a copy of that. So when I'm looking at notes and I say hey, there is a five millimeter pocket on 12. Why didn't you treat that? It's in your standard of care, it's in your period of protocol, right, why aren't we? And then it's just a checks and balances to make sure that what they're billing out is what they're doing.

Speaker 1:

And I, you know, just to kind of go off topic really quick I think that's really where the training is, just like the tip right, like it's it's really just the beginning, entry point of this whole coaching program that we have, because we're with our clients for 12 months and the coaching happens in at the very beginning. So it's at the front part of the coaching program and the training and then we're with them for 12 months. The remaining portion of that 12 month period is accountability, because it is through accountability that you get the needle to move. And if they don't get those follow-up check-ins where you're looking at their perio protocols and you're holding them accountable, right, you're saying, hey, this should have been treated for limited SRPs or gingivitis or whatever. It won't happen if you don't. And we have so I have so many case studies because we've been doing this program for years and it wasn't until recently that we changed the entire program to include 12 months of coaching and follow-up and because we would do our training and then be done.

Speaker 1:

And the reason why offices didn't see the change the way they thought that they were going to see it is because there was no accountability there. There is no doctor following up on the perio protocols that we all work so hard to create. Everybody just contracted and went back to their old ways and there was no accountability whatsoever. So I think when you talk about that and you say, look, I get a copy of them and I'm going to meet with the hygienist and I'm going to make sure that I hold them accountable so that we can create change with patient care, because that's essentially what it's all about. So what are some of the other things that offices can do? You're talking to a hygienist. Let's just say that. You're talking to all the hygienists that are listening and their interest is piqued and they're thinking Jen, I would love to do this. I have no idea where to get started. Once again, coach them through that.

Speaker 2:

Yeah. So I think first of all, you need to maybe make a list of things that you want to change in your office. So, what are you, what are you upset by? What are you trying to accomplish in your office? Are you trying to take care of perio? Are you trying to just see profies? Are you trying to get in and out as quickly as you can, like, make some goals for your hygiene department and, even if you're close with the other hygienists, do this together, like, like, what do we need to change?

Speaker 2:

Guys? And look at it from like a bird's eye view and say are we treating our patients the way that we should be? Are we doing everything we can to get them to health? Are we documenting correctly? Are we doing perio charts when we need to? And not just three, two, three, three, two, three, three, two, three guys I can't tell you how often I see that in its textbook not even doing a perio chart. You are just going on there and you're like yep, close enough, and then you save it because you don't have time.

Speaker 2:

So I would say look at it from a bird's eye view. Get together with your hygiene team, figure out what you want and ultimately, too, when you're treating perio the way that it's supposed to be treated and everyone's on maintenance and everybody's doing great and they're all in that protocol. Like your life is so much easier. You're not like fighting this internal battle of do I diagnose SRP now? Oh my gosh, where are they going to go on the schedule? Like if you know that you need to increase your payroll performance, that you're not taking care of your patients, that needs to be communicated to the doctor. You need blocks in your schedule moving forward to accommodate for the SRPs that you are about to diagnose. You need support from your front office when it comes to financial conversations. All of these things. Like it's so much to talk about.

Speaker 1:

Like I could spend an hour talking about all this One thing that comes to mind for me is what about these offices that are booked out six months? Yeah, there's no way you can clarify to mention gingivitis or perio to the patient. They'll just treat it right. But there's really no accountability with the patient. They have no idea what's going on in the mouth, they just know they're coming for a regular cleaning.

Speaker 1:

There's no maintenance program to maintain what you just cleaned, because every six months is not going to maintain perio right, it's not going to keep the permission. It's going to maintain theio right, Like it's not going to keep them to maintain disease. It's going to maintain the disease right. So, um, or talk to those offices who are Jen, I would love to, but we're booked out. I mean, I spoke to an office recently and they're booked out close to a year.

Speaker 2:

Yeah, you need more hygienists. Yep, that's what it comes down to. If you do not have time to treat what patients need, you need more staff to accommodate that and then divvy out the patients that are currently on the schedule and then make blocks for SRPs, at least like twice a week for each patient or for each hygienist. If it's not twice a week, at least once a day. Like I say, once a day. You should have an SRP on your schedule. I prefer morning, so I would block my morning schedule.

Speaker 1:

Well, you are a little bit more established.

Speaker 2:

Yeah, and like make, make some blocks and make some time for that, and then maybe after an SRP then you see a new patient, make those new patient blocks. Like that is how you grow your schedule and if you don't have an appointment, even an hour appointment, for six months, that is an administrative error and that's something that needs to be corrected. And in that same breath, like we need to make sure that we have time for new patients, and patients that come in for SRPs are now going to be seen every three months, so that even fills those hygienist schedules even more.

Speaker 1:

And to kind of add to those offices that are booked out six to nine months, because that's really what we're hearing is six to nine months. You know, three to four months we're booked out, we can't get anybody in. I think also we should start taking a look at reimbursement rates and taking a look at going out of network with the plans that are clogging up our schedule but not reimbursing reasonably. I think this is a perfect time to do that, because now we're going to open up to get paid more for services that your hygienist is actually doing. So the patient is scheduled for prophy but they have gingivitis. The hygienist is going subgingival during that prophy visit. In the absence of perio right, there is more than 30% bleeding in that mouth. That's being documented as moderate bleeding prophy with moderate bleeding.

Speaker 2:

I hate that term so much. Prophy with moderate bleeding.

Speaker 1:

So with moderate to severe bleeding and no perio chart done.

Speaker 2:

And no perio chart. That's the thing that kills me. There's no perio chart showing. No perio chart done and no perio chart. That's the thing that kills me. There's no perio chart showing no perio chart.

Speaker 1:

And do we blame the hygienist?

Speaker 2:

I don't know, I don't know.

Speaker 1:

I know that the hygienist wants more time with the patient. But because we're booking the hygienist out with all these bloody pro fees for low reimbursement, we have to. Instead of giving the hygienist an appropriate time with that patient, because we're not taking into consideration what the insurance companies are paying the practice right, we're just shoving all these patients onto that schedule, saying you need to meet goal. How in the world is the hygienist going to meet goal? So I think, to come back to that, you know the whole an office that's booked out six to nine months or four months. Take a look at your reimbursement rates. It might be time to go out of network with some of these plans. It might be time to start negotiating those rates so that you can afford to give your hygienist more time to treat, to properly treat what's going on in the mouth right.

Speaker 1:

Like if there's probably more gingivitis patients in that practice than there are prophy patients.

Speaker 2:

And we usually see zero done, zero gingivitis cleanings, 18 months Zero gingivitis cleanings.

Speaker 1:

But when you talk to the hygienist and you ask them, hey, do you go subgingival during a prophy with moderate bleeding? And they're like, oh yeah, all the time I had one doctor tell me wait a minute, erica. She learned about gingivitis the 4, 3, 4, 6 gingivitis cleaning at one of my workshops and we then had a follow-up meeting. Her mind was won't, this is the doctor. And she's like you know what? Now that I know what, you know what the criteria is, erica, that is all of our patients and she goes what she goes. You mean to tell me we've been billing for pro-fee when we should have been billing this and we're talking about close to a hundred dollars in reimbursement. The difference in reimbursement and her fee was low for her area, so there was even more opportunity if she were to go back and renegotiate that for the gingivitis cleaning that she just got done, saying that's all my patients. So I mean it's opportunities are endless.

Speaker 1:

Opportunities are endless. I mean it's, it's amazing. So yeah. Okay, so that's a couple of blind spots, yeah, I think the scheduling too.

Speaker 2:

If you don't prep for the day before you know, if you don't prep the day prior to your next day, how do you know what to expect? Like when you just leave and then you just come in for the day and you just wing it like you're missing a huge opportunity there. So for those hygienists, too, that want to change things like implement a daily checklist that you go through for each of your patients Do I need to pair your chart? Do they need x-rays? Do they have a root canal that I need to do a PA for? Do they have gingivitis in the past? Are we going to have that conversation? Are they due for a limited exam and PA? There's so many things that can go into that. So I always say your schedule should never look the same as when you walk in the door. So when you walk in and you have eight, it shouldn't look like that. At the end of the day, there should be some limited exams, some PAs. Maybe there's some desensitization, some fluoride thrown in there.

Speaker 1:

That all needs to be added to the schedule, so that it needs to be added.

Speaker 1:

Yes, I agree with that and that's kind of going, it's on topic but it's a little off topic. But it's so important that our schedule matches our day sheet at the end of the day, right, right, right, like. So if in the beginning of the day the patient was scheduled for a prophy but we added desensitizing therapy or treatment, you know, or we changed it to a gingivitis cleaning, we have to change it on the schedule so that when we I'll use balance or reconcile.

Speaker 1:

you know everything closes and matches so that we're not overwriting the appointment book or on the account or on the ledger. We just want everything to be consistent. So I agree with you, that's such a great point to bring up when we're talking about recalibrating the whole system is making sure that it could start as a prophy, but be sure to change and update your appointment to reflect what we actually did, yeah, and that's how we can increase that period performance.

Speaker 2:

You know, if you change that prophy to a gingivitis, you know. That's why I say it should never look the same, because what they come in for isn't what they should get necessarily. You know you want to really look at each patient individually and see what they need and see what their history is and then go forward with the, with the appointment. So if you can change things a day prior to great. But if you really want to increase that period of performance, look at it, see what could possibly be changed and then be open to changing that.

Speaker 1:

Right and then treat accordingly, okay. So I want to talk about one last thing and I want you to talk to the audience about perio conversion. So the whole idea, the whole point of the series, was to help our offices improve perio performance percentage. They can only do that by converting the existing prophy patients to some form of either gingivitis treatment, perio treatment. How does that look when we're talking about coaching an office to improve their percentage through perio conversions? Like how would you, how would you coach an office through that?

Speaker 1:

Oh man Um you asked me the last question.

Speaker 2:

We have enough time, um. So I think the biggest thing is conversations and confidence with a hygienist. So you need to be confident in your ability as a trained healthcare professional that you know what is best for this patient. You have all the training, all the tools. You are well-equipped to diagnose this with the help of your doctor, obviously and each state is different but you are well-equipped to handle this and you have the training to treat this and this is something that you can do to better their lives too.

Speaker 2:

So I don't want it to be something that you you think is being pushed as production or as collections. I know we talk a lot about billing, but that's because we're also billers. So don't look at it like that, but look at it as if this patient was my grandma and she was coming in. What I? How would I want her taken care of? This was my uncle that I love dearly. You know how would I want him treated? And if someone were to ask you I know, tess and I talked about this at one point if someone were to ask you, your cousin, your great uncle in Massachusetts for me, like if they came and said, hey, my dentist is saying I need SRP. Should I do it, you would say yes, yeah, because you know that's what's best for them and you know that's caring for them. You know, I don't think I don't think everybody is out for money. I do know that people really care about people. That's why we got into healthcare.

Speaker 2:

So when we talk about all of this coaching, it's coming from the standpoint of the patient. What is best for the patient? And when you think about perio conversions, you need to think about that. What is best for them? Is it the gingivitis cleaning? Like, are they in gingivitis? Okay, let's really go after. You know oral it's uncontrolled. Then you encourage them to go to their endocrinologist and get their diabetes. We're talking whole health for these patients and when it comes to perio conversions, that's part of their health. Like it's so frustrating to me when everyone, like even insurance companies, like your mouth is not connected to your body. Hey, guess what it is? And it's a huge part and it's right next to your heart and right next to your brain and what do you think? Perio happens, you know. So it's so frustrating to me when insurance companies and things don't recognize dental as healthcare. Right, your healthcare providers? That's what hygienists and dentists are. We are taking care of patients and their disease, and that's what it needs to come down to when we talk about perio conversions. This one.

Speaker 1:

I think we've definitely driven the message home that understanding your current perio performance percentage is vital. If you are an office that wants to improve, if you're happy with how things are, then take what we say and do nothing with it. But if you are an office that wants to improve, feel free to go back to. I believe it was episode two where I posted the actual formula so that you can diagnose your practice. You will have to pull a procedures report over the last 12 months. So I don't know what that looks like in each software, but I know each software will give you a procedures report by code. So you can pull all of the codes that we ask you to gather in that formula through that report and tally up how many prophys you did over the last 12 months, how many gingivitis cleanings did you do over the last 12 months? And then the formula tells you to add up one set. You'll add up a different set, divide one by the other and it will give you your perioperformance percentage. But you will have to go back and manually pull those numbers and see how many times you did that.

Speaker 1:

Now, if you need assistance, then we're here to assist you. You can call Jen. You can call me or email us. Our email address is listed there and if you're interested in having a one-on-one conversation with Jen, more of a hygiene specific conversation then I'm going to link her contact information and her company's information in the show notes so that you can directly get in contact with her. You can always email her. If you guys have any questions about anything we've talked about in the past four episodes, you know, feel free to reach out. We'd be happy to help you and Jen. Do you have any knowledge? Anything you want to close out?

Speaker 2:

with. I can say that we work with a lot of really wonderful hygienists and a lot of really wonderful offices and I think it's really great Like we get to do what we do and also help people, but then in like a different realm. And I guess in this last episode I just want to encourage hygienists don't be discouraged by all that we're talking about. You know you don't know what you don't know, so take newfound knowledge and move forward with it. You know, not everything's going to change overnight, but there's little steps that you can do to improve your practice, your patient care and ultimately you know, when we were talking about case studies maybe even your salary.

Speaker 2:

So that's something that we can help improve too, and so I just want to throw that out there and just don't be discouraged, but be encouraged and one step at a time.

Speaker 1:

Yeah, I agree. Well, thank you, Jen, for completing this series with me. I will thank Tessanet as well. She wasn't able to be here with us, but I think that this has been a really fun series and it's definitely something that offices are struggling with.

Speaker 2:

I am happy to help put you through it?

Speaker 1:

Absolutely All right, jen. Well, we'll see you. I'm sure you'll be back on the podcast at some point. I mean, we just got done talking about pediatric sleep apnea and how it is affecting my life right now, so I definitely want to bring you back and have a conversation about that as well. But until the next episode, I'll see you then. All right, thanks, erica.

People on this episode

Head Shot

Ericka Aguilar

Host