Section 4. Scheduling

Appointment System

Uninsured and underinsured segments of the population often have oral disease rates higher than those of higher income and/or insured segments. High levels of untreated oral disease lead to large numbers of people with emergent oral health concerns. Safety net dental clinics generally are challenged in meeting this high demand for emergent care while serving as a dental home for vulnerable, high-risk patients. Patients with emergent oral health care needs can be managed in different ways. For example, they may be asked to be seen at the clinic by appointment, on a walk-in basis, or both. How much emergent care your clinic can provide depends on available resources and the mission of the program. Regardless of how emergent patients are managed, definitive treatment should be provided whenever possible.

Care of walk-in patients is targeted to their chief complaint and is therefore unpredictable. The oral health team must determine the nature of the complaint and obtain appropriate radiographs and other information (e.g., blood pressure level, blood glucose level) before determining what services are needed for that visit. Only then can the operatory be set up for the needed procedure. Since specific instruments and materials are required for different procedures, appointment planning helps clinic staff plan operatory setup and sterilization procedures in an efficient and timely manner.

A comprehensive dental exam is the first appointment that most patients will receive. Future appointments can then be scheduled for discrete amounts of time based on the treatment plan. Multiple procedures or quadrant dentistry can be planned, with each patient's care delivered in the fewest possible appointments.

In establishing an appointment system, dental directors will need to decide upon a care approach for their program. In making this decision, the following points should be considered:

• Longer appointments afford the dentist time to provide quadrant dentistry, promoting comprehensive care, completed treatment plans, and improved health status, but they can lead to significant downtime if many patients fail to keep their appointments.
• To limit downtime when the broken-appointment rate is high, many programs may schedule short appointments, regardless of the procedure(s) needed.
• Short appointments usually permit a dentist to complete only one or at the most two procedures at each visit. This requires multiple visits to complete the treatment plan, which increases the risk of broken appointments.
• Short appointments also have higher marginal costs. Setup, clean-up, and sterilization are repeated for each appointment.
• Disposable supplies are needed for each appointment.
• Anesthesia time is needed for each appointment.
• Scheduling patient care in this manner may be viewed as unbundling procedures and is not consistent with a quality encounter when multiple procedures may be easily completed in one appointment rather than spread out over a series of appointments.
• Providing single services at each appointment so as to increase collections (e.g., minimum fee patients, FQHC reimbursement per encounter) or “churning” violates the ethical principle of beneficence, which gives priority to the needs and benefit of the patient.