Part 2:
Managing Continuing Care
Remember that credit is money.
Benjamin Franklin
Internal marketing aims to generate patients from within the practice and to encourage existing patients to remain with the practice for their continuing care. This is healthy from two perspectives. It improves patient care and oral health and makes good financial sense for the practice. Supporting continuing care is indeed a mutually beneficial situation.
Different offices have different names for the continuing care function. Although this seems a trivial exercise in semantics at first, how dentists convey to patients what they do has a tremendous impact on the patient’s perception of them. Words do matter, and patients form opinions based on the words they hear. Although different patients may have wants and needs that a dentist cannot control, they can control how they communicate services to the patients.
The most common name is the recall system. This is an office‐centric view of the function. Dentists recall the patient for their purpose and their procedures. In the patients’ minds, this is like a defective product recall, where the manufacturer must repair or replace a defective part. (Is the gas tank going to explode? Did a filling go bad?) Because all dental services have a lifetime that is often dependent, in part, on the care taken by the owner, moving from dentist responsibility to partnered responsibility for long‐term function seems appropriate. Some offices call the function recare. This moves the focus toward the patient’s health and away from the office procedure. It helps the patient and staff members realize that the purpose is to care for the patient’s oral health needs. Other offices call the process periodic maintenance or continuing care to emphasize the ongoing nature of the procedure and relationship. If the process is called maintenance, patients understand that they have a part in ensuring that their dental health remains good and their dental work remains defect free. Part of their responsibility is regularly returning for a follow‐up evaluation and necessary treatments. Finally, some offices call the process a check‐up. Although this infers the ongoing nature of the process, it also trivializes the vital function of the process in the individual’s oral health.
VALUE OF PREVENTIVE SERVICES
PATIENT CARE PERSPECTIVE
Continuing care, adequately applied, prevents additional restorative work for the patient (Box 23.7). Through a personal preventive orientation, patients can avoid recurrent caries and the replacements that result. This also decreases the severity of future work, as each time dentists replace a restoration, it necessarily becomes larger and the tooth weaker. Regular prophylaxis and reinforcement improve periodontal health and decrease the severity of this disease. Other oral problems – caries, periodontal, or pathological – can be found and treated earlier. This improves the patient’s oral health and decreases the total amount they spend on personalized dental care. Finally, ongoing care visits help the patient and doctor develop a more personal relationship instead of simply a client–provider relationship. This trusting relationship helps in communication, patient involvement in treatment decisions, and personal health awareness and ownership. All are important outcomes from both personal and public health perspectives.
FINANCIAL PERSPECTIVE
From a financial perspective, encouraging continuing care makes good sense for the practice (Box 23.8). Dentists charge for preventive services such as periodic exams, diagnostic radiographs, and prophylaxes. Although not enormously profitable, these services do generate revenue and profit when properly managed. At the periodic exam, dentists often identify dental problems that need treatment. This generates additional revenue and profit for the practice. Frequently this work is complex, generating higher‐margin procedures and adding to the practice profit. Routine visits help to “preheat” patients for future necessary work. When dentists remind a patient of a given problem (“That tooth needs a crown to avoid breaking”), they prepare the patient so that if the problem happens, the patient is ready for treatment. Dentists do not have to convince the patients of the need for the procedure. Finally, patients need to trust that the dentist is looking out for their best interest, not merely the dentist’s pocketbook, before they commit to complex and expensive treatments. Periodic visits help build that rapport and resulting trust.
Economic Value of a Continuing Care Patient
The economic value of a continuing care patient comes from several sources: periodic work, additional work generated, and referrals from the patient.
The first source of revenue is from the periodic visit itself. Box 23.9 shows the revenue generated from hygiene visits over five years, given the assumptions shown. Over this time, hygiene production by itself rises to $285 000 per year.
The second way in which continuing care patients add to the practice’s financial health is through additional work generated. For example, assume that a single patient comes to the practice every six months for periodic maintenance visits and never has any other dental work done. The value of the visit is $100, inflation increases the price by 4% per year, and each patient makes two visits per year. As seen in Box 23.10 column 3, the pure cumulative financial value of the periodic visits for that patient after 10 years is more than $2400.
Now assume that, beyond the periodic visit procedures, the patient needs one additional restoration per year. That restoration has a value of $150, also compounded at 4% per year. Box 23.10 shows that the cumulative value of the restorations is approximately $1800. The total cumulative value of that patient over the 10‐year example period rises to more than $4000 (Box 23.10 column 6). This is for a patient who has no complex or high‐value procedures done. Higher‐margin items (crowns or complex restorative services) increase the value. This example only shows 10 years. The value also increases quickly over a longer time as the fee compounds.
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