Second Year Clinic
Download
Report
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
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
Mostly ODTP & Perio
Almost Any Operative
Almost Any Endo
Almost Any Single Crown
No Removable
Sixth Quarter
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
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
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
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
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
Type accepted treatment
plan into computer
Get instructor to give
clinical approval
Print out treatment plan
Have patient sign
treatment plan
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
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…