by Dr. Dean C. Bellavia
Automatic Practice Management has been
the dream of most orthodontists in private practice. This is because it takes the burden of much of the daily
decision-making away from the doctors and places it on their team. Most doctors delegate too little to their
team, causing frustration for all and loss of production. The following organizational guidelines are
suggested for realistic automatic
management ... delegation with control.
For a more comprehensive approach to Automatic Practice Management,
refer to “The Other Book … on
orthodontics”, “The Environmental Safety Handbook” and “The Book … on
orthodontics” by this author.
Practice
Management (decision-making) exists on three
levels:
1. The first level is the ongoing decisions that are made by the Doctor, and include all decisions that affect treatment quality control and the overall operation of the practice. This level is minimized in Automatic Practice Management.
2. The second level is ongoing decisions that the doctor need not make that other team members should not make, which are made by the Team Coordinator (office manager).
3. The third level is the ongoing decisions that the doctor should not make, which are made by each Team Member in the performance of her daily duties.
Doctor responsibilities/accountabilities for management
Below are the kinds of decisions that only the doctor should make to have Automatic Practice Management control.
Treatment
Quality Control, including:
¨ a comprehensive examination, diagnostic records and a
comprehensive diagnosis and treatment plan.
¨ an accurate estimated completion date that is set and
kept.
¨ accurately pre-planning the next visit’s treatment and then do it.
¨ 6-month periodic progress reviews and control on
run-on cases.
Treatment
Fee Control, including:
¨ setting the fee structure.
¨ prescribing the treatment
at the exam.
¨ allowing the Team Coordinator to set the fee for the
treatment prescribed.
Systems
Control, including:
¨ considering system changes proposed by the Team
Coordinator.
¨ having the final say on all system changes.
Team Member
Staffing Control, including:
¨ who works in what position.
¨ when another team member is needed.
¨ who is hired.
¨ who is fired.
Production
Control, including:
¨ utilization of a
productive schedule.
¨ working the required treatment days per month and per
year.
Marketing
and sales control, including:
¨ motivating the patients to not want their treatment elsewhere.
¨ assisting the TC in a patient-centered exam and
consultation.
¨ leaving the majority of marketing to the TC and Team
Coordinator.
¨ marketing of the family dentist, directly.
Team
Coordinator management
responsibilities/accountabilities
Below are the kinds of decisions that the Team Coordinator makes to both relieve the doctor of unnecessary decision-making and to support the rest of the team in their daily decision-making.
Daily production-related decisions,
including:
¨
a short
morning meeting about the day’s schedule and how to best handle it.
¨
a check on
starting appointment availability and use.
¨
a check on
new-patient exams, which should not be getting too far into the future.
¨
a check
that all 6-month progress reviews are set up for the day.
¨
review the
daily OSHA checklists.
¨
a check
that all else to be done that day is prepared for.
Daily relationship-related decisions,
including:
¨
getting a
sense of the relationships between the doctor and the rest of the team, and, if
necessary, helping the doctor to resolve any problems that may be stressing
him/her out.
¨
getting a
sense of the relationships between the team members, and, if necessary, helping
them to resolve any problems that may be stressing them out.
Weekly
duties-related decisions, including:
¨
Team
Meetings: schedule, conduct, take notes on, and follow-up on.
¨
Doctor
Meetings to review the week's challenges/successes and follow-up on the
meeting.
¨
Team Member
work completion review: TC, receptionist, bookkeeper, etc.
¨
Payroll: calculate time sheets, obtain/write and
distribute checks.
¨
Benefits: maintaining accurate accounting of benefits
given.
Monthly
duties-related decisions, including:
¨
preparing
the monthly reports (written or computer reports, “Super Reports”).
¨
reviewing
the Environmental Safety Coordinator’s daily, weekly and monthly checklists.
¨
month-end
financial control (AP reconciliation, etc.).
¨
others as
required.
Quarterly
duties-related decisions, including:
¨
semi-yearly
critiques of all systems to make sure they are being used properly
¨
semi-yearly
and yearly OSHA training.
¨
year-end
reports and financial duties.
¨
others as
required.
Team
Member Utilization-related decisions,
including:
¨
team member Staffing Level decisions (who works in
which positions).
¨
changing staffing levels
as needed with growth.
¨
team Member Hiring, including:
·
seeking new team members
(newspapers, interviews, etc.).
·
making new team member salary level decisions with the doctor’s
approval.
·
setting new Team Member Benefits with the doctor’s approval.
¨
team member Replacement, including:
·
unsatisfactory team
member’s performance documentation for 2+ months with dates and warnings.
·
team member replacement
and timing approval by the doctor.
¨
team member Medical/Personnel File maintenance
including:
·
maintain Employee
Medical/Personnel Records.
·
make sure that all
initial and ongoing team member training is scheduled and completed.
Patient
Scheduling-related decisions,
including:
¨
determination of the
days to be worked in each office.
¨
maintaining the proper
number of work-days per month per office.
¨
modifying the days worked
to account for doctor vacations, branch office utilization and staff
utilization.
¨
momentary and seasonal modifications of the daily schedule.
¨
permanent modifications of the daily schedule
for changes in the doctor’s Tx Mechanotherapy or techniques.
Purchasing
Budget Control-related decisions, including:
¨
determining and
monitoring the practice’s budget for all expenses.
¨
having the purchasing
done by specific clerical and clinical team members.
¨
accepting all the usual purchases.
¨
reviewing and approving
all “Out of the Ordinary” purchases.
Marketing
Budget Control-related decisions, including:
¨
promoting internal
marketing based on exceptional, patient-centered services.
¨
promoting external
marketing programs.
¨
setting the marketing
budget, which is typically 1% to 2% of one year’s income, which includes:
·
Yellow Pages
advertisements.
·
all brochures for
practice promotion.
·
all promotional
mail-outs to non-patients.
·
gifts (Christmas,
birthday, etc.) to referring dentist’s or their families.
·
“lunch and learn” for a
referring dentist’s team with the practice team.
·
“muffin runs”, flowers,
etc., brought to the dental practices.
·
bonuses paid to team
members for increased referrals that
start.
·
expenses (not salary)
when doing school or community lectures, etc.
·
sponsoring local teams
or activities.
·
other, as new marketing
programs arise for the stimulation of more referrals.
Team Member management
responsibilities/accountabilities
Below are listed the team
member positions and the kinds of decisions that team members make in those
positions. Included are decisions that
require the Team Coordinators help.
TC (Treatment Coordinator)
Position responsibilities/accountabilities and
decision-making
Exam-related
decision making, including:
¨
pre-exam
call to patient/family and preparation for the exam.
¨
exam
Procedures
(refer to the Patient-Centered Services Manual in “The Other Book … on orthodontics.”).
¨
taking
Imaging Photos, if done.
¨
post-exam
Communications, appointments, DDS Referrals & letters and Patient Letters.
¨
post-exam
follow-up on Will-Call-Back patients.
¨
post-exam
statistics and use of the TC Tracking Log.
¨
treatment fees, courtesies, etc., for the treatment prescribed by the doctor.
Tx
Consult--related decision making, including:
¨
Records
Evaluation Control
(assemble records for the doctor's Dx & Tx Planning).
¨
Treatment
Consult procedures.
¨
post-consult
Communications, appointments, DDS Referrals & letters.
¨
post-consult
Follow-up on Will-Call-Back patients.
¨
post-consult
statistics and use of the TC Tracking Log.
Recall-related decision making,
including:
¨
on-going
recall patients not ready to start
yet.
¨
recall
patients who are ready to start treatment.
¨
The Team
Coordinator makes all decisions for:
·
fees that
are higher than was promised (e.g., Ph-II treatment).
·
changes in
the treatment initially stated at the start of Ph-I treatment..
Parent Conference-related
decision making including:
¨
parent
conference appointments and follow-up appointments (letters, etc.) for problem
cases.
¨
support for
situations where the patient/family
or the practice wants the braces
removed and the Team Coordinator determines the fee balance, removal date and
liability release and the doctor prescribes retention.
Marketing
Programs-related decision making.
(refer to marketing in the Team Coordinator position above)
The Team Coordinator makes all decisions
on procedure modifications or new situations.
¨
Once
resolved with the Team Coordinator this kind of decision is made by the TC.
¨
Once
modified the TC makes decisions relative to those modifications.
Receptionist (Scheduling Coordinator)
Position responsibilities/accountabilities and
decision-making
Daily procedures-related decision making,
including:
¨
Telephone
Control: answering and routing calls, telephone answering machine control.
¨
New-Patient
Call: use of New Patient Call Sheet,
mail out Health History, start New-Pt. Folder.
¨
Tx Chart
and Records Folder Control: daily
pulling and filing of charts.
¨
Daily Cash
Control: taking payments and using the
Daily Financial Control Envelope.
¨
Scheduling: appointments, missed appointment control,
canceled appointment control, and recall control.
¨
other
miscellaneous responsibilities.
Patient Scheduling Control-related decision making,
including:
¨
the number of days
worked per year per office as determined by the Team Coordinator.
¨
momentary schedule modifications, although a
properly designed scheduling system should be used as designed.
¨
permanent schedule modifications, requiring
the Team Coordinator’s and doctor’s input.
Receptionist-related decisions requiring the Team Coordinator’s input:
¨ for any modifications in forms or procedures.
¨
once resolved by the
Team Coordinator this kind of decision can be made by the receptionist.
Bookkeeper (Financial Coordinator)
Position responsibilities/accountabilities and
decision-making
Daily procedures decision making, including:
¨
daily
credit checks of all exam patients and giving rating to TC before or at the
exam visit.
¨
Daily Cash
Control: income received into the bank
using the Daily Cash Control Log.
¨
Daily
Charge Control of miscellaneous charges using the Misc. Charge Control Log.
¨
posting all
daily: contracts, misc. charges, payments, credit/debit adjustments.
¨
Past Due
Control: daily lists of past due patients to call and re-negotiate and receive
payments.
¨
Accounts
Payable and Payroll control.
¨
Petty Cash
Control.
¨
clerical
supplies Inventory Control: inventorying, ordering and stocking clerical
supplies.
¨
monthly
processing of reports, etc.
¨
insurance
processing control: initial claims, ongoing forms processing and past due
control.
¨
other
miscellaneous responsibilities.
Monthly, Quarterly, & Yearly procedures decision making, including:
¨
monthly
Financial Statistics & Reports.
¨
monthly
Insurance control.
¨
monthly
credit card payments control.
¨
monthly
computer file maintenance, if done.
¨
quarterly/yearly
financial processing.
¨
other
procedures as needed.
Financial-related decisions requiring the Team Coordinator’s input:
¨
for any new fees or new financial policies.
¨ for any changes in forms or procedures.
¨
once resolved by the
Team Coordinator this kind of decision can be made by the bookkeeper.
Clinical Assistant
Position responsibilities/accountabilities and
decision-making
Daily
Patient Treatment decision making,
including:
¨
cleaning up
after the last patient.
¨
preparing
(setup) for the next patient.
¨
starting
the prescribed treatment without waiting for the doctor first.
¨
understanding
the additions to the treatment as prescribed by the doctor.
¨
completing
treatment prescribed by the doctor.
¨
learning
all techniques to be able to do any appointment scheduled.
¨
keeping on
schedule with the low-volume patients scheduled to your column.
¨
keeping on
schedule in high-volume by getting any patient done on time.
¨
doctor
routing (after exam/consult) to the treatment chairs.
¨
adjusting
to early, late and SOS's (scheduled patients) patients to stay on schedule.
¨
handling
emergencies (unscheduled patients) and staying on schedule.
¨
conducting
6-mo. Pt. Progress Reviews: evaluate
cooperation, Progress Review form, and explain results to family.
¨
retention
conference procedures at the retainer insertion visit.
¨
other
miscellaneous responsibilities.
Diagnostic
Records-related decision making, including:
¨
taking
Initial Records after the new patient exam.
¨
taking Scheduled or unscheduled Miscellaneous
Records (Pano, Photos, etc.).
¨
processing
records and photos control.
¨
other
miscellaneous responsibilities (records area maintenance, etc.).
Sterilization-related
decision making, including:
¨
sterilization
procedures before, during and after the
patient treatment day.
¨
sterilization
area: daily/weekly equipment maintenance, materials labeling and restocking.
¨
other
miscellaneous responsibilities (hazardous materials control, etc.).
Patient
Training-related decision making, including:
¨
the Patient
Orientation (initial separation, impressions, etc.) Visit.
¨