THE READERS' CORNER

This month's topics are sterilization and overdue accounts.

1. What procedures do you use for sterilizing instruments, surfaces, appliances, etc., in your office?

There was a wide variety of responses, but the most widely used procedures were cold disinfection and alcohol swabs. Heat or chemical sterilization was mentioned only occasionally.

Glutaraldehyde-based disinfecting solutions were used by many offices. In some cases all instruments were placed in the solution--usually for about 10 minutes--and in other offices pliers were excluded. Hinged instruments such as pliers and hemostats were frequently wiped with 70% alcohol swabs and occasionally also placed in a glass bead sterilizer for 10 seconds.

Many respondents said they used alcohol swabs for wiping off surfaces, but some reported using a variety of disinfectants. Bands were generally either wiped with alcohol or placed in a cold disinfecting solution.

Procedures mentioned included:

"We use a glutaraldehyde solution and soak instruments for approximately 10 minutes. We have about four of each instrument at each chair to insure a full 10 minutes for each instrument."

"For instruments that have been contaminated with blood, we use a cold sterilizing solution."

"We have tried using gloves, but find it not feasible to change gloves between every patient. The gloves get sticky if the gloved hands are washed. Repowdering is only partially effective."

"The surfaces of our countertops are wiped with Biocide disinfectant by Biotrol."

"We change the disposable paper covers on our bracket tables after each patient."

2. When do you consider an account overdue in your office? What collection procedures do you follow at 30, 60, 90+ days overdue? Do you maintain an aged accounts listing? Do you make a service charge for late payment? Do you turn accounts over to a collection agency, and if so, when? Do you write off bad debts, or have you ever gone to court to collect? What would you say is your success rate in collecting overdue accounts?

Virtually all respondents considered an account overdue after 30 days and sent the patient either a letter or a statement. After 60 days a second letter was usually sent, sometimes including a warning about the possibility of suspending treatment. In some cases a certified letter was sent after 60 days. After 90 days many offices said they took stronger measures, including suspending treatment and reporting the patient to a credit bureau and collection agency.

Almost all offices kept an aged accounts listing, some using a computer. Very few reported making a service charge for late payments; those who did charged small amounts such as $5, and sometimes dropped the charge if circumstances warranted it.

About half the respondents did not use a collection agency. Those who did generally turned an account over reluctantly, and well after 90 days. Most offices wrote off some accounts. Many reported using attorneys to write letters, and about half went to small-claims court as a last resort.

Success rates in collecting overdue accounts were usually described as "good", with a range of 50-90%. Comments included:

"After 30 days we make a reminder phone call. If payment is not received in 10 days, we send a letter giving 10 more days for payment."

"After 90 days, if they still have their bands on, we tell them to be in touch with our office to make an appointment to have the bands removed. In any case we discontinue treatment until the account is up to date."

"The aged accounts are kept in a card file for continued follow-up and for documenting contacts."

JCO wishes to thank the following contributors to this month's column:

Dr. Richard E. Crowder, Wichita, KS

Dr. Velma H. Dyck, Fresno, CA

Dr. Marston Jones, Salisbury, MD

Dr. Robert Lindsey, Plainview, TX

Drs. Robert Rubin, S.M. Hamilton, Warren Karesh, and Walker Shivar, Norfolk, VA

Dr. Stephen M. Selby, Baton Rouge, LA

Dr. Gary R. Smiley, Spartanburg, SC

Dr. Brainerd F. Swain, Morristown, NJ

Dr. Arnold I. Winshall, Birmingham, MI