Hi Sally

I have been receiving your newsletters for approx 6 months now and thoroughly enjoy reading each one. You have very helpful and informative suggestions. Thank you.

However, today I would like to ask you a question that has come up many times in my dental career as an office manager for the last 6 years.

I have heard many ‘opinions’ on this matter and would like your feedback:

When you have a patient who schedules for major dental work (and signs a treatment plan and has been given a copy of your office’s financial policy) and gets approximately 60% thru the lengthy multi-appointment treatment without paying any money under the guise that they “have insurance that pays 70%” on major tx and continues to “forget” their wallet when asked each time for their co-pay.
Do I have any recourse to ‘encourage’ this patient to pay. We are down to the ’seat date’ for this bridge (which req’d an unexpected 2 RCT’s and other extensive procedures to prep it). Keeping ethics in mind, can we postpone seating the bridge in order to ‘encourage’ this patient to pay?

It seems like the patient is totally in the driver’s seat despite the fact that we did our part by educating her on tx plan and financial policies prior to tx and talking finances each time she comes in.
I feel that there must be something we have as leverage…I just don’t know what. Feeling helpless is not a dental office manager’s perogative – we should always be informed and educated for the sake of our patients and the practice.

Please advise me on thoughts about this ethical dilemma.

Thank you,

Melanie

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Hi Melanie,

Thanks for your kind compliments. First let me say that ethics and peer review, etc. will be determined by the state in which your doctor practices. I would have advised to do a financial plan or patient financing such as Care Credit on the patient’s 30% responsibility. Since it seems that this was not done or perhaps the patient is ignoring this, you are going to have to get on the phone with this patient and have a heart to heart. You have to let them know that to date they have not paid for their services and it is evident that you never have your wallet with you when you come in. Therefore, I am happy to take a credit card number over the phone from you but we must have payment in full before the work is completed. If she says she doesn’t have a credit card then take the information for financing over the phone.

Would I postpone seating the bridge…….yes I would. The patient is not playing a fair ball game. Hopefully you have a signed financial agreement that states the work must be paid for in full. The problem seems that the “toughness” on your part has not been tough enough along the way. The patient is NOT in control. She knows that she can push you over and she has. It’s time for you to stand firm now and let her know you are in control. If you have to get the doctor on the phone with her then I would do it. No more Miss Nice Office Manager.

Hope this helps.

Sally

HI Sally

The subject has come up in our office that our voice mail should never pick up a call during working hours especially early in the morning. I have been working in this area for 15yrs and over those years it has become my opinion that the majority of today’s society would rather leave a brief message and get back to their business than to be put on hold. It is my policy that I will attempt to answer all calls as quickly as possible and do not put calls on hold when appropriate but there are those calls where it is inappropriate to interrupt the patient and put them on hold, thus any other calls do go to the “voice”. What is your opinion? Is there a BAD time where calls shouldn’t go to the machine or voice mail??

I am the only one answering the phone with 2 lines, greeting and discharging our patients, posting all payments, charges and filing all the insurance, managing the records. Basicly I am doing all the clerical side of our dental office.

Frustrated Carrie

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Dear Carrie,

My opinion is that the answering voice mail should be turned off during patient hours. The question is…if you are the only person at the front office and you are checking in and checking out more than 22 patients in an 8 hour day then another employee needs to be hired.

If you are processing less than this # and still feel you can’t answer phones and get your job done, there is probably inefficiencies within the systems you are presently doing which requires an analysis of those systems to uncover the problem.

Patients know you are in the practice and do not understand why no one is answering the phone during your office hours.

Here’s an example, “Thank you for calling pine lake dental. I am currently with a patient. Do you mind holding”? If the patient on the phone says yes they mind, then kindly say “May I have your name and number and I will return your call.” There is never a call that cannot be interrupted.

“Mrs. Jones, I apologize but I must interrupt you for just a moment to respond to my other telephone line. One moment please.”

Hope this helps.

Sally

Have you had a situation that you wish to share regarding voice mail during office hours? I invite you to leave YOUR comments below. Thank you for participating in my Blog!

Hi Sally

I have a question concerning part time employees. I recently hired a hygienist to work only on Mondays. Just as the holiday season would have it, the day after Christmas and the day after New Year’s was considered a holiday. Would someone that has only worked with me for a couple months be considered for holiday pay if they only work one day a week? She has not worked with me long enough to accumulate vacation time. And before you ask, this was not discussed prior to her hiring.

Any recommendations or thoughts would be appreciated.

Dr. Stevens

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Hi Dr. Stevens,

First and foremost you should have an Employee Policy Manual that states your policy on “benefits” such as paid holidays, vacation pay, sick leave, etc. For example, usually dentists will state that a part time employee is less than 25 hours a week and are entitled to benefits as outlined in the policy. If that is the case, then she is not entitled to any benefits working one day a week. A person working 8 hours a week, is usually not entitled to benefits IF you have stated that in your policy.

Assuming you do not have an Employee Policy Manual, I strongly urge you to get one. You can purchase one on my website here:
http://www.mckenziemgmt.com/ss-manual.htm.

Moving forward as an employer, you want to avoid such issues and if it’s in writing you don’t have to do it after the fact.

Let me know if I can be of any further help.

Sally

Hi Sally,

I recently attended one of your presentations. You said something that interested me but you just touched on it.

We currently charge for missed/broken appointments. You mentioned that it really doesn’t work in dental practices. Can you ellaborate? We are on the fence about continuing this practice and would like to hear your viewpoint on the subject.

Thank you for your time.

Lisa.

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Hi Lisa,

First of all it is difficult to collect it legally should the account be turned over to collection.
More importantly the patient views it as an insult, a reprimand. Verbal communication with the patient
from the day they walk in the door as a new patient on your policy is first and foremost. Reiterating to every patient that makes an appointment that you are looking forward to seeing them again, they should expect to be there for (time) and if for any reason they are not able to make the appt.
you will need 2 days notice.

I would suggest that you take my on-line training course on Broken Appointments which you can find by going to my online training site, http://www.practicemanagementlearning.com and clicking on this URL:http://www.practicemanagementlearning.com/training.asp

Hope this helps.

Sally

Hi Sally

Our Dr. subscribes to your newsletter and has recently decided that as a group discussion we will all sit down together and decide how we can implement suggestions found in your newsletters on how to streamline our practice. While I feel this is an excellent tool to help our staff I am unsure on how we as the staff can explain to our Doctor items of concern we, as the staff, have observed practices that our Doctor partakes in that we feel create some of the existing problems we are having in our practice. He tends to have an “Oh Well” attitude towards our patients when they do not want to follow his recommendations. His bedside manor is lacking in tack and courtesy. We have had several remarks from our patients that he is very rude and non caring. How can we approach him with these problems without putting all the blame per say towards him. We feel like this latest suggestion of group meetings about making changes in the clinic are great but he does not like change and has made comments to the fact that “HE IS NOT CHANGING” based on the latest newsletter “Barrier to Change” he has to be willing to make changes as well as we do.

We feel like it is imperative that his bedside manor has got to change. You just cannot build a successful practice when you act like such a butthead. Please help with any suggestions. A lot of our staff is too intimidated to bring up these subjects. I cannot be the only person to point these problems out.

Connie

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Hi Connie,

Thanks for such an open an honest email. Unfortunately he is the one who owns the practice and signs the paychecks. I believe that you will all need to be a team to confront this issue and of course accept as a team the consequences. What is the worst thing he can do? Fire all of you? Are their dentists looking for employees, yes?

I want you to go to my website newsletter archives to the URL below

http://www.mckenziemgmt.com/managementtips/tips288.html

this is a previous issue dated September 14, 2007. Scroll down to Dr. Nancy Haller’s article.

If he wants to have group discussion regarding my newsletter then announce at the meeting that we want to discuss Dr. Haller’s article FIRST!

I would also implement a patient feedback system, i.e., put 3 x 5 index cards in every operatory, lab, sterilization front desk and every time a patient gives you a compliment or a complaint, write it down and put the cards in a central location box and then at your meetings pull them out and read them.

You need him to diagnose and hold a handpiece. The practice does not need him to talk to patients or present treatment. If he is not good at it, the only change he needs to make is to keep his mouth shut and say “Connie, will go over everything you need. Have a nice day.”

If you can show that he has lost patients, that a low % of patients accept his treatment then that is a trend reflecting back to him. Other than the suggestions above and him getting “therapy” to overcome his fear of change the only other suggestion is what your Mom used to tell you. “If you can’t stand the heat…..get out of the kitchen.”

Good luck,

Sally