Section 4. Scheduling

Continuum of Care

It is a best practice to provide a continuum of care for patients. Each dentist may have different treatment-plan philosophies and practice behaviors. Once a patient has established trust and a relationship with a dentist, they will be more committed to completing a treatment plan and keeping appointments. A good way to ensure a continuum of care for patients is to create dental homes for the dentists themselves—a predictable scheduling pattern so that a dentist is in the office when she or he should be expected to be and not covering another service site in a system of care.

Many patients require specialty care such as oral surgery, molar RCTs, periodontal surgery, orthodontics, and specialized pediatric dental procedures. If your dental program does not provide these services, this does not relieve you of the responsibility of helping patients obtain them. Additionally, it is very important that your referral resources make this care affordable to your patients either by offering special payment plans or discounted fees (a requirement if your dental program is part of an FQHC).

Tips for Managing Referrals

• Whenever a service is provided that requires any form of follow up, keep records of how that follow up was provided.
• If a patient requires referral for a service not available at your clinic, document that the referral was made; if the patient refuses the referral, document the refusal.
• Keep records of consultations and reports from the oral health professionals to whom you refer patients.
• When patients break appointments and fail to complete an agreed-upon course of treatment, document all of your efforts to re-appoint the patient and complete the treatment plan.
• When a biopsy is performed in your clinic, keep records of where the specimen was sent, the report from the pathologist, and the notification of the patient of the results of the biopsy. If there is an indication for further treatment based on the biopsy results, document the provision of that care or the referral for the services if you cannot provide them.
• If a patient requires services outside your scope of care but cannot afford them, document all efforts you make to arrange for the services through local social services agencies, county health departments, dental schools, or other agencies. Try to acquire signed agreements with specialists you may refer patients to that state that they will make care affordable for your referred patients by either offering a discounted fee, a payment plan, or work done pro bono as needed or determined on an individual basis.