Transcript Second Year Clinic

Clinic Organization
and
Business Protocols
December 5, 2005
Nader A. Nadershahi, DDS, MBA
Second Year Clinic -- A System
Overview -- The Clinics

Main Clinic

Located on Level C

Clinical Practice Breakdown
Senior (Third) Year Clinic -Groups I, II, III, IV)
 Junior (Second Year Clinic)

Clinic Organization




Four Group Practices with their own GPA and
Administrative Assistant (I, II, III, IV)
Second year faculty are in format that you are
familiar with in ½ of the alphabet
Third year students will work with mentor
groups and specialty faculty as needed
All rotations and other programs still apply
Patient Transfers

Patient transfers will be made in group
practices. (Students in 2nd ¼ of senior
class will transfer patients to students in 2nd
¼ of junior class.)
The People

Students
Senior Students
 Junior Students


+ AEGD, OMFS, &
Ortho residents
Patients
Senior Cases
 Junior Cases
 Sharing -- Referrals within the group practices and
between Seniors and Juniors

The People (continued)

Faculty: from all clinical departments

Staff: receptionists, sterilization, cashier,
patient care coordinators (PCC)

Clinic Administration: ADCS, Group Practice
Administrators (GPAs) & assistants
Associate Dean for Clinical Services
PSL
Clinic
Managers
Receptionists
PCCs
Sterilization
GPA
Group I
Admin Asst.
GPA
GroupII
Admin Asst.
GPA
Group III
Admin Asst.
GPA
Group IV
Restorativ
e Chair
Perio
Chair
Removabl
e Chair
Admin Asst.
GPM
Coordinato
r
Group I
2nd Years
and Patients
Group II
2nd Years
and Patients
Group III
2nd Years
and Patients
Group IV
2nd Years
and Patients
Group I
GPMs and
3rd year
faculty
Group II
GPMs and
3rd year
faculty
Group III
GPMs and
3rd year
faculty
Group IV
GPMs and
3rd year
faculty
Group I
3rd Years and
Patients
Group II
3rd Years
and Patients
Group III
3rd Years and
Patients
Group IV
3rd Years and
Patients
2nd year clinical
faculty
Endo
Chair
The Clinics

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Oral Surgery (Level C)
Radiology (Level C)
Emergency (Level C)
Pediatric Dentistry Clinic (1st Floor)
Orthodontic Clinic (1st Floor)
Oral Medicine and Facial Pain (6th Floor)
Faculty Dental Service Group (1st Floor)
Advanced Education in General Dentistry (Level B)
Perio Surgery (Level C)
The Year

Quarter

Fifth (Mon.-Thurs.)

Sixth, Seventh and
Eighth Quarters
(Mon.-Fri.)

Time Spent in Blocks

40 Percent Blocks

40 - 50 Percent Blocks
Second Year Clinic Goal

To develop the fundamental clinical patient care skills in
all dental disciplines for comprehensive patient care.

To provide close faculty interaction to carefully guide
student learning experiences.

To provide quality patient care.
How do we do it? -- The Year as
a Transition

Designed to introduce students to
comprehensive patient care with an emphasis on
diagnostic skills.

Teach students to manage dental cases.

Prepare students for more complex patient care
cases.
Fifth Quarter -- The Blocks
 2nd
Year Clinic
Blocks
 Perio Recall
 Perio Surgery
Assisting
 Oral Surgery
 Radiology
 Other
Blocks
 Local
Anesthesia
 Endo Block
 Implantology
Fifth Quarter -- The Operation

Staff



Some Patient Scheduling
Financial Contracts
Patients



Recall Patients
“check up & cleaning”
Simple New Patient Cases
Faculty



Manage Patient Care
Same Students with Same
Faculty
Students




Patient Exposure (Be
there and be prepared)
1st Impressions are
Important
Pay Attention
Patient Scheduling
Sixth Quarter -- The Blocks


40 - 50 Percent Block
2nd Year Clinic Blocks
 Perio Recall
 Perio Surgery
Assisting
 Others: Same as
Last Quarter

Other Clinic Blocks
 Same as Last
Quarter
 Pedo Block
 10-12 students
scheduled for 10
consecutive
clinic sessions
Sixth Quarter -- The Transition

Staff




Some Patient Scheduling
Financial Contracts


Patients


Increased flow of new
patients
Encourage students to bring
in their own patients
Faculty

Increase Student/ Faculty
Ratio
Assisting in procedures, less
patient management
Students



Increased Independence
Comprehensive Patient Care
Patient Scheduling
Seventh and Eighth Quarters -Turning It Over

40 – 50 Percent Blocks


Perio Blocks
Other Main Clinic
Blocks


50 – 60 Percent Open
Clinic Time

See your own patients

Same as Last Quarter
Other Blocks

Same as Last Quarter
Clinical Services in the Second
Year Clinic

Comprehensive Patient Care

Relatively Simple Restorative Cases

Clinical Experience
Clinical Services in the Second
Year Clinic -- (continued)

Fifth Quarter


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Mostly ODTP & Perio
Almost Any Operative
Almost Any Endo
Almost Any Single Crown
No Removable

Sixth Quarter

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ODTP & Perio
Almost Any Operative
Almost Any Endo
Almost Any Single Crown
Still No Removable
Clinical Services in the Second
Year Clinic -- (continued)

Seventh Quarter



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ODTP & Perio
Almost Any Operative
Almost Any Endo
Almost Any Single Crown



Eighth Quarter




Maybe Posterior Bridge

Full Denture Cases

No Partial Dentures
ODTP & Perio
Any Operative
Any Endo
Any Single Crown

Maybe Posterior or
Anterior Bridge
Any Removable Case
Clinical Services -- Most
Common CDT5 Codes
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D0150 -- Initial Oral
Exam (ODTP)
D0120 -- Periodic Oral
Exam (Recall)
D0210 -- Full Mouth
Series (FMX)
D0274 -- Four Bitewing
Films
D1110 -- Prophylaxis,
Adult
D4341 -- Root Planing
(per quadrant)





D4910 -- Supportive
Periodontal Therapy
(SPT)
D2140 -- One Surface
Amalgam
D3310 -- Anterior Root
Canal Therapy
D2790 -- Full Cast
Crown (FVC)
D2750 -- PFM Crown
New Patient Intake Service



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Screenings are done on a first-come, first-served
basis. Sign up starting at 8:30 and 12:30.
Done by Faculty
Monday-Friday
9:00 a.m. to 12:30 a.m. and 1:00 p.m. to 4:30
p.m.
Patient Intake Flow


Patient registers at Front
Desk
Fills out paperwork

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Demographic Form
Preliminary Evaluation
Health History

Patient Rights &
Responsibilities
Dental Materials Fact Sheet
HIPPA Acknowledgement
Patient returns forms to
Front Desk
Patient directed to
Radiology for Pano and
2 Bite-Wings ($25)
Radiology technicians
give forms and
radiographs to Screening
Faculty
Patient Intake Flow Chart -(continued)

Faculty member:
discusses patient’s chief concern/desire/
expectations
 explains clinical protocols
 briefly reviews patient’s medical status


medical consult form, if needed
determine patient’s dental needs
 determine teaching case status
 provides patient with very rough cost estimates

Patient Intake Flow Chart -(continued)

If faculty member and patient agree to make
patient a teaching case, then:
faculty member suggests Junior or Senior Clinic
 faculty member prescribes remaining films to have
FMX (for an additional $70)
 FMX taken or appointment made
 If patient brings in FMX, Radiology Faculty
determine acceptability of films

Patient Intake Flow Chart -(continued)

After FMX:
Patient Intake Manager, Mr. Robert Trezia, brings
cases to Group Practices on a rotating basis.
 GPA and AA’s assign based on needs list and
procedure tracking.
 Students check patient lists regularly for new pts.
 Student makes first phone call and appoints ODTP.

Screening Goals

To Determine:

To Discuss:

Chief Concern

Introduce Clinic

Expectations

Comprehensive Care!

Needs

Finance


Medical Status

Fees
Payment Plans
Screening Goals -- (continued)

Is this patient a teaching case?
Based on patient needs and expectations
 Based on faculty assessment


If patient is a teaching case, then:
Order FMX ($70)
 GPA assigns to appropriate student


If patient is not a teaching case, then give
patient referral advice and films
How to bring in your own patient


Patient must fill out patient information
form.
Chart must be made for patient




Information Desk
Complete ODTP steps 1 & 2 on clinic floor
Faculty determines appropriateness of case
for 2nd year student
Radiograph Rx from faculty
Main Clinic Business
Protocols
Clinic Business Protocol –
Prelude

ODTP -- Step 7
Prioritize Treatment Plan
 Entered into Computer in Proper Sequence
 Clinical Approval


ODTP – Step 8
Signed Treatment Printout in Chart
 All Charting in Computer
 All Forms Signed and Organized in Chart

Discussing Treatment
Alternatives
Explain clinical importance of preferred
procedure
 Respect patient’s ability to pay for services
 Patient Autonomy and Standard of Care
Practices

CARE and Denti-Cal

CARE office



Luis Rodriguez
Denti-Cal Approval from GPAs or Department
Chairs
After approval, chart taken to PCC for final
financial approval
Clinical and Financial Approval
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Type accepted treatment
plan into computer
Get instructor to give
clinical approval
Print out treatment plan
Have patient sign
treatment plan

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Patient fills out Patient
Credit Information Form
Preauthorization done
Sign up to see Patient
Care Coordinator (PCC)
Wait for PCC to page
See PCC for financial
arrangements and
approval
Road to Clinical Approval




Discuss Treatment Options & Costs with Patient
Treatment Plan Acceptance
Enter Accepted Treatment Plan into Computer in
Planned Delivery Sequence
Have Faculty Member give Clinical Approval
Hint: Ask for clinical approval from the faculty
member you worked with during the ODTP process.
Ways to Lose Clinical Approval

Change the sequence of the clinically approved
treatment plan

Add anything to the clinically approved
treatment plan

Delete anything from the clinically approved
treatment plan
First Steps to Financial Approval
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
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Patient signs clinically approved treatment plan
printout
Patient fills out Patient Credit Information Form
Complete pre-authorizations as needed
Go to Patient Services
Student signs up to see Patient Care Coordinator
(PCC)
Patient Services (PCCs)

Located directly behind the Front (Information)
Desk on Level C

Patient Care Coordinators
Irene Vargas
 Maria Bran
 Jerilyn Thompson

Patient Care Coordinators

Answer patient account questions.

Send out and monitor insurance preauthorizations.

Send out and monitor insurance claims.

Give financial approval to ALL patients.
Patient Care Coordinators -(continued)

See a PCC if you need information or assistance
with:
Financial Approval
 Private Insurance
 Denti-Cal (Public Insurance)
 Contracts (Financial Arrangements)
 Patient Accounts

Payment Options

Full Payment in Advance

Contracts (Under $500 or Over $500)
Pay for Treatment As They Go
(Depending on amount. Can bill under $300)

Full Payment In Advance

Advantages:

To Patient: 5 percent
discount

Disadvantages:



To Student: Financial
approval every visit (as
long as treatment plan
does not change)
To Patient: May not have
all the funds at that time.
To Student: None
Contracts -- Qualifications




Employment or Income Information
Major Credit Card
Bank Account (Savings or Checking)
Down payment equal to one month’s payment
(Procedures requiring laboratory fabrication
need 25% down payment
Contracts run no more than 20 months with
a $40 per month minimum payment. (Total amount
Divided by 20)
Contracts

Contract Under $500

If patient or co-signer has
employment verification
plus either a major Credit
Card or Bank Account

Treatment plan can be
broken down into ~$500
increments.

Contract Over $500

Patient or co-signer has
all qualifications.
Insurance

Private Insurance


We accept any dental
insurance plan that will
accept us.
Every plan has different
rules (see your PCC)

Public Insurance



Denti-Cal or Medi-Cal
Pre-authorizations a
MUST
Eligibility needs to be
checked EACH month.
Denti-Cal Procedures
Requiring Pre-Authorization

Root Planing

Root Canal Therapy




Dentures
Relines

Crowns (No posteriors
unless abutments for
RPD)
Stayplates
Partial Dentures

They are only a benefit
if opposing a full
denture.
Failure to wait for pre-authorizations will result
in your not receiving credit for the procedure.
Ways to Lose Financial Approval

Add or subtract anything to or from the
treatment plan.

Patient becomes more than 60 days past due
(delinquent account).

See your PCC
Financial Approval

Be prepared!

Always accompany your patient when making
financial arrangements.

Only a PCC can give financial approval
ALL PATIENTS NEED FINANCIAL APPROVAL
Thank You…