AADOM Clinical Corner
Featuring Ann-Marie DePalma, CDA, RDH, MEd, FADIA , FAADH
At AADOM we recognize that as the business professional who manages the practice, you need to understand all facets of the business. There will be times when the business and clinical sides of dentistry cross over. The business team needs to have an understanding of clinical team responsibilities and vice versa. We started the AADOM Clinical corner as a resource for the management team to ask questions regarding the clinical team/area of the practice. We’ve enlisted the assistance of Ann-Marie DePalma, a dental professional with over 25 years experience in clinical hygiene and a background in dental business consulting.
How Should an Effective Hand-Off be Handled Between the Clinical and Business Team?
The hand-off from the clinical team member to the business team member is an important communication skill that provides the patient with the assurance that the team members know what their needs are and are confident in the treatment provided or needed. When clinical team members merely bring the patient to the business team and “drop off”, the business team and the patient are often wondering what was done that day and/or what needs to be scheduled next visit. Whether the practice uses the practice management software for communication or provides paper or other communication tool, the hand-off from clinical to business needs to be seamless. Often there is the communication between doctor and hygienist or assistant in the operatory, but sometimes that doesn’t get transmitted to the business team. If the communication between doctor, hygienist/assistant and patient has not been initiated in the operatory, the hygienist/assistant can begin the process by recapping for the patient the day’s treatment and the next visit needs before bringing the patient to the business office.
Initiate the hand-off process by bringing the patient to a seated position in the operatory chair and maintaining eye contact, the hygienist/assistant can recap the day’s treatment and discuss future appointments. The importance of the day’s visit and future treatment can be stressed to the patient at this point, which helps build value for the patient for future dental care. Once that is completed and any questions asked and answered, the hygienist/assistant can bring the patient to the business office and reiterate the completed treatment and future treatment for the business team.
The business team member should already be aware of the information since the clinical team should have communicated the information prior to bringing the patient to the business office. The repetition is done for the patient’s benefit – the more times an adult hears a message, the more they understand and will take action. Additionally, the clinical team should position her/himself between the patient and the door to signal to the patient that it is not time to leave yet, while also shielding from other patients in the reception area.
Following HIPAA guidelines, especially if other patients or team members are within hearing, the exact treatment completed or planned should not be stated, but generalizations used. If appropriate, the clinical team member can give the patient her/his business card for any further questions or information (as well as to build potential referrals) and then the business team member can finalize the day’s appointment or handle scheduling future appointments.
If the patient does not wish to schedule future appointments at that time, the business team member should ask the patient for permission to make a follow-up contact if they have not heard back from them in a specific time frame. Often “life gets in the way” and well-meaning patients often forget to contact the office to schedule treatment. All of this does take a few extra minutes during the appointment, but since repetition is the key to learning, the patient’s current care and future needs will be reinforced, thus building value and respect for the practice and their individual treatment needs.
This triangle of patient, clinical team and business team communication may need to be practiced – spending time at team meetings to review the process may be effective. While business team members are not only responsible for checking out patients, there are a multitude of other responsibilities that exist. By planning and practicing an effective hand-off, all team members begin to understand how their actions, or lack thereof, can affect others abilities to do their job well and improve patient case acceptance.
How Do I Handle a Clinical Team That Isn't Completing Their Duties - Chart Notes, Treatment Planning, Etc.
When team members don’t “pull their weight”, resentment builds within the practice. The old adage, “there is no I in team” is so true when dealing with team members who refuse to complete assigned duties. Often when these same team members are asked about their job roles and responsibilities they don’t know how to respond. Many times clearly defined job descriptions are lacking. Does your practice maintain a job description for every employee? Are these discussed annually and changed appropriately?
Once clearly defined roles and responsibilities are outlined and discussed, the team members need to be held accountable for actions or non-actions based on their role. If a hygienist, assistant or business team member is assigned a task and the task has been clearly defined yet the hygienist, assistant or business team member does not follow through with task, she/he needs to be held accountable for their lack of action. Whether the owner/doctor or office manager is the person holding the accountability, team members need to understand the consequences of not performing according to their position.
All team members need to be held to the same standards; when some are “getting away” with not performing appropriately, other team members feel that they can get away with similar actions and tensions can build within the practice. Tension can then be felt by not only the team, but by patients. When patient care is placed in jeopardy by tension or inaction, the entire team and practice suffers. Holding team members accountable for actions based on clearly defined roles and responsibilities can be difficult, yet holding these discussions and holding the team accountable is a sign of a good leader.
Who Should be Discussing Financial Information with Patient, Including Insurance Benefits?
Each team member is an expert in her/his area of the practice; whether a business or clinical team member each person specializes in their knowledge and skills that benefit the practice. When a team member discusses an area that another in the practice is an expert on, it can create confusion in the patient’s mind. Confusion creates paralysis – the patient may or may not proceed with recommendations.
Clinical team members whether hygienists, assistants or doctors are the experts in the practice regarding patient treatments and conditions, not the insurance and financial aspects of the care the practice provides. Business team members understand the complexities of the financial world of dentistry whether involving patient investments or insurance benefits. When the clinical team ventures into an area that they are unfamiliar, inaccurate or inappropriate information can be presented to the patient. The clinical team may have knowledge of the patient’s insurance and while practice management software programs allow the clinical team to review insurance basics with the patient, the intricacies of patient finances need to be devoted to the team member who understands those intricacies.
Whether a small or large practice, a business team of 1 person or 20 people, the details of finances need to be handled by the expert of the practice in finances. Additionally, clinical team members are required to provide the patient with the appropriate treatment at the time. Insurance benefit plans require the treatment to be documented by the appropriate treatment code. Clinical team members are not experts in the codes, that is an area for the business team, yet the business team doesn’t know the treatment provided. Practice revenue is based on the treatment provided and the code that is used – teams need to understand these requirements to use the appropriate code for the treatment provided. Anything less can cause issues. When clinical team members venture into discussing that a code or service can be billed if it wasn’t appropriately used, ethical, legal and moral issues can arise. It is the practice manager’s responsibility to ensure the appropriate discussion is provided. These discussions can be either one on one conversations with the clinical team member or a team meeting to discuss the practice philosophy regarding handling the treatment investments for the patient and use of the appropriate code. These can be difficult discussions but in order to be a high performing efficient practice, each team member needs to understand the role their words and communication can have on the practice.
Being “insurance aware, not insurance driven” focuses on the importance of understanding the patients’ insurance but not being driven to provide treatment that only is “what the insurance will cover” rather than the treatment the patient needs. Team members need to understand that concept and the practice manager is the person to best convey that message.
How Can I Learn More About Treatment Planning and Products the Clinical Team Uses in the Operatory?
First, does the practice hold regular team meetings, including morning huddles and scheduled monthly, quarterly and annual meetings? Who runs these meetings? If the practice manager always organizes and runs the meetings, the team can be missing an opportunity to learn about various services, procedures or products. When team members are offered the opportunity to educate other team members, all members grow in their knowledge and understanding of each other’s roles and processes. Other than AADOM, dental managers and other business team members often don’t have opportunities to learn about clinical information while assistants, hygienists, and doctors are required to maintain continuing education depending on state requirements. During continuing education programs clinical team members often learn about new products. Having the ability to present the information learned at these programs back to the rest of the team during team meetings enhances the entire team’s knowledge and understanding.
With treatment planning, have you asked a clinical team member to explain a procedure to you or why it was recommended? A few years ago, an advertisement lauded potential buyers to “just ask about xxx.” Clinical team members enjoy when others ask for their opinion or to explain procedures or products. Everyone likes to feel valued and appreciated and asking a team member about a certain treatment or product in a non-judgmental manner can enhance the relationship. The key is to be non-judgmental since the clinical team member may consider it to be questioning her/his clinical expertise. Also, during team meetings time can be devoted to learning about a procedure to enhance everyone’s knowledge of the “why” behind a treatment.
Ann-Marie DePalma, CDA, RDH, MEd, FADIA, FAADH is a graduate of the Forsyth School for Dental Hygienists, Northeastern University and the University of Massachusetts Boston. Ann-Marie is a Fellow and Certified Educator of the Association of Dental Implant Auxiliaries (ADIA), a Fellow of the American Academy of Dental Hygiene (AADH), a continuous member of American Dental Hygienists’ Association (ADHA), as well as a member of American Association of Dental Office Managers (AADOM). She is the 2017 Esther Wilkins Distinguished Alumni of Forsyth Award recipient. Ann-Marie spent 25+ years in clinical hygiene, has experience in dental hygiene and assisting education and as a business/clinical consultant. She currently is employed as a technology advisor/trainer. In addition, Ann-Marie is a published author with dental hygiene publications and textbooks and provides continuing education programs for dental teams.
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