Heidi has been working in the dental field for more than 18 years. In 2010, Heidi launched Enhanced Hygiene. She is dedicated to helping dental groups create a strong hygiene development program that will create standards, systems, accountability, partnership and productivity. Learn more about her at www.EnhancedHygiene.com.

Heidi Arndt, RDH, BSDH

	When it comes to growing your hygiene revenue, there is one common theme many practices miss asking themselves: “Do we need to add more hygiene time?”  

	Week after week, we have doctors contacting us asking how they can grow their hygiene revenue. They feel stuck, as the productivity of their hygiene team is stagnant.  

	Increasing the productivity of your hygiene team is always something that should be considered, all within the confines of comprehensive patient care. Often many offices are not looking at the patient demand in their practice. In other words, how accessible is the hygiene schedule in the practice. Are your hygiene schedules full and booked out for weeks and weeks on end?

Related reading: 7 traps that are destroying your hygiene schedule

	If you are looking to increase your hygiene revenue and grow your practice, you may need to consider adding more hygiene time. But, when should you do this?  Here are some questions you should consider:

		What is your current hygiene open time? Look at your hygiene schedules from the past three months. Calculate your total hygiene hours available, and then how many hours were not filled.

		Are new patients being seen in the hygiene chair first? If so, how soon can a new patient get into your practice for an appointment?  

		Are new patients being seen in the doctor chair first? If so, how soon can a new patient get into hygiene following their exam with the doctor?

		If you were to treatment plan a patient for scaling/root planning, what is your next available appointment for them to have the treatment completed?

		If a recall patient were to call in for a hygiene appointment, how soon could you get them into your hygiene schedule?

	Most practices fear adding more hygiene days believing they may dilute their current hygiene schedule with the same amount of patients stretched over more days. Yet, if you wait too long to size your hygiene schedules you may risk losing patients. Patients feed the growth of the practice, and we want to be sure we are providing access to them. Therefore, timing is everything.

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	Here is a simple rule of thumb that we work by with our clients:

	If your hygiene schedules are booked out more than two to three weeks for new patients, scaling/root planing and recall, then you need to add more hygiene time. This does not mean adding a full-time hygienist to your team. Instead, we recommend stepping into the added hours.

	Consider asking someone on your team to expand their hours. This will eliminate the need to recruit in a new RDH. 

Articles

When it comes to growing your hygiene revenue, there is one common theme many practices miss asking themselves: “Do we need to add more hygiene time?”

When should you add more hygiene time?

 is such an uncomfortable topic for many, it remains a bone of contention in many offices.

Here are six things for the hygiene team to consider when asking for a pay increase:

What value are you bringing to the practice?

 In order for the practice to provide the dental hygiene team with a raise, they want to see the value the hygiene team is bringing to the practice. Make sure the value you sight is tangible and not subjective. “My patients love me,” is a subjective statement. However, if you present the value you brought to the practice in to the way of revenue, it is tangible and something the doctor will appreciate.

I suggest that each dental hygienist track their revenue from day to day and month to month. This will help you see how well you are performing and providing value to the practice. If you can show your manager that you have increased your production by 10 percent in the past year, I am sure they will want to reward that accomplishment.

Now, what about the “other” value you bring to the office… the subjective items.

Yes, these are important too. They should be highlighted, but after you have demonstrated your tangible value. Your subjective value will support the obvious improvements you have already demonstrated.

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Know what the market looks like in your area. 

I hate to bring this up, but I want to be realistic. 

 has changed a lot in the past few years, and mostly because of the high volume of dental hygienists graduating from programs across the country. The market is saturated in most areas, and this has been driving the rate of pay down. I know this is something that experienced hygienists like myself do not want to accept, but we have to factor this in. And, we need to make sure our expectations are in line with the market, just like many other professions out there.

Don't underestimate the value of benefits. Many dental hygienists will only weigh their compensation by their hourly pay, and not the whole package. Benefits can account for 30 to 40 percent of total compensation. The value of health insurance, 401K, paid vacation, sick time, etc. should never be overlooked.

Ask for quarterly performance check-ins and reviews. 

Scheduling a quarterly check-in with your manager is important, for you and for them. This scheduled meeting will provide you with an opportunity to discuss your performance, obstacles and needs with your manager. During these meetings you should highlight one to three specific development areas you will focus on over the next three months. These development areas should be developed in the way of a SMART action plan. SMART action plans require that you define how your goals and how success will be measured, which is key to objectively reviewing your progress.

Trending article: 3 ways to know you are overpaidhat do you do when they say “no increase” this year? 

Don’t get angry. Be calm and ask what you need to do to get a pay increase in the next year. Together with your manager, set some short-term and long-term goals. Again, make sure these goals are measurable. (Example: Increase my periodontal percentage to 40 percent, and my production per hour to a monthly average of $140 an hour by April 1.)  Then set up a follow-up meeting in three months, and ask if your compensation can be reviewed again at that time.

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“I have not had a performance review in the past three years, what do I do?” 

Ask for one. Set up a meeting with your manager/doctor and come prepared. My motto is this: “you don’t know, if you don’t ask”.

Times have changed, and compensation styles and levels have changed as well. It is important that we understand the current economy and how our managers, doctors and dental groups are looking at hygiene and compensation.

The tough economic times have affected all of us in some way, and for many this effect has come in the way of no pay increase in recent years. As news of a recovery and the “new economy” cross the news media, dental hygienists wonder where their recovery is.

Dental hygienists: I want a raise!

	If we described a team member who produced 30 percent of the practice revenue, was the reason more than 80 percent of new patients came into the office and from whose operatory 60 percent of restorative treatment was discovered, you may likely be thinking this is one heck of an associate and partner.

Actually, we have just described your hygienist!

As a provider of care, generator of revenue and a chief draw of new patient and recall traffic, the hygienist should be viewed as a 

 in the practice, and yet we often relegate them to subordinate, auxiliary employee status.

Free on-demand webinar: Understanding medical billing and its relationship with 3D

There are various reasons why we overlook the value hygienists bring to a practice, chief among them the fact that hygienists do not view 

 as partners and often do not realize their own value and contributions.

We are not advocating that professionals who do not diagnose treatment be given equanimity with the doctor. We all know that treatment decisions ultimately fall on the doctor’s shoulders. For that reason, giving a hygienist that 

A partnership does not mean identical equality in decision making or having complete financial ownership and responsibility. “Partnering” can mean many things and take many forms. 

 defines a partner as “a person who takes part in an undertaking with another or others, especially in a business or company with 

Giving hygienists a collaborative role in the practice has more benefit than risk. Give them a stake in the success of the practice, and you increase their accountability to the group. Partnership fosters responsibility and discipline. It sparks an awareness of accountability that we don’t see with more subordinate team members.

It is a known fact that those who have a sense of ownership in an endeavor take more thoughtful actions, view their work as more meaningful, show up early, leave late and generally work harder. They are more apt to educate themselves and others.

In short, they are less likely to be self-focused and tend to be more team-centered.

Hygienists weigh in: The most helpful hygiene products

These are the things we want from our hygienists and are often frustrated when they do not seem to take ownership. We don’t understand why they do not demonstrate the leadership qualities we know they surely possess.

However, when we relegate them to the hygiene operatory, exclude them from having input in decisions that affect the team and have closed-door “leadership” meetings without them, we will continue to see more of the same “subordinate” behavior we want to discourage. In other words, if we view them as auxiliary, they will never rise to be 

In order to spark a sense of leadership and accountability in your hygiene team, you will need to take leadership yourself. It may not happen overnight, but with each step you take, you will likely begin to see those latent leadership qualities emerging.

Read on for some simple actions that will elevate your hygienist to partner status:

		Hire hygienists whom you want as a partner, and understand the importance of strong patient care and the business objectives. Just as you would not hire a doctor who would not be on board with practice goals, hire hygienists whom you can see yourselves collaborating with and whose judgment you respect.

		Clearly define goals and expectations for your hygiene team. Using key performance indicators is the best way to communicate this and track success.

		Give them a financial stake in the practice-whether through production based compensation or bonuses.

		Provide training and coaching to them so they can reach their full potential.

		Have an open- door policy, and let them know honesty is safe.
		 

Related reading: Wendy Briggs on the future role of the dental hygienist 

		Give them autonomy where it is warranted. Do not micromanage.

		Highlight their contributions. Have a great production month? Let them know their contribution in more detail than, “Great job!” Tell them instead how much revenue they produced-and what that means for the practice.

		Share practice financial reports and goals with them.  Knowledge is power!

		Hold them accountable to being solution-focused.

It’s lonely at the top. Having a partner ensures burdens are shared, and we have another advocate we can depend on. It means knowing that this person has the good of the whole in mind. It means folks will mostly manage themselves rather than having to be managed.

Hygienists are fundamental to the success of a practice. Making sure your hygienists know and feel that is fundamental as well.

Andrea Kowalczyk, RDH, BS, works as a senior hygiene performance coach with 

. She is a national speaker and author. She can be reached at 

Related reading: 4 characteristics dental hygienists need to become successful entrepreneurs

 If we described a team member who produced 30 percent of the practice revenue, was the reason more than 80 percent of new patients came into the office and from whose operatory 60 percent of restorative treatment was discovered, you may likely be thinking this is one heck of an associate and partner.

The importance of partnering with your hygienists

Many dentists and team members think they have a strong perio program in their practice. However, after evaluating the numbers, it becomes obvious that many hygiene programs are not as strong as they think. 

There is no arguing that periodontal disease is prevalent in our adult patients. It does not matter where we live, how much money we have, or how well educated we are … periodontal disease is affecting a large amount of the patients in every practice.

One of the biggest hygiene opportunities within the dental practice is the opportunity to improve on the diagnosis and treatment of periodontal disease. Having a tangible way to measure your team’s effectiveness with treatment of periodontal disease lies within one important indicator – the periodontal percentage.

The periodontal percentage is the best Key Performance Indicator to truly understand how well your team is addressing periodontal disease. The periodontal percentage provides a look at how many of your patients are treated for periodontal disease vs. receiving a prophy.

		The perio statistics can be a good indicator if your team is coding procedures properly. We still see offices where they are alternating the D4910 code with the D1110 code because they think that it is helping their patient. In reality, it is not only hurting your patient, but it is also insurance fraud. If you code properly, your patients can maximize their benefits properly without putting your office in harm’s way.

		Hygienists by nature are givers and want to help their patients in any way they can. One way they feel they can help is by often underdiagnosing and saving the patient some money. When the appointment comes, they will treat them like a perio patient but not bill for it. Hygienists, you are putting your and your doctor’s license and reputation at risk if you do this. If the patient transfers to another office or needs to be referred to a specialist and proper diagnosing of the periodontal disease is not documented and billed, then trust is broken and the office could be liable for the potential outcome.

 released a report stating that half of American adults suffer from periodontal disease … and this number does not include “gingivitis,” as many earlier statistics did. The rate of periodontal disease went up to 70% in patients over the age of 65.

So how do you assess your office and evaluate the effectiveness of your perio program? When you are looking at numbers in your office, one of the top five is the perio production compared to overall hygiene production. We are going to dive in a little deeper and take a closer look at how to assess your practice and see in which category you fit.

Click here to learn how to calculate the periodontal percentage.

Within your practice management software, run a report that will show you the total count for each of these procedure codes. There are several ways to calculate the periodontal percentage, but here is the 

SRP Quadrant (D4341) + SRP Localized (D4342) + Periodontal Maintenance (D4910) + Prophy (1110) = 

SRP Quadrant (D4341) + SRP Localized (D4342) + Periodontal Maintenance (D4910) = 

The periodontal percentage looks at your definitive non-surgical periodontal therapy codes measured against the number of adult prophys performed in your practice. Once you have your periodontal percentage, let’s see where you stack up.

If so, you and your team are delivering a very high level of non-surgical periodontal care to your patients. You are effective at assessing, educating, and enrolling your patients in necessary treatment.

 Continue to focus on your periodontal therapy program and attend continuing education events to ensure you are always providing the best of care to your patients.

Click here to check out this webinar on how to remove

You are doing better than the average practice. However, there are several opportunities that still exist.

 Review your periodontal therapy program and focus on effective and consistent communication with your patients, as well as between all providers. Ensure everyone is speaking the same language to increase treatment acceptance.

Is your periodontal percentage below 40%?

Your periodontal program needs immediate attention. Most of your patients are receiving prophys and there is a good chance you have a high amount of untreated periodontal disease in your patient base. A low periodontal percentage is one indicator that it is time to evaluate the quality of diagnostic care occurring in the hygiene chair.

 to increase your periodontal program is assessing the patient and making a clear diagnosis. A strong and consistent assessment will guide you to a periodontal diagnosis for your patients.

Click here to keep reading about why the periodontal percentage should be the first place you focus your attention during periodontal assessment. 

No matter your periodontal percentage, the first place you want to focus your attention on is the Periodontal Assessment. The dental hygiene team must complete a comprehensive periodontal assessment on every adult patient, with a full documentation in the patient record annually.

, the comprehensive periodontal assessment should include: A review of the patient’s current healthy status, history of disease, and risk characteristics. Dental hygienists must then record the probing depths, recession, mobility, furcation, bleeding and exudate.

Using the comprehensive periodontal assessment, the dental team can develop a logical plan of treatment to eliminate the signs and symptoms of periodontal disease. The AAP’s website (

) provides numerous resources to help support a strong periodontal therapy program.

Click here to checkout 9 reason to consider continuing dental education courses. 

In addition, the team should attend a continuing education course focused solely on the development and implementation of a non-surgical periodontal therapy program. Your periodontal therapy program does not need to be elaborate. In fact, the best and most effective plans are created for simplicity and easily implemented into any office.

, has helped dental offices around the country transition down the path to paperless. Dayna channels her passion for going chartless to help fulfill her clients' goals and increase their profitability. 

With more than 20 years of experience in the dental industry, Dayna’s passion for efficient, consistent, and secure systems is grounded in personal understanding and professional expertise. With a direct, pragmatic approach, Dayna helps clients develop standardized protocols for all practice management systems.

Dayna’s expertise helped her earn the prestigious 

Spirit Award for Independent Certified Dentrix Trainers

 in 2011. Additionally, she authors the national 

, has been working in the dental field for more than 18 years. Her experience stretches from working as a treatment coordinator, dental assistant, and practice manager before graduating from the University of Minnesota with a bachelor’s degree in Dental Hygiene.

Heidi spent the early part of her career working in private practice and at the 

Mayo Clinic (Department of Dental Specialties)

, where she was a dental hygiene mentor/coach and was later promoted to Director, Dental Hygiene Development. Heidi managed over $140 million in annual revenue, and led all dental hygiene development activities for American Dental Partners affiliated dental groups (more than 250 practices and 1,000 dental hygienists across the entire United States).  Heidi created and implemented a mentoring and dental hygiene development curriculum, that improved patient care, created accountability increased hygiene profits exponentially year after year.

. She is dedicated to helping dental groups support the development and enhance the value of their dental hygiene team. Heidi’s coaching and training programs have helped hundreds of practices achieve their long sought after goals – improving leadership, teamwork, organizational systems, patient care, patient service, verbal skills, and the bottom line.

The Perio Percentage KPI . . . how does your dental practice stack up?

The past 10 years have brought many changes to the dental hygiene landscape. The supply and demand of dental hygienists has changed drastically due to the growth of dental hygiene schools all over the country. With that, the compensation of dental hygiene has also seen some big changes.

I went to dental hygiene school in Minnesota in the late 1990s. At the time of my graduation, there were only seven schools in Minnesota, and only one that was offering a four-year degree. Now there are more than 10 dental hygiene schools in the state and some are graduating two classes per year. Needless to say, the urban areas of Minnesota are saturated with dental hygienists, as are many other cities and states across the country.

The saturation of dental hygienists is also generating a lot of change in compensation models for dental hygiene. In my opinion, the changes are not so bad, as long as dental hygienists are committed to practicing to the top of their license and training something we should be doing anyway, right?

Although the per-hour pay is still the most popular form of compensation for dental hygienists, this form of pay is witnessing a slight decrease in those areas where there is a heavy supply of dental hygienists.

Today, many dental hygienists participate in a commission-type structure of pay, which is a compensation model that is picking up popularity in dental practices throughout the country.

There are several schools of thought ranging from hourly rates to base plus commission or full commission. There are benefits and challenges inherent in each method. Your selection of compensation plan should be based on finding the most balanced method for your practice, keeping in mind profitability, competitive rates, and personal incentive needs for the dental hygiene team. And, no matter the method, the focus of patient care is the highest priority!

 I have seen a lot of success with the commission style of compensation for hygienists, the practice, and the patient care that is delivered.

Commission pay is best calculated from the Adjusted Gross Revenue or the collections number. Using this, I have seen commission percentage ranges from 24-38%. And, the percentage depends heavily on your mix of business (insurance, write-offs, etc.). Commission paid from the UCR of gross revenue is an easy calculation for the hygiene team, but, depending on your collections and mix of business, it can cause fluctuations in your profit margin.

There is no doubt the commission structure provides an “incentive” for the hygiene team, yet it is often met with a lot of resistance. Why? Hygienists fear the unknown, the change, and how it will affect their personal finances which is completely understandable. 

Before implementing a commission-style pay structure, the dental practice needs to set a strong foundation of protocols, systems, and support for the dental hygiene team. These measures will help ensure success for the team. Not only that, the management needs to be prepared for all of the questions and concerns the hygiene team will have.

And by all means, NEVER implement a commission style pay as a punishment or as a result of frustrations with your hygiene team performance. Instead, reward your high-performing team with a piece of the pie. Allow them to keep a piece of the production they bring to the practice!

NOTE: Be sure to check on your state’s labor laws about commission-style pay for your hygiene team. There is some specific language you need to be aware of before implementing this type of plan.

 The base pay plus commission plan is a good compromise to the straight commission plan.

The base pay is provided to the hygienists as a per-hour or a per-day compensation. This rate should be set well below the standard pay rate for hygiene, so an incentive can be built in easily. Production above this amount will be paid as a percentage of the adjusted revenue (or collections) they produce. This plan requires some modeling in order to find the right base and commission based on your geography and mix of services.

The other plan that has some popularity is the base pay plus incentive.

It is much like the base pay plus commission, but it is set up slightly differently. The dental hygienists will be paid their standard hourly rate up to a set daily production goal. Once hygienists exceed their daily goal, they receive either another $1-2 per hour, or they get a percentage of the overage. Although this plan sounds nice, it is often times a short-term fix as it does not continually motivate the hygiene team to perform at a high level.

As a general rule of thumb, dental practices will allocate about one-third of hygiene production for compensation. This includes gross salary, tax match, and all benefits. This should be what you want your outcome to look like when modeling your compensation plan.

I have heard dentists say that all the good hygienists are already taken. While that’s not true, it can seem that way when it comes to creating a strong working relationship with your hygienist.

Dental practices should expect high performance from highly compensated hygienists, and the truly great hygienists know this. The mark of a true dental hygiene professional is a proactive nature, accountability, and eagerness to contribute. This goes both ways doctors should educate themselves on the expanding role of the hygienist and learn ways to open the lines of communications.

Building an appropriate compensation package is a foundational step in creating an outstanding, long-term relationship with your hygiene team.

There are several hygiene compensation plans out there today, and they all have their advantages and drawbacks. The plan you select for your hygiene team needs to be one that you are confident in and happy with the outcome of patient care and financial outcomes for them and your group.

After helping over more than 200 dental practices implement commission style plans, I can tell you this keep it simple for everyone. It needs to be simple for the hygiene team to understand, and simple for your accounting team and managers to calculate.

The more complicated the plan, the less result you will get. Honestly!

Second, be clear and transparent about the plan and help your team understand the benefit to the patient, to them, and to the business. They need to understand the entire structure and the “why” of the plan.

If you are seeking more information about hygiene compensation plans, please contact me directly via email Heidi Arndt @ Heidi@enhancedhygiene.com.