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Using Strategic Business Communication in the Dental Care Setting to Improve the Patient Experience and Grow the Dental Practice
Alan Braverman
According to the American Dental Association, in 2014 only 52.3% of working-age adults visited the dentist every 6 months.1 While there are numerous reasons why patients may not access dental care, University of Florida researchers have found that lack of health literacy-the ability to understand and use health information-is one new reason why many people avoid going to the dentist.2 Therefore, for many dental practices, a key factor in successfully growing the number of patients seen annually is to make it as easy as possible for patients to have smooth communication with their provider throughout the entire dental care process. This article examines how to best utilize current communication channels within one's dental practice and the important role that Short Message Service (SMS) can play in improving business communications.
THE IMPORTANCE OF BUSINESS COMMUNICATION
The business communication of a dental practice is not only a means of facilitating patients' ability and desire to make and keep their dental appointments, it also has a direct impact on the practice's revenue and the patient's lifetime value to the practice. While most dental patients are primarily interested in receiving quality care, they also want an anxiety-free experience that requires little effort or inconvenience on their part. Dental practices should keep in mind that, for some patients, the slightest difficulty in the scheduling process can be sufficient reason to opt not to make an appointment. In an increasingly digital world, patients are also seeking to minimize stress in their interactions with the dental office. According to a recent survey, twice as many patients prefer to communicate with their care providers via secure SMS than use a patient portal.3
Dental practices that utilize better communication strategies are more likely to have patients who are engaged in conversations with their care providers. This in turn results in more appointments filled and more patients returning for further appointments because they have had a favorable experience. Patients who have had favorable experiences also have a higher lifetime value for the practice, and are more likely to recommend the practice to others.
Challenges That Result From Inefficient Business Communication
Most dental practices face multiple challenges that stem from inefficient business communication, often specifically related to the delayed, back-and-forth nature of communication with patients. Other problems are the result of mismanaged communication among staff members. One of the greatest problems that dental and other healthcare practices face as a result of poor communication is the appointment "no-show"; nationwide, the annual rate of missed outpatient healthcare appointments can be as high as 30%.4,5 Other challenges stem from patient expectations that are not met. Such challenges can lead to a loss in revenue for the dental practice if they persist. The following are some of the more com-
mon issues affecting revenue for dental prac-
tices:
Evolving patient technology. Many patients expect the best and latest technological experience from start to finish, and want an easy tech-forward approach to their care. A 2017 Accenture report found that 77% of patients say the ability to book, change, or cancel their own appointments is important.4
Cancellations and appointment "no-shows." Missed appointments have cost the U.S. healthcare system $150 billion every year.4 These include cancellations and no-shows, which can occur for several reasons, including miscommunication over appointment information, conflicts with the patient's personal schedule, illness, forgetfulness, "feeling better" (no longer feel that the appointment is necessary), transportation issues, and difficulties leaving work or school.5
Missed calls. Reception departments can get busy, making it difficult at times to manage phone calls in a timely manner. Each reception employee can only handle one phone call at a time, so some patients will be left on hold (and may give up waiting) or will be required to wait for a "call back" and perhaps become unavailable to take the call.
Staff coordination.Calls made to everyone in the practice's staff to fill shifts when one staff member calls out sick can be inefficient, especially for practices that are short-staffed.
Late or delinquent payments. Making phone calls to patients regarding late or delinquent payments can take time that could be better-spent scheduling, rescheduling, or performing intake for patients. In addition, late payments cause further revenue problems.
Missing information from patients. Medical forms can be long and tedious to fill out, and sometimes patients will forget to share their insurance information or other necessary information. This can lead to unnecessary phone calls (and sometimes "phone tag") to retrieve this details.
Patients forgetting checkups. Patients may easily forget to schedule their 6-
month checkups. Reminding them to schedule their appointment, and reminding them early on, can help patients keep their regular biannual visits, and keep their teeth healthy.
THE TOP THREE COMMUNICATION OPTIONS
When communicating with patients, dental practitioners have several options, but the three key communication channels are the telephone, text messaging, and email. Using all three of these channels together will greatly increase a practice's efficiency, whereas using each one independent of the other tends to limit their success.
Telephone
The traditional telephone is a staple in all medical offices, regardless of the medical specialty. Reception staff spend the majority of the business day communicating with patients, insurance agencies, medical suppliers, and so on via the phone. Although it is a pillar of effective communication, it is also a tremendous drain on the availability of the staff for other impor-
tant tasks. Also, some patients don't answer their phone and have to call the office back, and other patients consider phone calls to be intrusive.
Text Messaging
Text messaging can help ease coordination of communication and share information that is easier seen than spoken. The key to using text messages to their fullest extent is to use a tool that allows two-way texting. Although one-way reminder appointment text messages can be helpful, being able to have a "full" conversation with patients (wherein patients can respond to the dental office's text messages, and vice versa) can be even more useful.
For instance, two-way text messaging can
allow patients to share their insurance card
information, patient intake forms, and even photo identification via text message. Text messaging can also be used for scheduling or rescheduling appointments or in the place of phone calls, to help ease the number of calls that the reception department receives.
Most dental practices use email for sharing internal documents or forms with staff and for communicating with patients and vendors. It is also highly useful for keeping a record of large files or documents that have been sent and ideal for sharing more formal information. However, email can sometimes be an inefficient and "clunky" mode of communication, and it has one of the slowest response times. The response rate for SMS is 39% percent higher than for email.6
HIPAA-COMPLIANT PATIENT COMMUNICATIONS
Dental practices fall in that unique category of businesses that must balance easy communication with legal protection of a patient's private information. Using communication technology to exchange information with and about patients carries the legal requirement that certain security measures outlined by the Health Insurance Portability and Accountability Act are maintained. This act, referred to as HIPAA, was enacted in 1996 to help protect the health data of patients and to protect patient confidentiality.7
HIPAA compliance is the set of rules and regulations that medical practices, health insurance companies, and any other entity handling sensitive health information must follow to protect
that information (referred to as "protected health information"). HIPAA rules stipulate that medical information and any identifying features about a patient must be stored, transmitted, and communicated securely. This ensures that patients will not have their medical records shared with a third party without their permission. Violation of HIPAA compliance rules can result in hefty fines for those in violation of the rules. The US Department of Health and Human Services (HHS) keeps track of how many complaints around compliance are made each year. Figure 1 shows the number of complaints received by the HHS per year from 2006 to 2020.
Electronic Protected Health Information
Protected health information is defined as any information that is "individually identifiable health information."7 When that information is stored, transmitted, received, or saved in electronic form, it is considered ePHI, or electronic protected health information.
The Privacy Rule
The Privacy Rule is the rule under HIPAA that protects any and all individually identifiable health information.8 This rule protects current and former health information and covers how that information is stored as well as how it is transmitted.
The type of information covered by this rule includes, but is not limited to8:
Names
Dates (except year)
Telephone numbers
Geographic data
Fax numbers
Social Security numbers
Email addresses
Medical record numbers
Account numbers
Health plan beneficiary numbers
Certificate/license numbers
Vehicle identifiers and serial numbers including license plates
Web URLs
Device identifiers and serial numbers
Internet protocol addresses
Full face photos and comparable images
Biometric identifiers
Any unique identifying number or code
The Security Rule
The Security Rule is the rule under HIPAA
that stipulates the measures that need to be taken to protect this information. According to the HHS, "The Privacy Rule requires that covered health care providers apply reasonable safeguards when making these communications to protect the information from inappropriate use or disclosure. These safeguards may vary depending on the mode of communication used."9
HIPAA-Compliant Texting and Emails
When communicating about any medical information that might be sensitive, dental offices must ensure that there is no identifying
information or must communicate over a HIPAA-secure platform. In order to prevent violating the Privacy or the Security Rules, those identifying features of patient information must be protected and safeguards must be in place to secure the information.
If a HIPAA-compliant platform is not being used, identifying information must be kept out of the correspondence. Consider the following example, wherein the dental office is sending a text message to a patient to remind him or her about a dental hygiene appointment scheduled for
Tuesday, October 7, at 11:45 AM. If an ordinary SMS is being used, the message would not be allowed to contain any ePHI, but if a HIPAA-compliant platform is being used, ePHI could then be included (Figure 2).
With a HIPPA-compliant platform, ePHI such as test results or follow-up care information could be included. With a non-HIPAA-compliant platform, the information would need to be more vague or patients would need to be directed to receive this information elsewhere, such as a secure patient portal (Figure 3).
IMPROVING BUSINESS COMMUNICATION IN THE DENTAL PRACTICE
To most efficiently and securely increase the revenue of one's practice, SMS, email, and telephone should be used together. Using all three communication channels can help bridge the inefficiency gaps and close them.
Reduce Call Volume
The number of calls the reception department of a dental office receives can be reduced by making the most of SMS and email channels. The dental office should share their SMS number and make it clear to patients that they can send the office text messages for any reason. Doing so can also help retain patients who do not have time for a phone call or who would rather not talk on the phone. In addition, SMS can be used to schedule phone calls or ask when
a patient would like to receive a call-back, to eliminate the time that a patient spends on hold.
Fill "No-Show" Appointments and Work Shifts More Efficiently
SMS has a 98% "open rate"10 (the rate at which the messages are "viewed" or "opened"), with 90% of messages opened within the first 3 minutes of being received.11 Messages that are used to learn whether a patient is on the way to an appointment (or has possibly missed the appointment) or to try to fill a last-minute no-show appointment are therefore very likely to be seen quickly. Using SMS along with phone calls can create a strong and effective communication flow for filling appointments, confirming appointments, and otherwise generally keeping interactions with patients running smoothly.
The combination of SMS and phone can also be used to contact staff members to cover any work shifts that are available. This approach can supplement emailing the staff members; staff members may first be sent an email asking if
anyone is available to cover an upcoming shift, which can then be followed by a text message to alert the recipients that they have been sent an email and that a shift is available. A link can be included in the text message by which the recipient can claim the shift, or the text message can explain that the details are included in the email that has just been sent out.
Foster Proactive Communication
Among the main reasons patients avoid mak-
ing appointments are financial considerations related to the dental procedures. According to one survey, 40.2% of adults who reported that they do not plan to visit a dentist during the next 12 months indicated that their reason for forgoing dental care was related to cost.12 By communicating proactively, regardless of which communication channels are chosen, dental practices can be clear about the cost of their care and procedures before patients come in, which may enhance patient confidence.
As mentioned earlier, some patients may tend to forget to schedule regular checkups. Email and SMS can be used together to provide patients
with reminders about biannual cleaning appointments and/or dental examinations, and patients can be sent a link through the SMS message to request an appointment online. By proactively reaching out and giving patients a convenient
way to schedule on-the-spot, dental practices
can help eliminate some of the barriers to access that might otherwise cause some patients to
delay scheduling appointments.
CONCLUSION
Communication is a powerful tool that can increase the viability of any dental practice. By combining the strengths of the top three communication channels-SMS, phone, and email- communication with patients can be fast and
efficient, while it is also handled on the patient's terms and timetable. When these communication channels are used together, patients will be more likely to schedule and keep their dental appointments, which will result in improved oral health and greater patient satisfaction with their dental care. Improved communication also demonstrates that the dental office is considerate of the patients' time and energy, in particular by streamlining the coordination of appointment scheduling. As a result, patients are more likely to be pleased with their experience with the dental practice overall, which in turn will lead to return visits as well as referrals from these patients to their family and friends. In conclusion, improved business communication results in a seamless end-to-end patient experience that not only helps retain current patients but fosters the growth of the dental practice.
About the Author
Alan Braverman
Founder and CEO
Textline
San Francisco, California
References
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