It’s that time again. Football is in full swing, there’s a chill in the air, the final months of 2012 are upon us. Shore up production before the end of the year by giving patients the incentive to be in the chair now.

This is the perfect time to alert patients to unused dental insurance. It’s also the perfect opportunity to inform your patients about treatment financing plans like those offered through CareCredit. I readily advocate of the use of financing companies because you want to do everything within reason to make it easy for the patient to accept treatment and easy for the practice to receive payment.

Moreover, educating your patients about available insurance funds as well as interest-free financing options can be an essential means of helping the patient get past the financial barrier to receive the treatment they need.

Use scripts to guide financial conversations. Consider incorporating the following points: “Mrs. Patient, we want to do everything we can to ensure that you receive the care you need. We understand that in today’s economy financial options are very important. We can make arrangements that will enable you to make low monthly payments at no interest for a full year. We are able to do this with the help of CareCredit, which is a treatment financing company endorsed by the American Dental Association. If you would like those payments to be even lower, CareCredit offers fixed rate financing options for two, three, even four-year payment plans. More and more of our patients are taking advantage of the payment option these days. And the process takes just a couple of minutes.”

Provide options and make it easy for patients to get treatment.

Hi Sally,

Hope you are doing well…here’s a good one.

I just recently hired a hygienist who just received her degree, and is working in the real work environment for the first time. She is caring, sweet, on-time to work, presentable, respectful, and thorough……..possibly too thorough. Granted it has been only two weeks in the “real world” environment but she has been working through lunch, staying about an hour after hours, and keeping patients waiting longer than they have been used to waiting. One patient had to leave because he couldn’t wait any longer.

How can I best let her know what she should and should not be doing to stay on time without compromising the standard of care she is used to and was obviously taught in school. Do you think I should schedule her appointments for longer periods of time or should I try to force her to adapt to our 50 minute time slot. I also think she is a good team player and I’m a bit nervous that the staff is a little resentful that she is running late and adding a degree of stress in the office. My staff is mature and after a few discussions with them I believe they will be patient with her. How should I handle this?

Dr. Tim

**
Dear Dr Tim,

Because you recently hired her, it’s time for a performance review. Especially by the fact that you have had patient complaints, i.e., a patient leaving. I would tell her that her running behind is an issue and is she aware of this? Why does she think it is happening? Is there anything she feels she needs from you in order to be more efficient? If none of the answers to those questions, in your opinion, solves the problem, then I would watch her work on a patient. Stand behind the patient so the patient is not interacting with you. I would never adapt the standard of care you have delivered in the past to accommodate her.

A Performance Review is necessary and give her another one the end of every week for the next 4-6 weeks. Confront the issue so she knows this is unacceptable. Have open discussion to find out the cause. Offer training and solutions. Re-evaluate the performance and if still happening give time parameter deadlines for compliance.

Hope this helps.

Sally
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The golden opportunities of hygiene production are, at best, unrealized income potential for many practices. At worst, they are a well-kept secret stymieing your practice profitability and keeping you at the mercy of a mediocre employee and antiquated systems. But how do you get the most out of your hygiene department? By measuring outcomes and insisting on accountability.

If the hygienist receives a guaranteed salary regardless of his/her production, the expectation must be that they produces three times their salary. In addition to a base salary, consider paying hygienists a commission for achieving additional production over the daily goal. Schedule the hygienist to produce at 3x her/his daily wage. Evaluate fees and determine if they are too low. Look at the procedures conducted in an hour to determine the production per hour costs. If, for example, the hygienist is paid $45 per hour and the cost for the prophy, not including the dentist’s exam, is $75, the hygienist is making 60 cents on the dollar.

The hygiene salary should be equal to or less than 33% of production, not including the doctor’s exam fee. Insist on periodontal assessment. One-third of hygiene production should be in interceptive periodontal therapy. Require the hygienist measure the total number of dollars produced in the ADA perio codes and divide it by their total production. Report that once per month at the monthly meeting. Customize the time per patient based on patient need not on a standard one-hour allocation for each patient. Provide hygiene hours in the evening if patients are requesting late appointments. Evaluate the effectiveness of pre-scheduling. Practices using six month scheduling achieve only 76% patient retention and have a nearly 50% higher loss of patients than similar-sized practices that do not pre-appoint.

Close the lid on poor hygiene production, doctor, and you’ll see financial improvements you never thought possible.

Sally

PS. I invite you to take advantage of the Free Hygiene Assessment on my website HERE. As always, I look forward to hearing from you.

I very much enjoy the feedback we receive from all of you who read and enjoy my weekly e-Management newsletter. Here’s another office having trouble with how to deal with “late patients” and they responded with the below to let me know how much they appreciated the “Late Patient” article McKenzie Consultant Jean Gallienne wrote earlier this month in issue #500. If you missed the 500th issue, you can find it HERE.

Jean urges dental care providers to treat the patient with respect regardless of their timing, she writes:

“Go ahead and review the health history, and begin the appointment as if you would any – do blood pressure, ask the patient what problems, concerns, or changes they have. Once you have actually evaluated the patient’s mouth, this is the time to decide what will and will not be done during that appointment. Even if you have seen this patient for years and you know they have a trash mouth, at least look in the mouth.”

She goes on to say, “If the patient does have a concern, and if time permits, at least address their concern – get x-rays, and even probe if that is all you have time for, and reschedule them for the specific time required to complete the cleaning. … “You may also want to have Mrs. Smith stay in the office long enough to make sure the next patient is going to show.”

Sally…

Thank you for the article on the Late Patient…..this information is so needed, especially now…..everything you said was perfect…..it is the same way Dr. and I feel and now it is on black and white and comes from someone else other than the owners of a dental practice. We have had multiple employees who have disagreed with us and with what you have put in print. We have actually had to terminate staff for not taking care of their patients due to them arriving a little late. …staff who think this way usually are not on the same page with other office philosophies as well. There is much controversy in offices about this, especially with hygienists. I agree with you in that if you have the right team in place everything can still go smoothly at their appointments for these patients.… it does affect patient retention….you don’t want to tamper with patient retention in these days, especially if you practice where there is a lot of competition. Thank you…Thank you….Thank you for this article and for saving our practices.
Dr. E & C.E.

Hi Sally,
I am a dental hygienist in North Carolina. First of all, let me say that I absolutely love my job as a hygienist (30+ yrs now) and the practice that employs me, The docs and I have the same goal which is to provide excellent dentistry while fairly compensating me for my over all contribution to the practice. The doctors are good people and I would like to measure up financially both to my own expectations and theirs. We have found conflicting information in our attempts to gather precise details about what is and is not included in the formula that defines the standard 33% compensation. Can you help?

Debbie, RDH

Hi Debbie,

A dentist should pay a hygienist based on what he/she deposits into the checking account from dentistry performed by said hygienist. HOWEVER, it is a bookkeeping nightmare for the front office to track hygiene collections so the industry bases it on hygiene “adjusted” production. Unlike associate dentists who are paid 33% on their collections which is easier to track from a bookkeeping point of view.

If you are making, example $300/day then you have to produce AFTER ADJUSTMENTS – $900/day.
If you produced $900/day and then there was $10 taken off Mrs. Jones for “march of dimes np discount” and $8.00 taken off for “Matthison’s coupon credit, $25 taken off for a “food discount” then your adjusted production for the day was $900 less $43 or production of $857 and $857 is all that the dentist is able to collect and deposit in the checking account to pay you. So your $300 for the day is now 35% and not 33%.

That means tomorrow that your adjusted production would have to equal $943. If it equals $900, the doctor, month to date, is paying you 35 cents out of the dollar and not 33 cents. A dentist is not able to collect any “adjusted” monies and therefore doesn’t have it in the bank account to pay.

However, this is my personal opinion and what I believe to be fair. Hygiene services provided to employees and employee family members is a “benefit” offered by the employer. These services should be charged out as the normal production, adjusted off as an employee benefit, leaving their balance as zero. So, let’s say the normal charges for Carol the receptionist for you to clean her teeth is $125. That employee benefit of $125 is put on the profit and loss under “employee benefit” and you should be given in your production full credit for $125. In other words, the dentist/business pays for any employee benefits not you the employee producer.

Regarding overhead for a general dental practice, employee benefits + payroll taxes ( worker’s compensation, federal unemployment, matching social security) should be no more than 3-5% of the monthly collections.

Now, regarding the discounts for the food store, churd, March of Dimes, etc. These discounts could be viewed and classified as “Charity”. It is the cost of the sale and that cost is going to charity. I do not believe it is fair to take that away from your production.

Items such as phone advertising, hygiene reactivation credit, lifetime bleaching, etc. These discounts could be viewed and classified as “marketing” expense which is a line item on the doctor’s profit and loss and should be no more than 3-5% of collections. It’s not just the cost of running the ad in the phonebook but the discounted amount that you receive as part of the marketing effort.

Now, if the doctor has elected, for example, to be a provider with insurance company X and agreed to be paid a lesser fee than his/her normal fee then that adjusted amount you should be paid on.

It is a personal decision on the part of the dentist/owner whether or not the 33% compensation is just your gross wages or if it includes additional payroll taxes and any benefits paid you. Obviously, these are costs to the business. Some dentists include all compensation as part of the 33% and others do just the gross wages.

I hope this provides some clarity.
Sally