Solvency in the Time of COVID-19

Here are some common problems that many clinicians seem to be experiencing in the current climate and solutions to help practices not just survive but thrive.

"I don't want to cut staff, but I don't know if I can keep meeting expenses."COVID-19 has tempted practitioners to make their staff "leaner and meaner." However, dismissing team members may not be necessary-or the answer. Every patient in the practice should be personally contacted by a team member. This contact should begin with an inquiry about the health of the patient and their loved ones, segue into all the practice is doing in the office to keep patients safe, and culminate in scheduling the patient (and their family and friends if they so desire now that they know safety precautions are in place) for at least a maintenance visit, radiographs, and thorough examination. An interactive conversation should take place regarding the need to maintain oral health during COVID-19, as for many people parafunction has dramatically increased, resulting in tooth fractures, older restorations breaking down, and so forth. Periodontal concerns that were under observation before the pandemic have now likely worsened. Patients with an artificial joint or other type of prosthesis may especially need maintenance care to help prevent infection or other complications.

Ideally, these phone calls are made by hygienists, with front desk team members assisting as necessary to complete the project. This outreach should result in most patients coming in for necessary immediate care and examinations and committing to more comprehensive therapies and maintenance. Additionally, in the author's practice approximately 5% to 7% of patients ask if we can see their friends and relatives in light of the safety precautions the practice is taking.

"We are busy but not productive, doing a lot of patch-up and repair work on emergencies." Visits for "chipped fillings, "gum bubbles," etc, must be transformed into thorough examinations that include checking musculature, tooth wear, periodontal status, and so on. Oral health problems have worsened during the pandemic, and patients are likely to be amenable to learning about their needs and hearing solutions during this type of visit. Clinicians need to reinstitute the concept of thorough examination and comprehensive care, rather than just treat a one-tooth emergency.

"Patients are putting off treatment." If patients are putting treatment "on hold," this therapeutic delay may be the fault of the practitioner. As previously mentioned, the team and the doctor must address the patient in a comprehensive, thorough manner, taking the time to explain therapeutic needs. Also, treatment plans must be established in a minimum number of visits, both to allay patient fears of having to visit the office and to proceed with necessary therapy as expeditiously as possible. By incorporating teledentistry, the author's periodontal practice is able to access its team of restorative dentists, other specialists, and laboratory technicians without the patient ever leaving the office. This, in turn, allows us to formulate and finalize treatment plans efficiently.

An example of this is a patient who presents to discuss a full-arch hybrid prosthesis. A CT scan is taken, and the treating dentist may have already taken digital impressions and photographs. After explaining the needs to the patient, the author will email all the digital information to the treatment team, including the laboratory technician, while the patient is still in the office. A teledentistry conference can be held involving all the members of the treatment team to ensure the patient's functional and esthetic needs and desires can be met. Appointments are scheduled and the patient leaves treatment-planned and committed to a hybrid prosthesis. This same approach may be utilized in a variety of less complex situations.

"Patients want long payment plans for everything." This is not necessarily so. Most patients do not refuse therapy because of cost. Patients refuse therapy because of lack of value. Dentists and their teams must convey the value of a proposed treatment to the patient, as doing so will result in a higher comprehensive case acceptance. With people limiting their travel, dining out, and socialization during COVID-19, many patients have sufficient income to address their health concerns.

To stay solvent in the time of COVID-19, don't just manage your practice. Grow and succeed beyond the usual barometers of success by putting forth a concerted, comprehensive effort involving teamwork, exploration, and vision.

Paul Fugazzotto, DDS
Co-founder, Dental Market Direction Consortium (DMDC) (dmdconsortium.org); Private Practice, Milton, Massachusetts