Patient Retention = A Big Deal

So what is the big deal with patient retention? Dr. Kuba and Bethany dig into this topic today to discuss why this buzzword is so prominent amongst dentists and consultants alike. Bethany discusses multiple different ways to look at the category of retention and then describes why this number is a litmus test for health in most dental practices. This is definitely an episode you do not want to miss!

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Transcript

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Are you looking for a podcast where you can hear from real people regarding their real dental drama? If so, then
0:09
you've come to the right place. Join hosts Bethany Penny and Dr. Reena Kuba
0:14
as we dive into the solutions we've created and the mistakes we've made while managing dental drama.
0:22
Let's get started. So, this is weird because we are not in your closet, my closet, or a car.
0:30
What's wrong with us? Do we even know what to say outside of those zones? We do. We just need to focus.
0:36
And um so here we are. We're doing a live podcast. Um and the only difference
0:42
is we're dressed up. We have makeup on. Hair is done.
0:47
The only difference is all of it. It's it's all different. Yeah. Exactly. But we will stick to our usual
0:53
format of um how did we know what we wanted to record for this podcast? We didn't. We just brainstormed that right
0:59
before starting here kind of going what's going on in your world, what's going on in my world. Yes. And um we decided on uh you guys ask a
1:08
lot of fantastic questions on Facebook and through our managing dental drama other forums. Like we get a lot of
1:15
really good questions asked. So we've tried to compile those and seeing if we can um answer those here. Yeah. So I
1:23
pulled one. Yay. I'm ready to talk about this one. And I want to talk about this one because I think there's a lot of
1:29
offshoots with it that may address some other questions that come
1:35
up too. So, uh, I'm going to read you the question. Let's do it. You ready? Ready. Okay.
1:41
Are you tracking your client retention metrics? Um, so I'm going to pause right there.
1:46
I'm going to say we are, but not we. She luckily she's there because I think if
1:52
you had asked me this, I'm like I I think we are. are pretty sure we are. But I know we are because you send me
1:58
reports and um that you don't read that that I'm just like uh they bring me anxiety
2:04
because I'm like what if this is a bad number? Um so you track it all and but you summarize it for me at the top about
2:11
not only how is the retention going, but what are some strategies to fix said retention?
2:17
So it's like you're managing all of that for me. So, when I first read this, I was like, uh. And you're like, "No, no,
2:23
no. We we do this, this, and this." So, we'll talk about some of those things. Anyway, are you tracking your client retention metrics? It's easy to focus
2:29
solely on new patients, but it's just as important to track how many of your current clients are sticking around. Um,
2:36
having the right metrics can help you identify what's working and where you need to improve. Tracking things like
2:42
repeat visits, average client tenure, and satisfaction surveys will give you a
2:48
clearer picture of how your business is performing in terms of client retention. So, I don't really know like
2:57
from a a listener perspective, what's your actual question other than you're asking me if I track retention, which I
3:03
do, and it sounds like you do too. Um, but I think the bigger point is there's a lot of people that don't they think
3:11
about it, but actually doing it is a whole another like, oh my god. Mhm. When do I have time for this? And I think I
3:18
mentioned it in one of my uh digest articles like, okay, so you have say say we go through right now, we're going to
3:23
go through like whatever you do to look at reports. Okay, you've got the reports. Now what? Yeah.
3:29
Like what what are we doing at that information? Um, so I'm hoping we can kind of unpack some useful tips that um
3:38
will help people like know what to do with that information or at least pick out a strategy and say, "Okay, we we may
3:45
not try all of this right now, but let's try this one." Um, and I I will say even
3:50
though I'm not the one doing the tracking, but I I can't stress how important that
3:56
is because if you think about, you know, say we hit 10 new patients this month
4:01
and we're all like, "Yeah, rah." But what are we doing? What What are we doing if we're losing
4:07
12, right? How do you solve the problem? Problems. like there's got to be a a uh
4:13
like a plug on the other end so they're not just all coming in and going right back out the door and we're spending all this money to get you back in the door
4:20
and then you're right back out. So um I think the I think we all like to believe
4:26
we're doing great. I think everybody assumes they're doing great. Yeah. And and it's like uh you know
4:32
unknown. I don't know so it must be fine. Yeah. Well, Mary was on the schedule last time and she she's back, so
4:39
everybody else must be right. I know for me personally that that is a problem. Like I I start going I think they are. I
4:46
hope they are because here's the problem. If they're not, then why are they not? Yeah.
4:51
And somebody like me, y'all know I tend to be very um my emotions.
4:57
And so I'm like, what did I do wrong that Mary's not coming back? What did I not need to meet her needs? It must have
5:04
been me. She must have not liked the way I Right. Yeah. So it to me that is one reason why a lot
5:10
of us don't look at it because one we don't know what to do with the information and two there's a high likelihood that it's like what did I do
5:17
wrong that you didn't come back right? And so facing that and navigating that
5:22
is just yucky. Yeah. It's like never mind. You'd rather not know. I'd rather not know. I'm going to assume
5:28
that some of these patients we've been seeing and I recognize those names and so we must be fine. Yeah. You know, it's interesting too. I
5:35
feel like the busier the practice is, the less likely they are to focus on retention because to your point, it's
5:41
like we're fine. Look at how busy we are. We don't even have time to think about retention. And I think that's
5:46
where it gets scary for a lot of practices. So then the argument that I could see a lot of people going, but yeah, if we are
5:52
busy, then what do we care about the retention because clearly we are booked. So we don't need those people or even if
5:58
those people did come back, we don't have a spot for them anyway. So does that matter? I'm busy. Yeah. So, what
6:03
would be your answer to that? My my answer to that would be why do we do blood work? You know, I feel fine.
6:10
Everything's totally fine. I mean, like I I sleep, I eat, I walk around, I'm
6:15
good. But we do blood work by the doctor's orders because there's things underneath the surface that we may not
6:22
even know are a problem. And same thing is true for retention. To me, retention is the tool that shows us whether or not
6:29
a practice is truly successful or not. And there's going to come a time where that volume may go away. And at that
6:36
point, let's say you've been in a really busy practice, the schedule's crazy, but you haven't noticed this slow bleed. And
6:42
then all of a sudden, you hit a tough month, and you're like, "What in the heck happened?" And you go and start to
6:47
look into retention, which is one of the first places I would say to look into, and you see in there like, "Oh, wow.
6:53
We've been losing patients for a very long time." And to me, that's a systemic problem. It means there's a lot of
6:59
things wrong with what we're doing. Not only we're not pursuing these patients to keep them, but do we have a
7:05
cancellation problem? Do we have a customer service problem? Do patients not trust our providers and therefore
7:11
they're just quietly leaving from our practice? So, it yeah, it to me is a
7:18
health marker for the practice. Um, correct me if I'm wrong on this, but isn't also like I start thinking like
7:23
did we do some sort of promo that brought people in or are we in network
7:28
with all of these insuranceances and that's why they're coming and then now I'm hitting a point where I'm going, oh,
7:34
I'm so busy. Maybe it's time to drop an insurance. Yeah. And then that's when you figure out
7:40
like, wait a minute, I wasn't that busy with like super productive. It looked like
7:47
productive, but it was just more volume. Yeah. And now I'm like I can't sustain the volume. Like it's hard to find staff
7:53
or it's whatever like whatever you're like okay I need to start figuring out how to get more seats
7:59
available cuz like right now my precare if you want to get in for reare it's another four months or another six
8:05
months. Well that's not good or new patient can't get in for another 3 months or four months and you're like
8:11
oh man I need to figure out how to slow this. I'm doing so great. I need to figure out how to slow this down. I'm
8:16
going to drop this one insurance. Well, then you're thinking that you're going to lose, you know, 20 patients cuz
8:22
you're going to drop this insurance. Well, you really lost 120. Yeah. Because a lot of them weren't coming
8:29
because of the care you were giving. They were coming because of the insurance. Yeah. And so, does that
8:34
Mhm. Well, and to me, retention is always important, but it's especially important before a big decision like an
8:41
insurance change, a location change, adding an operator, something like that,
8:46
adding a doctor, adding an associate, adding a hygienist, adding an additional team member. I'm like, don't do any of
8:53
that until you know who your patients are. Are we retaining them or not?
8:59
because yeah, you can get yourself into a hole real quickly because you just assumed that everything's fine and it
9:05
wasn't. And again, it often takes just like one or two little tweaks in the
9:10
practice to then reveal a problem. So, if you just stay status quo, hey, it
9:16
could continue like that. I don't know. But one little thing happens. We hit a snowstorm or heaven forbid we go back to
9:23
something huge like the pandemic or and then all of a sudden it blows the practice up for a minute and you're left
9:29
trying to put the pieces back together of why was this practice not as solid as I thought it was. And so before any
9:35
major decision, even any minor decision, especially hiring somebody, I would dig
9:41
into retention before you even go there, quite honestly. And I think you said
9:47
this earlier, retention to me is so much more complex than we make it out to be.
9:53
I think people my I don't know. I would think some people are like, "Is my
9:58
schedule full?" Okay, I'm retaining patients. But to me, we've got to look at how are we retaining patients? Like
10:05
in your practice, are we retaining patients through the hygiene department? Are they coming back regularly for their
10:12
cleanings? And when I say regularly, I mean on time. So why does that matter?
10:18
Why does it matter if somebody's on time or not? Well, because on time meaning every six months if
10:23
that's their protocol, if that's their Yeah. If you've said, "Hey, no, they're good for every six months." Well, then
10:30
if they are coming every 8 months, first of all, that's not what's what's best for the patient because you said they
10:36
need to be here every six months. Kind of industry standard is every six months. So then if they're not coming for every 8 months just because they
10:43
plan it around school holidays or whatever the case may be. Yes, we've retained the patient. That's not a huge
10:49
alarming situation. But over time, if you have a lot of patients that just kind of naturally default to 8 months, 9
10:56
months, you trace that out over a 2-year period of time and you're having to add that many more new patients to
11:02
supplement the loss of those patients on their regular inter interval. So even
11:08
looking at are they coming back, but are they coming back on time? Challenging the question of okay, we
11:15
said to little Johnny who constantly he just never brushes his teeth. We told mom he needs to come back every 3
11:21
months. Why is Johnny not coming back every 3 months? Why is he still on a six-month rotation? Is that something we
11:26
did? We didn't communicate that clearly to the business team or who whoever was scheduling him. Is mom just refusing
11:32
that? No, I'm just going to go with the six months. So there's so many things that can cause it to be delayed, but if
11:38
we're not taking the time to even realize they're delayed, then we're missing an opportunity. So hygiene's one
11:46
aspect, but also treatment is another aspect where we could be retaining them
11:51
consistently in the hygiene department. If they're on a six-month interval, it's like great, they're here on time every
11:56
time, and they've had fillings that we've talked to them about for the last two years, and they haven't taken one step in that direction. That to me is a
12:04
question of concern honestly because that means they're doing the free stuff because their insurance pays for it. But
12:11
when it comes to things that they actually need to do for their health, do they not trust us enough to do it? Have
12:16
we not presented good financial options? Are we is the doctor kind of clunky in
12:22
how they're re are they being clear that the patient needs those fillings? Do we have good documentation that they need
12:28
those fillings? Do we have intraoral photos? Do we have other tools that we could use to really
12:35
um convey that this is a need? And that's where we can lose this cuz if
12:41
we use the example of a patient that needs a couple fillings, which is every doctor's favorite procedure, then we're
12:47
looking at the schedule, we're like, man, we got a great productive schedule. We've got some crowns. We've got some
12:52
surgeries on there. We're feeling really good. And we don't really care that the fillings didn't make it on the schedule.
12:59
I I get that, but that's still indicating a retention problem. So, we're happy to kind of gloss over that
13:06
one or not even pursue that patient because we're like, ah, it's just feelings. He'll be fine, but it still
13:12
indicates he never scheduled from the get-go. So, trace it all back to go, what did we do wrong from the get-go?
13:19
And is this pervasive or not? Is this just Joe because Joe's going to deny everything because Joe's Joe? Or is this
13:26
when we start looking into it, we're like, "Oh, no. every patient that has a filling recommended to them doesn't
13:32
pursue it. So then that's got to indicate we're presenting something wrong to those patients. So yeah, that's
13:39
another avenue that we don't spend enough time on. Even you saying that like just makes me think in my own office like it's just
13:47
something that I'm like I don't you know I can't I can't make
13:52
the horse drink the water. Yeah. Like I've showed you that your kid needs this. You came to me because you saw the
13:58
black hole. You came to me because your kid was hurting. And we've got a strong
14:03
patient base that doesn't believe in fixing baby teeth. And a strong patient base that only wants whatever insurance
14:10
is going to cover. And there's only so much I can do. Yeah. So I my defenses do go up where I'm
14:17
like, why even think about it? Well, it's not even why think about it, but it's like what am I doing about it?
14:23
Because then if the answer does become Is it my treatment coordinator?
14:29
Is it me? Yeah. Like just trying to figure out how I would problem solve those. I start going,
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well, it's the patient's problem, not my problem. Yeah. Yeah. And I think it's normal to default to that because it that is an
14:42
easier solution. And and that could be the solution. It really could. It could be like, hey, they're actually it's just
14:49
the patient and that solves my retention problem and there's nothing I can do. I'm doing everything in my power. But I
14:55
think if we don't know that that problem exists, then we aren't taking the time to even trace back and go, is there
15:00
anything I could change? Because let's say it was your treatment coordinator. Let's say that as you started tracking
15:07
uh treatment statistics, treatment acceptance statistics, and you go back and your treatment coordinator started
15:13
in the summer of last year and everything prior to the summer of last year, we had a whatever 60%
15:21
acceptance rate on treatment. And then summer to now it's 32%. And you're like,
15:28
so we were doing something before treatment coordinator. So it becomes evident that maybe something's going on
15:34
with the treatment coordinator. Then what? Okay. When's the last time we observed her? When's the last time we've
15:40
recorded her conversation with the in the in your case the parents? Um
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is she does she need any kind of tools? Like what's the rejection that she's getting in the room? Oh, let's say it's
15:53
money. You know, the parents always say they just can't afford it. Okay, treatment coordinator, what are your
15:59
thoughts and ideas on that? What do you think the parents need to be able to afford this? Okay, let's look into
16:04
financial options. Let's start tinkering around with did that persuade the parent to move forward when you had that
16:10
financial option available. So to me, even if we're like, "Oh, it all hinges on it's a person that's kind of sinking
16:17
our our retention through treatment um statistic, you can still there's a lot
16:22
you can do to help that person." So, I think about um a treatment coordinator we had a couple of years ago and she was
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a little bit older. So, I like that she she looked mothering like she looked
16:37
like she um was very down to earth and she she had kids and so she could very
16:42
well be like I'm kind of mama bear. This is what I do for my kids and this is what I want for. So, on on the surface
16:48
she was a really good person to be the treatment coordinator. Yeah. um because she was approachable
16:53
and you could ask her questions and all of that. Um she was knowledgeable. She knew she'd been in uh many dental
17:00
offices before, but also pediatrics. Like she she knew um the terminology and
17:05
what the procedure entailed and all of that. So in our eyes, she was really great and she was easy to talk to.
17:10
Yeah. And she exuded this warmth about her. Well, it was not going well. and she
17:17
would be in there for like 45 minutes, an hour, and we're like, "Really shouldn't take this long." And she was
17:23
defensive going, "Well, I'm trying to build a rapport with the parents so that they do trust us, so that they" And I'm
17:29
like, "I mean, yeah, but also we've had other good treatment
17:34
coordinators that do this and they can wrap it up in 15 minutes." So, we probably just need to tweak what you're
17:39
doing and yeah, figure that out. Well, come to find, and it took us a while to dig down,
17:46
we finally realized like whatever she was saying, it was like I don't think
17:52
she outright came and said, "Yeah, I wouldn't pay for this." But that's really what we discovered was
17:57
the ultimate problem is that she would look at the estimate and be like, " $3,000? I wouldn't pay that."
18:05
So then she was really having a hard time with the parent. It's almost like she was agreeing with them like, "Yep, this is a lot of money."
18:11
Yep. Yeah. I don't know. Yeah. I Yep. And kind of leaving it at that, we're like, "Wait a minute. What?" Like,
18:19
so, and she herself had a motherly aversion
18:24
to Ivy sedation. Yeah. She would she herself said, "I don't know that I'd ever put my kid through
18:30
that because there's so many risks involved with it." So she she had not bought into
18:37
the value of that treatment, the value of being able to put a child to sleep for the treatment. She just didn't
18:43
believe it. Which ultimately to me says, "Well, then you don't trust us in this facility because we've had the training.
18:49
We have a great track record. You see what all we do. You've met our anesthesia providers. You've seen how great these kids do after. You've seen
18:55
the ones that have been tortured and held down. And you've seen how well our kids do. And yet you still don't buy
19:01
into it." Yeah. Well, then that's a fundamental problem in philosophy and it's we're never going to see eye to eye because
19:08
you don't believe I think she would rather have her kid held down or she rather would like have
19:14
teeth extracted rather than restored. Um which I'm not going to say is you know that's certainly her choice as a
19:20
parent but when you are in the position to try to help the parent that does want these services. Yeah. and you're not able to
19:27
relate and and help them, you know, if if if a parent was like, "My kid has to
19:32
be asleep." Yeah. Exactly. But that's what the doctor's recommending.
19:38
Yeah. And so she was inadvertently sabotaging and and it took us a while to see it
19:44
because she was very covert about her feelings on things. until we really held her feet to the fire and asked those
19:51
point blank questions, it didn't become obvious to us. And I think the timing is
19:59
really important here because 45 minutes to sit and chat with a parent, she was
20:05
she was a very warm, empathic connector type person. And so the longer
20:11
she would sit and talk with that parent, the more her heart was, which again, that's not saying that we didn't have a
20:17
heart when we recommended this stuff. It's just she would get so bogged down in their personal life stuff that she
20:24
didn't have clarity of mind in how to present this treatment and it led to a lot of patients, parents not moving
20:31
forward with treatment. But again, that was one of those slow bleed things. It wasn't anything like bam in your face
20:38
all of a sudden we don't have any treatment on the schedule. It was something that the longer she was here we were like what's happening and
20:44
honestly the the treatment statistics showed that we even set goals for her
20:49
like hey let's try to get it back up to this and she wasn't achieving those goals. We would have we were on it with
20:56
her I mean coaching from the get-go because we know how critical that role is and how critical retention is for a
21:03
practice. And so we were pretty honed in on her from the get-go, but it wasn't
21:09
until months and months into this that we're like, "Okay, there's something here that we're not picking up on." And
21:16
Yeah. And sure as we removed her from there, back up. Retention back up. Yeah.
21:21
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22:01
and go to the one resource that has it all. Yeah. So, I think treatment
22:07
retention is absolutely important. Even if it's the little stuff, the elective
22:13
stuff. Elective is a great one. I was just in a practice the other day where I was working with one of his clinical
22:20
assistants is the person responsible for tracking all cases after they leave if they didn't schedule,
22:26
which to me, most offices do not have this. yours does. This office, honestly,
22:32
any office that I'm working with, I'm like, this is we got to have somebody thinking about this. But this assistant
22:37
was new to taking over this job. Uh, one of the previous people went on maternity
22:43
leave and didn't come back. And so, we moved it to her. And it was really
22:49
interesting as we were building that list of, okay, you got some cleanup to do cuz so and so didn't come back from
22:55
maternity leave. First of all, I just love her passion for this because she as
23:00
a clinical assistant, she's been in that room. She knows how valuable that treatment is. She sees the results with
23:06
patients and so she's approaching that list in a very different way than the prior treatment coordinator did who was
23:12
at the front. That's not to say that either is better or worse. In this case,
23:17
she immediately had passion because as she's looking through that list, she's like, "I know these people. Oh my gosh,
23:22
Mr. Jones didn't get his crown done." like I'm putting him at the top of my list. So, she has a very passionate
23:28
approach to that list, which I love. But, we've got to be careful that whoever is responsible for pursuing
23:35
those unscheduled patients, it's not just a hey Joe, uh, notice she didn't
23:40
schedule crown, you want to go ahead and get that scheduled, that's that's not how we're pursuing Joe. We're pursuing
23:46
Joe from a clinical standpoint that goes, "Hey, that tooth is fractured. We
23:51
sure the heck don't want anything to happen to you." And so this clinical assistant brought that just by her
23:58
connection with these patients. So even if we've got a good pursuit plan after the patient leaves, first of all, we
24:04
need to make sure that's comprehensive, that we're not eliminating anybody from that list because doc doesn't like to do fillings. So we're not putting fillings
24:10
on that list. No, we're clinical providers at the end of the day. Like we have to ensure that we're doing what's
24:16
right for the patient, which is to pursue them. And so make it a comprehensive list and make sure that
24:22
the person that that is calling is actually has some enthusiasm for this task. And I know it's hard. This is not
24:28
an easy job to pick up the phone and call these patients. But if we view it as what it is, which is a clinical care
24:37
call. It's not a schedule filling call. It's a clinical care call. Then I think we can approach approach that with
24:43
enthusiasm. And that then goes to our retention goal, which I think even in our office, we've
24:49
got um the person that took over scheduling these and
24:54
um I think even one of the hygiene team members who kind of oversees things was
24:59
like, well, I don't think she is. It's like she's checking a box. Did I
25:05
make that call? Okay, so I called you. You didn't answer. Now I sent you the email and now I'm going to do like she's
25:10
going stepwise check. Okay, this patient still doesn't respond. what's the next step? And she's just going down the tree. And my hygienist was like, I can't
25:19
remember exactly what she said. She's like, I would approach it this way. Like if the parent is like, I don't have
25:25
insurance or my insurance is changing or whatever. She's like, unless the patient specifically says, do not call me, then
25:33
we need to call them back. And I think that was kind of what it was. The person, the parent was like, no, no, no, I'm not ready to schedule or no, I don't
25:40
whatever it was. And the person doing it was kind of like, "Okay." And would punt
25:45
it off. And my hygienist was like, "You need to dig a little bit more. These kids are going to be hurting." Yeah.
25:51
And so I think from Yeah. Certainly from a clinical perspective, a lot of times they can see
25:56
what this tooth is going to look like versus somebody the front may not, but it it is. It's going and saying our job
26:03
while we walked in this door was to take care of people and their health. Mhm. And if we're not following up on that,
26:09
we we know what's going to happen. Yeah. So, why are we what are we how are we
26:16
trying to get this patient to understand now? It did that patient go down the street to a different dentist who took
26:21
their insurance maybe. But at least we're making that call to say, "I just wanted to make sure your needs were taken care of. I just want and so I
26:27
think that's what we decided to do was then I think now we're going to have like the first line of call is going to
26:33
be the you know the person who's in charge of that but then if they don't schedule then then the next person
26:39
is going to be person is going to be a clinical person who's going to be like let me just make sure like did you
26:44
understand or is there anything I can clarify about the treatment for you because we tend to see and then they can
26:49
speak from their own experience because we tend to see kids with their faces blowing up we went we're trying to go on vacation and now we can't or whatever it
26:56
may be. Yeah. Um Okay. So my question for you then back to the original question of do you
27:01
track your retention and I think most of us if we've got a Bethany we do. My guess would be if you don't have a
27:08
Bethany chances are you are not tracking your retention or you are tracking it but then you are
27:14
not doing anything about it. I I would my gut would tell me just knowing myself that's so let's start with if I never if
27:24
I if I'm listening to this podcast going oh god how do I get started so what
27:29
would you say is the first place to start yeah it's getting familiar with the reports that you need to pull so I I've
27:36
been thinking about this since you asked the question how to to be able to simply explain this so I use the term macro
27:43
micro a lot I as a consultant I tend to look into when I'm in your office
27:49
pulling reports I tend to start really big picture as broad out as I can span
27:55
to kind of see looking down from up here what are little spots that look
28:00
interesting to me that I need to dig in further and then the micro view is
28:06
taking that subject matter whatever I choose to kind of jump down into and go
28:11
okay let's look at it this from several different angles So, I would say first and foremost, we want to get a big
28:17
picture macro view. And there's a couple things that we can do to pull those reports. First and foremost, you can
28:24
pull a report that shows you how many patients you saw for any period of time.
28:30
I think it's better macro-wise to go as big as possible, which I would do year-to-year comparison. So, if you're
28:37
just now starting to pull these reports, I might go back to 2023 and go, "How many patients did we see in our practice
28:44
in 2023? How many patients did we see in our practice in 2024? Did that go up?
28:49
Did that go down?" If it went down, it doesn't mean it's a overwhelming problem unless you had a whole lot of new
28:55
patients that year. And then I would go, why the heck did that go down? Because if we had 300 patients that year, new
29:02
new patients that year, then why did we see 300 patients less? That means we
29:08
actually lost 600 patients because we added 300 new ones and we lost our total
29:14
count went down 300. That's a pretty big problem. Um, so how many did I see? And
29:19
then pull one more year as a third comparison because you just want to see big picture how many patients. That's
29:26
the easiest quick. Now, if everything looks like, yeah, I went up, I went up, I went up. Let's not just assume it's
29:32
okay because patients seen in most softwares, it also tracks the number of
29:37
times they were in your office. So, it doesn't usually count individual like
29:43
how many times was Joe and his family in our practice. It counts how many appointments did Joe have as a part of
29:50
that number. So, if Joe had an extension an extensive treatment plan, it could be
29:56
that we it looks like we saw a lot more patients individual appointments, but really Joe took up 12 of those. So, I
30:03
don't I wouldn't just pull that and assume it's okay. But if I pull it and things went down, that would be a
30:09
concern for me, especially if we have new patients. So, that's the first picture.
30:15
Can I stop us there? Unless you want to come back to it, but okay. So, that's the first picture. Let's assume we did see that down. then what am I doing
30:21
about it? Yeah. So, that's where we dig in. So, even if the numbers look good, if if this is your first time pulling them,
30:27
I'm still going to tell you to go micro. So, the macro gives us like a big picture. If it went down, there's a
30:33
problem. We're going to do a lot of digging. If you pull the digging the micro, the digging is the micro view.
30:38
So, once we pull down, so that's our big picture look. Now, we're going to pull down. And I would track it in two
30:45
categories. Although there's a third category that I really like, but let's go with the two for now. So, hygiene. Uh, if you're a
30:53
practice that has any type of recall, ortho has recall, pedo has recall, perio
31:00
has recall, most have some to some type of retention. The only one that doesn't
31:05
have like a true prevention type program is going to be oral surgery. Endo and endo.
31:10
Yeah. Okay. Yeah. Um so those two we we are going to go with just the second um option. So
31:18
hygiene prevention recall whatever you want to call it. I would get in and I would take your first micro view to be a
31:24
quarter. A quarter is 3 months and I would compare if I were to look at where
31:30
it's a difficult time of year to do this. Let's just go I'm just going to forget what time of year we're in right now. But let's say I were to look at
31:36
January, February, March. I would want to look at how many recalls or how many
31:42
hygiene patients we have due during January, February, March. Let's go with
31:48
easy math and say that for those three months, it's 300 patients that we have
31:53
due. Then I take that number. I'm like, okay, 300 patients were due. Now, how many
31:59
were seen during that period of time? And you can pull that by looking at the
32:05
procedures that were charged out during that 3 months. So I'm going through pulling those three months of procedures
32:11
and I'm looking at let's say for your practice it would be proy adult proy child for an adult practice it might be
32:17
proy adult proy child pero maintenance um for ortho it would be their you know
32:25
retention whatever they call it growth growth valuation growth and development
32:30
whatever you want to call it for that but you would pull those codes and go okay how many did we see during that
32:37
particular ular time. And then if that number is 300, you're
32:43
like, that's fantastic. 300 people were due and we saw 300 people. What often
32:49
happens is we're off that mark a little bit. So maybe we saw 275 out of the 300.
32:57
That to me is the best mathematical retention. So we're always aim industry
33:02
standard is we want to always be at 90% or greater. So, if the number that you
33:07
pull is less than 90%, it indicates a true problem. If you're at 90%, I would
33:13
say you're still not safe. We need to really look into this. If you're batting 98%, honestly, I'm thrilled with that.
33:20
Um, could we bat 100? Yeah. So, you I would still say it's worth looking into, but there's not going to be a ton of
33:26
room for improvement because people move in pedo, people age out
33:32
in adult crisis, people die. I mean like we it's hard to retain 100%. So I would
33:38
say 98% is going to be it'd be hard to find areas improvement. So if when you
33:44
pull that you're like okay 290 out of 300 that's pretty darn good. I would
33:50
still look a little bit further and go let's look at the previous quarter. Let's look at October, November, December. How many were due? How many?
33:58
So let's say you're consistently low. This is where you go even further micro and you start a why who who is on that
34:06
list that's not scheduled. So denturric that's the continuing care list. Um
34:13
Eaglesoft calls it the recall report. A lot of them call them a recre list. So
34:18
you want to actually look at who was due during that quarter that didn't come in. And you just go start looking at those
34:25
patient charts and you go okay were they scheduled and then they canled. I see this. So many times when I look at this
34:31
report, I'll see patients on there that were on the schedule originally and they canceled at some point. It's the easiest
34:37
way to lose patients in a practice. And so then I'll find people that just never scheduled their recall. Okay, what was
34:44
our pursuit of that patient? Did they get emails, text messages? Did they get phone calls from us? How often have we
34:49
pursued them? I'll be honest, a lot of times it's just the auto messages. if
34:55
they've got a weave, for example, it's like, okay, they're getting all the weave messages, but they've gotten nothing else from us. And to me, that's
35:02
a that's a problem. Um, so you want to do a microscopic view to see what's our
35:08
pursuit of those patients. And then while you're looking at that, let's say you do have a really good pursuit
35:13
program. Y'all got a really good one. Um, where is are are the efforts that
35:20
we're making effective? So, let's say that we look and we're like, "Oh, yeah. They got all of the auto reminders from
35:26
Weave. And then also it looks like Sally called. So you say how would I or we would look?
35:31
Where are you looking? Like for us, you go into our office journal cuz that's our system of where we document that.
35:37
Yeah. Or Weave has a log or Yes, Weave has log, but I if you're just
35:43
logging through weave, I don't like that. I like where it sync syn synchronizes in with the practice
35:50
management software because I like for all of those pursuits to be a part of the patient record.
35:55
It provides us with some clinical protection to show that no, we've pursued this patient. So then like for example, if Amy in our
36:03
office called Miss Jones and then she made a journal note, but that could also be a skewing thing
36:10
if you don't have a system where you're supposed to track that or if Amy was new and didn't know she was supposed to be logging that in the journal. So, you
36:16
might have some digging and then some still some questions. Yeah. Let's say that sweet Sally at the
36:23
front printed out a recall list and she's calling off that list, but she's just making all of her notes on that
36:29
list and none of that's getting into the patient record. So, the pursuit could be there. We just don't know what the
36:35
pursuit is is because it's not attached to the patient record. So that's another aspect of this that as you dig in you
36:42
may realize you have a documentation problem and you need to address that and get those items in the chart. So anyway,
36:49
I would say big picture. Are we growing in patient base? Micro, look at it quarter by quarter. Are we seeing a
36:56
trend or are are we always off in quarter two? Because you can go back and
37:01
pull this as far back as you want to pull. Like what the heck is going on in April, May, June? Every April, May,
37:07
June, we're down. Like 300 patients are due and we see 200. What in the world is
37:13
going on? and we go and look and our beloved hygienist, she takes a one-mon vacation every May and we're always
37:20
we're always light or oh doctor loves to go to Alaska in May and that's that's
37:27
always his vacation time. He takes a couple weeks off. Now eventually that should if that's consistently happening
37:34
in quarter 2, then eventually the recall numbers should go down to reflect that. We shouldn't have 300 patients due every
37:41
single year if that's our norm. But if that was a new thing or sometimes it's May, sometimes it's it's July. It just
37:48
depends. But what my concern is is it let's say quarter 1 we look solid. We're at 95%
37:54
retention. Quarter two terrible 70. Quarter three 95. Quarter four 95. We've
38:01
lost a crap ton of patients still by the end of the year. And so that we can't just look at one quarter and assume
38:07
everything's okay. Um but if you constantly have a low quarter, dig in.
38:12
Why is that? What's What's going on that's forcing that lower retention during those months? So, that's how I
38:19
would look into it for a from a hygiene recall standpoint. Then you've got the second category, which is what we've
38:25
kind of been talking about treatment wise. So, a lot of the softwares have a
38:31
treatment statistics report. I found that it's not super reliable, but it's
38:37
still good to pull it cuz it doesn't matter if it's unreliable. Like a lot of the reports I'll pull will show like a
38:43
12% acceptance. And I'm like, "Holy moly, that sounds bad." But when you look into it, they're tracking it by
38:48
dollar amount. So if we've got a doctor that gives three options to a patient,
38:55
hey, you can do a bridge to replace that tooth, you can do an implant, or you can
39:01
do nothing and do a partial. So those three options are showing up as
39:06
dollar amount diagnosed, but they're not going to choose all of those. they're only going to choose one. And so
39:12
sometimes, don't be alarmed if you pull that treatment statistic report and you're like, "What in the heck have we been doing?" You want to actually dig
39:18
into the unscheduled treatment list is the second component. So your macro view
39:23
is the treatment statistics. Your micro view is let's go actually pull an unscheduled treatment list. Every
39:30
software has this or you can build one in the dental software. Let's look at
39:35
quarter one, who all was due for treatment during that quarter and who didn't schedule. But when you're looking
39:41
at that list, you're looking for repetitive trends, right? So, if I pull that list and there's 10 patients on
39:47
there and every single patient was recommended a crown, but we got a ton of fillings on a
39:53
schedule. Okay, what's the why? Why can't we get people to schedule crowns? So, and sometimes there's not trends,
40:00
sometimes there's not, but a lot of times it's like, okay, this is pretty pervasive at this point. So, those two
40:06
categories, treatment statistics and then unscheduled treatment, but doing the same micro look where you're auditing patients from that and going,
40:14
first of all, is there any trends? How have we pursued this patient? Sometimes I'll step into a practice that's really
40:20
good with their recre or recall program and they're terrible with unscheduled treatment pursuit. Like, there's none.
40:26
We haven't pursued the patient at all. And that's a concern to me. Yes, I care about it from a practice standpoint, but
40:31
I care about it from a patient care standpoint more more than anything else. Does that answer your question?
40:37
It does. This has g me a headache, man. It's a lot.
40:43
Put you on the line for like in the playbook maybe. Can you kind of put a so for people that
40:50
are tracking it or whatever and you just want to make sure you're doing it right, maybe this document would still be useful for you to go. But for those of
40:56
us that are like, okay, um, she knows what she's talking about.
41:04
Ain't nobody got time for that. I'm just going to, oh no, that's could be in the operatory
41:09
right now doing something to someone. I don't You're going to You're going to do the
41:14
schedule looks busy. We're good. Yes. Yes. Two patients, that's better than one. We're good, ladies. We got
41:21
this. Um, so can you make something for the playbook tip and then you'll put it on the hub as somebody wants to go back
41:27
and kind of maybe just even a system for those of us that are way overwhelmed with this to
41:33
just be like, okay, you may not have a Bethany to dig into all of this, but just even if you once a month for two
41:40
hours you did this. Yeah. At least that's better than nothing. Something's better than nothing. And the
41:47
other thing I would say is that maybe it doesn't even have to be you necessarily for all of it. You probably have a team member that is either needing more hours
41:55
and could at least pull reports for you is loves the math and
42:02
loves digging through or loves the you know I really want to take care of these patients and I want to know why Mr.
42:07
Jones didn't come back. Was it an insurance thing? Was it you Susie who didn't explain the insurance right? Was
42:13
it you do who whatever? Like you may have people on your team that can help you
42:19
fill in the gaps and try to figure out what little tweaks you might need in your system. I I agree. Yeah, I think it's worth all
42:27
of those steps and yes, we'll get you guys some support cuz I know it's a lot. It's it's a complex subject matter but
42:34
so critical to the patient and to the practice for that matter. So, um, yes,
42:39
if y'all don't know what we're talking about with Playbook and the hub, um, check the notes to this video and we'll
42:46
link you to our subscription and to our hub. Who doesn't know about the playbook and the hub?
42:51
We can't assume that everybody knows. If I know
42:57
if I know as a main contributor there. All right. Hey, thanks for
43:04
joining us. I I hope that you enjoyed this different format. Oh, wait. Let's move back to our professional mode.
43:10
Thank you. It's been a pleasure having you in the podcast today. Thank you. Oh,
43:19
thanks for joining the conversation today. We hope that you are comforted in knowing that you are not alone, but we
43:26
also hope that you're walking away with some really great tips and tricks to try in your practice.
43:33
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As always, please know that we are rooting for you today as you manage your
43:57
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