Ep 141: Easy Ways to Expand Care in Your Office

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Dr, John Meis (00:01.367)
Hey everybody, welcome to this episode of The Double Your Production Podcast. I'm Dr. John Meis here with my partner, Wendy Briggs. Hey Wendy, how you doing?

Wendy Briggs (00:09.41)
Hey, Dr. John, good to see you. I am so excited about our podcast today.

I know we have a couple of very, very special guests with us, don't we?

Yes!

So with us today is Bert Triche and Paige Hood. Bert and Paige are hygiene coaches for The Team Training Institute and they're fabulous speakers, educators, clinicians, leaders, and I'm just so excited to have them on the podcast today.

Bert (00:41.663)
Thanks, Dr. John. We appreciate the invitation and love the fact that we get to talk to the audience about what we do and how we do it.

Paige Hood RDH (00:51.379)
Yes, such a pleasure. Thank you.

Awesome. So one of the things that a lot of practices don't really have a good handle on is the profitability that's possible from hygiene department. And so you've heard, everyone has heard speakers talk about hygiene as a loss leader. And it can be if you do it poorly, but it can be a great profit center if you do it well. And so that's kind of what we're gonna be talking about today. It's a little bit about how we make that happen and talking a little bit about an event coming up that you could see Bert and Paige speak and show a little bit of their magic.

All right, I can tell you our podcast listeners are no strangers to the fact that we believe hygiene can drive a successful practice. In fact, when we look at all the common denomenaters amongst the most successful practices that we work with, all of them have one important thing in common. They have a couple of things in common, but one really critical important thing is that they all have a very effective and productive hygiene department. And those systems certainly help drive success. They help elevate patient care.

And Dr. John, as you mentioned, so many people out there, so many voices are saying the only way to be profitable in hygiene is to shorten appointments down, cram more people through, get rid of your hygienist altogether. And we've done a few episodes about some of that flawed thinking and how our approach is so radically different. And that's why I'm excited about today's topic because Bert and Paige certainly both have lived what we teach themselves in their story. And I think we've interviewed both of them on previous podcasts before. So if you like what you hear today, you might want to go back into the files and rejuvenate, relisten to those amazing podcasts because there's still some great value there.

But one of the things that I find so amazing about what we do is we bring real world solutions to these practices. So I know Paige and Bert probably could share with us a lot of the things that they're seeing in dentistry today right here, right now that practices are doing really well to overcome these current profitability challenges.

Yeah, I would love to share. I'm getting really passionate about the state of dental hygiene right now. And it's kind of a scary place that we're in as with the shortage, increased wages, doctors are looking at solutions. And sadly, some of those solutions are potentially elevating dental assistants to do a lot of the things that hygiene providers typically do.

Yeah.

Health Assistant, I believe in Mississippi is one of those initiatives. And so I've started talking to my hygiene providers about really, you can be viewed as just a tooth scraper and practice at the bottom of your license, or you can elevate yourself with a barrage of treatments, services that we can offer and practice at the top of your license.

I did that on Monday. I had a $1,900 production day with seven patients, one patient no-showed, but I did a gingivitis scaling and I did eight root protections and I did two sealants and I did four quads of scaling and root planing. So elevating the care and providing for the patients in my community makes me very valuable to my patients as well as the practice. And so I think we really need to offer all these services that our patients need to be profitable and valuable.

Bert (04:29.949)
Yeah, and you know, I think as hygiene goes, so does the practice. I mean, if hygiene is busy, doctors are busy. And when you elevate care and you educate patients, educated patients make better choices, right? And it has always been our philosophy. And when I was chair side as a hygienist doing this one on one with patients that they deserve the right to know if they were in trouble, right? What was going on with them from a health perspective, from what's happening inside their mouth, the habits that they have. And then if there were problems, were there things they could do to be proactive about that, right? And that's what we teach is we teach patients how to get a grip, right? On the disease process that's going on in their mouth.

But it constantly amazes me how patients don't really believe they have disease in their mouth, right? Somehow they think their mouth is a separate entity from their body and that the same blood doesn't run through the teeth that runs through the heart, you know? And so when we talk about perio in a minute, that's one of the big conversations, right? Is linking that.

So, you know, when you're not educating patients at that level, I was just talking to my hairdresser and she said, Bert, you know, would you tell me what you really do? And I said, well, I teach communication skills and I teach hygienists how to elevate patient care so patients are aware of what they have going on and they can make better choices. And I started telling her about it. She said, my hygienist has never said a word about that to me. And I said, well, I'm sorry, right? Maybe you should ask now that you know, right?

So it just changes the whole, changing the conversation that we're having at the chair with the patient changes the outcome, right? And it also then affects the practice in a very positive way because people choose more, right? In terms of prevention and restorative. So everything is, Wendy always says, as the water goes up, all the ships rise, right? So as the water goes up in the hygiene department, all the ships rise. And that includes the doctors, restorative, and that kind of thing. And that's what I love about what we do because it's so connected to all of it, not just hygiene.

Thanks. That's awesome. You know, I just love to hear the passion in your voices about this. It's really inspiring to me and I'm sure it's inspiring to a lot of our listeners.

Bert (07:06.293)
Thank you.

You know, getting practices, practice owners and getting hygiene teams with the same mindset. And I love, your description, your metaphor of the bottom of your license and the top of your license. That is a great way to think about it. It's a great way to talk about it. And what we've seen in the profession with the shortage of hygienists, the increase in hygiene wages, we've seen practices really driving their hygienist to the bottom of their license to try thinking that that's going to somehow make up for it. But unfortunately, it doesn't. It's exactly the wrong move.

The right move is, as you mentioned, going to the top of your license. And Bert mentioned, you know, just starting to have the conversation so that we can have a higher level of care. One of the things that a lot of practices don't understand is that when hygiene goes up, hygiene productivity goes up, doctor productivity goes up times two. So when we go, it goes up that same amount times two. So when you wonderful coaches go into an office and we see this gigantic bump in hygiene production the very next day, going up by half, sometimes doubling. You know, the doctor productivity, takes a few months, but the doctor productivity will go up that same amount times two. And if we have more, and the great thing is that we're improving the quality of care, right? We're improving the health of our patient base. We're really following the mission of what we're trying to do.

So it works for the best, it's best for the patient, it works for them, works for the team, works for the practice. And it is the way to manage the challenges that we're seeing in hygiene workforce, hygiene wages, and lowered reimbursement.

I couldn't agree with more. We absolutely do see that impact come through. And I was going to just have Paige and Bert be thinking about it, Bert, and then we'll get to your comment. I know we can probably think of a variety of practices that we've gone in and things were not good, right? There's times where doctors reach out to us. Most of the time we work with practices that are already doing a lot of things really well. They're very successful and they just want to reach the next level. That's most often what we see.

But occasionally we come into some hard circumstances where there is a profitability squeeze and there's been times where the doctors are worried about meeting payroll and they take a leap of faith, right? And they say, okay, we're gonna, know, can you throw us a life preserver and come in and help turn things around? I know you probably at least have several stories you could share, but maybe just be thinking Bert while you're doing your comment on one of those circumstances you can share, whether it was the practice itself that was struggling from a profitability standpoint or the doctor and the hygienist were somewhat skeptical. They didn't think it would have that big of a difference. And I'd love for you to share even just a story or two with our listeners and then we'll get into some other things, but go ahead, Bert, what was your comment?

Bert (10:02.111)
Well, you now I've lost it because I I focused in on you. But what I was thinking about was what happened to me, right? When you came and taught us and that was what 19 years ago now. It's been such a long time. Wendy was like, you know, just this breath of fresh air. And most hygienists that I come into contact with, here's the thing. I know my comment, I remember now. When we go into this whole volume driven, it came back to me. I'm sorry. I'm getting old. It came back to me.

When we get into this volume driven model where we try to run a patient through every 30 minutes without giving the hygienist any help and we ask the hygienist to sacrifice the quality of the care, right? There's no time to educate in that scenario. We're really asking them to step down a page right to the bottom of the license. And I think the dentists sometimes don't realize that all they see is we need to make more money to support the practice to support the salaries, right?

And in my world, it's just amazing to me that time after time in my practice was one of that, you know Wendy, we did not have live coaching in the beginning. We had only your DVDs back when, I was first exposed to you and we listened to those DVDs and in a matter of a month at double hygiene. And the only thing that we changed was the level of conversation that was happening at the chair. We, in what we offer to the patient, right?

It was not a big, big deal. It was pretty easy and it was stuff we already knew. And that's what I've always loved about TTI is that what we do is easy, right? And if they do it, it works every time. We really see it. It worked in my practice. We doubled in a month and then you came in and coached us and we tripled in a year and nobody was working any more time. Nobody, no extra hygienists, no extra days, no extra hours. It was just in the same eight hours with the same eight patients that we were seeing, but we increased production per visit because we had better conversations about what was available to those patients.

So it's really not hard and it does take care of some of the low reimbursement rates we're seeing from insurance companies, the higher wages that we're having to pay in the field and those kinds of things. And it keeps us from having to go to the assisted technician model, right, Paige, which we're starting to see more of, which is very disheartening to me as a provider.

Yeah. Yeah, absolutely. I had an office in Utah that I went to, Wendy, one of those offices that kind of needed a life preserver, took a leap of faith, but was committed to implementation and supporting the vision that we provided. And I went and did a training of the preventive services on a Friday. Monday evening, I text the doctor and I said, how'd it go?

And he was like, holy cow, like my hygienist just needed the why, the skillset, the tool set, the mindset, which we provide in that training. And by noon, they had hit their production goal. Sealants were, you know, happening on adult patients. And he says they, the two hygienists almost outproduced him that day because he had kind of a quiet schedule. He's like, everyone's pumped and jazzed and super excited about where we can take the health of our patients. So that's my little story.

I love that. Well, very good. One of the reasons that we've chosen the topic that we have for our Summit this year, which is the meeting that Dr. John referenced earlier, is we chose the topic of profitability through five-star patient care because of these challenges, because of that level of thinking that in order to grow or be profitable, we have to shrink the services down or provide that high-volume model.

And Bert, I want you to share the story of the practice that worked with us for a while, shifted back to the high volume model at the advice of another marketing firm and then what happened there. So be thinking about that.

But again, five star patient care is how we get to a higher level of profitability. And I think there's, we should probably recognize the fact that there's certainly more than one way to be successful in dentistry. But what we bring to practices is things that are tested and proven and are replicable and I think that's one of the reasons why this is such a compelling and timely topic for our Summit this year, because there are so many practices that don't know which path to take to improve profitability.

I remember reading the comments of one doctor just last week that said, yes, we still accept Delta, but I treat my Delta patients radically differently than I treat a regular patient on purpose because Delta's basically, you know, some of the earth was so unfair and so unnecessary. And so unethical, right? That's the antithesis of everything we teach.

The things that we teach our patients deserve the very best care we can provide. And then we figure out what does that look like in your practice with your model, with your patient base? What does that look like for you? And that's why I love this theme of the Summit of profitability through five-star patient care. We're going to be showing practices and providers a different way or a better approach. And certainly those that have been with us a long time, we're just going to build on their current knowledge.

But I love this theme for the Summit. And I know you guys will be sharing some really great insights about what you're bringing to the group here in a minute. Bert, tell them that story about the high volume practice real quick.

Bert (15:33.461)
So it was a former client of ours, probably in 2014, they had been away for about 10 years and had done a different marketing strategy, right, which was built on a volume hygiene model. And the hygienists were, you know, there were all these columns of patients and, you know, just running in and out of rooms, scraping teeth, basically, and not educating. And what they saw was that their restorative was diving because of that and they knew that it was better when they had worked with us previously.

So they called me and they said, would you come back? We think we need to go back to the basics, right? So our fundamental program, Hygiene Explosion, which is the preventive strategies, I went back in and they talked to the hygienist. They agreed that they would go back to a single chair model. When I went in, there were five hygienists. They were doing $88,000 a month. When we ended nine months later, they were doing $188,000 a month in being alone in single chairs, no running all over the place, doing that kind of thing. So more than doubled, right? What they were doing and incredible result in the restorative went up as well again. So they were back in the neighborhood of where they were before. And that was very encouraging to them. So it was a great story. It really was.

Yeah. Wendy has always taught the three roles of hygiene, that is the preventive therapist, the periodontal therapist, and the treatment advocate that's talking about treatment that the doctor might recommend. And when you narrow down the hygiene appointment times, one of those roles doesn't get done, right? And guess which one? It's the treatment advocate, which then dries up treatment in the doctor's chair. And we've seen it over and over and over again that when you go to assisted hygiene, or just shorten the treatment times down, it's that treatment advocate role that gets, now it can be done with assisted hygiene well, but it's very difficult to do it well. But when you narrow down the time, the treatment advocate role just doesn't get done and the doctor's treatment dries up and productivity drops. And you think it's not going to, it makes sense that if you saw more patients, you would earn more, but that's not what actually happens.

Bert (17:52.755)
Never has been.

Yeah, we love that. So Paige, let's give everybody that's listening a quick hit preview of what you're going to be talking about this Summit. And this is one of my favorite things that we teach. And it's kind of a specializing that we teach, but it's one of my favorites because I began this journey before hygiene school. I was an assistant in a pediatric practice. And so I've always had a really warm place in my heart for all things family and kids focused because that's what we lived. So let's share with our listeners kind of what your focus is going to be when you're speaking at the Summit so they can get a little bit of an idea of other opportunities to really elevate their care in the community.

Yeah, absolutely. I'm thrilled to be able to talk about six keys to a world-class children's experience in the dental office. And I know a lot of doctors, a lot of team members are like, oh no, we don't do kids, that's not our jam. And I think we're really overlooking potentially a sub-demographic in our practice. You ask Dr. John, ask doctors all over the world, you know, what do you want more? Number one answer, I want more new patients. Well, we potentially have little new patients in our practice, but if we're not catering to them, mom, maybe taking them somewhere else. Now, I'm not going to advocate that we paint the office primary colors or put a jungle gym in the reception area, but you can be extremely profitable having kids in the practice if we just adjust a couple of things.

Yeah.

And really I'm gonna start kind of with the why 60 % of US kids have a cavity by the time they enter kindergarten. And something like 51 million hours are lost from school every year from children with tooth pain. So there's a need, there's a definite need. And so we're gonna talk about six strategies that you can easily implement to really elevate that children's experience and what we find is who loves that when their kids are treated really well? Mom does. And so it's a retention strategy. It keeps our patients in the practice. It creates, you know, world-class reviews and referrals to the practice as well. So we talk about the ours, referrals, retention, and several others, but it can really be, and also you can utilize social media and moms will start sharing the incredible experiences that their kids are having.

So one of the gems that we're gonna talk about that Wendy's been passionate about since she started in dentistry is really having a world-class kids-focused prevention program. based on the stats, we really need to provide a higher level of prevention for our kids. You know what's going on politically right now and fluoride, you know, being more of a hot topic again and potentially being taken out of the water. Lots more conversations are going on around that. We need to really help our patients at the highest level. And when we do again, do the right thing for the patient, production naturally follows.

And so some of the things that we focus on is we start with a risk assessment and a kids focused risk assessment. Sadly, that's one of the things that gets thrown out the window as well when we shorten appointment times. We don't talk about the risk and then use that risk status to drive the preventive services. So whether that's really maximizing fluoride, maximizing sealants on teeth and patients of all ages. And now we've got Curodont repair, extremely profitable to be able to fit in to a visit.

I find when I have families in the practice, those appointments can be sometimes much more profitable than my hour, you know, single booked adult that's doing fluoride and maybe a couple root protections here or there. So we maximize that, that preventive service with the risk assessment and moms are happy. And, know, going back to Curodont, what I'm finding, and I think, know, Bert, Wendy and Dr. John, you can agree.

Bert (22:08.478)
Mm-hmm.

You know, it's a costly in perspective, not overly costly. It's cheaper than a filling. But because we're not seeing amazing insurance reimbursement for it, some teams are getting a little scared. But what I'm finding in practice is moms are and dads will include all the parents and the caregivers. They are more than willing to pay out of pocket to be able to prevent that cavity from needing a restoration, avoiding the shot, avoiding the drill. And let's just face it, our parents are wanting their kids to have a much better dental experience than they maybe had. And so they're really willing to pay when we build that compelling why, you know, even if some of those sealants aren't covered, why they need it.

If fluoride is only covered once a year, why Johnnys need it. And, you know, the gingivitis code has no age restrictions. We can be doing gingivitis cleanings on six, eight, 10 year old kids. So it can be really profitable to have a great preventive program. I've got a couple more. All my gems, but let me know if you want, you want some little nuggets.

I love that, Paige.

Yeah, that's awesome.

That's a really great overview. And like I said before, some of the things that you'll be sharing at the Summit, know, the kids' day events and things like that really do open the door and allow us to invite our communities to know all these amazing things that we're doing. And that's one thing that I would say to many, many practices. We just had a webinar last night, very recently on marketing strategies. And so that's probably part of why my brain goes there. But I'm thinking, you know, every time you serve a family, there's an opportunity to build value within the community on social media about what we're doing and why we're doing it. And certainly those kids days give us lot of opportunity to have fun in the practice, to engage and create those long-term relationships with families.

Another statistic that I'll throw out there that's often overlooked is on average, what's spent to care for a child's teeth from the time of birth to the age of 18, not including ortho, is more than $10,000. So again, it does add up over time and that does not include ortho, that does not include lids and teeth extraction. So, you know, we're often missing out on a very significant profit center within the practice by not having child-friendly, practice-friendly systems for kids. So I love that you're going to be talking about creating that world-class experience for the littles in the practice.

Yeah, I've got a really great video from my practice when we did, we had a professional video crew come and we did a Harley Davidson themed kids day and it was wildly successful and it'll be fun to share that with our members at the Summit.

Bert (25:13.663)
Yay. Good.

Awesome. Very good. And Bert, what are you going to be speaking at the Summit?

Bert (25:21.769)
So I'm going to talk about increasing case acceptance with perio, which, you know, as a hygienist, I think one of the hardest conversations we have is convincing somebody who believes that they're healthy, that they need more, right, than just the cleaning, which is what we get a lot of.

So, but when you look at perio and we look at some of the bullet points concerning perio, you know, twice as likely to have a heart attack, three times as likely to have a stroke with active untreated periodontal disease. I often say, know, I knew the why around everything that we do is hygienist, right? I knew the what. I knew what to offer my patients. What I didn't have was the how, right? How do you have that conversation in a way that gets the patient to first understand that they have a problem and second, then own that problem, right?

And when you look at perio, you know, 85 % of patients have some form of perio from gingivitis all the way up to severe class four perio. And yet we see 3 % of the codes that go in the insurance companies build out in the 4,000 level. So what that tells me is we're doing an awful lot of bloody big prophys out there when we should be doing more perio, right? So how to have that conversation, and I think again, it starts with helping the patient connect that this mouth is an organ in the body, just like their liver is and their kidney is and their heart is, and that we are right, the people who help them maintain health with that organ and, you know, likening that to the medical model.

And we too, on the perio side, recommend a risk assessment process where we identify the factors that contribute to the disease and then offer them the opportunity, right, to understand that something more is going on and that they need something more to treat that, to get stable and under control again, right? And again, verbiage is such an important part of that, how we talk about it, you know, them not being a candidate for the healthy prophy anymore, healthy cleaning, and then identifying why that is, the why, and getting them to own that is a big part of that.

So we'll be talking about some of our strategies concerning perio acceptance,how to identify it properly, the five steps to getting acceptance. We'll go over that in the session and just a good overall how to talk about this in a way that gets patients to say yes, right? I understand I have a problem and yes, I wanna move forward. And again, this is probably the most difficult conversation we have as hygienists. It is very difficult. Hence the reason we see so many bloody big prophys or the under-diagnosing of perio, right?

In the practice, I think we don't catch it early enough in the gingivitis stage so that we can stop it. We wait till the pockets there, right? And the blood is everywhere. And you know, we run into the patient that says, my gums have bled for 40 years, Bert, I'm just fine, right? How do you counter that, right? How do you talk about that with the patient? I'll be sharing some of my pearls that I used with my patients that really got them to move forward and then how to liken that to a medical diagnosis, right?

And then here's what you have. Here's the treatment plan for treating it. And this is what we need to do long term to maintain that stability, right, with that disease. So we'll be talking about that and how to do that properly so patient really gets it and owns it. Yep.

I was just going to say, I can tell you that this is something that people desperately need. There was a conversation on one of the social media groups not too long ago. And I mentioned, you know, we have a five steps to case acceptance process that we teach in our perio course. I think I've had probably more than 25 requests for information on that so far, because it's something that people really need. And now I'm kicking myself. like, I should have just sent them a link to join us at the Summit because we're going to be talking about it.

So that will be going out to all of those people who requested information, because it is something that we all need help with long time hygienists even more so because there's been so many new advents and technology to help us treat it better that maybe we're not as familiar with how to utilize that. How do we make it visual for people? Those are part of the five steps you'll be talking about. So I know it's something that a lot of people really, really need. And that's one of the reasons why we're so excited to have you share this at the Summit.

Bert (29:47.859)
And then where should you be from a perio percentage? You know, like if you see 100 patients a month, you know, how many of those patients really should be in a 4000 code if we're diagnosing at the proper level? So those statistics, you know, based on the national statistics, I think are really important. Some people don't even realize there is a range you should be right in if you're doing it properly. So we'll be talking about all of that that day and how to do a better job with that.

Awesome, Bert. I love your real world scenarios and how you communicate with patients with everyday language and what sometimes seem like silly metaphors, but they work. They help people understand what's going on and help them to move forward with care. as you can all tell, this is going to be an amazing Summit and the information is going to be really, you know, life changing in your practice. So we're excited to have you two as speakers at the Summit and we invite everyone to register for the Summit because we'd love to see you there. And anything else, ladies?

And we will actually, let's just let our listeners know we will include the link for the registration on our podcast homepage so that if you'd like information, you can go there. You can also go to ChampionsofDenistry.com and find that information.

Fantastic. All right, that's it for this episode of The Double Your Production Podcast. We'll see you all next time. Bye

Bert (31:21.301)
Bye guys.

Thanks everybody.

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Ep 141: Easy Ways to Expand Care in Your Office

Ep 141: Easy Ways to Expand Care in Your Office

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