The Art of Practice Management

A dental practice management consulting company that focuses on revenue and collection systems, front desk systems and forms, dental insurance processing, medical/dental cross-coding systems and employment-law compliance.

Introduction

How long has it been since you began using your current health history questionnaire? Has it been the same form since the opening of your practice? Have you taken a good look at it to evaluate if it has kept up with the times? These questions need to be considered, as your questionnaire may be obsolete.

We are all well aware of the medical advances made over the last

decade. As far as dentistry is concerned, there has been on-going research into the systemic link. Although this link has not been proven, the association between the mouth and the body has been. This alone gives us reason to re-evaluate our medical history questionnaires.

It is likely that patients are apt to see their dentists more frequently than their primary care physicians. With our recare system based most often on visits of no more than six months apart, we have the greater opportunity to spot a medical problem. If we spot signs of disease through visual exams or through reading the responses on the patients’ health history questionnaires, we can recommend that the patient see his or her primary care physician. We can truly play a very important role in our patients’ overall health.

The American Dental Association suggests that the medical history form should begin with basic questions about how the patient perceives his or her health status. If your form does not ask these questions, they need to be added:

Are you in good health
When was your last physical exam
Are you under the care of a physician and for what condition(s)
Have you had any serious illnesses or operations and ask for details on this
Have you been hospitalized within the last five years

I then suggest that the form become much more detailed to include the following:

Do you have, or have you had any of the following diseases or problems?
a. Damaged heart valves or artificial heart valves, including heart murmur	Yes No
b. Congenital heart lesions	Yes No
c. Cardiovascular disease (heart trouble, heart attack, coronary insufficiency, coronary occlusion, high blood pressure, arteriosclerosis, stroke)	Yes No
1. Do you have pain in the chest upon exertion?	Yes No
2. Are you ever short of breath after mild exertion?	Yes No
3. Do your ankles swell?	Yes No
4. Do you get short of breath when you lie down or do you require extra pillows during sleep?	Yes No
5. Do you have a cardiac pacemaker?	Yes No
d. Allergy	Yes No
e. Sinus trouble	Yes No
f. Asthma or hay fever	Yes No
g. Hives or skin rash	Yes No
h. Fainting spells or seizures	Yes No
i. Diabetes	Yes No
1. Do you have to urinate (pass water more than six times a day?)	Yes No
2. Are you thirsty much of the time?	Yes No
3. Does your mouth frequently become dry?	Yes No
j. Hepatitis, jaundice or liver disease	Yes No
k. Arthritis	Yes No
l. Inflammatory rheumatism (painful swollen joints)	Yes No
m. Stomach ulcers	Yes No
n. Kidney trouble	Yes No
o. Tuberculosis	Yes No
p. Do you have persistent cough or cough up blood?	Yes No
q. Low blood pressure	Yes No
r. Venereal disease	Yes No
s. Epilepsy	Yes No
t. Psychiatric problems	Yes No
u. Cancer	Yes No
v. AIDS or other immunosuppressive disorders	Yes No
w. Other _____________________________________________________________
_________________________________________________________________
Have you had abnormal bleeding associated with previous extractions, surgery or trauma?	Yes No
a. Do you bleed easily?	Yes No
b. Have you ever required a blood transfusion?	Yes No
If so, explain circumstances _________________________________________
________________________________________________________________
Do you have any respiratory disorders such as asthma?	Yes No
Have you had surgery, x-ray or drug treatment for a tumor, growth, or condition of head or neck?	Yes No

As we are all aware, the medications that patients take impacts their health both as its intended purpose but also in the form of side-effects. Some of these medications have been proven to cause problems with a patient’s oral health. The following section addresses both prescribed medications and over the counter medications:

Are you taking any drugs or medicine?	Yes No
If so, what? ________________________________________________________
Are you taking any of the following
a. Antibiotics or sulfa drugs	Yes No
b. Anticoagulants (blood thinners)	Yes No
c. Medicine for high blood pressure	Yes No
d. Cortisone (steroids)	Yes No
e. Tranquilizers	Yes No
f. Antihistamines	Yes No
g. Aspirin	Yes No
h. Insulin, Tolbutamide (Orinase) or similar drug	Yes No
i. Digitalis or drugs for heart trouble	Yes No
j. Nitroglycerin	Yes No
k. Oral contraceptive or other hormonal therapy	Yes No
l. Over the counter medications	Yes No
Other _______________________________________________________________

Allergies must also be addressed:

Are you allergic or have you reacted adversely to:
a. Local anesthetics	Yes No
b. Penicillin or other antibiotics	Yes No
c. Sulfa drugs	Yes No
d. Barbiturates, sedatives or sleeping pills	Yes No
e. Aspirin	Yes No
f. Iodine	Yes No
g. Codeine or other narcotics	Yes No
h. Latex	Yes No
i. Other ___________________________________________________________

I then suggest that some additional questions be asked that can give you a good idea of where the patient is at present both dentally and medically:

Have you had any serious trouble associated with any previous dental treatment?	Yes No
If so, explain ________________________________________________________
___________________________________________________________________
Do you have any disease, condition, or problem not listed above that you think I should know about?	Yes No
If so, explain ________________________________________________________
___________________________________________________________________
Are you employed in any situation which exposes you regularly to x-rays or other ionizing radiation?	Yes No
Are you wearing contact lenses?	Yes No
Have you had anything to eat or drink in the last 4 hours?	Yes No
Are you wearing removable dental appliances?	Yes No
Do you smoke or use tobacco?	Yes No
Does your physician require you to take antibiotics prior to dental treatment?	Yes No
Is there a family history of diabetes, heart disease, high blood pressure, obesity, or high cholesterol?	Yes No

Special questions need to be asked of our female patients that should include the following:

Are you pregnant?	Yes No
Do you have any problems associated with your menstrual period?	Yes No
Are you nursing?	Yes No
Are you taking birth control medication or hormone replacement medication?	Yes No
Are you taking any bisphosphonate drugs (e.g. Fosamax, Boniva) for osteoporosis?	Yes No

The last suggestion that I make is two-fold. Address any specific dental concerns and ask the patient if he or she has a chief complaint. For those practices that file medical cross coded claims, the answer to the chief complaint is vitally important in determining a patient’s diagnosis. In the future, dentistry will also be required to report a patient’s diagnosis on a dental claim form. We will have to prove why we performed our procedures ( as is required in the medical field). Watch for more information in future newsletters on this.

Medical history forms that include this much information can be daunting to some patients. I suggest that either a front desk staff member offer assistance to those that seem to be having difficulties in completing it or possibly the dental assistant who will accompany the patient to the operatory.

A questionnaire as thorough as this will undoubtedly give us the full dental and medical picture of our patient. This can only result in your practice helping your patients to reach their optimum level of health.

Articles

Time Line

Red Flags Rule – November 1 is the latest deadline for compliance with the Red Flags Rule. Be sure that your practice is prepared with a written plan. For additional information regarding Red Flags Rule, please refer back to my last two newsletters (the July newsletter and the July special edition newsletter)

Medical Cross Coding – October 1 marked the effective date for the current update to the medical diagnosis codes (ICD-9-CM). If you file medical claims for certain dental procedures, you must obtain the latest coding manual. If you purchased my medical cross coding manual, please contact me to obtain your updates. Protect the investment that you made in the manual by keeping it current. Also, help prevent denials by using the up-to-date codes.

September 23, 2009 was the effective date for the Breach regulations. The FTC created the Breach regulations to require that health providers create a plan for notifying patients of a breach of their personal health records. Information regarding this can be obtained online or through companies such as Total Medical Compliance.

Tips

For our patients – Is your practice cautioning patients about how acidic drinks and candy can be damaging to teeth? We have concentrated so long on the sugar content of our foods and drinks, but we should also be advising patients that acidic foods and drinks are corrosive to tooth enamel. The journal of General Dentistry published an article that suggested that, after consuming citrus-fruit juices and sodas (that contain citric acid and phosphoric acid) that one should wait an hour before brushing. According to Kenton A. Ross of the Academy of General Dentistry, “The acid in the drink weakens the enamel, and brushing can then remove microscopic amounts of that important enamel layer.” We should let our patients know of this study and possibly suggest that the patient rinse with water after consuming these beverages to dilute the acid.

(Martha Stewart Living, May 2009, p. 39)

My Favorite Quotes:

"Life is an opportunity, benefit from it.
Life is beauty, admire it.
Life is bliss, taste it.
Life is a dream, realize it.
Life is a challenge, meet it.
Life is a duty, complete it.
Life is a game, play it.
Life is a promise, fulfill it.
Life is sorrow, overcome it.
Life is a song, sing it.
Life is a struggle, accept it.
Life is a tragedy, confront it.
Life is an adventure, dare it.
Life is luck, make it.
Life is too precious, do not destroy it.
Life is life, fight for it. "

~Mother Teresa~

Dental Humor for the quarter:

"At 5 P.M. one Halloween afternoon, my dental hygienist realized that she wouldn't make it to the store in time to get snacks for trick-or-treaters. So she took home some free samples from the office supply cabinet. That night she handed out dozens of toothbrushes, toothpaste, and dental floss. The next year, although she had bags of chips and popcorn, not one child came knocking at her door."

http://www.butlerwebs.com/jokes/medical-dental.htm

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The Art of Practice Management
2217 Fox Horn Road • New Bern, NC 28562 • Phone: 1-252-637-6259
www.artofpracticemanagement.com • a.p.m.1@suddenlink.net

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