The final piece of the puzzle

Instigating a patient-manager system may be the spark your practice needs.

by Debbie Best

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Do you get a warm feeling when someone recognizes you by name, notices a change in your hairstyle, or inquires about the soccer tournament you played in? Does a personal touch add a spring to your step and bring sunshine to your smile? Perhaps this is the vision you had for your orthodontic practice during those first idyllic years — before the stress of managing a growing practice and staff began to infringe on your individual interaction with each patient.

Many ortho- dontists are searching for a solution to set them apart from their competition. How can you continue to provide quality care in a growing practice, stay on top of the latest techniques, yet be efficient and profitable? How can you provide to every patient that unique experience upon which many people evaluate the quality of their treatment?

One helpful development is the patient-manager system, a program designed to assign patients to a designated clinical assistant. The treatment coordinator position, which came into vogue several years ago, allows practices to improve new- patient care, personally guiding patients through the initial exam to the start of treatment. The patient-manager program extends this process, from the initiation of treatment right through the retention stage.

With the patient-manager system, clinicians are scheduled to see a designated group of patients 90 percent of the time, which allows them to closely monitor each patient's progress.

Transitioning to a patient-manager program takes time and careful preparation. You can't take a farm team to the World Series without strategic planning, player development, and a clear timeline to accomplish the ultimate goal. The road to incorporating a this system follows a similar path; teams must learn basic skills and strategies and have total confidence in the coach and their teammates before taking home the trophy.

Before making the transition to this system, you must first develop a team that understands your vision and has the drive and ambition to see it through to completion. It is important that your clinical team takes pride and ownership with every patient. When forming a patient-manager team, look for employees who have:

Attention to detail
High self-confidence
Excellent communication and problem-solving skills
The ability to work independently
Team player attitude
The ability to take full ownership of their actions

Once your team members are in place and their clinical skills reach a comparable level, you can start your journey to the program.

Let's explore the steps involved in converting your practice to the patient-manager program. Systematically dividing your patients by groups allows your team the opportunity to become comfortable with the program and gain confidence. Take it slow and steady, and have each step firmly in place before moving to the next level.

Getting started
The first step is to distribute your "prize patients" among your clinical assistants. "Prize patients" are those special individuals whom you would love to give away to another orthodontist ... those patients who make us secretly wish we could hide in a closet and avoid working on them! These patients are often beyond their estimated completion date, have issues with orthodontic compliance, and miss appointments frequently. Evenly dividing these patients gives each assistant the opportunity to take a few patients under her wing and take an active interest in their clinical treatment and well-being. In most cases, you will see a positive change in attitude and compliance; these patients begin to realize that someone is taking a personal interest in their treatment. A difficult patient who becomes a motivated one often becomes a strong referral source for a practice.

Once your "prize patients" have been paired with a patient manager, the next step is to add new patients as they start treatment. When distributing the new patients, it is imperative to consider not only the type and length of treatment, but their personalities as well. It cab be helpful to group family members with the same patient coordinator. Consider these treatment types:

Phase I
Phase II
Comprehensive treatment — child
Comprehensive treatment — adult
Surgical treatment
Limited treatment
Invisalign treatment

Monitor how many patients have been paired up with each patient manager on a monthly basis to keep the load evenly distributed among the technicians.

Next is the division of patients in the recall/observation program. This category includes the monitoring of eruption pretreatment, patients who are between phases of treatment, and the recall-ready program. Integrating these clients into the patient-manager program allows you to build personal relationships with them prior to the start of active treatment. Each patient manager should be responsible for keeping her own recall systems up-to-date, which ensures that their patients are seen as the dentist instructs.

Dividing all active patients is the next step. Ideally, this task should be done over a couple of nonpatient days with all team members actively involved in the process. Using your patient database, print out a copy of all new-patient starts by treatment type and by month over the past two years. Systematically distribute them amongthe patient managers, evaluating the type and length of treatment for each patient. Having a list of "new," "challenging," and "recall" patients already in the system for each manager will allow you to take into consideration family groupings.

Your final step will be to divide up any remaining patients who slipped through the prior four steps, as well as patients in your retention system. Patient managers should monitor their own retention programs as well as ensuring that patients are dismissed from active retention at the appropriate time.

Allow at least three months between each stage for the team to become comfortable with the transition. This allows practitioners a chance to evaluate the performance of each patient manager, as well as the opportunity to make appropriate changes in the program where needed. Monitor the number of patients in each treatment category on a quarterly basis and continue to evenly distribute patients among your patient managers.

The benefits of the patient-manager program outweigh the time and effort expended. Proponents believe that patient compliance improves; clients appreciate having an additional person actively involved in their treatment. It is also easier for clinicians to make personal care calls and increase their "cheerleading" when they have an active, ongoing relationship with their patients.

Your clinical team will also increase their awareness of mechanics of orthodontics. Members can observe the results of every step of the treatment and learn the effects of different appliances and wires.

Staff retention is often higher in a practice that employs the patient-manager program because the team forms close relationships with the patients. It is more difficult to leave a group of friends than it is to walk away from a sea of nameless faces.

Some issues that may complicate the patient-manager program include inconsistencies in clinical experience or speed, part-time employees, staff illness or vacation, and turnover. Occasionally, a personality conflict will erupt between a client and the assigned patient manager. If this happens, allow time for the patient manager to work out the problem with the patient and/or the family. This will enhance conflict-resolution skills. If the situation persists, merely transfer the patient to another manager.

Chairside computer scheduling complements this system, allowing patient managers to schedule their own patients and ensure an appropriate amount of time for the appointment.

You can also use the patient-manager program as a marketing tool for your practice. Schedule "lunch and learns" with general dentists in your area to explain the system and outline its advantages. Incorporate the program into your practice literature, and enlighten potential patients as to why your practice is different than the one down the street.

Debbie Best, co-founder of Consulting Network, focuses her in-office consulting on effective scheduling techniques, analyzing financial concerns, collection follow-up, cost containment and overhead control. She clarifies job descriptions and implements organizational changes involving administrative and clerical staff. Debbie has 25 years of financial and front desk experience in the dental field and has lectured throughout the United States and abroad.

Responsibilities for patient managers: