Andre Talks About Rejected as a Stage in Eaglesoft Charting
Rejected, as a stage of Treatment Planning, can be tricky. When you Proposed a Service and it is “rejected” by a Patient. You can change the Response to the Proposed status to Rejected.
In File>Preferences>Chart, the status of Rejected has its own color option.
What are best practice protocols when using the Rejected Status?
Scenario: There are three options for Treatment:
• Extraction, Implant and Crown
• Extraction and 3-unit Bridge
• Extraction and Partial Denture
The Patient decides to go with one of the 3 options. The 2 other options can be changed to Rejected. There are advantages and disadvantages to this.
Advantage: Visually you’ll “see” the treatment that has been Rejected in the Odontograph (“chart”).
Disadvantage: When scheduling treatment or Walking out Treatment you will “see” Rejected treatment as part of the “pop-up” window of Proposed Treatment.
What I have recommended is that the practice creates a Treatment Plan for each of the three scenarios; Process each plan individually; then delete the plans that were rejected by the Patient. As I reject Services I “zero out” the fee. This keeps your Outstanding Treatment Plan figures in line.
Make sure that you have the Preference to Save Processes Treatment Plans to SmartDoc. There is a Preferences to save a Copy of any Printed Tx Plan into SmartDoc. If you use that, you have a "copy" and can delete a rejected treatment plan. As part of your Progress notes, a good practice is to inform the patient of treatment options and make note of that ("recommended a RCT, BU and Crown but patient insisted on extraction and adding the tooth to existing partial. Informed of risks and benefits of each. Rejected Tx Plan saved to SmartDoc") Mary
The Preference is found in File>Preferences>SmartDoc
The rejection must also be documented in the Progress Notes.
Example:
Spoke with Patient [ ]Alone or with __________________________________
I recommended the following treatment: ____________________________________________
I reviewed these alternatives to my recommended treatment: _____________________________
Reviewed the following risks and benefits of treatment with the Patient: _______________________
We also discussed the following Patient’s questions and concerns: __________________________
There are Patients who also reject treatment without telling the practice. This would be considered a “Time Lapse” rejection.
Scenario: A Patient that a Treatment Plans a Service never has the treatment completed is reevaluated and different treatment is required. Should the Practice change the Response to the Proposed Service to “Rejected”?
Example: 3 years ago, a MO filling was treatment planned on #18; Patient never returned for treatment and on reevaluation needs a Root Canal, Build up and Crown.
Question: Should the Practice “change” the original MO to Rejected?
Pros and Cons to this Scenario: While I do recommend the Color red for the Response Rejected, I sparingly use it. Typically, I use Rejected for elective procedures that the Patient might reject but I want the visual reference to be visible on the Chat at a quick glance. Remember that inaction by a Patient could be considered “rejection” of the treatment. Example would be that the Patient was asked about clear aligner treatment, and they said, “not interested”. A big part of the choice can come down to “how” Practices tracks Outstanding Treatment. For offices who use certain 3rd party “analytics” Providers and “treatment follow-up” Providers, Rejected Services might still consider "Proposed" and can throw off statistics. I have been told that Dental Intelligence (DI) and Practice-by-Numbers (PBN) do NOT consider Rejected Services as Proposed.
Every Proposed treatment should be connected to a Progress Note that includes a statement like this:
Patient is aware of the reason(s) for the recommended treatment and understands risks of neglecting, and the alternatives to this treatment. Informed the Patient that the degree of success of this treatment typically exceeds negative results. Alternative to this care (including the choice for a second opinion) have discussed including: ____________________
Rejected Services can be “hidden” from the graphic Chart by default using the File>Preferences>Chart option and unchecking Rejected or on demand in an individual Chart using the Show What and unchecking Rejected. It will need to be checked on all workstations for it to show. It is a workstation specific setting. It's Workstation Specific PER Windows login.
Example:
If All Employees have a Windows Login that at Workstation 1 you'd have to Log in as "Mary", change her setting on that workstation, log out; log back in a "Sally", change her setting on that workstation, and repeat for all other users. Your IT Company could do this and push this out to all workstations at the Domain level.
Changing the Response to Rejected at a date AFTER the original proposal does NOT change the original Proposed date.
Process:
Propose service
Process the Treatment plan for patient review and signature (a copy is saved to SmartDoc if Preferences are set up)
Make Progress Note of treatment. Example: “Explained to Fred that to restore #18, the optimal treatment would be to do RCT, Build-up and Crown. Pnt said that "my grandmother said never to get a RCT" so he chose to have the tooth Extracted with plans for future Implant and crown.
Reject the RCT, BU and Crown that was Proposed.
Propose and post to walkout the Extraction
Propose the Implant/Crown
Delete the Rejected RCT, BU, Crown (if your goal is to remove the Proposed services from outstanding treatment)
I have used the Phase option for Treatment that is “elective” but “deferred”. Example: Patient would like to have whitening done “when I can afford to get it done”. When this situation comes up, I mark the Service as Proposed but phased as “99”. This lets the Crew know that this is an “Elective Deferred” Service.
Be the only way to get a report of Rejected Treatment plans is to run the Detailed Treatment Plans report filtered to just Rejected.
If those Outstanding Treatment Report (OTPR) is "important" to you, be prepared that the information will be “clouded” with Rejected Services. If you want the OTPR to be "accurate", don't reject Services.
As a last result, and with the guidance of the Patterson Technology Center (“Support”), there is an option to purge Services (Utilities>Purge Options>Delete Treatment Plan Items) that were marked as Rejected. I would cautiously select a date range of (say) created 5+ years ago.
You may be able to get the Patterson Technology Center ("Support") to run a command to change all Proposed services to Rejected for a Date range. It's not something that could happen at the user level
I'm not 100% The Proposed Treatment will be purged but the Treatment Plans themselves might still be there. I just re-read the FAQ and it says "Treatments Plans can be deleted from the system either by specific status or all can be deleted at once. After the specific criteria is selected, click OK. " So... you might want to confirm that the PLANS go with the Proposed Services when you purge.
I use it as a tool for my scheduler and providers to see delayed treatment. the "99" was part of our "culture" and those scheduling knew that it meant that Patients had put off something and our providers knew that it was Proposed but deferred. I don't do treatment plan follow up in the traditional "dental" way so running a report of "99" wouldn't be in my wheelhouse. I do typical recall with a 3rd Party Patient Communication software, and I do targeted treatment follow up using The Money Finder.
Treatment Plan stages: Mandatory, elective and cosmetic.
What I suggest is to "phase" treatment using numerical priority like
Option 1 = 1XX
Option 2 = 2XX
Option 3 = 3XX
Example: Option 1 Extraction and Implant. Visit 1 is Phase 101, visit 2 is 102, visit 3 is 103 etc.
I have always taught to use "99" in Phase for "elective" procedures.
But no, there is no way to search Proposed by Phase.
DISCLAIMER:
This is a resource guide and all decisions on each dental office setup should remain the sole decision of the dentist/owner of the practice. Eaglesoft is a registered trademark of Patterson Dental Company. All other software or products mentioned are the property of their respective owners. Although Andre Shirdan was an employee of Patterson Dental, he is not associated with Eaglesoft or Patterson Dental Company or endorsed by Patterson or any other Company Mentioned in this blog.
