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893: 3 Keys to a Full Schedule – Miranda Beeson

Is your schedule looking a little bit empty? It’s time to take back control! In this episode of Practical Solutions Day, Kirk Behrendt brings back Miranda Beeson, ACT’s director of education, to break down the hidden reasons why your schedule isn't full and what you can do to fix it. Full schedules don't happen by accident! To learn the three keys to a consistently full schedule, listen to Episode 893 of The Best Practices Show!

Learn More About Miranda:

Learn More About ACT Dental:

More Helpful Links for a Better Practice & a Better Life:

Episode Resources:

Main Takeaways:

  • Figure out how much you're diagnosing and if it’s enough.
  • Identify how many patients are saying yes to treatment you present.
  • Of the treatment you present, how much of that are patients saying yes to?
  • A consistently full schedule only happens when you put clear systems in place.
  • Use resources like Pearl to improve your patients’ understanding and to gain trust.

Quotes:

“A consistently full restorative schedule does not just happen — we have to make it happen. And it tends to be a result of when we are really clear-headed and we are using data to guide our decisions so that we can diagnose, we can communicate those diagnoses, build value with our patients, and then ultimately gain acceptance so that they're going to schedule before they leave. Then, we won't have that pre-panic anymore because our schedules are full.” (3:49—4:15) -Miranda

“Recession has come up more often lately. There's always holidays, there's always, ‘Well, it's spring break,’ or, ‘It's summer,’ or, ‘Everyone is paying for summer camps now.’ There's always a reason or something you can do to justify why people aren't saying yes, or why that person didn't say yes to treatment, or why the schedule is starting to fall apart. I think those are rationales that you're trying to give yourself to make yourself feel better when we don't know that there's truth in them.” (5:39—6:08) -Miranda

“The first thing I think you need to ask yourself is, how much are you diagnosing? We know, first and foremost, that to have a full schedule, you have to diagnose treatment. So, the first thing that we look at together is, what is your diagnostic percentage and what is it telling you? Meaning, of the number of exams that you've completed within any given period of time, what percentage of those resulted in you creating a new treatment plan, diagnosing something new, whether it be elective like veneers, or it's therapeutic such as a crown for a cracked tooth, whatever it may be. So, you're looking at that diagnostic percentage to try to say, of the potential opportunity I had this week, this month, whatever it might be, to diagnose, what percentage did I do so? A benchmark is going to be around 40%, 45% of the patients that you're seeing for exams, there's going to be something diagnosed.” (7:42—8:42) -Miranda

“I think the first thing you really have to do if [your diagnostic percentage is] low, whether you're a wuss or not, is to revisit your treatment philosophy, in general. Are you more proactive or are you more reactive? Not to say that one is better than the other, and maybe there's a happy medium of a little bit of both. Do you make assumptions for your patients? Like, in your mind, are you thinking, ‘Man, that old amalgam is looking worse every time she comes in. But it's not hurting yet, and I know that she struggles because she's on a limited income,’ so you don't mention it. You say, ‘We're going to keep watching that one. Let me know if it ever starts to bother you.’ Are we making some of those assumptions erroneously? Do you perform what you like to call a “wallet biopsy”? Are you making judgments about whether they can or can't take care of it financially, and then allowing that to weigh into your treatment and diagnosis process? Do you consider insurance? I've seen dentists in the past in offices I've worked in that won't recommend a new crown — even if there is an open margin — because they know that there's a five-year clause and they're probably not going to get any reimbursement for it for another couple of years. They'll recommend it later when they know that the patient will have some insurance coverage. But what's going to be happening to the bacteria within that open margin for the next two years? So, I think the first step is you have to revisit your treatment philosophy and decide how you want to be taking care of patients, and really, really look in the mirror and reflect on, do I create some limiting bias or assumptions? Do I perform these wallet biopsies, or am I truly presenting all of the information to the patient and allowing them to make that decision for themselves?” (12:12—13:52) -Miranda

“My key is always making sure you know what the goal is of your patient. What do they want for themselves? If you don't ask them, you're truly assuming what they want for themselves. So, asking them their goal from that very first visit, and then periodically asking that question again. In our Best Practices Association platform, not too long ago in the forum, somebody said, ‘What's some good language for my hygienist for when the patient first sits down other than just, how are you feeling today?’ I think a great thing is if you have a goal that you've already documented and established with your patient from the beginning is to say, ‘Hey, we're going to revisit this goal every time you come in. When you first came in, you shared with us it's going to be really important to keep your teeth. You don't want dentures like your grandparents had. So, if I see anything today that would put you at risk toward that goal, I'd like to revisit it, if that's okay with you. Also, if your goal has changed, please let me know.’ Now, that patient's goal is always front and center, not just what we're looking at, or what we're seeing, or based on our assumptions.” (14:20—15:22) -Miranda

“If [your diagnostic percentage is] under 75%, say you're at 50% or even 62%, that's part of the reason your schedule is light, because if not enough people are saying yes, you're not going to have people in your schedule. So, what do you need to do? Start by evaluating your own self first, then lean into the team. How are you presenting treatment? I think co-discovery is how everyone should be presenting treatment because that's how you really build value with the patient, is working alongside the patient to see, ‘Hey, we're always looking for health, patient. But if we see something that isn't health, would you want to know about it?’ Of course they do. So, photos, radiographs, disclosing if you can use it. I love extraoral and intraoral photos. If you can take occlusal shots, especially wear cases, and you compare that year over year, visit over visit, anything that you can do to help raise the awareness and understanding of your patient so that they're looking at what's happening with you.” (18:09—19:08) -Miranda

“If you are behind the patient, the patient is laying down and you're calling out tooth numbers and tooth surfaces to your assistant or your hygienist and they're plugging that in the computer, we're not building value with our patient. We need to be sitting up, looking at the images, looking at everything together, and really making sure they understand and have the ability to ask questions. If you've asked their goal, you can tie that into how it would impact the goal that they've shared with you for their oral health. For me, without value, there's only price . . . So, you have to know what motivates your patients. If you're delivering the information exactly the same every single time, I would say you're probably not customizing to who is in your chair. We should be customizing to what their motivators are or how they like to receive information, which you can usually do pretty well reading someone's body language.” (19:09—20:02) -Miranda

“The next piece to evaluate to see why we don't have that level of acceptance that we should is what's happening in the administrative area, how treatment is presented in the admin area . . . I think that's where we go first, most of the time. If patient acceptance is down, it's like, ‘What are they doing up there? Nobody is saying yes. Nobody is scheduling.’ But that's why I say the first thing you have to do is look in the mirror and reflect on how you are having those conversations with your patients. Because if you didn’t build the value, there is no amount of amazing administrative saleswoman person that can close that. You have to have the value there first, but then go to that piece and say, ‘What is our process for presenting treatment?’ And if you don’t know, the first question is to ask, ‘Hey, can we pretend like I’m a patient and you walk me through how we present treatment? Because I honestly don’t even know how we do it, and I’m the leader here. I feel like I should.’ We humbly approach our team and say, ‘Let’s walk through this because I want to know more.’” (20:10—21:13) -Miranda

“Perhaps you have someone in the wrong seat. You do have to have somebody who is comfortable having direct conversations in a very nice and kind way, being able to present money and not feel bias, or feel a certain way, or make assumptions about patients. So, do you have the right people in the right seats? Are you perhaps delaying same-day scheduling because you're sending everything for a pre-authorization and waiting for that to come back before you put someone in the schedule? Do you not have financing options to create opportunities for people who maybe are going to struggle with the investment? I think it's really important for people to remember that the average American has $600 to $1,000 in their emergency fund. Most of what we treatment plan and recommend costs more than $600 to $1,000. So, it's really important to remember that when we're making treatment recommendations.” (21:13—22:05) -Miranda

“If you're diagnosing enough and 100% of people are saying yes — that's amazing — and your schedule is still light, then I would look at what is the acceptance percentage of the dollar amount. So, it's not enough to have patients saying yes. If our schedule is still struggling, then perhaps they're not saying yes to enough. So, one, you need to look at the average dollar amount that you're treatment planning. What's the average case size that you're treatment planning? If you're treatment planning one filling every time you treatment plan and that person says yes, that's great. But that's going to be 30 minutes one time. So, you want to take a look at your case size. Then, of that, what percentage of that dollar amount are people scheduling?” (23:01—23:48) -Miranda

“The difference between patient acceptance percentage and the treatment dollar amount acceptance percentage is super simple. If you have one patient who you see for an exam today and that one patient has four crowns that you recommend — and let's just say it's 1982 and they're $1,000 a piece, for simple math. So, you have one patient that you've diagnosed four crowns on. The patient schedules today for one of those crowns. They're going to show up as patient acceptance percentage 100% because we had one patient who had new treatment, and that one patient scheduled something today. However, if you look at the treatment dollar amount acceptance percentage, it's going to be 25% because they only scheduled $1,000 of the $4,000 that was presented. So, that's what I mean by, if you have enough people saying yes, are they saying yes to enough?” (23:52—24:49) -Miranda

“If you have a new patient visit that's two hours long, and they've gone through the panoramic, they've gone through the extraoral photos, intraoral photos, X-rays, oral cancer exam, periodontal assessment, you've reviewed everything, you probably did some hygiene services, the doctor came in for the exam, they're mentally drained. So, if you're, at that point, trying to present a four-step plan with five different treatment options and it's going to be $6,000, it's going to be a lot harder to have acceptance of more of that than if we say, ‘We'd love to have you back about a week from now so that we can go back through all of these diagnostics, really take the time to make sure we have everything perfect for you and give you an opportunity to process what we've talked about today,’ and we're going to sit in this private space in this consult room. The percentage of acceptance from a consult room is so much higher than chairside, even if it is the same day. You just don't do it at the administrative checkout area. You say, ‘You know what? This one, we're doing in the consult room.’ And hopefully, you have one of those. Now, if you don't, you can still do this in a way that creates a more personal space and intimate conversation than, again, the patient laying back and we're talking over their head to the auxiliary team member.” (25:38—26:53) -Miranda

“[Work] with your treatment coordinator on scheduling as much as possible on day of diagnosis. This one is pretty key, because I've talked to a lot of treatment coordinators who never really had the conversation around this. It's like, ‘Yeah, I just always schedule whatever you say is step one. Then, when they come in for step one, we talk about step two. When they come in for step two, we talk about step three.’ But the level of commitment and understanding and value for the patient is highest today because they've been in that. So, if there's a way to get as much of it on the schedule as possible right now, while they're here today, even if it is phased out — they could have appointments for the next three or four months. But if we can do it while that value is at its highest, then we're going to have a higher level of overall long-term success in them joining our schedule.” (26:56—27:46) -Miranda

“If you have a new patient that walks through the door but you don't diagnose enough, or you do diagnose enough but they're not saying yes because we haven't built value, or perhaps we have the wrong person presenting it when they go to leave that day, or we've presented a lot of things — because a lot of times a new patient, yeah, comprehensive exam, we're finding multiple things that we need to address, especially if it's been a while since they've been in. Are we creating and documenting systems for how we present that information when it's more than just one or two things? Do we have the right people doing it the right way? Do we have financing in place? Because no matter how much you recruit new patients, if these systems down in the day-to-day of it all aren't refined and well-documented and thought through, all of that marketing money that we're putting into bringing in new patients is almost to waste.” (29:16—30:03) -Miranda

“If you're a dentist and you're a wuss, a huge win is having something like Pearl, which is an AI second opinion, something that can lay over your radiographs and help for not only you, who might be on the fence about feeling confident in a treatment diagnosis to have that as a second opinion, but even more so to be able to have it for co-discovery. When your patients can see the colored visuals, the tooth structure versus these little shades of gray that we're trying to help them see alongside of us when we're making a diagnosis, it can be hugely impactful to helping you feel more confident in diagnosing. So, that first step is doing a little better, but also the patient acceptance and the dollar amount acceptance and that going up as well, because they're a part of that conversation and they're able to see it in a different way. They don't have the keen eyes that we have of knowing how to read a dental X-ray. So, I love the idea of something like Pearl and having that in every operatory to make it a little easier to make these conversations happen.” (30:24—31:27) -Miranda

“These KPIs, these three data points alone, individually, are not going to tell you the whole story. You really do need to look at them almost as a series or as a set to see where to be the most impactful. Start with that diagnostic, move to patient acceptance, and then move to the dollar amount acceptance. One without the others isn't as full of a story, kind of like when you're looking at perio visit percentage. And if you're also not looking at how much perio are we diagnosing and how much are people saying yes to, it's not as deep of a story. So, to get the full picture and to hopefully end up with a full schedule, you want to look at all three of them, and then start to dig into some of these little actionables if you see something isn't where it needs to be, or it's trending in a negative direction.” (32:48—33:36) -Miranda

Snippets:

0:00 Introduction.

1:42 Why this is an important topic.

4:24 Figure out why people are cancelling.

7:34 How much are you diagnosing?

9:35 Revisit your treatment philosophy.

17:11 Are enough patients saying yes to treatment?

20:03 Dissect your treatment presentation system.

22:37 Are patients saying yes to enough treatment?

30:06 Final takeaways.

33:41 ACT’s BPA and other resources.

Miranda Beeson, MS, BSDH Bio:

Miranda Beeson has over 25 years of clinical dental hygiene, front office, practice administration, and speaking experience. She is enthusiastic about communication and loves helping others find the power that words can bring to their patient interactions and practice dynamics. As a Lead Practice Coach, she is driven to create opportunities to find value in experiences and cultivate new approaches.

Miranda graduated from Old Dominion University, and enjoys spending time with her husband, Chuck, and her children, Trent, Mallory, and Cassidy. Family time is the best time, and is often spent on a golf course, a volleyball court, or spending the day boating at the beach.
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