The
Hurrier I Go, the Behinder I Get!
Don’t
you just want to pummel a punching bag when you hear
about practices doing over a million dollars a year
per doctor? Meanwhile your production numbers remain
frozen on some primeval plateau month after month.
What’s wrong with this picture?
Well, just because your practice has hit a plateau
doesn’t mean you’re doomed to live in
the shadow of the high flyers. You might just need
to reengineer your practice systems, personnel, or
structure, but the sun is ready to shine on your practice.
Gaining
Ground, Losing Face
Unfortunately,
some practices wait till year-end to take a really
good look at their practice performance only to discover
that they’ve been stuck on a plateau for the
whole year! Those that review their numbers every
month will see the plateau as it’s approaching
and can put a program of recovery into place right
away. More often than not, a practice will slide into
a plateau because both the doctor and the staff have
exhausted their knowledge of how to make the practice
grow.
The only way to avoid the practice plateau is to find
flaws in your systems and then constantly monitor
the practice for those flaws. Following is what McKenzie
Management has found over the last 22 years as the
most prevalent causes of the practice plateau:
• Business staff turnover
• Lack of training of business staff
• No expectation levels of systems
• Lack of practice performance measurements
• Unclear job descriptions resulting in no accountability
• Decreased patient retention
• Unscheduled treatment not being tracked and
scheduled
• New treatment services not added to the practice
mix
• Not being clinically efficient
• Not reviewing fees for increase
• No practice vision
Which Came First, the
Egg…or the Turkey?
The
trouble is, all these causes and indicators are interdependent.
Why is business staff turnover such a problem? For
starters, compulsive hiring decisions are often made,
placing a person whose temperament or skill level
is not conducive to the job that needs to be done.
Then again, without a clear job description, it’s
mpossible to determine the exact right fit between
a job candidate and a staff position, accountability
for practice systems or measurements for job performance.
To regain control we need to stop and see where we
are. Let’s start with expectations. If you do
not have specific expectations of a particular system,
you cannot communicate those expectations to your
employee. It should come as no surprise, then, that
the employee doesn’t quite know what to deliver.
Once an employee
has been given the necessary training and understands
how the expectation for a particular system fits into
the practice vision, they’ve got the tools to
deliver that level of performance. Don’t worry
about the appearance of being a demanding boss. You
are actually doing your staff a favor and making it
easier for them to succeed at their jobs.
Taking this idea a step further, the practice needs
to have systems in place whose success is not dependent
on any one person, but on the system itself. It is
critical that doctor and staff understand how systems
should be performing, compared with not only
industry standards but with the practice vision.
Such goals would include 95% patient retention; 98%
collection ratio; 85% case
acceptance; 33% hygiene to practice production; 75%
emergency patient conversion to comprehensive exam;
and less than .5 hygiene openings per day. |
Take
Charge or Take Cover!
Discussing
the issue of accountability–or the lack
thereof–we are reminded of a rather distressing
situation: recall is the principle vehicle for
patient retention, but it is the most neglected
management system in a dental practice. As a result,
the incidence of patients not being retained often
exceeds that of new patients coming into the practice.
If the doctor in this practice had hired a patient
coordinator for an average of 15 hours a week,
she would have been able to handle a recall system
of up to 1,000 patients. At the rate of $15 an
hour, it wouldn’t have taken many recall
appointments to make her salary a profitable investment.
If
recall is the weakest link, then unscheduled treatment
runs a close second. Using the Unscheduled Treatment
Plan Report only for filling holes in the schedule,
the scheduling coordinator is being reactive instead
of proactive. She needs to be taught to think
of this report as a record of unproduced revenues.
Now, give her a definitive script that will likely
result in her being able to
schedule treatment. Your scheduling coordinator
should make at least five ‘sales’
calls a day, and should report at your monthly
meeting how much unscheduled treatment has been
added to the list that month, and how much has
been scheduled and taken off.
Speaking
of valuable tools, the Production by Provider
Report from your computer system is a dynamic
means of determining the number of each type of
procedure you performed over a specified period
of time. Your business assistant should be accountable
for generating this year-to-date report every
month for each doctor and hygienist, so they can
determine how their production compares with the
same time periods last year as well as with production
goals that have been established for this year.
Case
in point, in the past six months Holly Hygienist
has taken 319 bitewings and done 1,039 prophys.
If the practice philosophy is to take bitewings
once a year on recall patients, then the number
of bitewings is 20% below practice expectations.
According to Dr. Allan Monack, Consultant and
Hygiene Clinical Director of McKenzie Management,
33% of hygiene production should be derived from
periodontal therapy...namely the 4000 insurance
codes such as #4910 and #4341. Holly was averaging
a pitiful 6%.
Before we leave the clinical area, let’s
take a look at new treatment services not being
added to the treatment mix. Practices that have
stagnated may have been doing the same-old thing,
i.e. crowns, fillings, and prophys year after
year. Dentists who are doing interceptive perio,
root canals, veneers, bleaching, and implants
become recharged and their enthusiasm is infectious.
Efficient time use, as a treatment service, often
falls casualty to inefficient planning. Dr. Phil
Devore, Consultant and Clinical Director of McKenzie
Management states that some doctors may reuse
the same bur five times, alternating it with other
burs during
a single preparation instead of using each bur
until finished with it. They also get up from
their chair numerous times during patient procedures,
or have their assistants leave the treatment room
to retrieve items that should have been set up
in the first place. Clinical time and motion studies
reveal three more reasons for a production plateau:
1) slow treatment room turnaround; 2) underutilization
of chair-side assistants; and 3) poor planning
for armentaria and procedural protocols.
Balancing
Act
While you’re sitting on top of a practice
plateau, give some thought to your fees. What
you need to do is calculate your production per
hour (PPH) along with a PPH analysis of every
procedure you offer. This is much easier to figure
out than you think. Just take your fee, divided
by the amount of time it takes to do the procedure=production
per minute x 60 minutes=pph.
Once a year you should implement fee increases
following an analysis of comparative fees in your
area. Finally, you may want to challenge yourself
to reduce your procedure time.
Remember, the door to success has two signs, PUSH
and PULL. The trick is to recognize when to do
which.
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