Th 163659

At home ... in a capitation office

Dec. 1, 2004
The mission statement of Willamette Dental Group, P.C., is, "Our mission is to deliver superior patient care through a partnership with our patients, and to stop the disease/repair cycle by means of evidence-based methods of prevention and treatment."

by Jonalee Potter, RDH

Jonalee Potter, RDH, poses in front of display of consumer products.
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The mission statement of Willamette Dental Group, P.C., is, "Our mission is to deliver superior patient care through a partnership with our patients, and to stop the disease/repair cycle by means of evidence-based methods of prevention and treatment."

Office managed by Williamette Dental Group.
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Willamette Dental Group (WDG) originated as a partnership between two Oregon dentists and is now owned and operated by one of those dentists. From the beginning, WDG pioneered managed care programs for dental services. In 1970, WDG established the first capitation dental plan in the Pacific Northwest with United Metal Trades Association. In 1974, Blue Cross & Blue Shield of Oregon marketed a capitation dental plan known as Dentacare. WDG contracted to be the provider for patients with Dentacare in the Portland metropolitan area. WDG serves patients of Willamette Dental Insurance and other insurers in Oregon, Idaho, and Washington.

The company has grown from one Portland office in 1970 to more than 50 offices in Oregon, Idaho, and Washington.

The management corporation that provides administrative services throughout the company was established in 1997. This corporation supports WDG through administrative positions in the following departments: appointment center, clinical support, dental laboratory, facilities, purchasing, finance, government relations, human resources, information systems, insurance, legal, marketing, patient relations, records, and scheduling.

Each office has a management team comprised of an office manager and managing doctor. Each office has a lead dental hygienist, lead dental assistant, and a lead patient service representative (PSR). Within each office there are general or specialized dentists, dental hygienists, dental assistants, and PSRs. The specialized practitioners include orthodontists, endodontists, periodontists, pedodontists, oral surgeons, and denturists. General dentists refer patients to the specialists. The number of staff members varies in each office.

I have been employed with Willamette Dental Group since October 1984, and I'm currently the lead dental hygienist in the Hillsboro, Ore., office. I work as a dental hygienist under the direction of several general dentists and as a "periohygienist" under the direction of the Portland metro area periodontist.

When I started with the company, I worked in an on-call position for the Jefferson Street office. A Hillsboro Office was under construction, and I asked to be moved there because I live in the Hillsboro area. The Hillsboro office opened in September 1985 and was staffed by one dentist, one hygienist, one assistant, and one PSR. I was the hygienist and worked 20- to 30-hour workweeks.

Today, I work 40 hours per week and am one of the full-time hygienists. The office has three full-time dentists, three full-time hygienists, three full-time assistants, and four-full time PSRs. We also have two part-time hygienists, a records technician, a managing doctor (based in the administration office), and an office manager. The office has 16 operatories, two X-ray units, one panoramic X-ray unit, a small lab (to prepare cases for the company dental lab), and a sterilization area.

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All of the WDG offices operate six days a week from 7 a.m. to 6 p.m. All staff members, with the exception of the office manager, work 10-hour days, and the days vary depending on the employee's schedule. The doctors work with their own assistants, while the hygienists work with one doctor on a particular day. One to three hygienists work each day.

For example, Monday is Dr. Deimling's hygiene day, and the patients seen by the hygienists have Dr. Deimling as their doctor of record. The hygienist will do the services rendered, but the doctor of record will do the examination and make the treatment plan according to his findings. However, there are exceptions to each day.

As a long-term employee of WDG, I often feel this is my "home away from home," and I take pride in my work as a lead dental hygienist and periohygienist for the company. Through the years I have worked with many people and patients and have learned to treat each person as an individual with his or her own needs. I learn new things each day and enjoy this aspect of working for Willamette Dental Group.

The patients seen at Willamette Dental Group come from many walks of life. We see patients who work and carry different dental insurance plans (HMO or other insurers), patients with mental and/or physical disabilities, and patients who carry the Oregon Health Plan insurance (Medicaid and welfare). We see patients ranging from in age from one to the elderly. We have patients who have immigrated from many countries, speak very little English, and communicate through interpreters.

Even though the patient population is very diversified, their needs are treated equally. There is no discrimination in care due to their financial status or disabilities.

Notes from journal

On day one of my journal entries, I thought about the paradigm of calculus removal and periodontal disease. A large portion of my patients have subgingival calculus, boggy tissue, and heavy bleeding. There have been shifts throughout the years regarding full subcalculus removal and the health of the gingival tissue. I strive for complete calculus removal, teaching the patient home care skills, and stressing the importance of the patient's role in their oral health. I am the "helper" who gets them cleaned, but I am also the person who teaches them how to care for themselves.

Tuesday was a hectic day with some scheduling errors, but it worked out fine. It was odd seeing a periohygiene patient on this day because I usually see this type of patient on an "A" week Monday in Hillsboro or "B" week Wednesday in Tigard. But no harm was done. I was able to see him and schedule him for a follow-up visit in three months.

Wednesday was a periodontal day in the Tigard Office. My comments included "a hard but rewarding workday." I enjoy the challenge of periodontal hygiene, have come to know the patients well, and can see the results of my work.

Thursday is my Friday. Every Thursday, I have one hour to do my administrative work, which is the role of the lead hygienist. I audit hygiene charts, review upcoming schedules, check the hygiene schedules, and meet with my office manager to make sure everything is on track. My thoughts for this particular day were, "A good flow to the day, things seemed to be on track for the upcoming week, and I'm looking forward to the weekend."

During the week of journal entries, I was surprised by my thoughts and comments. I didn't learn anything new about my skills or profession, but I did learn some things about myself. I realized how much I enjoy the company and my career as a dental hygienist. WDG strives to deliver superior patient care through a partnership with our patients, and I am in partnership with our patients. I see myself as the provider of care and the one who teaches patients to care for themselves. We are a team working for the betterment of people's oral health.

Willamette Dental Group uses evidence-based care and researches ways to improve patient care. The company strives to stay current on all aspects of dental care and patient services. Prevention is the focus of the practice and the company researches ways to promote it. I feel hygienists are the prevention providers.

Whether a patient has standard insurance benefits or Medicaid, has to bring an interpreter, or has physical and/or mental disabilities, the services provided by Willamette Dental Group is the same. I can give all patients quality care.

There is one more aspect to Willamette Dental Group that I feel is very important. Not only do they deliver care to the people who come into our offices, they do community service. WDG promotes dental care with schools at science fairs, health fairs, sealant programs, office tours, and sponsors a "Hooray for Healthy Teeth" promotion in February. Employees and their families have the opportunity to help with these programs.

I enjoy working for Willamette Dental Group and will work there as long as I can. The company offers many opportunities for their employees, but most of all they give quality care on an equal basis. I uphold the mission statement and agree with the evidence-based methods that WDG uses in stopping the cycle of disease.

Jonalee C. Potter, RDH, BS is a practicing clinical hygienist in Hillsboro, Oregon. She has been employed with Willamette Dental Group for 20 years and continues her employment with the company. She graduated from Weber State University in Ogden, Utah, in 1982 and returned to WSU to earn a bachelor's degree in dental hygiene in May 2004. She is a member of ADHA and ODHA. Jonalee can be reached by e-mail at [email protected].

The dental hygiene schedule

The patient's doctor of record determines the treatment plans, and services rendered by the hygienist are determined by the treatment plan. Each patient is diagnosed and placed in a category. These categories help in the diagnosis and treatment for each appointment. However, just because a patient is "placed" in a category does not mean he or she is locked in that category. The overall health is evaluated at each appointment and, if needed, the course of treatment is changed.

The appointment types, for the hygienist, include:
Continuing care (CC)
Hygiene prophy
Supportive periodontal therapy (SPT)
Caries management therapy (CMT)
Caries continuing care (CCC)
Periodontal continuing care (PCC)

We see patients who need sealants placed and oral hygiene instruction reinforced. These types may be seen as an individual service or may be in a combination. For example, a patient may be seen for an SPT/CMT appointment. Continuing care patients are "recall" patients who will have an exam, X-rays if necessary, periodontal probing, a prophylaxis, and fluoride treatment. A hygiene prophy appointment is a continuing care appointment without an exam and X-rays. SPT appointments are for patients who have been diagnosed with periodontal disease and are seen every three months for an ultrasonic debridement and scaling. CMT patients are seen every three months for homecare instruction and an application of fluoride varnish. The CCC and PCC patients have completed a year of quarterly visits and will follow the continuing care protocol with reevaluation of their disease.

There are two types of schedules that the hygienists work each day. There is a "straight" schedule, where patients are scheduled on one schedule with appointments every 30 to 60 minutes. Then there is an "assisted" schedule where the patients are scheduled between two chairs, and the appointments are from 30 to 45 minutes. On the one-chair schedule, the patients are scheduled on one-hour increments, and in half-hour increments on the two-chair schedule. Schedules can be posted in any combination, such as an assisted schedule with a straight schedule or a combination of two straight schedules. Whenever there is an assisted schedule, a hygiene assistant is needed.

The hygienists work on a "first chart up" basis, unless a patient requests a particular hygienist. The first patients of the day are seen at 7 a.m. and the first hygienist to take the chart will see the patient, and the other hygienists see subsequent patients. Throughout the day when a hygienist is available, he or she will take the next chart and see that patient. If there is a request, the staff works the schedule so that the requested hygienist is available for that patient. This type of structure allows the hygienists to see a variety of patient types and keep the workload balanced.

The hygiene assistant helps with the patient flow by taking X-rays, assisting the doctor with exams, cleaning and setting up the operatories, taking blood pressures, etc. She can also see patients 12-years-old and under, and the CMT patients for their homecare instruction and fluoride application. While this may all seem complicated, it goes smoothly with good teamwork.