A Dynamic Change by Dr. Jason Battle

A Dynamic Change 

Dynamic scheduling can improve the way you practice, the orthodontic industry and your life

by Dr. Jason Battle

Dynamic scheduling is a buzz phrase that has been going around the orthodontic field lately. In this article, I will clarify what it is, the benefits and costs, and how best to implement it into your office, based on my own experience.

What is dynamic scheduling?
Dynamic scheduling is the process of scheduling patients when they need to be seen, instead of at regular intervals. This breaks one of the cardinal rules of orthodontics: “Don’t let your patient leave without an appointment.” With dynamic scheduling, patients will indeed leave your office without an appointment, and only when you determine through a remote monitoring app that they’re ready for their next appointment, wire change, elastics or space closure will you call them to schedule. (Our practice has had great success using DentalMonitoring for remote monitoring.) You will use notifications in your app to prepare for broken brackets or hygiene instructions.

This is scary territory for many orthodontists to enter, but once you leap the mental hurdle of not scheduling using the traditional six to eight weeks, the benefits to your practice are tremendous.

What are the benefits?
  • Time is valuable—maybe even more than money. With dynamic scheduling, you can use your time and your team’s time in the most efficient manner possible. This often results in fewer overall team members and less overhead, because you schedule based on patient needs and not only on industry norms.
  • More oversight on patient care. Patients are no longer going six to eight weeks without supervision.
  • Better communication with patients. Patients have direct communication with the doctor or team member through an app.
  • More data for patient records. You know what happened, when it happened and why it happened. This is beneficial for patient and team member education, plus communication with referring doctors.
  • Fewer no-shows and rescheduled appointments. Because you’re scheduling when your patient needs to be seen, instead of every six to eight weeks just for a visit’s sake, patients are more likely to attend their appointments.
You probably don’t need the capacity you currently have; so many patients are cancelling, rescheduling and no-showing to appointments that you most likely are overstaffed. For example, if you have four assistants who see 15 patients per day, your capacity in a four-day workweek is 240 patients. In many cases, 40 to 80 of those patients won’t attend the appointment they were booked for. This is a hidden tax on your practice your front desk will never tell you about. They have no incentive to efficiently manage your schedule, because your team gets paid the same whether your practice sees 240 patients per week or 120 patients per week. However, you may be paying your assistants two to three times to see some of the same patients.

Dynamic scheduling helps fix this issue because you schedule patients only when they’re ready and available. So instead of spreading 180 patients across a weekly 240-patient scheduling block, you’ll book only 180 patients. This eliminates four patient columns per week, one patient day per week, or the need for one assistant.

What are the costs?
  • Depending on the features and volume use, an app such as DentalMonitoring will cost 2%–3% of collections. This should be offset by a 5%–10% decrease of your overhead through payroll reduction, creating a more efficient practice. There are no worries of sudden sticker shock because you won’t onboard all patients immediately, so the price will slowly increase month to month.
  • During the process of onboarding patients, if you lose team members because of attrition, replacing them isn’t always necessary.
  • Some patients will be hesitant about the new technology; some will be inconsistent with scanning. These patients will lower the cost of monitoring. A patient who refuses to scan can still be scheduled at regular intervals.
How is it implemented?
  1. All active patients need to be onboarded with your remote monitoring application. This will take some time, so to make it easier, consider starting with your new patients and those whose treatments have more than six to 12 months to go. This likely will be 50%–75% of your active patients.
  2. Write out your treatment protocols, when you like to see your patients and what the next procedure in the series is. A generic treatment plan, for example:
    1. Bonding appointment, with 0.014-inch nickel titanium (NiTi) wires.
    2. Reposition appointment, with 0.016- inch NiTi wires.
    3. Reposition appointment, with 0.018- inch NiTi wires.
    4. Reposition appointment, with 0.018-by- 0.025 NiTi wires. Start elastics.
    5. Reposition appointment, with 0.018- by-0.025 stainless steel wires. Continue elastics.
    6. Start finishing bends.
    7. Evaluate finish.
    8. Deband.
    Always write the next procedure notes in this chart so your team members know how long to schedule appointments. For example, if your first appointment is to bond upper and lower brackets and place a 0.014-inch NiTi wire, write what you want to do next into the chart. “Next visit, reposition brackets, 0.016 or 0.018 NiTi wire, 30 minutes.”
  3. Set the monitoring goals you want to see before the patient’s next appointment, and an interval for when you think that might happen. For example, “Goal: wire passivity of 0.014-inch NiTi wire. 8–12 weeks.” You can also set goals for other metrics, like:
    • Class I canine or molar.
    • Midline, normal overbite or overjet.
    • Anterior space closure.
    • Extraction space closure.
    • Correction of crossbite.
    • Loss of deciduous teeth.
  4. Pre-set your “90-day notifications”—alerts that auto-activate in case you or your team forget to set patient goals. You will be reminded to check in on your patients every 90 days no matter what, to ensure treatment is going as expected.
  5. Let your patients know that you:
    • Are investing in the latest technology to improve their treatment outcome.
    • Expect a scan once a week. Missing a scan is like missing an appointment.
    • Will review the scan once a week to coordinate and plan future treatment.
    • Are available through the messaging app, but if they want to schedule or reschedule an appointment, it will be faster to call the front desk.
    • Are scheduling all future appointments around the progress of their teeth and their needs.
  6. After a month or two of onboarding patients, implement dynamic scheduling. Don’t schedule their next appointments; let them know you’ll monitor them through the app and will call them when it’s time to come in. Within a few weeks, your schedule will empty, leaving large holes in the late morning and early afternoon (the least desirable appointments). Use this time to have assistants with few patients review the app for patients who have “goals due” (need to come in) or broken brackets/wires. Have them write down the amount of time needed for each patient, then have them or the front desk call or text the patient to schedule these appointments.

The specifics in my practice
We’ve found that our schedule now doesn’t completely fill until about 48 hours before the patient day. Early morning and late afternoon appointments are available in less than a week’s notice because patients are no longer “appointment camping”—clogging the schedule with appointments they can’t make or intend to reschedule at the last minute.

Also, you won’t need to run as many columns because your patients aren’t occupying as much of the schedule. Reduced columns will equate to a reduced need for assistants. (Assistants don’t need to be fired! They can get involved in practice marketing, cross-training or helping add capacity to see more new patients.)

The percentage of patients you choose to onboard when you start dynamic scheduling will determine how long it takes to completely onboard the majority of your patients. If you choose to onboard only 50%, for example, it will take about 12 to 15 months; if you start with 75%, it will take about six to nine months.

Onboarding will take additional chair time. To not overwhelm your practice in the beginning, start scheduling your patients out two additional weeks to prepare. If you normally schedule every six weeks, then schedule every eight weeks before you get started. This will alleviate your schedule and free up an assistant who can do nothing but onboard patients all day. You can even onboard multiple patients at the same time at your tooth-brushing station.

Once all of your patients are onboarded and you’ve implemented dynamic scheduling, you should see relief in your schedule in about four weeks. After that, your schedule will become less hectic every month until you’ve onboarded 100% of your patients.

When this happens, you can see the same number of active patients with fewer chairs and assistants, and will be at a delightful fork in the road. Do you see fewer patients per day, or see the same number of patients in fewer days? I chose the latter—same number of patients per day, but working fewer days. Making money is great, but nothing is better than making more time: Time for family, time for improved health, time for vacation, time for a passion or hobby. You will have time for whatever you want to do, without sacrificing patient care. That’s a life-changer!

Making closer connections

Through the remote monitoring app, I can create closer relationships with my patients through the messaging feature. My team handles most messages during the week, and I respond on weekends. I get eight to 10 messages each weekend, mostly with simple questions about treatment. Patients love that I’m available to them and it adds an additional layer of customer service. There are many ways to create connection points with patients through the app, including in-office appointments, phone calls, email and messaging. The app allows us to augment those connections to make them stronger.

I’m sure there are other ways to implement dynamic scheduling, but in my experience and after speaking with other doctors who have implemented dynamic scheduling, I believe this is the easiest way. There are only 168 hours in each week; dynamic scheduling allows you to maximize those hours by reducing no-show appointments and not wasting chair time with meaningless appointments, resulting in less time physically inside your office.

I hope this helps you reclaim more time, and I encourage you to get in touch if you have any questions. Leave your comments or questions under the digital edition of this article below!

Author Bio
Dr. Jason Battle Dr. Jason Battle is a technology-loving, leading-edge specialist in orthodontics, with more than 19 years of experience treating some of the most difficult cases and people possible. He is well-known in Orlando for two things: delivering amazing smiles and grilling incredible BBQ, both served hot. Since 2004, Battle has been practicing orthodontics and dentofacial orthopedics in Florida and has successfully treated thousands of patients. He treats his patients like family and fully incorporates them into all aspects of treatment. Communication, openness and respect are his top priorities.

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