3 KPIs to Know if Your Periodontal Protocol is Working

Episode #582 with Miranda Beeson

Is your perio at zero percent? If it is, it doesn't have to stay that way! Once you create a periodontal protocol, your next step is to track a few numbers. To reveal what those key KPIs are, Kirk Behrendt brings back Miranda Beeson, one of ACT’s amazing coaches, so you can understand what's working, what's not, and the countermeasures to put in place. Your perio percentage should be as high as possible! To learn how to go from zero to 60 — and beyond — listen to Episode 582 of The Best Practices Show!

Episode Resources:

• Miranda’s email: mirandabeesonicc@gmail.com 
• Miranda’s social media: @actdental
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Links Mentioned in This Episode:

3 KPIs to Know if Your Periodontal Protocol is Working: https://drive.google.com/file/d/1T8shs-Fz86O7dtbfx3dma5kKOknvsIJo/view

The Best Practices Show Episode 574 with Miranda Beeson: https://podcasts.apple.com/us/podcast/5-strategies-to-encourage-dental-hygienists-to-diagnose/id1223838218?i=1000612492886

Katrina Sanders’ Disease Prevention & Wine Tasting course (October 5-6, 2023): https://www.eventbrite.com/e/act-dental-hygienists-live-course-october-5-6-2023-tickets-368595568267

Main Takeaways:

Monitor your periodontal visit percentage.

Monitor your periodontal diagnostic percentage.

Monitor your periodontal acceptance percentage.

Look at all three KPIs together to get the whole picture.

Help patients discover what they need rather than telling them.

Build value through conversation and bringing patients into the process.

Quotes:

“If we put something into place, strategies around creating periodontal protocol in the office, that's great. But it really doesn't mean much if we don't know if it’s actually working. Are team members following through? Are we getting the response from patients that we want? We want to know if those protocols are working so that team members can have accountability for their role in the process. Their own accountability, maybe we need to be tied into that. Or we have our own as practice owners and doctors. And also, so that we can course-correct. Or, even better, celebrate when we need to. When the data points show us that we need to put some countermeasures in place or course-correct, great. But if we’re doing really well, we want to take the time to acknowledge the team members who've been putting in the effort and making that happen. So, there are a lot of reasons why monitoring this is really important.” (3:12—3:58)

“I would venture to say very few [practices have a periodontal protocol]. From my own personal experience as a hygienist, over the years, I can't remember a practice I joined that had an established periodontal protocol when I joined the practice. And then, when I look at coaching and the teams that I have had exposure to, most of those teams have none, or something they’ve tried to develop on their own and they really need some help getting it growing, getting it where it’s actionable. So, I would say, if I had to put a percent on it, it would be a really low percentage of the number of offices that truly have a documented and aligned periodontal protocol in their practice, which is why we did that previous podcast around the strategies to help make that happen in your practice. But again, if we put that into place and we don't monitor for its success, then what's the point?” (4:27—5:14)

“I worked in a practice that when I joined the practice, it was two percent perio. That's when I started looking into — I was the only hygienist there — how do I make a periodontal program? By the time I left the practice about three-and-a-half years later, we were at 22% perio. So, it’s a matter of sitting down and aligning, and really creating that philosophy in the practice and putting strategy into, how are we going to identify health in this practice, and then what are we going to do to treat anything that’s not health so that we’re all doing it the same in a way that is the most optimal care for our patients?” (6:30—7:06)

“The first thing that we’re going to measure is our periodontal visit percentage. Now, a lot of our clients and coaching clients have Dental Intel, so this helps us do that pretty easily. But you can do this manually as well, or just print reports within your practice management software. And what that is is the percentage of patients that are seen by the hygienist within a given period of time, whatever timeframe you select. Generally, we’re looking at it weekly or monthly when we’re reporting on that.” (7:56—8:21)

“So, what percentage of patients that the hygienist is seeing are periodontal patients? We’re going to look at prophys, the D110, separate from all of those 4000 codes. And this is where you talked about — I have codes on my cheat sheet here. The codes that go into that periodontal percentage are D4355, the gross debridement; D4346, the gingivitis therapy, because technically a patient is not diagnosed with periodontal disease when we’re using that code, but they're not healthy. And it is still technically a perio code by way of how we classify it. The D4910, periodontal maintenance patients. And then, the quadrant codes, the periodontal therapy codes, D4341 and D4342. And in Dental Intel, which you can also customize this in your own software, would be your implant maintenance codes or your implant therapy codes, like the D6080 and D6081. So, what percentage of the patients that the hygienists have seen within a given month, of those patients, how many were a periodontal procedure that was performed?” (8:22—9:29)

“A lot of people, like we talked about in our previous podcast, are doing periodontal services and gingivitis therapy and coding it as a prophy. So, it really does start with coding for what we’re truly doing, putting out a treatment plan, talking with our patient about the difference in this type of cleaning or hygiene services than what they're used to with preventative nature. So, really putting the appropriate codes on the services that we’re providing.” (10:13—10:40)

“If you're at zero percent, two percent perio, like I was telling you, my practice I joined was two percent perio. If I had thought I was going to get to the benchmark of 35%, 40% perio in the first six months, that would've been crazy. I want to go from two percent perio to four percent perio, four percent perio to maybe seven percent perio. Now, as time goes on and you're working a periodontal protocol over time, and it gets more established and your team gets more comfortable having the conversations with patients, the business team gets more comfortable with handling objections around the treatment plans, you're going to see that gap increase larger each time. You might start with a two percent increase. But eventually, you might go from seven to 12%, or 12% to 18%, 18% to 29%. That gap will start to increase over time as the confidence and knowledge within the team improves over time.” (11:06—11:54)

“I have some awesome teams, so shout-out to all my teams. All of them that are working on this right now, the biggest thing is celebrating and helping them stay motivated with the small accomplishments. I have a team right now that's, again, they started at zero percent. When we did our last check-in for the weekly numbers, they were at three percent. And we’re going to talk about periodontal acceptance rates in just a minute as well, that was 100%. So, they went from no patients to three patients being diagnosed this week. All three of them accepted treatment, so we had to stop and really celebrate that progress. Three patients might not seem like a lot if you have an active patient count of 4,000. But three patients being treated optimally for their disease state, and your team feeling comfortable and confident, we have to celebrate that growth. And that means next time the growth is going to double because now they're more motivated.” (12:47—13:38)

“When we look at our community, our culture, we look at research — we know that based on age differentials the research is a little different — but over half of the population has some form of periodontal disease, gum disease, gingivitis, and or active disease. As we get older, 65 and above, that number goes up into the high 60s, in some research, even the 70 percentiles. So, what we’re looking for is, how do we reflect in our practice, on our patient population, that same level of care? And so, the benchmark is going to sit around 35%. And that will vary. I know that's a Dental Intel benchmark, and we do work with them pretty exclusively with a lot of our coaching clients. There are some people who would argue that that benchmark is 40% to 60%. It depends on your geographic area, access to care. There are different things that come into play. But certainly, 35% is a solid benchmark to start from.” (13:49—14:43)

“The second KPI you're going to want to monitor is your periodontal diagnostic percentage. What that means is, it’s the patients that we’re seeing for hygiene that were diagnosed for new periodontal treatment. So, new codes that are those 4000 codes, the same ones that I mentioned before. So, a patient comes in for care. You have eight patients today, and two of them were treatment planned for a 4000 code. Maybe one of them for gingivitis therapy, and one of them for quadrant periodontal therapy. And so, we’re going to look at, out of those patients, what percentage of the patients that I saw at any given period of time were diagnosed with new periodontal treatment codes?” (15:38—16:15)

“I think it’s really important for the hygienist to track [these KPIs]. The accountability really comes back to that team member. First, making sure that the team members who are going to be asked to track these numbers are part of the strategy around, why are we tracking them? They really have to have the buy-in. Otherwise, this is just a chore or a task that you're giving them. But when the hygienist is responsible for monitoring that, they're going to be paying closer attention to the outcome. They're going to be thinking more mindfully about it throughout the day and thinking to themselves, at the end of the day, if they're tracking day after day or week after week, ‘What can I do? Because, oh, man — I was at two percent this week, but Michelle was at 22% this week. Maybe I need to get with Michelle and figure out what she’s doing that I'm not doing.’ So, there's a level of accountability when the hygienist is the person tracking those numbers.” (16:31—17:22)

“When you're looking at your periodontal visit alone, that's telling you one piece of the picture. What we need to be looking at is, ‘How do we make that grow?’ Well, let's look at, how often are we making this diagnosis? If we can see that that number is maintaining relatively low, or maybe it has a spike, ‘Oh! What did we do last week when we had that spike?’ so that we can improve our efficiency with more diagnosis and more acceptance. These numbers are going to follow suit with your perio visit, initially. When you're first implementing a periodontal protocol program and you're at one percent in terms of your perio visit percentage, this number is also going to be relatively low because you're not really diagnosing perio. But as we start to diagnose more perio and this diagnostic number goes up, then over time as we schedule those appointments, that visits percentage is going to go up as well. And so, they really all tie into each other. But the consistency of monitoring it and ideally monitoring it at weekly team meetings, reporting to each other, checking in with each other so that we can see ourselves along the way and not waiting till month’s end and looking backwards and, ‘Wouldn't it have been nice to know if halfway through the month I wasn't anywhere near where I needed to be?’ So, if we’re looking at that weekly, monthly at minimum, then we can start to make those changes that we need with the efficiency of the protocols to try to improve over time.” (18:07—19:30)

“If your periodontal visit percentage is doing great, you're up to 10% now, and then all of a sudden, it levels off, I bet if you look at your periodontal diagnostic percentage as of late, it’s gone down. Because if we’re not diagnosing new perio, that visit number, that overall periodontal percentage is going to decline. So, they do have a direct correlation which feeds into our other KPI as well. But you can't really look at just one and tell how healthy your protocol is. You have to look at all three of them together to get the whole picture.” (20:01—20:35)

“The third [KPI to monitor] is periodontal acceptance percentage. So, what that one is is the number of those patients that we diagnosed with gingivitis, or some form of periodontal disease, and treatment planned those 4000 codes, how many of those patients commenced with all or at least part of the treatment that we recommended? So, what was the acceptance percentage from those patients of moving forward with that treatment that we recommended? And you can see how those tie in with each other. So, it might be important to see, ‘Great. Our diagnostic percentage was 20%. That’s huge! We did awesome diagnosing perio.’ But if our perio acceptance percentage was four percent, are we doing a good job relaying the value in what we’re recommending, or are we just doing it and checking the box? Now, if we’re at 100%, that's awesome. We’re killing it. Every single patient that we treatment planned for periodontal therapy this month proceeded with treatment. We must be doing something right. Let's celebrate that and talk about what we did this month to make that happen.” (20:40—21:41)

“[Acceptance means patients] scheduled. They scheduled something. Something got put into the schedule from that treatment plan. So, if I treatment planned four quadrants of periodontal therapy for a patient and they scheduled for their first quadrant of therapy, that's considered the patient accepting. Now, there are two different ways you can measure this. And to [not] get too complex, we should probably be careful. But you can measure it by the dollar amount. You can measure it by like, ‘I treatment planned $20,000 of periodontal therapy, and $10,000 of periodontal therapy got scheduled.’” (21:59—22:33)

“In the very beginning when periodontal protocols are newer to teams, I like to focus on patient acceptance first because it’s an easier measurement to understand and wrap your head around. And sometimes, when it’s new to our teams, that means it’s new to our patients. We haven't been talking about this. And so, them accepting even one quadrant is a big deal. And then, we can work through the experience of that first quadrant, building more value. They're not scared anymore because we kept them nice and comfortable. And then, they're going to proceed with scheduling the rest of that treatment. So, when it comes to breaking down acceptance, it’s that that patient that we treatment planned scheduled for something off of that treatment plan — at least got started with that treatment plan.” (22:33—23:18)

“I have teams, and I know they're not the only ones out there, that the doctor is doing the initial periodontal assessment, diagnosing, treatment planning, and discussing that with the patients. They see the doctor for their new patient visit. So, these periodontal protocols are going to be built into your new patient experience, but they're also built into your existing patient experience, those recare visits. So, that's your hygienists, for sure. And in a lot of offices, the hygienist also does see the new patient, so it would be built in there as well. But I don't want to miss out on mentioning that there are doctors who perform the new patient evaluation. They perform the full-mouth periodontal charting. They sit the patient up and go over those findings with them. They're talking about the value of what's next, and treatment planning. And so, we have to also know that the doctors, this information is really important to them as well. And in some offices, it might be the doctors or their assistants that are tracking this data around acceptance because it might be them that is having to develop that.” (24:03—25:00)

“These all fit together in a bubble, but the diagnostic percentage and the acceptance percentage probably feed in the most. If you're just looking at acceptance percentage, you're going, ‘Great! We were at 100% this week. We killed it with patient acceptance for our periodontal procedures,’ but if we’re not looking at diagnostic percentage, is it that we diagnosed 50% of our patients with perio and 100% acceptance, or did we diagnose one patient with perio, and that one patient accepted? So, if we’re just looking at acceptance, we’re missing the piece of, ‘How big is the exposure?’ which is where that diagnostic percentage comes into play. In the same way that if we’re just looking at, ‘How many did we diagnose? What percentage did we diagnose?’ but not looking at how many of those actually moved forward with treatment, we’re only getting a piece of the picture. Those two really go closely together.” (25:18—26:13)

“[Your periodontal acceptance percentage should be] as high as possible — 100%. I shoot for high goals. I want 100% of my patients that I'm recommending perio care to move forward. But we have to do, just like we have with anything else, where are we starting at? Are we starting at zero? If we don't have a periodontal protocol and we’re starting from scratch, then we might start a little bit lower because we know our team is not as confident yet presenting that. We know our business team hasn’t really worked through how they handle presenting the investment and handling the objections around it. So, maybe our percentage starts at — we'd like to have at least half move forward. And by next month, we want to be at 70%. By the next month, 80%. And eventually, my goal would be all of the patients that you're recommending treatment to are moving forward because they have the value, and you've set up easy systems for them to be able to pay for this investment if they're stuck there. There's...