When a friend of mine was planning to open her own orthodontic practice a number of years ago (in the days before I had jumped into the world of consulting), she was stymied by the difficult time she had finding a consultant to work with her. She was unable to find anyone who really specialized in orthodontic practices and, more often then not, consultants she respected were telling her they did not work with orthodontic offices at all. As an admitted “ortho geek,” I couldn’t help but wonder why it was that orthodontics was, in effect, the red-headed stepchild of the dental consulting world.
As I gave this some thought, I began to remember my first days managing an orthodontic practice. I had moved to Colorado from the East Coast and came with an extensive background in general dentistry, endodontics, periodontics and oral surgery. How difficult could managing an orthodontic office really be? Because I was so supremely confident that I was well prepared for the job, the next few months were indeed a humbling experience. I discovered that the only areas of expertise I had that really translated into orthodontics were management and people skills. Everything else I knew was completely different. Areas such as scheduling, financial plans, insurance billing and even terminology were all new and uncharted territory. The following are brief descriptions of what makes “ortho” such a challenge for a dental consultant.
Scheduling – In every successful dental office there is one mantra you hear above all others: “keep the schedule full.” An open spot in the schedule not only looses valuable production, but it also represents time that is being wasted by the doctor and staff members. In general offices, as well as most specialty offices, the solution to this problem is pretty straightforward. When a patient cancels or reschedules we get on the phone and try to move an appointment of similar type and duration into the time slot. We need to pay attention that the lab work is back for prosthetic cases, but otherwise it’s pretty basic. Not so in orthodontics. The first time I told the front desk receptionist to work on getting the next days scheduled filled, she told me what that actually entailed. She had no candidate to fill the two and a half hour banding appointment because a patient with that type of appointment would need separators placed a few days to a week prior to enable the bands to be fit comfortably. Thus it followed that all the patients who were ready for this type of appointment were already in place with an appropriate set of appointments. She also had no candidate to fill the slot for expander placement because that needed to be preceded by expander impression. And she further had no candidate to fill an empty consultation appointment because that needed to be preceded by study models, x-rays and doctor time to review them. And while all orthodontists do not follow this strict a scheduling template, there is definitely a progression in orthodontic scheduling that does not exist in other offices. Scheduling in a busy orthodontic office is an art form like no other.
Payment plans – Payment plans are a fact of life in orthodontic offices. While the general office asks for fee at time of service (maybe allowing for 2 or 3 payments for crown and bridge work), the orthodontic office needs to set up a plan with down payment and monthly payments for each patient. These plans need to be structured to keep the patient’s parents (or the patient himself) reasonably happy while also getting an appropriate amount paid to the office in a timely fashion. Insurance (which I will discuss on its own later) can further complicate the picture. Creating an orthodontic contract that works for the patient and the office can be time consuming. In addition, setting the fees that these contracts are based on can present a conundrum for the doctor and treatment coordinator. As parents and caring human beings, we are loath to ask for amounts that we know would stretch our own budgets, but we also know the value of a treatment plan that may take us one to two years to complete. This is a time frame we don’t usually have to deal with in other types of offices.
Insurance – This is yet another area where orthodontics presents challenges that differ from those in other types of practices. With the exception of very few plans, insurances all have what’s known as an “inside maximum” for orthodontics. This is almost always a lifetime maximum, as opposed to the yearly maximum allowed for all other dental work. Couple this with the fact that insurances pay a down payment, then monthly or quarterly payments as treatment progresses and you have a huge job for the “insurance specialist” in the office as she follows up on payments and makes sure appropriate billing goes out periodically. This job is made even more interesting by the fact that a patient’s insurance may change one, two or more times during the course of treatment as dad changes jobs or dad’s company changes benefits. Orthodontic insurance billing is not a job for the faint of heart!
Terminology – For someone like myself who had worked in dental offices for many years and thought she’d pretty much “heard it all” when it came to dental terminology, working in an orthodontic office was a real continuing education course. From bands, brackets and separators to lingual arches and incline planes, learning the names of the appliances was only the beginning. In addition, the entire game plan the orthodontist uses to decide how to correct the problems of aesthetics and function is a fascinating area and very different in nature from composites and crown and bridge. It takes a good deal of time and work to learn the language needed to function intelligently in an orthodontic office.
Having said all this, I must now say how lucky I consider myself to have spent years working in orthodontics and to have learned a great deal about how these practices should work. I really enjoy being able to say “Ortho, no problem, I’d love to be your consultant because I know I can understand what you need and how to work with you…and I’ll enjoy every minute of it.”
