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Washington State Dental Association

Sharpen Your Staff's Skills at PNDC

Are you bringing your staff to the Pacific Northwest Dental Conference this June 15-17? PNDC has some especially fun and informative speakers who will teach your staff skills and techniques that they can begin using the Monday after the conference, bringing new efficiencies, new knowledge, and new methods to improve the functionality of your practice. 

Learn more and register for PNDC at wsda.org/pndc

Cindy Ishimoto

If You Do Not PRE-pare, You Will Need to RE-pair! For Practice Success
Friday, June 16, 7:30 – 10:30 a.m.
Target Audiences: Dentists, EFDA/Assistants, Front Office, Hygienists, Lab Techs

Broken Appointments: The Black Holes of Scheduling Success
Friday, June 16, 1 – 4 p.m. 
Target Audiences: Front Office Staff

One great example is Cindy Ishimoto, a lecturer we’re bringing in from Hawaii to talk with your staff about preparation in her lecture titled “If You Do Not PRE-pare, You Will Need to RE-pair! For Practice Success.” Her experience comes from living it. Ishimoto became an assistant at age 18, went to hygiene school, and married a dentist. When her husband’s business became so successful that they needed help to manage it, they hired a consultant, who later hired her to consult. Between her consulting work and her hands-on experience running a successful practice, Ishimoto “gets” the business of dentistry. She’s also a seasoned singer and performer who loves being in front of an audience. Her knack for humor and delivery will make the experience even more enjoyable. 

In this lecture, Ishimoto will attack some core issues that every practice faces. Do you have anxiety about scheduling holes created when patients cancel? Do you feel like you’re not able to close the deal with patients? Ishimoto is going to school everyone on the dental team about their role in the three core systems: scheduling; collections; and the continuing care program. She’ll also show how being prepared for these roles can help move the practice forward. Ishimoto explains, “This lecture is a great team experience because everyone on the team is responsible for all three systems. They each hold a specific puzzle piece, and if they don’t move their individual puzzle piece, they will never take the system to the highest efficiency and effectiveness.” 

According to Ishimoto, an office can’t schedule to meet goals if assistants and hygienists don’t work to help seal the deal chairside. She explains, “Clinical assistants help patients through the educational piece of why a procedure is important. We can’t do anything if the patients don’t believe they need it. The front desk people and business assistants are only selling a chunk of time, a financial arrangement. How much does it cost, and how long do I have to be here? If the sale twists on that, the patients don’t move forward. It’s educating the patients that if they’re on a three-month visit plan because they have periodontal disease, going four months or five months could kick them right back into active disease instead of remission. So there’s a direct link between filling the schedule and effective clinical closure.” And while you might think collections are just the purview of your business and front desk staff, Ishimoto disagrees, saying, “In terms of the collections system, in order to get money out of people’s pockets, they have to value what they have received, or what they are going to receive. If it doesn’t go well, if patients don’t understand what they just got, they may be disinclined to complete the treatment plan. We can’t assume that everyone does a great treatment plan, explains what the investment will be, and clarifies to the patient that a treatment plan is only an estimate based upon two-dimensional images, so costs could be higher. In that sense, it’s the clinical team who helps educate and inform the patient about what’s going on (in terms of) the level of care they’re receiving.”

Ishimoto calls continuing care the “backbone of the practice,” explaining that “in order to keep our patients healthy, they need to keep up with their regimen of when they come to the office. If they’re not coming in and we have lots of holes in our hygiene schedule, the doctor will never be productive because he’ll be doing exams and X-rays and finding decay and fractured teeth. Two-thirds of a doctor’s production comes from patients coming for their continuing-care visits. Only one-third of the doctor’s production comes from seeing new patients. They may only see one or two new patients a day. Managing continuing care effectively means more opportunities to diagnose dentistry.” 

Doing things differently
What will attendees take away from the lecture? Ishimoto says, “What they’re going to take back are the basics that are easy to implement, and ones that they won’t necessarily need to have permission from the doctor to do. Most of the time, what I’m recommending isn’t about spending money or buying equipment, it’s about doing things differently. For example, what are the three things patients need to hear before leaving the clinical zone in order to help them understand the value and urgency to reserve their next appointment? What are the three or four financial options we can offer patients when they say, ‘I don’t know if I can afford it?’ What can we do to help them work the cost into their family budget?” Again, Ishimoto encourages dentists and their entire team to attend this lecture, explaining, “If only one team member attends the lecture, they’re going to have to teach things to everyone that may not make sense because only one brain was listening. But if the whole team attends, you have the collective mind, and everyone can share what they learned from their personal perspective.”

Canceling cancellations
In Ishimoto’s other lecture, “Broken Appointments: The Black Holes of Scheduling Success,” she’ll talk about effective measures staff can take (and yes, everyone has to be on board, not just front office staff) to head cancellations off at the pass. After all, according to Ishimoto, the most common reason patients cancel is because “something came up,” which she says is just BS for “I got a better offer.” According to Ishimoto, when the practice has a talented front office staff, a doctor and his clinical team may never even notice that a patient cancelled — they’re that good at filling scheduling holes — but it doesn’t address the core issue. “We’ll talk about where the cues need to start,” says Ishimoto, “which is chairside, with the clinical staff. Are they talking with the patient about the importance of the next appointment, or did they just ask to book him a two-hour appointment? If a patient calls to reschedule, are they making it easy for him, or are they taking the time to remind him how imperative that appointment is to his oral health? If your staff says, ‘Let’s reschedule you,’ they’re essentially giving the patient permission to cancel. When we make it easy to reschedule, they become prone to that. A reschedule is as dangerous as a cancelled appointment. You still have a hole to fill.” 

Statistically, Ishimoto says, it can take 15 phone calls to fill an hour of a hygienist’s time. Staff may not be aware when they lose an hour of time, but the accumulative effect can really hurt. Collectively for the month, they could lose as many as 24 hours, or three full days in a month. Practice management software has difficulty tracking lost hours because doctors work out of two or three chairs, so each column has a lot of open time. Since computers think linearly, staff has to measure it themselves, but the lost time can be calculated. “You have to want to track it,” says Ishimoto, “and most practices don’t. But left unchecked, all kinds of things can happen, and doctors are free to micromanage staff, which can increase stress. We don’t ever want a doctor with an hour free. They don’t want to micromanage, but now they feel they should because they’re sitting around. That’s the sign of a disease they want to cure. With every cancellation, the dentist is thinking, ’That appointment is worth X amount of dollars, how am I going to make that up?’”

Ishimoto also will discuss technology (and its limitations), and how she wants offices to consider tech a safety net, not an answer. “There’s an assumption that patients need to be reminded about appointments. Some do, some don’t. The challenge with tech is overkill. Most of the people on the business team who work with the system don’t know when something is too much. In this lecture, I’ll talk about how we can personalize our approach, as opposed to globalized vomit of sending everyone everything. Tech has good and bad. For me, the bad thing is the overkill of contacts. The receiver can turn off the onslaught by replying, ‘Yes, I’m coming,’ but many of these systems continue to send out messages regardless. Tech can help by decreasing a task list for the team. But without the work of the team incentivizing the appointment for the patient (Why do I need to come? What are the ramifications if I don’t?), then no amount of tech is going to get people to their appointments.”

Ellen Gambardella, CDA, RDA

Assisting in Implant Surgery
Thursday, June 15, 1 – 4 p.m.
Friday June 16, 7:30 - 11:30 a.m. (repeat)
Target Audiences: EFDA/Assistants, Hygienist 

Ellen Gambardella has been lecturing for 30 years. She brings her expertise to the PNDC again this year with a key workshop devoted to assisting in implant surgery. She was a full-time teacher speaking on the side, but when she retired from teaching, she transitioned to lecturing at dental conferences across the country. Gambardella stays fresh through her vast array of dental contacts, taking loads of continuing education, and keeping her head buried in a book. Because so many GPS are adding implants to their arsenal, assistants who aren’t keeping up with the technology run the risk of falling behind and becoming obsolete, she says. It’s also important to stay abreast of the options, their differences, and the instrumentation protocols for each type of implant. But what if you’re already assisting your dentist in the placement of implants? Why attend this workshop? “I equate it to CPR,” Gambardella explains. “Every two years you should have a refresher course. This will be a great refresher for those people, and they’ll walk away learning something new. For those who are just starting out? Oh, my goodness, it’s a bonanza. They are going to learn so much in the workshop!” 

Gambardella will pour over the details of implants, the preparation involved, and how the clinical team is often considered an unbiased opinion by the patients, making their role in patient acceptance vital. And while assistants and hygienists working with a GP may well only need information about one type of implant, Gambardella explains that “an assistant working with a maxillofacial surgeon may have referrals from many doctors. One of those GPs may use a Straumann, while another GP may be comfortable with a different type. So if you’re working in a specialty practice, you really do need to know more than one system. Regardless, the ongoing training is essential because the team has to be current with the changes that are taking place in the industry. They’re always coming out with new implants and surfaces that are more compatible with osseo integration.” Assistants and hygienists play such a vital role in patient education and acceptance, they’re also critical for treatment success. Gambardella will review how to plan ahead, how to stay organized, and how to be a second pair of eyes for the doctor. “The doctor is looking at the implant from one perspective,” she says, “while assistants and hygienists see it from another. The two have to be able to communicate.”

Gambardella will also review proper preparation, especially as it relates to infection control. She says, “As with all dental procedures, infection control is of the utmost importance, especially when you’re placing implants. It’s critical to prevent cross-contamination throughout the procedure, including with the implant. If there is any cross-contamination on the implant, you may not have a successful result, not to mention all of the infection control that goes on after surgery. I would say that infection control is of the utmost importance.” Gambardella is a popular presenter who often sells out. Make your workshop reservation online today!

Lori Trost, DMD

From How…to WOW! Become the Awesome Dental Assistant
Thursday, June 15, 8 – 11a.m.
Target Audiences: EFDA/Assistant

Efficient and Predictable Provisionals
Thursday, June 15, 2 – 5 p.m.
Target Audiences: EFDA/Assistants 

Dr. Trost is a dentist who practices part time when she isn’t lecturing. “It’s a great balance,” she says. “I keep my fingers wet and still stay clinically savvy, and I do a lot of research, as well. It’s a great blend for me. I’m a real geek/nerd when it comes to reading and research.” Trost’s two lectures are aimed at assistants and EFDAs. They cover how to be a better assistant, and how to create better provisionals. We wondered, would her lecture titled “From How…to WOW! Become the Awesome Dental Assistant” be strictly relevant for a new assistant? No, she says, explaining, “The lecture is pretty broad spectrum. I have a lot of attendees who’ve been in the dental field 20-plus years, and I have ones who are brand-new out of school. Dentistry is changing and evolving so much and so fast, you have to stay current. For instance, there are more than 70 different types of composites on the market right now. Not that we’re going to cover all 70, we don’t have the time, but within that range we’ll talk about the different types of composites. It’s a critical conversation because we spend about a third of our time placing composites. It’s a massively done, repeated procedure.” 

Trost says assistants need to know what types of materials they’re using and be totally prepared to make it a more efficient procedure. “You really need to figure out how the methods and techniques have evolved, what’s current, and what’s the best for a given procedure,” she explains. “There are flowable composites, and there are bulk-fill composites that allow you to place in 4mm increments versus 2mm increments. Most composites have been layered in over time, so if you have a class 2 composite restoration you’re replacing, it’s more efficient to layer in 4 mm at a time than 2 mm. It can expedite the whole process. We talk a lot about light science through clinical cases. We show how all of that has evolved, and what is working.” 

The other aspect Trost will explore is taking initiative in the practice, and why it’s so vital. She explains, “In dentistry, there are many things that compete for our focus. On average, we’re distracted every seven minutes, ranging from a coworker entering the operatory, to the phone ringing, to a request from someone. So when we look at fine tuning, it’s about being prepared. It’s not about what’s now, it’s about what’s next. When we find good assistants who are in that mindset, it helps the practice run better. So we learn about taking initiative to prepare for what’s next. Fine tuning is huge. The more we can improve that, the better.” This ultimately benefits the patients because they see your workflow is smooth, and they see the balance, harmony, and synchronization in the practice and how you handle the office, she says. 

Trost will also cover what’s current, and tips and tricks assistants can use chairside when anesthesia is being delivered or they’re giving post-op instructions to patients, and how to make things more efficient and predictable. 

Taking the stress out of provisionals
To paraphrase our current president, “Who knew how stressful provisionals could be?” Trost explains, “They create a lot of anxiety. The key to doing them properly, and ensuring a predictable outcome is to have a game plan going in. I’ll teach a couple of different methods to overcome obstacles.” For example, say you have a patient who had an accident and half the tooth is missing, and is going to need a root canal and a crown. “Obviously,” says Trost, “you can’t just mold something in there. I show strategies that will take you from A to Z to create a predictable outcome.” Currently, about 48 percent of billable procedures in offices across the country are for crown and bridge work, and for each of those procedures a temporary has to be made. “Think about that,” Trost says. “There’s a lot of wasted time, and a lot of studies right now that show us that offices lose when they have to remake or even re-cement temporaries. If they do two of those a month, they’re losing almost $6,000 of revenue a year. It’s not the cost of the actual temporary, it’s the cost to get the patient back in. It’s a disruption of the schedule. I’ll teach people how to create temporaries that last and make the patient is happy.” 

In addition, Trost will cover traumatic injuries and the way that dentistry can help provide emotional recovery. “Broken teeth and traumatic injuries are a huge part of the clinical presentation. They’re so important to getting people back on their feet and feeling good about themselves again,” she says. “ Sports injuries, elderly people falling, and just doing crazy things leave people in situations where they need a temporary. And the more experience an assistant gets doing them, the more they’re able to improvise and think on their feet when they’re confronted with a really crazy case.” Trost will provide attendees with a wealth of information, and give them a break in the middle of the lecture to test run some of the materials that will help set up assistants for success. 

She’ll also encourage them to work collaboratively with their dentists about the choice of materials. She explains, “I think that the decision of what materials to use for temporaries is best done as a choice that the dentist and assistants make together, if possible. For example, in my practice it was easy to train assistants who were new, young, and fresh because it was the only thing they had ever known, but other assistants might have had a style or method in their wheelhouse that I was able to adopt into my practice. Good team members, dentists, and assistants learn what works best in their hands. And by attending my lecture, an assistant who isn’t having success with a particular material may have a light bulb moment where she realizes that by making a lateral move, she can be successful. For instance, by staying in the same category, but changing manufacturers. It’s good stuff to learn!”

Kathy Bassett, RDH

Complementary and Alternative Local Anesthesia
Thursday, June 15, 2017, 8 – 11 a.m.
Target Audiences: Hygienists 

Kathy Bassett started her career in private practice, but now lectures and is a full-time professor at Pierce College. What’s unique about her clinical career, she says, is that 80 percent of her time was in expanded function doing just restorative and anesthesia. She has worked in oral surgery, perio, pediatrics, and general practices, giving her a breadth of experience. Additionally, Basset co-authored one of the definitive textbooks on local anesthesia. “There are three general anesthesia textbooks that are used in classrooms across the country. One of them is Malamed’s, which has been used for 40 years, and most of us learned on,” she says. “The second one I co-authored with Dr. Arthur DiMarco of Eastern Washington University (“Local Anesthesia for Dental Professionals”). We are the only book out there that was written by a team of a dentist and a hygienist. I think one of the things that is really valuable is that our book has been looked at from both perspectives, and we’re having the conversation as a dentist and hygienist, together.” Bassett will lecture about all aspects of anesthesia at the PNDC, including CCLAD technology, and the new nasal anesthesia delivery methods, like Kovanase. She also will cover new rules in the state and talk about why they’re important to anyone who delivers anesthesia to patients. She explains, “I’m an expert witness in a case right now. And while I might have answered this differently three months ago, I now realize how important it is to refresh your memory, explore different approaches to techniques, and be able to give evidence that you are current and up to date on your skills.” Basset told us that, in the deposition, a hygienist was asked when she had last taken a course in anesthesia. Her answer wasn’t supportive. “As part of your professional risk management, you have to show continued competency in skill sets that are considered a little more risky,” says Bassett. (Depending on the kind of practice you work in you, may do more or less anesthesia.) “I did the majority of the anesthesia for the entire practice, and hygienists who work with endodontists will likely do all or most of the anesthesia for the practice. Some dentists aren’t comfortable with letting their hygienists do it, and some hygienists lack the confidence. If you are charged with administering the anesthesia in a practice, whether as a dentist or a hygienist, this class will be relevant for you.”

As of January 2017, Washington state law mandates that hygienists can give local anesthesia without the dentist present in the office. There are set parameters about when that agreement can be made and how it is documented. Bassett will cover the general supervision laws in Washington, and the responsibilities of dentists and hygienists under the law. “I think it’s really important to talk about that,” Bassett says, “because one of the things that happens a lot is that the doctor will say, ‘Hey, I will be back at 1:15, get that patient numb for me so they’re ready to go when I return,’ which in the past was commonplace, but illegal. This law takes the stress off of those of us who were asked to do that. It also makes it easier for patients who need to come in three or four times a year for their cleanings because now the doctor doesn’t have to be present. We can already see patients when the doctor is not in the office if they’re a patient of record, but the new law opens the door for me to perform those procedures without the doctor in the office. We’ll review all of this information for attendees.”

Computerized anesthesia delivery
Bassett will also cover CCLAD in her lecture. This is a computer- controlled method of delivering anesthesia. While by no means new tech, Bassett says it is underutilized, especially given that, in the scheme of things. it’s not expensive — around $2,500. She explains, “CCLAD takes all of the guesswork out. When you have an injection, it’s all about the rate of delivery and the amount of pressure being applied during the administration. It totally depends on the individual and whether they’re male or female and have small hands or large. It’s what I refer to as ‘fluid dynamics.’ A computer-controlled device has a microprocessor in the delivery system that controls all of that. Everyone gets a uniformly consistent injection. Additionally, the hygienist or dentist doesn’t have to use their hand muscles in awkward ways to give that injection. The win-win is that it’s more comfortable for the patient, and it reduces cumulative trauma and strain that clinicians don’t really think about when they’re giving injections.”

Dr. Gregory Yen

Saving Your Autonomy: How to Evolve Your Practice to the Direct-care Model
Thursday, June 15, 2017, 3:45 – 5:15 p.m.
Target Audiences: Dentist, Front Office

Every dentist has struggled with insurance reimbursements and insurance providers in the course of running their practice. Over the years, companies have tried to create payment options that circumvent the insurance process altogether, but they’ve run afoul of state laws and regulations prohibiting prepaid medical and dental wellness plans and similar memberships. This past year, WSDA met with the insurance commissioner’s office to talk through ways that such a plan could be structured to comply with existing laws. WSDA member Dr. Greg Yen took the information and developed a plan that he’ll present at this year’s PNDC. “Start up is easy,” says Yen. “Everything that encompasses a program such as this is already done in a dental practice (e.g., give discounts, make ledger adjustments, and create codes). Prices need to be determined, and then you’re pretty much good to go.” After that, Yen explains, there is little to no paperwork on a day-to-day basis. He recommends that the first member of a program be either a relative or a fictitious character (stuffed animals work great), so that the front office can practice. “It really is straight forward,” he says. “Patients are very grateful for the discounts and perks, and are very forgiving because they know it’s new and, most importantly, it’s for them.” 

Getting started
Yen concedes that there can be some tinkering and evolution to the process, but reaffirms that keeping it simple is the path to success. “Some offices have a tendency to get into what I call ‘bureaucracy mode,’ and create so many clauses that their program sheets end up resembling a loan application. Yikes! I cannot stress it enough, simple is better. I’ll show you what I mean in this lecture.” As for the patient, Yen calls it a no-brainer, explaining, “They are extremely grateful for the direct consumer option, which ‘middle men’ will find hard to beat on price. It is extremely transparent. After discounts and perks, (patients) will know exactly what their costs will be, to the penny, for every procedure.” And although the program could be offered to patients with insurance, Yen says it’s targeted to those without. 

A sustainable prevention program
The main benefit to providers, Yen says, “is that it promotes an economically sustainable prevention program. There are no narratives, no paperwork, no insurance clauses to deal with (revealed or hidden), and no 1970s-based calendar max’s. The program is customizable to fit your practice, and will create loyalty to your practice because you get all the credit. For patients, the program will promote prevention, is easy to understand, and provides the best value for dental care. They don’t pay for anything they don’t need. And what about equipment to get started? Yen says, “I forgot to mention that you do need to buy one piece of mandatory equipment to make this happen…. a ream of paper. My IT guy just fainted.”

Engaged, educated staff + smooth practice

As you can tell, we’ve upped the wattage this year on educational offerings for staff because we believe that the better informed and educated your staff is, the smoother, more successfully your practice will run. We encourage you to bring your staff to the PNDC for these and many other lecture and workshop offerings. 

Learn more and register at wsda.org/pndc.

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