Profitable dental hygiene: Why knowing your numbers benefits everyone

When it comes to the topic of hygiene department production, conversations can range anywhere from supportive to resistant. When I first graduated and began working, I was unsure if production was something I needed to learn about, or if it was something upon which the business office or dentist focused.

I was also not sure how to react when I explored job opportunities. I wondered: Are offices that discuss production of the “all about the money” mindset where treatment might be overplanned and not based on the specific needs of each patient? Am I going to be treated more like a salesperson with rigid goals, or a health-care professional acting in the best interest of patients?

Are offices that don’t focus on production better to work for, or are they so not focused on it that the office does not have enough of a profit margin to cover expenses like competitive wages, new equipment, and the like? Will underdiagnosed and undertreated disease be the norm here?

The hygiene department as a business unit

In the years that followed, I learned that understanding hygiene department production and paying attention to it had many benefits. I am not suggesting overtreatment or suggesting procedures that are not necessary or beneficial for the patient. I am also not suggesting shortening appointment blocks and attempting to pack as much in as possible in a race to beat the clock.

What I am suggesting is viewing the hygiene department like a unit in any well-run business. You might be saying, “Wait a minute. I’m not running a business. I am in health care.” I encourage you to think about some industry standards. We do work for a business, and it is a business with significant overhead.

Operating a dental practice is incredibly costly. I learned from a dental consultant mentor that opening the door to a practice costs on average 50% to 60% of collections. This does not include salaries, lab fees, and supplies.

Also, consider the difference between the terms production and collections. Production refers to all the billable procedures. What is billed, however, is not what is collected. Consider offices that are in network with insurance companies. The amount collected can be significantly less than what is billed because contracted fees between an office and an insurer are often less than the office fees, resulting in less of a reimbursement and write offs. Further, not all services billed will be collected in that unfortunately, not all patients pay for services rendered.

A well-run practice furthers your career

You might be thinking that all of this seems out of your control and should not affect you, but consider the reality of the environments we may find ourselves in. All of us have heard (and may have personally experienced) the situations that occur in dentistry with regard to colleagues discussing how they have not had raises, the lack of job perks or benefits, the time clock being scrutinized to manage payroll, schedules being packed with patients which can leave us feeling like we are on an assembly line, and complaints about not being able to order new instruments or procure equipment designed to make our jobs more effective.

In order for patients to have the best possible care, a practice must have the profits to be able to attract and competitively compensate high caliber staff and secure the resources necessary to create a highly functioning hygiene department and good work environment. Often the best practices in which I have worked and the most satisfied hygienists that I have met understand that quality patient-centered care happens best in a profitable environment. It is a win-win-win. What I am referring to is healthier patients, a healthier practice and more satisfied practitioners.

In my RDH magazine article, "Production and compassion: Can they coexist?" I discussed the concept that compassion, offering the best care for individuals, and a productive office can and should all exist in concert with each other. When we approach patient relationships from having the best interest of the patient at heart and sharing the value of what we have to offer, being proactive and prevention-centric, and doing so with good communication skills, the big picture falls more easily into place for patients, providers and the dental office.

So, what are some basic production numbers to consider?

Average daily hygiene production should be about 30% of total office production. What constitutes hygiene production is anything you personally deliver (within the scope of practice of your state). It does not include exams in most states, as those must be done by a dentist.

This percentage can be affected by things such as:

Working in a practice that has very high volume of doctor production, a doctor who executes on extensive cases or does a large number of costly procedures like implants could cause hygiene production to be below the 30% of office production.
Hygiene fees that are too low in comparison to restorative fees could cause hygiene production to fall below the 30% of office production. Hygiene fees should be re-evaluated when restorative fees are re-evaluated and remain competitive with what is customary in your area.
If there is a large number of hygienists compared to doctors (for example a large hygiene team and only one dentist), a dentist who has more open chair time, or a dentist who focuses primarily on services that are billed at lower fees this could result in hygiene production above the 30% average.

30% of your hygiene services should be D4000 codes (therapeutic, not preventive). I am referring to scaling and root planing, periodontal maintenance, scaling in the presence of inflammation and debridement. With regard to your perio maintenance patients, are you suggesting retreatments when they are no longer maintained, and the disease is progressing?

When you consider statistics around periodontal disease, it is interesting to see how your own numbers measure up. According to a 2018 study published in the Journal of the American Dental Association, “an estimated 42% of dentate US adults 30 years or older had periodontitis.”¹ Looking at the numbers can help us to evaluate if we are treating disease with the appropriate therapeutic procedures.

A hygienist’s production should be about three times his or her hourly wage, including benefits.

Why does this matter?

The more aware you are of these numbers, the more you have concrete information as to where you contribute to a practice’s success and how you compare to industry standards. When you have solid and measurable information, you can directly show where you add value.

In my experience, having this information resulted in better job satisfaction in that I was more appreciated and valued. It also put me in a better position to ask for what I wanted and needed. For example, I had measurable facts about what I brought to the practice when it came time to ask for an increase or other benefits. I was also able to confidently ask for necessary equipment and instruments as needed.

Having measurable metrics about the value I brought to a hygiene department and what I did to increase productivity and patient health was also a very helpful and relevant piece of information on my resume. It was often a point of interest for perspective employers, and one of the things that helped me to bridge my way from clinical to a nonclinical position when a hand injury forced me to move from daily chairside practice.

The fact is that an employee who can ethically and responsibly contribute to the success of the business, focusing on the best interest of the patient, is a highly valuable asset to the practice and to the patients entrusted to his or her care.

In the next article we will discuss some examples of ways you can ensure that you are most accurately representing all you do and bring to a practice. Oftentimes, it can be as simple as looking at old problems or pain points through a different lens. The result can be a smoother schedule, better production numbers, and a more appropriate way to align patients with the necessary care based on risk factors and presence of disease.

Reference

Eke PI, Thornton-Evans GO, Wei L, Borgnakke WS, Dye BA, Genco RJ. Periodontitis in US adults: National health and nutrition examination survey 2009-2014. J Am Dent Assoc. 2018;149(7):576-588.e6. doi: 10.1016/j.adaj.2018.04.023

Julie Whiteley, BS, RDH, is certified in human resources. She holds degrees in business administration and dental hygiene and has worked extensively in both fields. She is on the faculty of Massachusetts College of Pharmacy and Health Sciences University in Boston. Julie bridges her knowledge and experience from business, clinical hygiene, and teaching to deliver information and programs that enhance dental practices. Contact her at [email protected].