Are you using the latest Initial Records and TC procedures to get your patients started? Are they effective and efficient and getting more patients started, sooner? Maybe this pearl can help you put this important aspect of the changing face of orthodontics into prospective.
Over the 50 years that I’ve been organizing orthodontic practices there has been many changes, all with their own pro and con price tags. In this third and final part of this series we will discuss the changing face of your Initial Records and TC Bio-Systems (people-systems)—how it all started and how it evolved to what works best today.
A Little History:
Back in 1972 when I started designing orthodontic bio-systems (people systems) for “The Millennium Society”, Dr. Carl Gugino of Buffalo, NY introduced me to the “Treatment Coordinator” (TC) concept for getting new patients started. Back then, there were more patients than the practices could handle and most practices hired me because they over-started and were going crazy trying to get them treated. Their IR-TC bio-systems were: New Patient Exam, then Initial Records, then Dx & Tx Planning and then Initial Appliances, which typically took between two and three months. It took so long because of too many patients and because it took weeks to get initial records processed in order to Dx & Tx plan the case. The doctor only had enough time to briefly see the patient at the exam and initial appliances appointments. The scheduling was also a mess with patients stuck anywhere in the schedule; whether they “fit” in there or not—the TC concept helped by scheduling the exams/consults and records in separate rooms (columns) instead of in the busy clinic columns.
One saving grace was that Dr. Gugino’s TC concept helped spread out the new patient’s initial appointments for better control of the treatment and to provide a much better “service”. Treatment is moving teeth; service is the way you provide that treatment to make it more effective/efficient and to make the patient feel like “they do not want to go anyplace else for their treatment”. This same service applies today where the competition is more fierce, requiring a more timely, marketing/selling approach to getting patients started. In this pearl, we will use a chronological approach to describe the pros and cons of how these bio-systems have changed/improved over the years.
Before about 1975:
Most doctors did the new patient exam in a Tx chair in the clinic. The pros were: 1) The patient got started sooner; and 2) The doctor spent little Dr-Tx-Time getting the patient started.
The cons were: 1) The patient/family got little information on their Dx and Tx Plan; 2) the exam and its discussion wasn’t private [HIPAA would not have approved]; 3) in order to keep it short, the exam typically wasn’t comprehensive enough; 4) the family wasn’t properly informed and had many unanswered questions; and, 5) it did nothing to market the practice (quite the opposite, but there were many patients available). If the doctor did the exam in a private operatory instead of an open clinic the pros and cons above were the same, except that there was some HIPAA privacy.
From 1975 to about 1995:
The TC concept became popular because of its pros: 1) the Exam & Tx Consult was done in a private exam/consult room with the TC; 2) the TC could record the patient’s data while making the patient the subject and not the object of the exam, getting the patient more involved in treatment; 3) the doctor could do a more comprehensive exam; 4) the doctor could dictate his/her findings to the TC, making it a “good show”, impressing the patient/family and internally marketing the practice; 5) the TC could better explain the doctor’s findings and the treatment required to resolve the patient’s problems; 6) the records/starting appointments could be scheduled by the TC, having the patient/family only deal with one person.
The cons were: 1) the TC concept increased staff-related expenses and daily appointments; 2) being distracted from the clinic’s needs while in the exam room, the doctor spent 20 to 30 minutes at the exam, unfortunately doing the TC’s work—when in fact the patient/family would rather talk to the TC; 3) the TC concept required separate Exam, Tx Consult, Initial Records and starting appointments to get patients effectively started. Effectively started means that they were sold on Tx, they knew how to cooperate, their financing and their starting appointments were acceptable.
From about 1995 to about 2005:
New pros were created for the TC program by the use of computers and digital records: 1) digital x-rays were instant, requiring little processing time; 2) photo “imaging” eliminated the long time it took to print 35mm slides; 3) the Dr time at the exam was reduced to about 10 to 15 minutes; and 4) the TC could schedule all of the patient’s appointments in the exam/consult room without going to the reception area.
Eventually, the Tx Consults collected some cons: 1) separate exams, records, Tx Consults and starting appointments took too long to get patients started, driving some away; 2) the scheduled exam times almost doubled, by trying to do the exam and Tx consult in one appointment; and 3) all of that information “burnt out” the patient/family.
At the same time the Tx Consults still had some pros: 1) Patients who needed to go home after the exam and think about it, still required a separate Tx Consult; 2) Tx Consults were still needed for difficult treatment plans (i.e., wait for full vs. do a Ph-I/Ph-II, do surgical or not, etc.); and 3) some patients needed a Tx Consult after they went home to discuss starting treatment with the entire family—those Tx Consults were later replaced with a short Financial Consult with the Financial Coordinator, typically the same day as the initial appliances.
Another approach that started in about 1987 was the “Instant Start”, used by practices with strong, get-it-done director doctors using a weak relator TC—they started treatment right after the exam. The pro was: 1) treatment started by not allowing the patient/family to go home and get buyers remorse and not start treatment.
The cons were: 1) Some felt too pressured and didn’t start; 2) If started, collecting the initial payment (or any payment) was difficult (buyers remorse); 3) they ransomed the teeth with a few brackets/appliance and later placed all of the appliances; 3) If full braces are placed they had to have a lot of DA and Dr. time available after the exam, wasting that appointment if they didn’t start; 4) Patient cooperation was not great.
The only resolution to this problem was to have a proper TC personality so that they didn’t need an instant start. Refer to the management pearls: “How the Director Style* HELPS or HINDERS your Success”, "How the Relator Style HELPS or HINDERS your Success" and “Balancing your Practice Personality”.
From about 2005 to date:
The new pros were that: 1) the use of digital x-rays, tooth-scanning devices, photos, the proper sequencing of appointments and succinct exam procedures provided a shorter, more efficient exam/consult and got the patient started sooner; 2) the doctor could do a better exam and Tx explanation using a digital Pano printout and a photo collage printout that the patient/family could take home and discuss.
The cons were: 1) The records tech had to be able to give the TC the pano (and photos) before the doctor arrived at the exam; or 2) If the TC took/processed the photos it required more exam time while she ignored the patient/family to process them.
Finally after about four decades, an ideal TC-RT two appointment sequence:
Appointment One:
1) The TC obtains the patient and family and brings them to the Exam/Consult room.
2) The Records tech is called in and introduced to the patient/family who brings the patient to the records room and takes the pano and photos while the TC obtains financial information from the family.
3) The Records tech brings the patient back to the exam/consult room for the TC to start her patient interview.
4) The Records tech prints out the digital pano and photo collage and makes it available to the doctor before he/she enters the exam.
5) The Doctor does his/her exam and uses the pano and photos to describe his/her findings and the treatment required and then leaves.
6) The TC better explains the doctor’s findings, Tx plan and Tx fees and possible financial arrangements.
7) If the patient/family accepts treatment, the TC has the records tech take the ceph and scan for the models while the TC wraps up the Financial Agreement, Informed Consent, etc., and schedules the starting appointments.
8) If the patient/family is hesitant about starting, a short Tx Consult later with the TC or with the Financial Coordinator is scheduled before the Initial Appliances appointment to resolve the finances.
Appointment Two:
Initial appliances.
I hope that you have already taken advantage of these orthodontic bio-systems to get your patients started sooner with a better service—and if not, it might be a good time to start.
You might also want to review the attached PDF covering “Patient Availability” (to the TC) over the past 62 years, and over the next 13 years, which might be helpful in planning the types of patients you should market (adults?).
