Prescheduling Hygiene Visits

Aug. 1, 2007
Dear Dianne,I work in an office that does not schedule hygiene visits six months out.

Dear Dianne,

I work in an office that does not schedule hygiene visits six months out. When I asked the scheduling coordinator why they don’t believe in making the patient’s six-month appointment ahead of time, she said they had too many no-shows when they prescheduled. The downside for me is that my schedule has one or two (sometimes more!) unfilled appointments every day I work. It seems like the scheduling coordinator is always on the phone trying to fill my schedule, but something is not working.

In the previous practice where I worked, we always prescheduled. Sure, we had some no-shows, but my schedule was much fuller than it is in my current practice. I’m worried that the doctor will reduce my days because of the problem keeping my schedule full.

What are your thoughts about prescheduling? Are you pro or con?

- Sensible Sarah

Dear Sarah,

I have been in both kinds of offices - those that preschedule and those that do not - and I’ve seen success and failure with both protocols.

My observation is this. Offices that are successful in keeping the hygiene schedule full without prescheduling have two essential ingredients: (1) strong demand for hygiene services, and (2) an effective business assistant who is dedicated to hygiene scheduling exclusively. Without these two elements, the “call-us-in-six-months” model comes up short.

When I speak of “strong demand,” I mean there is an overabundance of patients who seek hygiene services in that practice. These are practices with more active patients than the amount of available hygiene time. For example, it takes anywhere from 800 to 1,000 active patients to keep one full-time hygienist busy. (“Active” refers to people who have had treatment in the past 18 months.) If a hygienist works 180 days per year and sees an average of nine patients per day, that’s 1,620 appointment slots. That means that 810 people could get appointments (1,620 / 2 when patients come in twice a year). This doesn’t take into account three-to-four-month periodontal maintenance patients, new patients who need periodontal scaling, or sealant patients. But what if the practice has 2,500 active patients? That is far more patients than one hygienist could see in any given year. In this situation, it would be better for the practice to refrain from prescheduling. If space permits, a second or even third hygienist should be added, or a switch made to an assisted hygiene model with one hygienist and a dedicated hygiene assistant using two operatories, to increase capacity to meet the high demand.

When patients receive reminder cards instructing them to call for an appointment, the call-back rate in most offices is around 20 percent, not a great return rate. However, when you factor in other people, such as new patients and existing patients who are past due for their preventive care visit, a “high demand” office will have no problem keeping the schedule full.

Most of the offices I work with preschedule hygiene patients simply because it reduces work for the front-desk assistants, who struggle to keep the hygiene schedule full. If an office preschedules hygiene appointments, fewer patients are “lost” in the system. This model makes it easier to keep people on a regular six-month hygiene regimen. However, it is unwise to arbitrarily preschedule every preventive patient. Here are my rules for prescheduling:

(1) Prescheduling is a privilege that we allow some of our patients. Patients who have proven to be unreliable by their history of disappointment should not be allowed to preschedule their six-month appointment. Rather, such patients should receive reminder cards that instruct them to call for an appointment.

(2) Do not completely fill days six months out with appointments. Leave some scattered openings, and block off one day toward the end of the month as a safety net in case patients have to be reappointed because of hygienist absence. If no absence occurs, the day can be appointed with patients who telephone for appointments.

(3) Patients should be informed that a reminder card with the appointment information will be mailed about three or four weeks before the appointment.

(4) Do not allow prime-time appointments (first morning appointment or late afternoon appointments) to be scheduled beyond seven months out. If a patient requests a prime-time appointment and none is available, offer the patient a close alternative. “Mr. Jones, the schedule indicates there are no appointments available at the time you have requested. However, I do have _________ or ____________ available.” Since there is more demand for late afternoon/early morning appointment times than middle-of-the-day appointments, some offices award prime-time appointments on alternating visits to allow more people to enjoy those time slots. Other offices offer an incentive or discount to accept a time that is typically hard to fill.

(5) If a patient disappoints a prime-time appointment, succeeding appointments will be non-prime time only.

(6) Reminder calls should go out 48 hours ahead of the scheduled visit.

The amount of unfilled time in your office may seem excessive. If the average hygiene appointment is worth $90, and you have two openings per day, that’s a loss of $180 each day. Multiply that times 180 working days per year and that’s at least $32,400 lost!

There could be some communication problems with the verbiage used by the front-desk assistant. Such phrases as “We have a cancellation ...” or “It’s time for your cleaning and checkup ...” are ineffective. If the assistant is making the calls during the regular workday, she is probably leaving hundreds of messages on voicemail for patients to call for appointments, and patients are simply not calling back. What a boring, demoralizing job! She might get a better response rate by placing some calls at nontraditional times, but even that is not ideal. We never know when we are interrupting people just sitting down to dinner.

Am I in favor of prescheduling dental hygiene visits? The answer is yes for some patients and no for others. We need to be discriminating in whom we allow to reserve time six months away. Further, if your practice has more demand than it can handle, meaning hygiene is overwhelmed with appointments, be even more discriminating. You have that luxury.

Lastly, the best hygiene recall system in the world is doomed to failure if there are no competent business assistants in place to make it happen. They must be confident, organized, and dedicated to keeping the schedule full, and to do this, they need excellent communication skills. Seeing how much money the practice is losing to downtime, it would be wise to invest in some outside training.

Best wishes,
- Dianne

About the Author

Dianne D. Glasscoe, RDH, BS, is a professional speaker, writer, and consultant to dental practices across the United States. She is CEO of Professional Dental Management, based in Frederick, Md. To contact Glasscoe for speaking or consulting, call (301) 874-5240 or e-mail [email protected]. Visit her Web site at