Elevating Hygiene Services: A Conversation with Rachel Wall of Inspired Hygiene
Episode Description
Join us as Rachel Wall, CEO and founder of Inspired Hygiene, shares invaluable insights on elevating hygiene services, systems, and profitability in dental practices. Learn practical strategies for developing standards of care, addressing staffing challenges, and maintaining profitable hygiene departments while delivering excellent patient care.
Episode Navigation
- 00:00 – Introduction and welcome
- 00:54 – Why practices seek hygiene consulting
- 03:07 – Developing clinical standards of care
- 10:38 – Current landscape of dental hygiene staffing
- 14:11 – Public health implications of hygiene shortage
- 24:38 – Maintaining profitable hygiene departments
- 30:52 – Elements of an ideal hygiene program
- 36:09 – Actionable takeaways for practice improvement
Key Takeaways
Building Successful Hygiene Departments
- Establish written clinical standards of care through team collaboration
- Focus on comprehensive patient assessments beyond basic prophylaxis
- Document bleeding indices and periodontal measurements consistently
- Implement regular one-on-one communication between dentists and hygienists
- Expand service offerings beyond basic prophylaxis to maintain profitability
Meet Our Guest
Rachel Wall: CEO and founder of Inspired Hygiene, a coaching firm dedicated to elevating hygiene services, systems and profits. With 20 years of experience, Rachel helps dental practices achieve the triple win of healthier patients, engaged hygienists, and profitable practices.
Featured Discussion Topics
- Developing clinical standards of care
- Addressing hygiene staffing challenges
- Insurance network participation strategies
- Documentation requirements for periodontal therapy
- Implementing assisted hygiene models
- Practice profitability solutions
Industry Updates Discussed
- Recent ADA resolutions affecting hygiene licensing
- Changes in hygiene education requirements
- Evolution of guided biofilm therapy
Connect With Inspired Hygiene
- Website: inspiredhygiene.com
- Free Resources: Standard of Care Worksheet available online
Topics: dental hygiene, practice management, periodontal therapy, clinical standards, staffing solutions, practice profitability, dental consulting, hygiene systems, patient care, dental education
Transcript
00:00
Dr. Mustafa Shah-Khan
Welcome to the Simplify Dentistry podcast.
00:02
Dr. Richard Offutt
Join us as we discuss clinical, operational.
00:05
Dr. Mustafa Shah-Khan
And financial aspects of your practice, help.
00:07
Rachel Wall
You enjoy life and dare to simplify dentistry.
00:11
Dr. Richard Offutt
Hello and welcome to the Simplify Dentistry podcast. I’m Dr. Mustafa Shah-Khan, along with my co host, Dr. Richard Offutt. We’d like to welcome today’s guest, Rachel Wahl. Rachel is CEO and founder of Inspired Hygiene, a coaching firm focused on elevating hygiene services, systems and profits. Inspired Hygiene strives to help dental teams achieve a triple win with healthier patients, empowered, engaged hygienists and a profitable practice. Welcome back to the Simplify Dentistry podcast. Thank you for joining us today.
00:45
Rachel Wall
Yeah, thanks for having me.
00:46
Dr. Richard Offutt
So tell me.
00:47
Rachel Wall
So happy to be here.
00:48
Dr. Richard Offutt
So when a doc calls you up, what’s he asking you? What’s he looking for? Why? Why? Why? Call Rachel Wall.
00:54
Rachel Wall
Yep. So we’ve been really fortunate over the last 20 years to develop a really great reputation and platform for really helping practices elevate the systems in the hygiene department, the services that they’re offering and profitability. So they’ve either heard us on a podcast, they’ve been referred by their dental financial advisor, dental cpa, referred by maybe a colleague or another consultant. And they know they have some challenges in the hygiene department or the hygiene department’s just not reaching potential and they want to at least see, you know, how we can help and what we can do to support them in that area.
01:31
Dr. Richard Offutt
So let’s get even a little more specific. What would you say off the top is the one issue that dentists are facing?
01:39
Dr. Mustafa Shah-Khan
What was the pain point?
01:40
Dr. Richard Offutt
Yeah, exactly. What’s the pain point?
01:41
Rachel Wall
So I would say there are the practice pain points that they see based on data or just, you know, when they’re doing exams, things that they’re seeing maybe that are inconsistent between hygienists. And then there are the industry pain points and there’s a couple different layers there. So we’ll start with the first thing is what they might see is they just know that they’re going in and doing hygiene exams and they’re seeing that patients are bleeding or the hygienist is telling them that the patients are bleeding, but there’s no periodontal therapy being done. They’re not referring out. There’s just not really anything being done about that.
02:20
Rachel Wall
Maybe they were on a podcast or one of our growth forums and we talked about, you know, the risk of not documenting properly or diagnosing disease and they recognize that there’s a lack of consistency and clear standards of care in that area, and they know they need to do something about it. It could be right now a big one is like profitability. Right. The hygienist wages have gone up significantly for those practices that are in network reimbursements have gone down. So they’re in that crunch point, and they want to see, you know, what can we do? So our first. Our first kind of lever that we turn is first looking at, okay, let’s look at the service mix. If everything’s a prophy, then there are things that can be done that will benefit the patients, because not every patient.
03:07
Rachel Wall
That’s not appropriate for every patient. It’ll benefit the patients, it’ll benefit the practice, and it also benefit those hygienists, because if not every patient is appropriate for a prophy, then they’re. I mean, I think in 20 years, I’ve seen one practice that I really, truly felt was intentionally, intentionally neglectful. So most team members want to do the right things for patients. There’s just not a system within which to do that.
03:36
Dr. Mustafa Shah-Khan
Do you think that’s the biggest thing is developing a system and a process?
03:40
Rachel Wall
Yeah.
03:41
Dr. Mustafa Shah-Khan
And that. Do you see those systems and processes being created by your lead hygienist or your hygiene team or. I mean, for me, I’m a solo doc, so I have two hygienists. Or do you see that having to come from me, come from the clinical leader?
03:58
Rachel Wall
So when they work with inspired hygiene, we can help start those conversations and facilitate that. But it’s a collaborative approach. So really what we’re talking about is one of the root causes of these issues that these practice owners are seeing is there’s no written clinical standard of care. I mean, really, in dentistry, there is no defined standard of care that every practice is expected to follow. I mean, it’s understood.
04:25
Dr. Richard Offutt
I hear you, Rachel, on that. But there actually is, you know, there is a standard of care for periodontal health. Right.
04:31
Rachel Wall
By the aap. What is health versus disease?
04:33
Dr. Richard Offutt
Yes, yes. And to get a little. Even a little more granular on that.
04:38
Dr. Mustafa Shah-Khan
But is there an actual process? I mean, there’s not a book that you can grab off the shelf. This is how you practice.
04:45
Rachel Wall
There are periodontal textbooks, which we utilize to set some of our standards by that and the AAP standard. So.
04:52
Dr. Richard Offutt
Yeah, but, you know, I’m getting more into the idea of, you know, if. If you have all of us. I hear exactly what you’re saying, that they’re you know, they’re. The doc’s frustrated. He goes in hygiene room A and, you know, there’s bleeding, there’s mess, there’s stuff going to go into the next one. And the standard of care may be different. Right, right. It’s really not the standard of care. It’s the level of care being provided.
05:18
Rachel Wall
Okay.
05:18
Dr. Richard Offutt
The standard of care. Right. Would be a benchmark for health.
05:22
Dr. Mustafa Shah-Khan
It’s the best practices.
05:25
Rachel Wall
Yes.
05:25
Dr. Mustafa Shah-Khan
It’s, it’s employing the standard of care. Not that there is a standard of care. Yeah, yeah.
05:31
Dr. Richard Offutt
You want to be disease free from.
05:33
Dr. Mustafa Shah-Khan
Because every. I mean, every practice operates differently, obviously. So you know what I think what you’re getting at? Tell me if I’m wrong. If Dr. Offit and I are both general practitioners, you know, we may, I may have a strict guideline of you’re probing every visit, you’re doing this, and if you see this, you’re doing that. Dr. Offit might be, well, we’re going to spot probe, and then every 18 months, we’re going to full probe. And, and we’re gonna do this or we may do that. So I think we’re all in the standard of care umbrella, which is kind of the clinically acceptable umbrella, but how we’re implementing it is different.
06:12
Dr. Richard Offutt
How about this, Rachel? So you were touching on this. You’re in a practice and there’s different buckets of patients, right? There’s. There’s patients that have been seeing you every six months for years, and then there’s the new patient that comes in the door. It takes two different conversations, right, to present, ma’am, you have gum disease. Okay? It’s two different issues. A bucket of patients that have been being seen every six months. Their question is, how did I get this way? And that may be the same question for the person coming in the door. Right. So how do you coach that languaging to the different buckets of patients? You know, I mean, if Janie the hygienist has been seeing Mrs.
07:02
Dr. Richard Offutt
Smith for every six months for six years, and now there’s bleeding on probing and calculus on the roots of the C, that’s pretty much on the dock, right? She’s been there the whole time. If the new patient coming in the door, it’s a little easier to have that conversation. You know, you can say, well, you.
07:18
Rachel Wall
Know, we don’t know where you’ve been.
07:20
Dr. Richard Offutt
Yeah, right. Yeah, yeah.
07:21
Rachel Wall
So if it’s okay, I’d like to answer or address something before we get to that.
07:25
Dr. Mustafa Shah-Khan
Sure.
07:26
Rachel Wall
Because what you gave as an example of these two levels of care within two different practices is going to impact how we have that conversation and when we have that conversation. So I would say that, yes, the AAP has set out standards. There are periodontal textbooks, and there’s a lot of information that creates an understood standard of care. However, based on my experience, there are vast majority of dental practices and clinical leaders have never seen those documents. Right. That the AAP has put out. So we bring those to light, like, this is what health is versus disease. So what percentage of your patients would fall into one of these categories? So then we help the team create their own level, or we call it standard of care. That’s written. That is a written document that is created.
08:20
Rachel Wall
It’s not you sitting in your office, like, writing this out and then just handing it to them. It’s a collaborative effort based on clinical acceptable authorities. Right. That give those standards of care. And then you create that, you know, definition of this is what it means in our practice. So now once that’s created and everybody agrees to it and is committed to that, now we have something concrete that we can really compare our patients to when we’re doing those diagnostic assessments. So then, you know, patient A comes in, and we’ve been seeing them for 10 years, every six months, maybe we’ve been seeing them every three or four months because they always have bleeding. And now we have this defined standard of care, and we’ve recognized. All right, well, Ms. Smith actually has active periodontal disease, and she has for years.
09:09
Rachel Wall
And we need to convert her into the appropriate therapy so we can stop the progression of this disease. Or is it time to refer? And so how we coach teams to do that is first look back at the documentation, look back at your clinical notes for all, maybe the last year or two that you’ve been seeing. You know, Mrs. Smith, likely there are some hints there where you’ve planted seeds with that patient. Maybe it’s, you know what I notice you’re bleeding more. Let’s have you come back in more frequently or you’ve recommended a sauna care, or you’ve done something, you’ve made some recommendation in the hopes to get a different outcome. And if you’re still seeing the same chronic inflammation, then you can say, you know, Mrs. Smith, we’ve tried this and this. Your body’s not responding the way we had hoped.
09:55
Rachel Wall
It’s time to do something different. So it’s not just, hey, went to this ce and now our policy is when we see four millimeter pockets and bleeding, we’re like, the patient doesn’t want to hear that. It has to be relevant to them. Or maybe it’s. Ann, I know that you’ve been having a hard time managing your diabetes. It’s time to do something different and really address this inflammation.
10:18
Dr. Richard Offutt
Perfect. That sounds great. Dr. Chukan, I’m not currently in practice. You are. And Rachel, what’s the landscape look like out there for dental hygiene? Finding dental hygienist training. Dental hygienists. What’s that? Where’s that going?
10:38
Rachel Wall
Yeah, it’s tricky right now. I’d love to hear your take on it too. What’s happening in your practice right now?
10:43
Dr. Mustafa Shah-Khan
I mean, I had a hygienist retire, I guess it’s been two and a half, almost three years ago. Had kids, retired. You know, we, when we used to have hygienist leave you’d put a dental post ad out there and you’d get, you know, 80 resumes or whatever.
11:02
Rachel Wall
Wow.
11:02
Dr. Mustafa Shah-Khan
All of a sudden you’re getting two.
11:04
Rachel Wall
Yeah.
11:04
Dr. Mustafa Shah-Khan
You know, and. Or three. And then you’re finally finding somebody and you’ll bring them in and we had one. Just, just didn’t work out. Was not. Not a good hygienist. You know, didn’t adhere to what were trying to do. Patients complain. We just got rid of her, brought another one in. Was not great either. And then you kind of get to where you can’t even find them. So now it’s this void that has been created and you have so many hygienists that are now using temp, me or cloud and things like that. So. Which are basically the Uber of dental hygiene. So you’re going in and you’re getting fill in people from that and, you know, you’ll have four, five, six, seven people coming through your office and sometimes more.
11:52
Dr. Mustafa Shah-Khan
And, you know, you try to hire them out of that pool and things like that, but that’s kind of where it is. You’re just not getting resumes.
11:58
Dr. Richard Offutt
Well, that really makes it a challenge to do the things that we talked about before. Right. I mean, if you’ve got somebody new, you can’t do anything every couple days. Yeah. What you’re hoping for is a body there to treat these people.
12:11
Rachel Wall
Right?
12:11
Dr. Mustafa Shah-Khan
Correct. And not only can you not do it, you know, if you want somebody to probe and they don’t want to probe, they’re not going to probe and they’re Kind of like, look, I just won’t come back. Yeah, I’ll. I’ll just take you off my list. Yeah.
12:28
Rachel Wall
So I’ve been telling all my friends that are not in the dental industry, like, if you see a different hygienist every time you go to the dentist, don’t assume that your dentist is difficult to work for. Like, we’re kind of going through a crisis right now in the industry. But yeah, so I would say it varies in different regions and areas of the country. But we do hear that. I think some areas don’t have, you know, it was in a practice not that long ago in a small town in Louisiana, and they don’t have enough hygienists in that area to. For these online staffing apps to really work. Right. So it’s a little bit different in those areas, but we’re in a metropolitan area here in Charlotte, and so that is very common in this area. I would say.
13:12
Rachel Wall
One of the benefits of that is you do have the opportunity to do a, of an actual working interview. You get to really have an experience with them. So there’s some upside there. But that’s one of the things that we’re seeing with clients and just industry across the board is, you know, some hygienists left in the last few years retired, maybe retired early a lot, also reduced the number of hours that they are working. So it’s not just number of hygienists, it’s also, you know, capacity to work or desire to work. There are a lot of opportunities for hygienists that, outside of clinical, that were not there even five, 10 years ago. So there are things that hygienists are doing, you know, in the dental industry and outside of the dental industry as well.
14:00
Rachel Wall
And so it is really forcing business owners and us as well to really look like, okay, how do we get creative with this? Because the bottom line is patients need care.
14:11
Dr. Richard Offutt
Yeah.
14:11
Rachel Wall
And you’re ultimately responsible for that.
14:14
Dr. Richard Offutt
No, no, that’s right. I mean, at what point does it become a public health issue?
14:17
Rachel Wall
I think it’s there.
14:18
Dr. Richard Offutt
Yeah. To be honest. And we as dental professionals need to control that narrative. Because if we don’t control the narrative and it is a public health issue, that’s going to be taken out of the, out of our control. Other words, requirements, you know, training requirements will be reduced. Things are going to be changed. There’s going to be a lot more, you know, therapists.
14:44
Rachel Wall
It’s already happening.
14:45
Dr. Mustafa Shah-Khan
What did the ADA come out with the other day that changed regulations?
14:49
Rachel Wall
So what the ADA passed last week before last. We just did a whole growth forum on this last week was there were, you know, a number of resolutions that come before the House of Delegates. There were three in particular that were approved. One was to allow internationally trained dentists to be licensed as hygienists. The other was to allow dental students, dental residents that had passed a certain level of clinical competency to be licensed as hygienists. And then the other was to basically remove the ratio of instructors to students in dental hygiene programs. And my interpretation of it was to kind of leave it up to the program to determine that ratio or at least have it be the same as dental student ratios.
15:42
Dr. Mustafa Shah-Khan
Sure.
15:42
Rachel Wall
And so obviously the adha, their job is to, you know, represent their members. They came out with a very strong opposition to those resolutions, to the approval of those resolutions. Based on what I could read is it’s all going to be left up to the states. So the states are going to have to decide how they’re going to embrace these resolutions, if at all, and how, you know, dental students, residents, internationally trained dentists, how they’re going to require them to go through licensing requirements. So it might be that they’re required to be licensed just the same as a hygienist.
16:22
Dr. Mustafa Shah-Khan
Well, you know, you could see where you have students and residents and internationally trained practitioners coming to fill the void. But kind of the thing that I was looking at in the resolutions is the faculty to student ratio. It doesn’t seem like there is a glut of people trying to be hygienists has that. Is there an overwhelming demand of people who want to be in dental hygiene programs? Would that solve anything?
16:52
Rachel Wall
Actually, the information that we received, and I’m trying to think of if this was on the COTA website or the adea. I think it was COTA was. There are some statistics on that website that they’re about 25% of the applicants. I think the number was around 40,000 applicants to dental hygiene programs versus about 10,000 that were being accepted into dental hygiene programs. Now in the last couple years, there has been an increase in. There have been a few new programs and some increase in spots in available programs, but there’s plenty of people applying.
17:30
Dr. Mustafa Shah-Khan
Okay.
17:32
Rachel Wall
And also the other thing that’s a realistic issue is dental hygiene instructors have historically made less than practicing dental hygienists.
17:41
Dr. Mustafa Shah-Khan
Sure.
17:42
Rachel Wall
And now with the dramatic increase in hygiene pay, that gap is probably even farther apart. So, and there’s never been like an overabundance of hygiene instructors. So even if you know, increase the seats, you still have to have a certain number of instructors to supervise. Right. But, but now if that is removed via coda, then the schools can make more of an independent judgment, is the way that I interpreted that.
18:08
Dr. Richard Offutt
Yeah, I mean, I read what y’all are discussing and when my, when I read it, I thought about it and saying even if the aggregate number of those three categories aren’t going to really move the needle in terms of a public health issue. So, you know, I was more speaking to. We as in the dental profession need to control perhaps it. And I’m just saying this, I haven’t thought through this terribly. Maybe we need to have different levels of therapists. You know, just like in dentistry. Right, where there’s, there’s the one day. Yes, but there’s also therapist category that, that’s being, that’s being discussed to be able to expand services.
18:51
Rachel Wall
Like a mid level provider.
18:53
Dr. Richard Offutt
Exactly.
18:53
Rachel Wall
Yeah. And that’s been something that look, I’m not super active in the political side of dentistry or dental hygiene, so but my understanding is that mid level, that there has been a push by ADHA and dental hygienist for a mid level provider. Something between a hygienist and a dentist. And what’s happening instead right now, is it something between a dental assistant and a hygienist?
19:17
Dr. Richard Offutt
Right. And that I think is the spot where, if it is indeed a public health issue, where that number is going to expand. You know, and you think about the military, right, in Corman and how long they’re trying to clean teeth.
19:33
Dr. Mustafa Shah-Khan
A couple hours.
19:34
Dr. Richard Offutt
Couple weeks. A couple of weeks. And then they clean our soldiers. Right. So, so, you know, there’s going to be. And they do that because there’s a massive number of young guys and there’s a need. Right. So, so they solved it. Well, I think that we, we all this, all the stakeholders in dentistry need to be actively involved in controlling and suggesting outcomes. Otherwise it’s going to be forced down us. Right. And so, you know, so people like you, Rachel, I mean you need to be out in front on this because it’s in. And the dental practitioners and hopefully the ADA would get involved. But in terms of being able to meet this public health need, what are your thoughts there? I mean, is it, what do you think? I mean, what are you thinking?
20:29
Rachel Wall
I think that an increased number of dental hygiene schools is needed. I don’t know that the ADHA feels the same way. You know, obviously again, they’re representing their members and they’re. We want to look at the long term solutions, not just short term solutions. So the fear is always that then there’s an overabundance. But even a reasonable number of expansions here and there would not, in areas that really need it would be very helpful. I think that we’re going to need to embrace the idea that we’re going to need to work within this, with this model. I think that it’s appropriate to expand roles in all parties, for all parties. And the general number of hygienists, I think, are very nervous and resistant to expanding duties of dental assistance to address scaling and things like that. I get that. But there’s an issue.
21:30
Rachel Wall
There’s a problem.
21:31
Dr. Mustafa Shah-Khan
Well, we looked at points in time when we couldn’t find anybody. We were looking at some assisted hygiene opportunities and if you have the right hygienist and things like that and can accomplish that, I can see it work. You have to have the right assistant too. But it is definitely a difference in the delivery of care, at least from a patient perspective, I would think.
21:55
Rachel Wall
Yeah, and we teach that. I mean, we endorse assisted hygiene and we actually have an assisted hygiene boot camp online program that’s coming out in January, in 2025, and we’re actually doing a webinar on December 6th about it to just kind of introduce that. So we believe that. And that’s different than accelerated hygiene. So we’re not talking about just packing it in. And I’ve seen that done and it burns everybody out pretty quickly. But if you think about like dentists have been working with assistants forever and that works well.
22:28
Rachel Wall
So if you have that same type of relationship where we’re really focused on, you know, everybody working to the top of their license and really delivering great customer care, communicating to the patient, not having that assistant be like a second hand, but really being a part of that delivery team, that care delivery team, it can work very well.
22:50
Dr. Mustafa Shah-Khan
We were on Russell Schaefer’s totally oral podcast a while back and he’s in Louisiana and he said basically he doesn’t have a hygienist, lost hygienist, and his co host doesn’t have a hygienist anymore. So what they have done is they’ve embraced is the biofilm.
23:07
Rachel Wall
Guided biofilm therapy.
23:09
Dr. Mustafa Shah-Khan
Yeah, guided biofilm therapy. They have embraced that and they were talking about. So they use it and they’re.
23:16
Rachel Wall
Doing the hygiene themselves.
23:17
Dr. Mustafa Shah-Khan
They’re doing the hygiene themselves with the guided biofilm therapy, but then they’re also saying that there are some practitioners, that they’re having the assistant do the guided biofilm therapy. So I kind of posted that we’d had this conversation and it was interesting to see kind of some of the responses. You had a few people coming in there like, well, that can’t happen. And they’re like, well. And I was like, well, how is it they’re not scaling? You know, I was like, well, there.
23:45
Rachel Wall
Is scaling as part of guided biofilm.
23:47
Dr. Mustafa Shah-Khan
Therapy, but I guess. But it’s essentially from sandblasting, though, isn’t it?
23:51
Rachel Wall
Well, it’s a combination of piezo instrumentation and subgingival air polishing. So it depends on the licensing of the state, but I would think that would be very specific. Yeah, that would, they would need to be practicing according to the state law.
24:11
Dr. Richard Offutt
Yeah, but the use of the piezo.
24:13
Rachel Wall
In particular, I think, and subgingival air polishing.
24:17
Dr. Mustafa Shah-Khan
I mean, even air polishing.
24:18
Dr. Richard Offutt
Yeah.
24:18
Rachel Wall
Yes. Because, I mean, in North Carolina, I mean, we’re in a really conservative state with regards to this. You know, it’s just coronal polishing.
24:26
Dr. Mustafa Shah-Khan
Sure. Yeah.
24:27
Rachel Wall
And I have, you know, I would assume that’s rubber cut polishing, but I don’t know if I don’t believe that includes air polishing. So that would be very specific to state by state.
24:38
Dr. Richard Offutt
Let’s, let’s change this, let’s change this up a little bit. I’m sure we’ve solved all the issues with manpower on, on those, this conversation. But let’s look at, let’s look at this, this deal. So, and you touched on it before, and I think it, I think this is a dilemma when we talk to Dennis and that we’re seeing. So there’s a doc that he’s in a bunch of networks and you mentioned that the margin compression. Right.
25:03
Rachel Wall
Yes.
25:04
Dr. Richard Offutt
The reimbursements are going down, the cost of delivering the services going up. So you walk into an office and the office is highly dependent on network reimbursement for their hygiene program. And you know, you walk in there and you’re going to see that the cost, their employee costs are high compared to the norms and all those sorts of things. So how do you coach that? I mean, how do you, how.
25:28
Dr. Mustafa Shah-Khan
Is hygiene profitable in those situations?
25:30
Dr. Richard Offutt
Yeah, well, how do you coach that doc to, to say, look, you know, you’re in these networks, the reimbursement is X, your cost of delivering the care is not, is about the same. And so how do you, how do you leverage that up? Or do you just say, hey, quit the network? What’s your approach?
25:48
Rachel Wall
Yeah, so it’s all the above with regards to adding services. And also, are there any of these networks that are not working for you anymore? So before we’re ever in the practice, we do the hygiene analysis essentially. And if we see that they’re having a difficult time getting patients in. So if they’re booked out months and they have a profitability, I like that term, margin compression. If they have that issue, then that’s a first conversation. Like, are there any of these plans that are not serving you anymore, like the lowest paying plans? Now it’s tricky when that lowest paying plan is maybe your military plan or.
26:30
Dr. Richard Offutt
Your teacher’s plan or the largest plant in your.
26:33
Rachel Wall
Exactly right. And so there’s a, a business and sometimes a philosophical right. Need or desire to, you know, honor that type of thing. But so that always comes into play whether or not they’re willing to do that. But we’ve seen a lot of our clients make changes in the plans that they’re in network with to free up some space in the schedule so that then they can elevate the level of care and provide more services to those patients that they need that are necessary. So that’s the first part of the conversation. And then when we go in there and we see, okay, they’ve addressed that and they’re at the point of participation that they want to be at, then we look at, okay, how do we expand services that are addressing patients needs and problems.
27:22
Rachel Wall
And sometimes those are going to be within accepted and covered services and sometimes they’re not. So it depends on where that practice wants to go. And sometimes they are, they’re not addressing periodontal disease at all. So the first thing is, okay, that’s the low hanging fruit. But it’s got to be diagnosing and figuring out what’s in this patient’s best interest, what do they need? And the other thing that we’ve really been working a lot with our clients on recently, in the last maybe a year or two is, you know, because we don’t want to create a problem, a solution in one part of the practice and create a problem in another. So if we’re helping them create this great standard of care, hygienists are presenting treatment, doctors are backing them up.
28:04
Rachel Wall
Patients are saying yes to periodontal therapy, but yet they’re not providing the documentation to get the claims paid. Then your insurance coordinator is like drowning. They’re drowning. And they’re resentful because they’re like, is this really necessary? Like were doing fine before this.
28:19
Dr. Mustafa Shah-Khan
Because you have the charting, you have to have all this.
28:21
Rachel Wall
Yes.
28:21
Dr. Richard Offutt
Right. And it all has to be submitted.
28:23
Rachel Wall
And it has to be super detailed. There have to be diagnostic radiographs, there has to be a complete periodontal evaluation that’s charted. Right, including all of the parts of that bleeding, pocket depths, recession, everything. And in, again, in the vast majority of practices, I would say 90% of the practices that we evaluate now, they are doing a much better job of at least getting like probing depths. But there’s no bleeding charted or anything else. And so that’s not going to support that claim. So you’ve got to really look at things from, in any practice, but even more so in that type of practice, you have to look at like, is the documentation there to support this? And then just really kind of taking it slow and helping them like master one thing at a time as far as services go.
29:11
Rachel Wall
And then they might say, you know, we have some patients come back that they’ve had non surgical therapy and you know, we want to add an adjunct service or we need to know when to refer or you know, we’re looking at how can we help them remineralize, you know, areas and what are the different services that are available now? And then how do we have those conversations with patients if it’s not a covered service?
29:33
Dr. Mustafa Shah-Khan
And are these the keys that you’re talking about when you’re looking at, you know, how do you keep hygiene profitable?
29:39
Rachel Wall
Yes.
29:40
Dr. Mustafa Shah-Khan
Or is there something else that when you say, okay, well this is what I want, Dr. Offit, this is what I want you to focus on to have hygiene profitable in your practice.
29:49
Rachel Wall
It absolutely is expanding services beyond prophy and bitewings because it’s very, very difficult to do that in a heavy in network practice with the rate that hygiene wages are at now. It’s very, if it’s just profi and bitewings, it’s very difficult to be profitable. So it is expanding services, but in order to get the hygienist to really embrace that, we have to get to the core of what is in the patient’s best interest and what are the solutions to the problems that the Patients are showing up for and having that written standard of care for the practice that went back to.
30:25
Dr. Mustafa Shah-Khan
The ideal, thriving practice. If I want to have, if I want my hygiene to be ideal, if I’ve been coached by you, if you put it in, obviously you’ve developed the.
30:34
Dr. Richard Offutt
Process and you’ve, you want your hygiene to be inspired.
30:37
Dr. Mustafa Shah-Khan
That’s right. You’ve developed the inspirational standard of care process. What, what does hygiene look like in my practice when you’ve, when you’ve got it kind of at a thriving spot?
30:52
Rachel Wall
So the hygienists are, when the patient sits in the chair, they’re absolutely connecting and building relationships with that patient. But then they’re pretty quickly moving into their overall and oral health conversations. So they’re doing a detailed review of the medical history. It’s not, it’s not just a, hey, have there been any changes? Yes or no? It’s, here are the medications you were taking last time. You know, what was your conversation with your medical doctor the last time you were there? You know, what are your, what’s changed since you were here last? So, and they’re really taking all those clues from the patients and what they see in the documentation to like, okay, where, what am I really looking at today? And how is this going to play into my evaluation of what I see orally? Right.
31:39
Rachel Wall
So then they’re doing a thorough oral cancer screening. Enter an extra oral. They’re, they’re doing blood pressure screening. They are potentially, while they’re doing that intraoral cancer screening, they’re looking at airway. You know, they’re seeing if there are any things that are indicated on the patient medical history or in that patient interview that might indicate that there’s an airway issue. They’re doing an evaluation to see, like, okay, this is the treatment plan that was created by Dr. Chukan the last time the patient was in or when they were a new patient. What has been completed, what is incomplete and does that still seem like the most important thing based on what I’m seeing and what the patient is saying to me? And then based on our standards of care, I’m doing, you know, periodontal evaluation at the time frequency or the time interval.
32:30
Rachel Wall
But if I see that this, you know, one of the things that I feel we really do well is helpful. The hygienists develop critical thinking skills. So it’s not enough to just follow.
32:43
Dr. Mustafa Shah-Khan
Be a professional.
32:44
Rachel Wall
Yeah. Really think about your job, your role as a Healthcare provider. It’s not just, well, this patient had their periodontal evaluation completed, you know, 11 months ago. So they’re not due for perio charting, but yet they come in and I can clearly see that they’re bleeding everywhere.
33:02
Dr. Mustafa Shah-Khan
Sure.
33:03
Rachel Wall
Like I gotta stop and say we’ve got to figure out what’s going on. Or just really thinking about after they go through non surgical therapy, like what’s next? Did this resolve?
33:15
Dr. Richard Offutt
Did that solve it?
33:16
Rachel Wall
Right. Did this resolve? Is there something in their systemic health that could be affecting the result? Do we need to move to the next level? Yeah. So really thinking past procedures and really thinking about that patient as an overall, I would say then, you know, those types of things and employing some of the products that we have and technology we have on the market today, helping that hygiene department be a profitable part of the practice, building relationships, building patients that want to refer, and also just being a great positive, contributing part of the team, you know.
33:55
Dr. Richard Offutt
You know, it’s interesting. I practiced forever and ever and as a periodontist and so I’d be at the grocery store, I’d see a friend that or some acquaintance and they’d go, hey, you know, how do I know if I have gum disease? And I always tell them, I go to your dentist, ask them, do I have gum disease? And it should be yes or no. Yes, it shouldn’t be. You know, And I said, if you can’t get a yes or no answer out of that, then you need to explore it further. Right. And that seems so perfect to then fit into the wheelhouse of what you’re talking about. Rachel, with Dr. Chukan and I will both just, you know, like clap out really loud on this is practice at the top of your license.
34:36
Dr. Mustafa Shah-Khan
Sure. Yeah.
34:37
Dr. Richard Offutt
I think that’s an expression that I had not really heard that. And I think that is something that if we can inspire, I hate to use your word over and over, but if we can encourage.
34:48
Rachel Wall
Thank you.
34:48
Dr. Mustafa Shah-Khan
It’s a good word.
34:49
Dr. Richard Offutt
We can encourage all of our folks that work with us, all our colleagues to practice at the top of their license, that we would, it would be. The services to our patients would be just overwhelmingly better. Right?
35:01
Rachel Wall
I agree. Yeah, yeah, I agree. And I think we, and there’s a lot of opportunity to do that. I mean there are hygienists and dental assistants now are, that are being licensed for, you know, for blood draws, for platelet rich fiber and things like that. Like that’s not necessarily in the scope of the dental assistance license, but it’s in, it’s attainable. And talk about practicing at the top.
35:24
Dr. Richard Offutt
Sure. I mean, you can go for a two week phlebotomy course. I mean, you know, the lady that takes your blood at the hospital, lady or man, they learned for two, they studied it for two weeks and now they’re drawing your blood. So we can all learn those skills. Right.
35:36
Rachel Wall
And so anesthesia that we now have in North Carolina, like really embracing. What are you able to do?
35:43
Dr. Mustafa Shah-Khan
Yeah.
35:44
Rachel Wall
Yes, I agree.
35:45
Dr. Richard Offutt
Okay. So Rachel, for our listeners, they’ve heard us go on and on about all these different things. Tomorrow they’re going in the office tomorrow. And they want. And you want, we want their day tomorrow to better than their day today in the office. What are the takeaways that you can give them right now? That they can go to work tomorrow and their practice will better.
36:09
Rachel Wall
If you are a dentist, a dental leader, communicate with your team. You know, communicate with, we’re talking about hygienist specifically. Like schedule some one ones. Have some one ones. Don’t wait till the annual review. You know, just schedule some one ones and say, you know, how are things going? What do you feel like is going really well? Where do you need support to be able to fully, you know, to work at the top of your license? What does that mean to you? And what do you need to be, feel fully supported in this role? And I think that’s a good foundation to lay.
36:45
Rachel Wall
And then I would say for the dentists and hygienists, like really evaluate when you’re seeing the patients, you know, if you were to ask them that question, if you were to ask yourself that question, does this patient have periodontal disease, yes or no? You know, what is your answer going to be? And if it’s like, well, I’m not sure they have a little bleeding, then that leads you to the next step is create that standard of care in your practice. And we have a worksheet on our website. If you go to inspiredhygiene.com under free resources or resource Guide, I think it says there’s a standard of care worksheet. And just look through it and start having some conversations. Like what? You know, if one hygienist is doing perio charting at this interval and another, like just get on the same page with one thing.
37:32
Dr. Richard Offutt
Implement systems.
37:33
Rachel Wall
Yeah, but even just one tiny thing.
37:35
Dr. Richard Offutt
Yeah.
37:37
Dr. Mustafa Shah-Khan
Just go in there and figure out, you know, are we probing?
37:39
Rachel Wall
Right.
37:40
Dr. Mustafa Shah-Khan
I mean, I think that’s. That’s one of the takeaways for. I mean, I see a lot of general dentists, you know, do your hygienist probe. You know, I mean, maybe. Maybe start there. And. And they may or may not.
37:50
Rachel Wall
And if they’re doing that, the next step is, are they recording the bleeding? Because that’s super revealing. One thing. It’s one thing to take the numbers down, right, in kind of a rote way, but then when we’re really looking at, is there active inflammation there? And so it’s just one small thing.
38:09
Dr. Mustafa Shah-Khan
Well, thank you very much for joining us today, Rachel. We really appreciate having you here. You know, kind of what we, you know, a term we use a lot is basically daring to make dentistry simple. You know, what are the things that you can do? Can you go into your office and can you dare to engage your hygienist, you know, to add things that they’re not doing and do things to practice at the highest level? So, you know, our goal here is to kind of develop a community and to bring people together and give them the resources to simplify their lives, Simplify Dentistry, and simplify care for their patients. So thank you very much for sharing your insight on hygiene, and my pleasure. We look forward to talking to you again soon.
38:49
Dr. Richard Offutt
Rachel, thank you so much. I appreciate it.
38:50
Rachel Wall
Thank you. Thank you for having me.