How to ―Live Off the Land‖ in the World of Community Oral Health
Dori Bingham Manager, Safety Net Solutions 2008 Primary Health Care All-Grantee Meeting National Harbor, MD June 23-25, 2008
What Do We Mean by ―Living Off the Land‖?
Grants are great, but can you live without them?
If all your grant funding disappeared tomorrow, could your dental program survive (and even thrive) on its own?
The answer can and should be yes!
The Fundamental Truths
You can’t run a dental department like a medical department (no matter how hard you try!) Your dental department will remind you of this often in the hope that you will leave them alone You can’t afford to leave them alone because their lack of financial sustainability impacts the entire organization But you CAN run a dental department like a dental department And you CAN create a dental department that is able to live off the land
And It’s Not Rocket Science!
Knowledge is power Once you understand the key concepts, you will hold the keys to the kingdom Use these concepts to evaluate dental’s current performance, identify opportunities for improvement, develop realistic financial and productivity goals, achieve staff buy-in and foster accountability An efficient dental department is a sustainable dental department And a sustainable dental department has the potential to expand over time to increase both access and revenue
The Key Concepts to Increased Efficiency and Financial Sustainability
You need good data to evaluate and measure dental’s performance Use this data to create a business plan for the dental department This business plan is a road map that shows the department how to achieve sustainability Despite what your dental staff may say, you can have an efficient dental department that also provides quality dentistry
Key Data
Number of visits Gross charges Net revenue Payer mix Total expenses (direct and indirect) No-Show rate Emergency rate Transactions (procedures by ADA code)
Next Steps
Determine the cost per visit (total expenses ÷ visits) Determine the revenue per visit (total net revenue ÷ visits) If revenue/visit is higher than cost/visit, pat yourself on the back and keep up the good work If you’re like the majority of community health dental programs, cost/visit is higher than revenue/visit The difference is what the dental practice needs to make up in each visit to reach sustainability
The Business Plan
What the dental practice needs to accomplish to be financially sustainable Numbers and types of patients to be seen Numbers, types and lengths of appointments Scope of service for the practice Financial and productivity goals to be met
The Strategic Plan
Use the business plan to create specific strategies for dental: Review the fee schedule to make sure it’s current Review the encounter form—is it user-friendly and built around the procedures the practice should be providing Develop a strong and universally enforced no-show policy Develop a clearly defined and universally enforced system for managing emergencies Develop a scheduling system that maximizes efficiency, productivity and patient access to care Develop clinical protocols to standardize the services to patients across the entire dental practice
The Strategic Plan (cont.)
Meet with dental staff to share the business and strategic plans Present the current situation and the goals that need to be met to achieve sustainability Encourage discussion and consider feedback, but decisions ultimately rest with administrative and/or dental leadership Focus first on the low-hanging fruit—what changes require the least work and will yield positive results? Success breeds success Keep the goals—and progress toward meeting them—in front of the dental staff at all times; celebrate successes and coach setbacks
Case Study 1 —Rural Maine
Four-chair clinic opened in 2003 Since its inception, the clinic had operated in the red, incurring over $200,000 in losses The Board of Directors was ready to close the program down In a last-ditch effort to save dental, SNS was hired to conduct a practice assessment (funded by a local foundation that had invested heavily in the dental program over the years)
Case Study 1 (cont.)
FY2006 Number of visits = 4,227 Revenue = $436,552 Expenses = $595,507 Profit (Loss) = ($158,955) Revenue/visit = $103.27 Cost/visit = $140.88
Case Study 1 (cont.)
Recommendations
Improve scheduling system to maximize productivity and best use of four chairs given current staffing Tweak payer mix to improve access for Medicaid children and create a sustainable balance among payer classes Develop clinical protocols to standardize services to patients and ensure no revenue opportunities are missed Increase fee schedule slightly Revise encounter form
Case Study 1 (cont.)
Develop policies and procedures (emergency, scheduling, noshows) Recruit a full-time dentist for the practice (who can also serve as clinical director) Establish financial and productivity goals for the practice Meet with dental staff to review current situation, present and discuss practice enhancement plan, and lay out recovery plan Review progress in meeting goals with staff regularly to celebrate successes and develop strategies to overcome roadblocks— overall goal to establish accountability among all members of the department
Case Study 1—One Year Later
FY2007 Number of visits = 4,464 Revenue = $566,928 Expenses = $535,680 Profit (Loss) = $31,248 Revenue/visit = $127 Cost/visit = $120 In one year, this program went from a loss of nearly $160,000 to a gain of $30,000!
Case Study 1—Summary
Between FY2006 and FY2007, this dental program continued to operate with two part-time dentists (which constituted one FTE) and two part-time hygienists Their move from the red to the black occurred primarily by streamlining operations, increasing efficiency, improving the payer mix and maximizing revenue opportunities for existing patients They have recruited a dentist from the Arizona School of Dentistry & Oral Health who will be joining the practice fulltime in July, as well as another part-time dentist We expect great things from this practice going forward!
Case Study 2 –Southeastern Massachusetts
Two-chair clinic in a large suburban city in southeastern MA (previously four chairs) Since its inception, the clinic had operated in the red, and in FY2005, the FQHC had taken two chairs out of operation, laying off several members of the dental staff
Case Study 2 (cont.)
FY2006 Number of visits = 1,753 (clinic) and 1,638 (portable) Revenue = $240,102 Expenses = $314,833 Profit (Loss) = ($74,731) Revenue/visit = $70.80 Cost/visit = $92.84
Case Study 2 (cont.)
Recommendations
Improve scheduling system to maximize productivity and best use of two chairs given current staffing Tweak payer mix to improve access for Medicaid children and create a sustainable balance among payer classes Develop clinical protocols to standardize services to patients and ensure no revenue opportunities are missed Reorganize portable program and improve coordination for greater efficiency and productivity Add part-time dentists and expand hours of operation
Case Study 2 (cont.)
Recommendations Review and refine policies and procedures (emergency, scheduling, no-shows) Streamline encounter form Establish financial and productivity goals for the practice Meet with dental staff to review current situation, present and discuss practice enhancement plan, and lay out recovery plan Review progress in meeting goals with staff regularly to celebrate successes and develop strategies to overcome roadblocks— overall goal to establish accountability among all members of the department
Case Study 2 –One Year Later
FY2007 Number of visits = 5,642 Revenue = $598,052 Expenses = $490,854 Profit (Loss) = $107,198 Revenue/visit = $106 Cost/visit = $87 In one year, this program went from a loss of nearly $75,000 to a gain of $107,000!
Case Study 2 –Summary
Between FY2006 and FY2007, this dental program added two part-time dentists and expanded their weekly hours of operation from 35 to 52 Their move from the red to the black occurred primarily by maximizing productivity, increasing efficiency, improving the payer mix and maximizing revenue opportunities for existing patients Now that they are operating in the black, they are ready to consider expansion and have recently applied for a grant to open a second clinic site
Safety Net Solutions
Partnering to Strengthen and Preserve the Oral Health Safety Net
http://www.catalyst-safetynetsolutions.org