Patient Care Coordinator: Are You Ready for a Challenge?

GLOSSARY

Active listening – involves asking for clarification and encourages the patient to keep talking

Advocate – a supporter or person who acts in favor of another person

Co-discovery – by helping the patient understand how current conditions within the mouth can affect future dental health, the dentist can help the patient discover less obvious feelings about, and desire for, future dental care

Cross-bite – a condition where the mandibular teeth are buccal to the maxillary teeth

Dental IQ – a classification of patients based on a patient’s: appreciation of dentistry, willingness to participate in dental care, and ability to pay a fair fee

Empathy – identification with and understanding of another’s situation, feelings, and motives

Facilitator – a person responsible for leading or coordinating the work of a group

Financial agreement form – a document that describes the arrangements that have been agreed upon for payment of fees

Guarantor – the person financially responsibility for services rendered

Independent lending company – a lending company that will advance payment in full for treatment. The dental practice subscribes to this company’s service and pays a percentage of the fee to the company

Induration – hardening

In-office payment plan – the practice agrees to allow the patient to pay for treatment over an agreed upon period of time, with or without interest

Insurance plan maximum – the maximum amount of treatment the insurance company will pay for in a specified time period

Integral – necessary to the completeness of the whole

Leukoplakia – adherent white patches on the mucous membrane of the oral cavity

Liaison – one that maintains communication

Modality – method

Objective – not motivated by personal feelings or prejudices

Open-bite – a condition which the posterior teeth contact prematurely and there is a lack of contact with the anterior teeth

Open-ended question – a question that requires more than a “yes” or “no” answer

Overbite – the condition in which the maxillary teeth overlap the mandibular teeth

Overjet – a condition in which the maxillary teeth overlap the mandibular teeth horizontally

Philosophy – a system of ideas or beliefs relating to a particular subject

Review of findings – a report of existing conditions, patient concerns and treatment recommendations

Synergy – combined effort of more than one whose result is greater than one acting alone

Treatment plan – a list of treatments and their fees

As dental assistants remain in the profession longer, they acquire a large amount of knowledge concerning oral conditions, treatments, and how dental procedures are accomplished. After years of working chairside, some dental assistants seek additional responsibility. A very interesting and extremely beneficial position in the dental team is emerging for the assistant: a patient care coordinator (PCC). The PCC is an adjunct to the dentist, patient and team, and can improve the services provided and overall productivity of the practice. Years of dental experience offer the dental assistant vast knowledge of dental procedures and the understanding of many patient personalities and attitudes. The ability to interact as a liaison between the patient and the dentist with compassion and objectivity is an important attribute for the PCC.

Working side by side with a dentist allows a dental assistant to learn and understand the dentist’s treatment philosophies and modalities, and to be able to discuss treatment options with patients in a way that complements the style of that particular dentist. As a team member dedicated to this position, the PCC has the time to fully educate the patient concerning needs and the suggested treatment. While the PCC is assuming these responsibilities, the dentist and clinical assistant are free to provide clinical dentistry to other patients. The dentist can be confident that the PCC is providing accurate information and thoroughly addressing the questions or concerns of the patient as well as gathering information to pass along to the dentist during the comprehensive examination. Although the specific responsibilities of a PCC may vary from practice to practice, this course offers a general outline of a PCC’s responsibilities. (Always refer to the state practice act to verify delegation of duties allowed.)

Education and Experience

The position of a patient care coordinator (PCC) requires extensive knowledge and background in dental conditions and treatments, excellent telephone and interpersonal communication skills, and a thorough understanding of the state’s dental practice act. The PCC candidate should have experience working as a dental team member with the dentist for at least two years, or have previous experience as a patient care coordinator. Preferably, the candidate will have completed an ADA accredited allied dental program and attained certification, registration, or licensure in dental assisting or hygiene.*

*The above guidelines are suggested so that the PCC will have adequate knowledge and experience to immediately work with the practice with minimal training and supervision. There are presently no state or national requirements to fulfill in order to function as a PCC.

A key guideline for the PCC to follow is the dental team’s “practice philosophy.” This philosophy will convey a system of beliefs that are the focus of patient treatment. The statement will convey the practice values concerning the variables of patient demographics, technical excellence, economics, and privacy. A major responsibility for the PCC is to professionally convey and represent this philosophy to all patients.

Personal Characteristics

The PCC is both an advocate for the patient and a liaison for the practice. Developing a trusting and empathetic connection with patients is essential in building a positive relationship. Good listening skills are important and will help the PCC understand the patient’s past history with dentistry and ask pertinent questions so the PCC and patient can go forward with a co-discovery of what the patient wants and needs from the practice. The PCC ushers the patient into the practice and has the first opportunity to knowledgeably and enthusiastically introduce the attributes of the dental team. The PCC must exhibit professionalism in the promotion of the practice and discretion over the patient’s personal information. As a result, the patient will trust the PCC to represent prospective patient’s anxieties, fears, and conditions with other team members in a respectful manner.

The Role of the Patient Care Coordinator

This dental team member, the PCC, offers the patient’s first face-to-face experience with the practice. The PCC will greet, bring the patient into a private area, and establish a relationship with the patient prior to the comprehensive clinical oral examination. This meeting is crucial to developing trust and gathering information. After this important initial trust building portion of the appointment, the PCC will escort the patient to the examination treatment room. If the patient does not have current radiographic images, the PCC will ask the dentist to come meet the patient and prescribe the necessary images. If the PCC is a licensed dental radiographer, they will take the radiographic images and proceed with charting existing intraoral and extraoral findings. The PCC may also obtain intraoral and extraoral photographs. If the PCC notices obvious decay or wear problems, the PCC notes these issues as discussion items prior to the dentist’s exam. It is critical to remember the dentist is the only team member who can make a diagnosis.

The PCC will briefly share with the dentist any clinical findings and relevant personal information gathered during the initial fact gathering. The PCC discusses with the dentist all of the information exchanged with the patient and the patient’s reaction. The dentist and PCC then proceed with the rest of the oral examination together. The dentist (or dental hygienist) will perform periodontal probing and the exam will be recorded via a manual form or computerized charting. The dentist will examine the patient and discuss recommendations. As the dentist speaks to the patient, the PCC prepares educational sheets, a treatment plan, and fee sheet to discuss with the patient once the dentist is finished with the exam. The PCC must be well versed on the dentist’s treatment philosophies so that the patient’s treatment plan can be properly prioritized. For more extensive treatment plans, the PCC may ask the patient to return for a follow-up consultation appointment. This allows time to prepare a review of findings, verify the treatment plan options with the dentist, and organize an information packet for the patient. The PCC will then assist the patient with appointment scheduling and confirm the payment options.

After the patient has completed the appointment, the PCC will review all the information recorded in the patient’s record. The PCC lists any interesting facts about the patient in a designated section of the record, which is accessible to any team member meeting the patient for the first time. A mention of these facts confirms the value of that patient to the dental practice. The PCC can also prepare a separate review of findings (Appendix A) that may be useful at a future consultation appointment as needed. For patients with extensive treatment plans, the PCC and dentist should develop alternative treatment plans in case the patient does not want or cannot afford an optimal plan. It is important for the PCC to understand every aspect of the treatment plan and the dentist’s reasons for recommending each treatment so that the PCC can confidently and correctly answer the patient’s questions during the follow-up consultation.

The PCC will track the patient’s appointments through to the completion of treatment and will continue as the practice liaison tracking maintenance and preventive recare appointments. If the patient has questions during any step of their treatment, the PCC should be available to answer them. The PCC can also offer to accompany the patient to consultations with referred specialists. If the patient and specialist agree to the escort, this can be especially helpful if the coordination of treatment is complicated.

Asset to the Dentist and the Team

A dedicated PCC position allows the dentist to garner more information about the patient without losing productive operative time. While the PCC spends time getting to know the patient by asking and answering questions, the dentist can perform tasks specific to the dentist’s expertise.

This information gathering by the PCC can begin with an introductory phone call. This call should serve three purposes: to greet the patient and make a positive first impression; to begin gathering information to assemble a personality profile on the prospective patient; and to confirm the initial appointment for a comprehensive exam.

Since the PCC is the liaison between the patient and dental practice, the PCC must be a professional practice advocate and make the patient feel confident that the choice made to come to the practice for treatment was a good one. The way the patient perceives this contact can color the view of the practice and influence decisions and interactions thereafter. Barry Polansky, DMD, in his book entitled The Art of the Examination, suggests developing a “Personal Patient Profile” for each patient. This information allows the whole dental team to learn about the patient before treatment and creates a comfortable entry into the relationship for the patient. A briefing by the PCC eliminates repetitive questioning of the patient by other team members. Instead, the team members can concentrate on making the patient feel comfortable and welcome. Getting the patient into the practice in a timely manner gives the comprehensive examination importance and reassures the needs of the patient will be met in a reasonable timeframe.

The PCC will also function as an educator on behalf of the dental team. A patient who has been properly educated regarding dental issues increases their dental IQ and can make better-informed choices regarding dental care. The dentist can begin the new patient consultation with a patient having preliminary knowledge of dental conditions and the ability to discuss necessary and rec­ommended treatment options.

The PCC will gather all the information from each part of the examination. After a review of the findings with the dentist, a treatment plan will be generated and presented to the patient at the next appointment. The PCC should spend a thorough amount of time discussing the results of the examination, the dentist’s recommendations, and allow for sufficient questions and answers to gain informed consent. If a second appointment is needed to discuss treatment options, this appointment should be scheduled as soon as possible following the initial appointment. This is important so that the information discussed at the first appointment is still fresh in the patient’s mind and also shows the patient the importance of getting started on the treatment.

The PCC will act as a patient advocate and liaison. Any questions the patient may have regarding treatment can be answered by the PCC, or the PCC can obtain answers quickly from the dentist or other team members. The PCC should record the patient’s preferences and be sure that any team member involved in that patient’s treatment is aware of these preferences.

The First Contact

As stated, the initial telephone call with the PCC is the patient’s first full impression of the office. A pleasant, positive and encouraging demeanor during this contact phase is essential. Qualities such as empathy, warmth, and non-judgmental attitude, will make the patient feel comfortable and at ease. The goal of the questions asked during this introductory phone call should be to acquire the information necessary for the practice. In addition, permission should be received to request and obtain historical dental radiographic images and records prior to the patient’s appointment. Answers to carefully posed questions can provide information about the patient’s personality type. According to Dr. Bill Lockard, there are generally three reasons that people call for an appointment: they have been referred by a friend or specialist; they have a painful emergency or other urgent need; or they want a second opinion.

A new patient packet should be prepared and sent to the patient before the first appointment. It should contain the office brochure that introduces the team and the office philosophy regarding treatment, a welcome letter that includes a place for the date and time of the patient’s appointment, the office’s financial policy and payment expectations, directions to the office, a patient registration form, a medical/dental history form, and anything else deemed appropriate. The patient should be asked to complete the forms at home and bring them to the first appointment. If the patient is comfortable and the information is available electronically, the information may be emailed or downloaded from the practice web site and completed and returned before the appointment. This allows the PCC access to the information before the patient arrives and patient time in the office can be minimized.

The Pre-Clinical Interview

Every patient should be made to feel important immediately upon entering the office. The team member at the reception desk should rise, greet the patient by name, and introduce him/ or herself. Address the patient formally at this time unless permission has been given to use the patient’s first name. It is important to make the patient feel accepted; the greeter should engage in some warm, genuine conversation with the patient to relieve anxiety and create an atmosphere of friendliness and trust. The PCC, having already reviewed any available information about the patient before this time, then meets the patient. The PCC should go to the reception area, extend a hand in welcome, make eye contact, and invite the patient to the consultation room. The greeting should be warm, friendly, and should give the patient the feeling that the PCC has been anxious to meet them. This moment often opens the door to a good relationship between the practice and the patient.

Once the PCC and patient are settled in the office, the PCC can explain her or his role in the practice and clarify how the comprehensive examination will be conducted. The important thing is to make the new patient feel accepted, first as a person, then as a patient. As rapport is established, discussions about the patient’s family and hobbies can be started. The PCC can share personal information on a professional level, especially if there are interests or areas that the PCC and patient have in common.

The examination of a person’s oral condition is a very personal procedure. The pre-clinical interview gives the patient and the dental professional a chance to develop a connection and become comfortable with each other. If performed correctly, the exam can offer insight to the patient’s dental history, any dental fears and desires, and the patient’s personality. This also allows the PCC to explain the philosophy of the practice and to determine whether or not the patient is ready to accept responsibility for their oral health.

As suggested, this process begins by learning about the patient. This can be accomplished by asking open-ended questions and using active listening techniques. Open-ended questions require more than “yes” or “no” answers and provide more insight about the patient. Active listening conveys attentiveness and reflects that the listener is ensuring understanding of the information. The office should generate a guided list of questions that can be asked of patients. The following are some suggestions that Dr. Polansky gives in The Art of the Examination:

1. Are you new to the area? This is a good conversation starter.

2. Are you married? Do you have children? This will allow the PCC to share personal information with the patient.

3. Why did you choose to come to our office at this time? This will lead to the patient’s chief complaint.

4. Do you believe that you will eventually need dentures? This will reveal the patient’s beliefs about dentistry that should be discussed.

5. How would you feel if you were to lose a tooth? This will tell about the patient’s dental IQ.

6. How would you describe the condition of your mouth at the present time? This will tell about the patient’s expectations.

7. How do you feel about your past dentistry? Ask about fears. Explore this question as it will reveal much.

8. How important is it for you to retain your teeth all of your life? If the patient says, “Not very,” think twice about presenting comprehensive dentistry too quickly.

9. Would you like to change the appearance of your mouth? If the patient says no, avoid being forceful about dentistry.

10. If you could start over, what would you do differently regarding your mouth? This open-ended question can offer insight as to how the patient regards their appearance.

11. If you had a magic wand, how would you repair your own mouth? This reveals expectations without regard to time or financial restraint.

12. Would you like to set goals regarding your mouth? Listen closely for financial concerns.

13. Would there be anything that would stand in the way of treatment? There are five major objections to dental treatment: fear, money, time, a sense of urgency, and trust.

The above questions are designed to get the conversation started. They are not meant to be a rigid pattern to be followed with each patient. The PCC must decide which questions to ask based on each patient’s personality and temperament. Notes concerning the appearance of the patient’s smile and oral health should be recorded. Here are points to consider during the initial interview:

• Clarify the patient’s desires and potential needs, and encourage articulation of concerns regarding oral health.

• Determine how much the patient understands about his/her present condition and how it affects the patient’s overall health and happiness.

• Explain the practice’s philosophy to the patient.

• Gauge the amount of responsibility the patient is ready to accept for his/her oral health, now and in the future.

• Remember to meet them where they are right now without making them feel guilty about their present condition.

• Congratulate the patient on making the decision to seek care and be excited for the patient regarding the improvements that will be accomplished with the help of the dentist and team.

• Let the patient know not only what the practice can do for the patient’s oral health, but also clarify what will be expected of the patient as a partner in oral health.

• Observe the patient’s feelings and reactions. Don’t judge the patient, rather encourage the patient to express any doubts and concerns, the patient’s true feelings about oral health, and any reactions to the information provided about the practice and its philosophy.

This is a critical time in determining whether this is the right practice for this patient. If the goals of the patient and the expectations of the practice are in opposition, the PCC must restate the practice philosophy towards dental treatment and objectives. The team should be prepared for the possibility of a patient leaving the practice when they stand firm to the practice’s values.

When proceeding with the interview, the patient’s health history must be reviewed. The team must ask questions to reveal any health issues that could alter future treatment. Questions should include topics of overall physical health and focus particularly on oral health and habits. Listed medications should be paired with a condition or reason for treatment. This is an important step because some medications can treat multiple conditions. For example, a patient with heart disease may not mention this condition if the patient assumes the medication has cured the disease. Probing a little further may also help patients to remember medications they are allergic to or other information that the patient may have neglected to provide initially. If the patient uses tobacco products, the PCC should promote the practice philosophy concerning a smoking cessation plan and work to gain acceptance with each patient visit.

Each potential patient deserves equal consideration in a non-judgmental and caring manner. This attention will make the patient feel accepted and valued. When consulting with a new patient, the PCC must be certain to highlight anything positive about the patient’s condition or attitudes. The dominant feeling should focus on the positives and not the negatives. Always discuss problems with a focus on improvement. Congratulate the patient for taking this step toward improved oral health and offer support. The patient’s desire for restorative care needs to be balanced with the realities of the dental disease. Establishing a good relationship with a patient consists of listening to the patient, providing hope for the future, and treating the patient in a respectful and thoughtful manner.

When conducting an interview, HIPAA regulations must be followed at all times to protect the patient’s privacy. Interviews are to be conducted in a quiet and private area of the practice, preferably in an office with the door closed. During this interview, the patient is most likely to be open about any fears and past dental experiences. If the patient becomes emotional, be supportive without judging and give the patient time to regain his/her composure. Handling this correctly will allow the patient to see that the PCC is trustworthy and caring. Finally, ask the patient if there are any questions, explain what will happen next in the examination and proceed to a treatment room. At this time the dentist will come into the treatment room to be formally introduced, quickly scan the oral cavity and order any necessary radiographic images. The PCC (if a licensed radiographer) will proceed to expose the radiographic images so they will be available to the dentist for review during his/her extensive examination of the patient. The PCC then continues with the initial soft tissue and clinical examination.

The Clinical Exam

The clinical examination begins with the extraoral, soft tissue exam. The patient can be informed of what is begin checked and why, and what is discovered. This is a critical educational step and allows the patient to be a part of the discovery process. It is important to watch and gauge the patient’s reactions. Many times this will be the first time they are receiving this much information. Encourage the patient to ask questions at any time and let them know that the dentist may be repeating many of the same questions because this is such an important part of the examination.

Steps in the soft-tissue exam include the following:

• Ask the patient if they’ve noticed any changes or if they have any sores or ulcers that haven’t healed within 10-14 days.

• Ask if they’ve noticed any numbness or hoarseness or have the feeling of having a lump in their throat.

• Begin by feeling for any unusual lumps, bumps or swelling in the face and neck area. Make a note of any non-tender, non-movable swelling and any asymmetry.

• Place two fingers just in front of the patient’s ears. As they open and close, feel and listen for any abnormal sounds or grating. Ask the patient if they have experienced symptoms such as pain, sounds, headaches, earaches, or locking of the jaw.

• Look at and feel the parotid glands for any swelling.

• Palpate the thyroid gland and visually examine the area for enlargement.

• Palpate the lymph nodes and notice any swelling, induration, tenderness, and enlargement and ask the patient what they’ve noticed.

• Notice any scars, ask about them and measure and record the size and location of any moles.

• Make a note of whether there is any noticeable malodor of the patient’s breath. An overly sweet smell can indicate diabetes.

• Examine all surfaces of the tongue for any sores, white patches of leukoplakia or any other abnormalities. Leukoplakia presents as a white patch on the mucous membrane that are usually found in adults age 40-70. They are found in males twice as often as females and are often a result of tobacco use. Five to 25% are pre-malignant lesions. Explain that oral cancer is often found on the tongue and that the dental team will regularly check this area carefully.

• Examine the lips and mucous membranes and note any abnormalities in color or texture, note any scars, lesions, effects of tobacco use and frenal abnormalities.

• Examine the hard and soft palate, anterior portion of the throat, and sub-lingual area, noting any tori or abnormalities.

• If the patient is wearing removable appliances ask the patient to remove them and check the mouth for redness and irritation. Check the appliance for wear, cracks, rough spots, cleanliness and fit.

Next, the PCC will chart present conditions:

• Note any missing teeth.

• Measure any overjet or overbite with a probe.

• Go tooth by tooth and record all seen restorations, crowns, bridgework, and removable appliances.

• Look at the radiographic images and record any endodontic treatment. Ask the patient when the work was done.

• Notice areas of food impaction and plaque retention.

• Ask the patient about brushing and flossing habits. If the patient indicates problem areas that are hard to brush or floss, review the correct technique with the patient and suggest alternative toothbrushes or floss aids.

• Make a note of excessive wear and ask the patient about grinding or clenching of teeth.

• Check the margins of crowns and restorations for decay or leakage.

• Test teeth for mobility and record any that are found.

• If in the scope of practice for the PCC, they can perform a load test and record any slides or deviations in the patient’s bite.

Examine the mouth and make notes of obvious decay, fractures and failing restorations for the dentist to confirm. The PCC will make notes during the examination or have another assistant record the findings. It is important to remember that the PCC may not diagnose or prescribe treatment. However, as questions are posed, the PCC can educate the patient on possible treatment options.

When examining the position of the teeth, confirm from the dental history if the patient has ever received orthodontic treatment. If the teeth are out of alignment, (excessive overjet, overbite, crossbite, open bite, etc) the PCC can ask the patient whether orthodontics would be considered at this time. If the patient does not want to consider orthodontics, the PCC should ask for reasoning. Many people don’t realize that orthodontists treat patients for more than cosmetic purposes. This is an opportunity to educate the patient about function as well as form. The PCC should be educated in these areas by reading or by consulting with the referring orthodontist and staff to gain a comprehensive understanding of the procedures and appliances being used.

Every discovery is an opportunity to educate the patient and gain the patient’s trust. Return the patient to an upright position and provide informational sheets or a video relating to the treatment just received before the dentist comes in for the comprehensive examination.

The PCC offers all exam information to the dentist, reviewing what was discovered, what was discussed with the patient, and the patient’s reactions and attitude toward receiving treatment. When the dentist returns to the treatment room, the dentist will conduct a thorough exam and review all initial findings, diagnoses, and treatment recommendations. At the completion of the examination the PCC has two options:

Option 1: The PCC will go over all of the treatment plan options with the patient.

Option 2: If the patient has an extensive treatment plan, an appointment for a follow-up consultation in the near future would be suggested. This would allow the PCC to discuss the treatment plan with the dentist, prepare a review of findings and put together an information packet for the patient.

The PCC will escort the patient to the business office and assist the business assistant in setting up a follow-up consultation or the next appointment or series of appointments for the patient. The PCC will express pleasure in meeting the new patient and anticipate the patient’s return appointment. Also, the PCC can assure the patient that if there are any further questions, the PCC is available to answer them.

Legal Scope of Practice and Responsibilities

The PCC must be aware of, and act in accordance with the legal scope of practice in their respective state and as allowed by the PCC’s licensure and/or education. For example, a PCC may not perform periodontal probing (in most states), but can inform the patient what to expect prior to the dentist or hygienist’s periodontal examination. By informing the patient about pocket depths and what the absence or presence of bleeding means, the PCC is taking a first step in educating the patient about this part of the examination. Educating the patient establishes a trusting relationship and promotes treatment excellence. The PCC can relate to the patient with a more personal touch that there are conditions in the mouth that may indicate decay or other detriments to dental health. However, it must be remembered that the dentist is the only person who can address the patient with an absolute diagnosis.

The Final Consultation

The first step in preparing for the final consultation appointment, if needed, requires the PCC to accurately enter all the gathered information into the patient’s record. The patient record (chart) is a legal document so it is critical to be careful, objective and accurate in every aspect of the record. Once the information has been entered, it is advisable to prepare the review of findings. The review of findings document organizes all the information gathered from the patient and from the examination of the patient. It details the treatment that is diagnosed and recommended by the dentist. Once the PCC has completed the findings document, they will meet with the dentist to go over possible treatments options. The PCC must understand the treatment options that are being suggested including advantages and disadvantages of each. The dentist’s recommendations must be placed in a preferred order according to the practice philosophy and what is in the best interest of the patient. Once this information has been obtained, the PCC can complete the review of findings documentation.

The first part of the review of findings will list all observations noted during the examination process and the causes and effects of present conditions. The second part of the review of findings will entail the recommended treatment in the suggested sequence. This will begin with the dentist’s first choice of treatment options. Finally, a sequenced treatment plan with fees will be needed. If there is more than one possible choice of treatment, a separate treatment plan for each option is necessary. Duplicates of treatments plans are to be kept on file. This consultation must be conducted in a private office so that the patient can feel free to ask questions and give fully informed consent. Many patients will enter the consultation and immediately ask about fees. It is best to discuss the treatment options available before discussing the fees.

All of the patient records should be available when reviewing the positive aspects of the patient’s oral health and discussing areas of concern. It is best to not overwhelm the patient or to make him/her feel guilty or ashamed. If you were careful to education the patient about conditions found during the comprehensive examination, the patient will not be shocked to hear that they have some conditions that need attention. It is best to systematically discuss all of the findings including all the positives and the problems that exist. The discussion continues with reviewing the benefits of all treatment options and the implications of doing nothing. You can talk about de-identified patients who have had similar treatment and the benefits they have derived from the treatment. To gain full informed consent, the patient must be allowed to ask questions and express concerns. The patient must not feel pressured into treatment. Use visuals such as the radiographic images, intraoral photographs, and diagnostic casts to help the patient understand the conditions present. The use of additional visual aids and any applicable demonstration items such as de-identified before and after photographs, bridges, dentures, and implant components that are available may also be helpful.

Financial Arrangements

If finances are a concern for the patient, the office should have different financial plans available to make it possible for the patient to proceed with treatment. Some possibilities include phasing treatment and using a financing company that serves dental patients. When a course of treatment is decided upon, the patient, or their guardian, must sign the accepted treatment plan and a copy should be provided to the patient/guardian. The original is kept with the practice and, if possible, scanned as a digital document. The PCC will collate any written information and educational sheets for the patient and present this to them in a folder. Offering to answer any questions or concerns at any time establishes continued rapport with the patient.

The discussion of fees will arise during the consultation appointment. By saving the discussion about fees until the end of the consultation, the patient will hear all the possible treatment options. Then, the PCC can review the fees with the patient. There are times that patients will become annoyed or upset to hear how much the treatment will cost. At this time, the role of the PCC is to provide the patient with information and help the patient decide which treatment will work best for the patient and the patient’s budget. By remaining calm, the PCC may help the patient find ways to afford the desired treatment. Options may include: in-office payment plans, independent lending companies, obtaining a credit card that will be dedicated to dental treatment fees, and phasing treatment. If the patient has insurance, the PCC can offer to submit a request for a pre-determination of fees and suggest an informed estimate of what the insurance company will pay based on insurance plan maximums. The PCC must be prepared in advance to be able to suggest ways to phase the patient’s treatment over the course of a few years. One advantage to phasing treatment over two or three years is that it maximizes the patient’s insurance coverage if the patient has insurance. The patient must be made aware of the practice’s fee increase policy if the treatment will span over dates when fess may increase. If fees are only guaranteed for a certain length of time, be sure that the patient understands that the fees on the treatment plan may increase if the treatment is not completed within a certain time frame.

Once the patient has made a decision, the PCC will assist the patient in getting started. If the patient will use a dental lending company, the PCC will provide the necessary information and allow the patient to call from the office. This process is often very easy and can be accomplished by the responsible party with a single phone call or can be done through an online process. If the pa­tient will be using an in-office payment agreement, draw up the agreement and print out a truth in lending statement. The PCC can copy the agreement into the patient’s guarantor notes or prepare everything in duplicate and store a copy in a financial agreement file. The PCC can print out a financial agreement form that outlines the fees and payments and ask the patient to sign it as well as a copy of the treatment plan. This protects the practice and prevents any future confusion.

Remember that patients are often surprised by the expense of the treatment suggested and the patient’s first response is usually driven by emotion. The PCC should continue to remind the patient of the benefits derived from the treatment plan. At the same time, the PCC must respect the patient’s decision and be careful not to try to persuade the patient to accept a plan that is unaffordable or that the patient may resent in the future. Even if the patient decides not to accept treatment at this time because of the fees, it is important to remember that “no” today doesn’t mean “no” forever, so it is in everyone’s best interest to maintain a good relationship with the patient. Offer to discuss treatment plans with the patient in the future, if he/she desires.

Tracking Treatment From Beginning to End

The final step in the process is to work with the patient to set up an appointment, or series of appointments, to begin treatment. Having the PCC involved in this process continues the personal contact and offers assurance of complete and thorough dental treatment.

Once the patient has left, the PCC must record objective notes about any decisions and concerns in the patient’s record. Discussing the results of the consultation with the dentist and team members can be completed during the office staff meetings. This sharing of information ensures that as the entire dental team interacts with the patient the trusted patient-team relationship can be maintained.

A primary responsibility of the PCC is to be available for the patient. By tracking the patient’s treatment, the PCC indicates to the patient that the treatment is important and necessary. Also, the PCC ensures that the treatment is completed in a timely manner and that it is coordinated with any specialists that may be involved. Once the patient’s trust is earned, it must be respected. The patient needs to know that the PCC is available to answer any questions or concerns. The PCC should be prepared to coordinate treatment with any specialists who are brought into the patient’s case, and must also be aware of any conflicts or miscommunications between different treatment plans. The PCC should not only ensure that the patient understands the treatment and the time it will take, but also any discomfort that the patient may experience, the medications that will help, and provide awareness of the fees that are involved.

The PCC will review the progress of patient treatment to check that the sequence is correct, and also regularly run an unscheduled treatment plan report to ensure that all patient needs are being met. Often, a patient will wait for the office to call in order to make an appointment to commence treatment. If these misunderstandings occur, and are not corrected, the patient may feel that the practice is not interested in providing care.

As stated earlier, the PCC will make contact with any specialists who will be working with the patient, and offer to share information and results. The specialist must be made aware of the steps that need to be coordinated between the two offices, in order to fulfill the treatment process. For instance, if a patient is referred to an oral surgeon for implants, an agreement must be made on who will perform any extractions, whether a surgical guide will be needed from the PCC office, before surgery, how long the treatment will be expected to last, and even which implant size and style were used by the oral surgeon.

If the patient is to receive treatment that requires pain medication, antibiotics, or other medications, the PCC must ensure that the patient is given the proper prescriptions prior to the appointment date, and of course determine any allergies of the patient. The patient should be called after treatment, not only to determine post-treatment condition, but also to find out any future dates of treatments that are scheduled with specialist offices. Essentially, the PCC must do everything possible to coordinate the patient experience and demonstrate a concern for the patient’s welfare. The end results will benefit both the patient and the practice.

Summary

Fulfillment of the role of Patient Care Coordinator not only provides great satisfaction for the employee, it also yields a positive impact on the patient, the dentist, and the dental practice. The PCC is a career-ladder position for an educated dental assistant with complete credentials, excellent communication skills, and good organizational skills. That person must enjoy the challenges of the position, which center on working with many different people on a regular basis. The PCC is an educator and a facilitator, playing an integral part within the overall care of the patient, including the synergy between the practice and any specialists brought in for patient care. There is room for a PCC in any practice that wants to provide excellent service to their patients.

ABOUT THE AUTHOR

Linda Zdanowicz, CDA, CDPMA

Linda Zdanowicz, CDA, CDPMA, is a contributor to Dental Practice Solutions magazine and has had articles published in Inside Dental Assisting, The Observer, and Dental Economics. Linda received the Journal Award from the American Dental Assistant’s Association in 2010. She has been a lecturer at the Holiday Dental Conference and the Florida National Dental Conference. Linda writes the Exceptional Dental Practice Management blog, which can be found at http://dentalpracticemanagement.typepad.com. She is employed as the practice administrator and chairside assistant for Nigel Morgan, DDS, in Hendersonville, North Carolina.

SUGGESTED READING

Lockard MW Jr. The Exceptional Dental Practice. Lockard Publications; 2007.

Pankey LD. A Philosophy of the Practice of Dentistry. Medical College Press; 1987.

Oral Diagnosis: The Physical Exam. Tufts University website. 2007. http://ocw.tufts.edu/data/24/339120.pdf.

Detecting Oral Cancer. National Institutes of Health, National Institute of Dental Research. Baylor University. 1996. http://www.tambcd.edu/oralexam/nidroc00.htm.

REFERENCES

Bird DL, Robinson DS. Modern Dental Assisting. 10th ed. St. Louis, MO: Elsevier; 2012.

Finkbeiner BL, Johnson CS. Comprehensive Dental Assisting: A Clinical Approach, Normal Structures of the Oral Cavity. Mosby.

Lockard MW Jr. The Exceptional Dental Practice. Lockard Publications; 2007. Wikipedia, http://en.wikipedia.org/wiki/Leukoplakia.

Phinney D, Halstead J. Dental Assisting: A Comprehensive Approach. 4th ed. 2012.

Polansky B. The Art of the Examination. Word of Mouth Enterprises; 2002.

APPENDIX A - REVIEW OF FINDINGS

Review of Finding Form Example

John R. Doe, DDS; 1234 Main Street; Anytown, USA 01234; telephone number; www.johndoedds.com

Review of Findings for Patient’s Name

The most important services any dentist or physician can offer are a thorough examination, diagnosis of the existing conditions and development of a suitable treatment plan that serves the short- and long-range needs of the patient. Your understanding of the existing conditions in your mouth provides you with the knowledge to make informed choices that meet your individual wants and needs. While it is important for you to understand existing conditions, it is even more important to understand how these conditions occurred and what can be done to prevent the recurrence of dental disease to protect your teeth and supporting structures from more damage and loss in the future.

Our goal is to help you achieve optimal oral health. In the past your dental treatment may have been carried out without a plan, without concrete goals and objectives of what you would like to have happen. For this reason, we take a great deal of time and effort in the beginning to help you completely understand your mouth and dental concerns, and then help you make the decision that is right for you. More and more research is linking oral health to complete body health. A healthy mouth can literally add years to your life. High quality care should remain constant, with the amount of time needed to complete this care suited to the needs of you as an individual. Once your master treatment plan as been agreed upon by our practice and yourself, it will be your responsibility to complete the plan in a time period that works for you and meets your objectives for your optimal oral health.

People lose their teeth either through destruction of the teeth themselves or through deterioration of the supporting structures that hold the teeth in place. Our concept of complete dentistry is to eliminate all factors contributing to breakdown of both the teeth and their supporting tissues.

Other than accidents, the causes of accelerated breakdown of teeth include: Bacterial plaque – Bacteria produce acids and toxins which cause cavities and contribute to periodontal diseases (pyorrhea); Bite related stress – Unbalanced and destructive stresses contribute to cracked teeth, excessive wear of teeth, “TMJ” problems and loose teeth.

Contributing factors that lower resistance to causes of dental disease include: Hereditary predisposition; General health; Nutrition; Emotional stress

A complete dental treatment plan should include: A personalized approach to instructing homecare techniques for plaque control and maintenance of oral health; The reduction of stresses on the teeth to a point that they are not destructive; Restoring natural teeth to optimal strength and natural contours; Replacement of missing teeth as indicated.

An important requirement of good treatment planning is to do the minimum treatment needed to achieve optimal oral health. Among other things, optimal oral health provides for comfortable function free of pain and infection as well as a natural appearance. The following is a treatment plan for your recommended dental care.

DIAGNOSIS OF PRESENT CONDITIONS FOR [Patient’s Name]

Chief complaints

• Your daughter has told you that your teeth do not look attractive

• State of existing dentistry

• You have numerous very large, old amalgam(silver) fillings

• You are missing 5 premolars and 1 molar

• You have lost a filling from tooth #29 (lower right side)

• You have incomplete fractures in your molars

• You have severe erosion on your premolars and front teeth

Active dental decay: There is decay on teeth #’s 3, 6, 7, and 32

Periodontal condition: 1-3 mm measurements are considered a healthy periodontal condition. Anything above 3 mm may be cause for concern. You have generalized1-3 mm probing with localized 4-5 mm pockets with bleeding on probing.

Occlusion: There is occlusal wear on your anterior teeth

Other: Teeth #’s 4, 12, 13, 20, 21 & 30 have not been replaced; Teeth #’s 3 & 14 have drifted down out of their sockets; Your lower molars have drifted forward; Your plane of occlusion is uneven

TREATMENT RECOMMENDATIONS FOR [Patient’s Name]

Phase I - Periodontal control and maintenance: Scaling and root planing with our hygienist

Phase II - Caries control: An amalgam (silver) filling in #3 and composite (white) filling in #32.

Phase III – Restoration: Adjust your bite and reshape #26; Crown teeth #’s 6, 7, 8, 9 & 10 and fixed bridges to replace your missing back teeth; Crown teeth #’s 2, 3 & 5.

Phase IV - Maintenance and prevention: Three-month periodontal maintenance schedule with our hygienist. This plan was presented on [month day, year]

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Presenter

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Patient