COVID-19 has had an incalculable impact on the world. Many businesses have greatly declined or simply not survived. Luckily for us, dental practices have been more fortunate. Most have not only survived but recovered to some degree. The good news is that this is a time for practices to take advantage of maximum recovery to help ensure a bright, protected future. 

Understanding a Business Turnaround 

Since the pandemic started, I have said that recovery is the No. 1 area where dental practices need to focus. Dentistry has never experienced a series of events this chaotic before. The initial confusion and uncertainty of COVID-19 was followed by practice shutdowns and reopenings with significant investments in new infection control equipment. Then came extreme pent-up demand followed by a period of decreased production due to patients still being uncomfortable returning. 

Dental practices have now entered a business turnaround period. Most business scholars advise the best way to conduct a business turnaround is to focus on a small number of essential areas. Following are three essential areas of dental practice and the corresponding actions that can be taken to ensure a faster, better and deeper recovery. 

1. Go beyond reactivating patients. During the early stages of the pandemic, I strongly recommended that patient reactivation was the single most critical factor to maintain the highest level of practice production. Prior to COVID-19, reactivation focused on contacting patients who had not been in the practice for 18 months. Reactivation now includes any patient who does not have an appointment. 
   
   And it’s not enough just to have a short-term focus on scheduling patients without an appointment. The practice must always address reactivation as an ongoing process and focus continuously on keeping all patients scheduled. Arguably, this may be an unreachable goal, but it should be the goal nonetheless. The practice should have every patient scheduled for a next appointment before he or she leaves and be in contact with patients as soon as they become unscheduled. This protocol will have a positive impact on production beyond the pandemic. 
   
   
2. Contact overdue patients multiple times. Reaching out only once to attempt to schedule an overdue patient is almost futile. You may capture some small percentage of patients, but it’s likely that many won’t answer the phone, respond to a text or answer an email. Instead, I recommend a nine-step contact program. 
   
   The first three times should be telephone contact so that if you’re able to reach the patient, you can then use carefully designed scripting to identify an appointment time, explain practice safety protocols and remind them of financial options. This gives patients the confidence to make an appointment and eventually accept recommended treatment. These calls should be placed exactly one week apart on the same day every week. This will make the system easier to track for the front desk team. 
   
   The next three contacts should be by text. While texting is not nearly as effective as a live conversation, it’s a good alternative after three call attempts. The text should be positive, explain the benefits of maintaining optimal oral health and ask the patient to contact the office to make an appointment. These text messages should also be sent exactly one week apart. 
   
   If the patient has still not responded after the three telephone calls and three text messages, the last step is to send three emails. The emails should be short, positive and carefully crafted to let patients know that you’re reaching out to them for the benefit of their oral health. Again, the three emails should also be sent exactly one week apart. 
   
   I understand that this may seem like you’re overwhelming the patient or being aggressive. However, according to the Levin Group Data Center, general practices using this system in the pre-COVID era had an average response time of 4.1 weeks. While it has been difficult to measure today’s average response time, we’re confident that this system will continue to be effective to some degree even during the COVID-19 recovery. 
   
   
3. Maximize productive chair time. Maximizing chair time has always been an essential factor in creating practice production, and production is the single most important factor in achieving a strong and successful recovery. Challenges to maximizing chair time have included poor scheduling, an absence of daily goals and appointment cancellations. These factors didn’t seem as important in the pre-COVID era when practices were performing at a higher level. However, now that dentistry is challenged by a lower patient volume, maximizing chair time must be elevated to a higher level of importance.  
   
   My first recommendation is to prioritize productive procedures as quickly as possible. This means scheduling certain types of patients or appointments sooner rather than later. You might consider prioritizing new patients, who typically have a 200%–300% higher financial value in their first year. Getting new patients in sooner will help increase practice production, which will lead to a faster recovery. Another example is to prioritize larger cases, which also represent a higher level of production. 
   
   Additionally, each practice should evaluate the possibility of using teledentistry to consult with postoperative patients. These patients typically have a higher no-show rate than any other category, and, when they do present for an appointment, there is no additional production involved. If some of these appointments can be moved to a teledentistry platform, chair time will be freed up for productive procedures. Each office will have to make its own choices, but I believe teledentistry will begin to play a larger role in maximizing productive chair time.
   
   Finally, I advise practices not to forget about the perennial problem of cancellations and no-shows. Practices must clearly communicate to patients the importance of keeping appointments and contacting the practice 48 hours in advance if they must cancel. Practices should also use scripting for communicating the consequences of a no-show. Although the goal is never to lose patients, Levin Group’s study of habitual no-show patients reveals that practices typically lose money on them. Fortunately, most patients will stop missing appointments once they understand that there may be a negative consequence. We recommend that this consequence be hardly, if ever, implemented, but nonetheless used as a tool to motivate patients to reschedule or keep their appointments. 

Summary 

Focusing on the three key areas outlined above will help any practice recover faster, better and deeper. Each of these areas will increase practice production, which is the key element for a successful short- and long-term recovery. 

Roger P. Levin, DDS, is the founder and CEO of Levin Group, a dental management consulting firm. To comment on this article, email impact@agd.org.

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