There are three common reasons why dentists find themselves treading the waters of financial crisis:

1. You have too many employees.

2. The hygiene department is not meeting the industry standard for production, which is 33% of total practice production.

3. You are giving raises based on longevity rather than productivity/performance.

Doctor after doctor after doctor will say they feel like they’re just working to meet payroll, which only continues to escalate while production stays flat or, worse yet, decreases. Establish a compensation policy. The policy states that raises will be given based upon employee performance. Follow these guidelines when dealing with an employee who tells you s/he deserves a raise.

•Don’t give raises because you feel sorry for an employee or are afraid they won’t like you if you don’t give in.

•Don’t answer a request for more money with comments such as: “I can’t afford it right now.” “You haven’t been here long enough.” “I need to be fair to the others.”

•Do ask the employee to provide sound business reasons for why they should be paid more.

•Do ask them to provide a report on recent problems/issues and how they addressed them or new responsibilities they’ve taken on since their last raise.

•Do ask them to explain in writing what they have done to increase revenue, cut costs, and/or save time.

•Do tell the employee what is expected of them. A job description is essential.

•Do inform the employee of how you will measure their performance.

Under no circumstances can raises be given if the practice is losing money.

Many employees cringe at the idea of contacting patients that are delinquent in making payments, because they believe that it will require some sort of nasty confrontation. In reality – kindness, compassion, and clarity are the order of business for this task. Here’s how:

Patients that have not paid their bills should be notified 30 days after services were performed. Messages should be polite and courteous and they should be customized for the specific patient. The more personal the message, the more effective the communication will be. For example:

Dear Ms. Wheat, (You can use the patient’s first name if you know him/her well and they have been a patient for many years – Dear Jennifer, …)

We wanted to alert you that we did not receive your payment on March 15 as requested. If you are experiencing financial difficulty, please contact Peggy in our office. Otherwise, we would appreciate your prompt attention to this balance by sending payment before April 6.

Before contacting patients, do your homework. Review the account history. Confirm that there is not an insurance issue that might be delaying matters, and make sure the practice is not in error. Never apologize for requesting payment. A dental practice is a business that cannot effectively deliver necessary services to patients without cash flow.

It can be tempting to increase fees – the economic indicators are up, many practices are seeing improvements in new patients, treatment acceptance, etc. Understandably, some are asking, “When can I increase my fees?” Since 2008, many dentists have chosen to forego the standard 3-5% annual fee increases that were common in the pre-recession years. By now a fair number want to get back on track with routine increases.

But it’s a whole new world out there, and the old standards no longer apply. Today, fees should be based on your actual overhead, expenses, patient base, your individual level of professional expertise, and debt. Don’t establish your fees based on the dentist down the hall or across the street.

Additionally, be honest with where you truly stand on the skill continuum. Newer dentists simply do not perform dentistry at the same speed as more experienced doctors. For these doctors, what they don’t have in speed they can make up in relationship building. And one thing is true across the board – the doctors who are successful in today’s economy have a relationship with their patients. They are focused on providing the level of dentistry that achieves the greatest return for the patient. After all, when patients have a good relationship with their dentist, they don’t question the fee.

Hi Sally,

I have a big problem with my front desk. For the last three years, it turns out the front office has mostly collected what insurance paid and did a lot of write offs, never bothering to bill patients when they were supposed to. So now patients are questioning their bills over 3 months. They don’t want to pay since it’s long overdue, although they do admit to getting the work done & how wonderful the dentistry is that the Dr. does. How do I resolve?

New Office Manager

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Dear New Manager,

Obviously the failure of the front office team to perform is a result of a lack of training, systems, protocol and MEASUREMENTS of performance of the system and the employee. With those things in place, you would know within 30 days if the employee was performing up to the standards of the protocol of the system.

To the patient: I would admit to the failure of the employees and systems to bill them in a timely fashion after the treatment was performed. Considering this failure, the practice could agree to allow patients to pay over 3 monthly payments to make it easier on their cash flow. However, you must be clear that moving forward, you will require them to pay for their portion at the time of treatment.

Let’s face it – the office dropped the ball. It’s not fair to reprimand the patients when they had no idea. Better to take all of the blame and make it easy for them to pay and retain them as a patient than to anger them and lose them.

Here to help,
Sally McKenzie

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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