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Episode #496: What Are You Willing to Do?, with Rachel Wall, RDH, BS

the best practices show podcast Nov 09, 2022

You want a successful, profitable practice. So, what are you willing to do to achieve that? There are a few key things you should be willing to invest in, and Kirk Behrendt brings back Rachel Wall, CEO and founder of Inspired Hygiene, to help you identify what's worth doing to help your patients and your practice. To hear her advice for elevating your systems and your practice, listen to Episode 496 of The Best Practices Show!

Episode Resources:

Links Mentioned in This Episode:

Overjet: https://www.overjet.ai

Pearl: https://www.hellopearl.com

Denti.AI: https://www.denti.ai

Dr. Roy Shelburne: http://royshelburne.com

Inspired Hygiene’s Standard of Care worksheet: https://www.inspiredhygiene.com/standardofcare

Main Takeaways:

Be willing to commit to a high standard of care.

Be willing to look into medical reimbursements.

Be willing to get out of your comfort zone.

Be willing to consider assisted hygiene.

Be willing to train and to delegate.

Be willing to use AI diagnostics.


“There's not one way to run a dental practice, and there's not one way to elevate and improve a hygiene department either. And you're going to hear a lot of great things from all of Kirk’s guests. If you get one little pearl and put it all together, it’s going to make an amazing difference.” (5:05—5:21)

“You want to have as few denied claims as possible. We’re playing in that lane. We want to have as much success for our patients in our practice as possible, from a clinical and a financial standpoint. So, what are some of the things that we can arm ourselves with to be able to make sure that our diagnosis is ironclad, and our documentation is ironclad, and that our systems within the practice are supporting the hygienists to be able to have the time that they need to do a diagnosis? Because that's always the knee-jerk reaction with this. We’re in this age right now of like, ‘Okay, something’s got to give.’ Hygiene wages are going up. Reimbursements are going down. And the first thing everybody thinks about is time, ‘Well, we’ve just got to see more patients in the day.’” (10:47—11:41)

“Consider something like assisted hygiene. Dentists have been working with dental assistants for a hundred years, and it works really, really well. It can also work really, really well with a hygienist when they're willing to help train this dental assistant.” (12:34—12:51)

“The dentists that tend to have the highest production per hour are delegating to the top of their state regulations. They're delegating and they're training their assistants to be at the top of their game so they can do as much as possible. So, same with the hygiene assistant. What can we delegate? They can be an extension of us. We’ve got to be willing to consider that, at least. And that patient may still be in the chair for the same amount of time, sometimes even longer, if they're working with the hygienist and an assistant together. So, that might be one thing that you say, ‘Are you willing to consider? Are you willing to do this?’” (13:14—13:51)

“Assisted, or I've heard the term “team hygiene” — which I love. I love that because that's really what it is — they're working together as a team. And yes, you now have the opportunity to see more patients. But the patients may be spending the same amount of time in the chair. So, if you're working out of two columns, typically, what we say is your hygienist with an assistant can see 50% more patients than they can see with a straight column. And the other thing that’s really cool about it is, if you have an assistant who is X-ray certified and they can use the digital scanner to take great impressions, they could do other things in that extra chair where the hygienist is seeing patients. So, you can put in an emergency patient there. You could put in a digital scan there. Maybe that assistant is helping the doctor prep for a consult when everybody is taken care of. So, there are a lot of different things you can do.” (15:17—16:21)

“If you are in a model that is very heavy in in-network participation, you have communicated that your environment is very insurance-friendly. And so, your patients are coming with an expectation that you are going to follow whatever their plan dictates. And if you don't follow that, then you either have to have some very clear financial and treatment conversations ahead of time, or you're going to have to have some very difficult conversations on the back end. And we don't want that.” (18:20—19:00)

“Most financial surprises are not fun, so you don't want to have those in your practice. And there are times when you're going to have to talk to patients about a treatment that you know their insurance is not going to contribute towards the cost of that procedure. You are going to have to have some of those conversations. But if you're in this model, your patients are coming to you with this expectation. So, you want to reduce your chance of these claims getting kicked back as much as possible because that's going to cost you time, frustration, money, and probably some patient relationships. So, this AI technology with the diagnostics, I'm going to say three that I know of. There are probably more. Overjet, Pearl, and Denti.AI. So, these are the three that I'm seeing on the market right now, all very good. I recommend everybody take a look at them.” (19:13—20:10)

“My interpretation of [AI diagnostics] is, it is technology that reads your radiographs, and it gives you information on the radiographs that you probably either can't see or is difficult to see with your eye. And it calls out and creates awareness for the provider and the patient on what the X-ray is revealing. So, for this particular example of what are you willing to do, are you willing to invest in this type of thing? Because this is going to also help create consistency between your providers.” (20:32—21:05)

“I'm going to say something that might get somebody’s hackles up, but I'm just going to say it. In a very heavy in-network participation type practice, it is very common, not always, for us to have this philosophy, ‘Well, insurance doesn't dictate treatment.’ But I'm going to challenge that because I see it happen every day. Team members will say, ‘Well, there has to be obvious bone loss, or there has to be three millimeters of attachment loss in order for insurance to pay for it. So, that's when we start perio therapy.’ Well, that right there is allowing insurance to dictate treatment.” (22:30—23:14)

“[When you use AI diagnostics], you could say, ‘This AI technology is showing us there's three millimeters of attachment loss here on this X-ray. And we’re going to send this image to the insurance company, and we know that that is their threshold. They're going to reimburse and accept this when there's at least three millimeters of attachment loss. Now, we have another layer of documentation to prove why we made the decision to do this type of treatment with this patient. And we’re also documenting bleeding. We’re also documenting medical risk factors, and we’re sending all of that to the insurance company with that claim.’ So, what are you willing to do? Are you willing to have multiple layers of diagnostic documentation? Because that's going to help you.” (23:52—24:35)

“You want to make it easy for your patients to say yes to the treatment that you feel is in their best interest. And so, it’s important for dental providers first to have lots of ways to offset that or help our patients pay for that treatment. So, medical billing and medical reimbursement may be one of those things . . . You may exceed this patient’s dental benefits as you move into more complex and more comprehensive care. So, with what you're doing, you may want to look into this and learn some of this to be able to have even more benefits for your patients.” (31:15—32:00)

“Any time we want to take something from where we are and make major improvements, we have to get out of our comfort zone. So, we’ve got to talk about what are we willing to put on the line, what are we willing to invest in to help us be successful and get there. And it’s never just one thing.” (32:04—32:22)


0:00 Introduction.

2:41 Rachel’s background.

3:33 Why this is an important topic.  

10:09 What are you willing to do?

11:42 Are you willing to consider assisted hygiene?

13:51 Assisted hygiene, defined.

17:52 Are you willing to consider AI diagnostics?

20:11 AI diagnostics, explained.

24:36 The problem of documentation in dentistry.

26:37 Why standard of care is important.

29:50 Are you willing to look into medical billing and reimbursements?

32:46 Last thoughts.

34:46 More about Inspired Hygiene and how to get in touch.

Rachel Wall, RDH, Bio:

Rachel Wall, RDH, BS, coaches dental teams to build highly productive hygiene departments by implementing systems for high-quality periodontal care, enrolling restorative care through hygiene and letting go of negative mindsets and old beliefs while managing the logistics of a high-performance hygiene department.

Drawing from her 20-plus years of experience as a hygienist and practice administrator, Rachel delivers to-the-point clinical speaking presentations around the country. Her interactive teaching style coupled with a workshop environment creates a learning space where dentists and team members are compelled to get to the heart of what’s held them back and are inspired to reach for more for themselves and their practices.


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