What Your Software Counts as Unscheduled

Four practices pull the same report on the same morning, each looking at a screen that says how much treatment has been diagnosed and not scheduled. Each one gets a number.

None of the four numbers is comparable to the others, and none is wrong.

That is what happens when four companies each answer a reasonable question in a reasonable way and nobody ever agreed on what the question means. It is also why the unscheduled-treatment figure quoted in benchmark decks does not measure what people think it does.

Whether you are counting people or procedures

Three of the four systems we work with build this report around the patient. One builds it around the procedure code.

CareStack's Procedures Report says so plainly. Codes are grouped as either scheduled or unscheduled, and the test is mechanical: "Unscheduled: The procedure codes are not linked to any appointment."

A patient who has eight treatment-planned procedures and no appointment is one row in Open Dental, Dentrix, or Dentrix Ascend. In CareStack that same patient is eight.

So any per-unit figure, average unscheduled treatment per patient or number of patients with outstanding treatment, cannot survive a move across that line. Neither can any comparison between a practice on one side of it and a practice on the other.

Who is eligible to appear at all

Open Dental's Treatment Finder is the report a practice reaches for here, and out of the box it is filtered on something other than treatment. The manual:

"When first generated, the list includes patients who have treatment planned procedures, no scheduled appointment, and who have insurance with a benefit year that follows the calendar year."

Patients without insurance are a checkbox. So are patients whose benefit year runs on some other schedule. That design is sound; the report exists to help offices work end-of-year benefits and it does that well. But two practices who both say they ran the Treatment Finder are not describing the same population unless they compared their filter settings, and almost nobody does.

Dentrix has the mirror image. Its Unscheduled Treatment Plans Report is described in the vendor's own documentation as "highly customizable," and whether the treatment-planned procedures appear on it at all is one of the options. It also offers three separate dollar columns: total amount, insurance estimate, and patient estimate. Unscheduled treatment dollars is not one number in Dentrix. It is at least three, and which one a practice quotes is a column-picking decision.

Which date the report is hung on

This one is invisible until you go looking.

CareStack's Procedures Report states its anchor twice: "The procedures report is dated by status change date." The default range is today, so a practice that opens it and reads the total off the screen is looking at a single day of status changes.

Its Treatment Tracker Report, in the same product, uses a different anchor: "This report shows real-time data and is dated by appointment date." That report also carries a Proposed Date column, the date the code was added to the chart, which is a third date concept again.

One vendor, three ways to answer when. All three are legitimate anchors for different questions. But a practice comparing this month to last month has to know which one it is standing on, and a practice comparing itself to another has no chance of matching.

Whether the number is current

Dentrix Ascend's Unscheduled Treatment Report documents something none of the others do. Its data syncs with the reporting system on a schedule, the report shows the time of the last sync, and:

"Data entered in Dentrix Ascend after the time shown will not be available on the report until the next sync."

CareStack states the opposite, that its reports show real-time data.

One system hands you a timestamped snapshot and tells you how old it is. The other queries live. Treatment diagnosed this morning is in one of those numbers and not the other.

What happens to treatment the patient declined

Dentrix lets you record why a case was rejected, and then lets you decide whether rejected cases appear at all: "Select Include Rejected Cases." CareStack's Treatment Tracker offers the same decision from the other direction, letting you "choose to exclude rejected and completed codes."

Declined treatment is one toggle away from being inside or outside the total.

Open Dental handles it a third way. Priority on a treatment-planned procedure is a user-defined field, and the manual is explicit about how loose it is: priorities "can be customized" and you "can use numbers, letters, or words up to 7 characters." The manual's own example list includes Sched, Wait, Next, Decline, and Urgent. So in many offices, "the patient said no" is a seven-character string of somebody's choosing, which is unqueryable across practices by construction.

The number depends on habits, and the vendor says so

The most useful admission on this subject comes from Henry Schein One's own magazine, which walks through three different Dentrix reports for tracking unscheduled treatment and tells you to pick a favorite. On one of them:

"What I like about this report is that you can search for treatment that has been accepted, rejected, or proposed (if you are marking your cases with these statuses)."

If you are marking your cases with these statuses. The report is only as complete as the team's habit of maintaining optional metadata. Open Dental's Planned Appointment Tracker carries the same dependency, stating that for the process to work, every patient who needs treatment must have a planned appointment created before they leave the office.

Two offices on identical software with different habits get very different numbers from the same report. Neither is broken.

Why there is no standard to appeal to

You might expect a standards body to have settled this. The ADA has standardized a great deal of dental data and has never standardized this.

There are published ADA standards for a clinical data architecture, for a core set of reference data shared between dental information systems, for eligibility and benefit responses, for claim attachments, for nomenclature, and for tooth designation. Eligibility data, claim data, teeth. Not treatment-plan status, and not what belongs on an unscheduled-treatment report.

The ADA has also told the federal government why. In comments to CMS on the health technology ecosystem, the association wrote that electronic dental records "are typically procedure-based" and that "structured dental data is generally less comprehensive and standardized than medical data." On coding: "Although standardized code systems exist, they have not been widely used in dentistry."

Each vendor built a sensible answer, and nobody was ever required to build the same one.

What to do with your own number

Use it as a trend against itself. Month over month on the same report with the same filters tells you something real. Beside another practice's number it tells you almost nothing.

Write down your definition. Which report, which filters, which date anchor, whether declined treatment is in or out, and whether the figure counts patients or procedures. A number nobody can reproduce gets redefined the next time somebody rebuilds the report, and nobody notices.

And when a benchmark shows up in a deck, ask which system produced it and which filters were on. Most of the time nobody can tell you, which is your answer.

We integrate with Dentrix, Dentrix Ascend, Open Dental, and CareStack, and we will tell you before you sign exactly what we read and what we write back. No long-term contract and no onboarding fee.

Deren Flesher, DDS. Founder, AiroDental.