the “Missile-aneous” Budget Explosion
When it comes to miscellaneous
expenses, this line item is often a giant missile aimed right at
your rosy revenue picture. All those rinky-dink nickel and dime
costs individually appear to be insignificant pocket change. But
once the trigger is pulled … “Doctor, where should
I put this expense? Oh, I dunno. Just stick it in miscellaneous.”
… It’s just a matter of time before a giant “missile-aneous”
sized hole is blasted into your budget.
to industry standards miscellaneous items should account for no
more than 10% of the practice budget. In reality, it often runs
as high as 15% of monthly collections. If you’re nodding your
head and saying to yourself, “Well I KNOW my miscellaneous
costs are well within industry parameters,” consider
this, practices frequently will have several small budget line items
- .48% here for professional dues, 1.2% there for accounting, 1.7%
for attorney fees. All of those are miscellaneous expenses, but
they are not designated as such. They have been given their own
individual budget line items causing the miscellaneous expenses
to appear lower than they actually are. And because
of their seemingly small numbers those individual items are hardly
given a second glance. Little do you realize that all those itty
bitty expenses are likely to cause your miscellaneous budget to
explode into the 15% range.
Then there is the matter of running the correct reports. Because
the individual responsible for managing virtually every dime of
practice revenues is seldom properly trained or given necessary
reference manuals, they do not know how to run the correct reports.
For example, miscellaneous expenses are commonly shown only as a
total dollar amount on the profit and loss statement and not as
a percentage of practice revenue, which gives the
doctor no real information regarding exactly what percentage of
practice revenues are being “nickel and dimed” away.
it a point to take a close look at all those seemingly insignificant
expenses starting with malpractice insurance premiums. Doctors frequently
will just make the payment with little thought and no effort to
shop around for a more affordable plan. The same
holds true with hospitalization, business, and overhead insurance.
Check out your accountant’s fees as well. Are you paying a
$300-$500 retainer for outdated, vague financial reports or are
you actually receiving accounting services and a clear understanding
of your practice revenues for the bill you are paying each month.
question, many of the items that fall under miscellaneous expenses
are completely necessary and unavoidable such as professional fees,
telephone services, etc. Nonetheless, ask questions, pay attention
to the grand total on all those little percentages, make sure the
financial reports you are reviewing are giving you the complete
picture, and you’ll be much better prepared to avoid
a giant “missile-aneous” hole in your budget.
you have any questions or comments, please email Sally McKenzie
in having Sally speak to your dental society or study club?
YOU FIND YOURSELF WAIST DEEP IN
HERE TO ANSWER THESE
10 EASY QUESTIONS
to improve management techniques through your technology platform
VP Professional Relations
Last week, [see
article], I discussed the pharmacy database in your practice
management software and ways to use this area to expand your service
level to your patients.
This week, let’s stay on the topic of doing the “little
things” with your software to enhance the customer service
experience. These are primarily operational customer service techniques
done when you utilize some of your software’s otherwise “hidden”
“My software is broken! It won’t estimate properly!
It is driving me crazy!”
Wow, I wish I had a nickel for every time I heard this one. Estimating
insurance and patient co-payment amounts are definitely “service
centric” in an office that accepts assignment or participates
with insurance plans. This topic was generated by an e-Motivator
It’s your fault! Yes, that’s right. I said it. It
is your fault your practice management software is not estimating
properly. I say this as a direct challenge so you have
the motivation to follow the following steps to find out where you’re
Overview – (coverage tables/bluebooks)
Most (if not all) of the practice management software has something
called “coverage tables” or “bluebook information”
in their software. This is where you enter the exact insurance payment
for each ADA code when posting insurance checks. Your practice management
software uses this information to estimate coverage for the next
patient that has the same insurance coverage.
Mistake #1 – We don’t update our insurance coverage
If you do not update your insurance coverage tables, your practice
management software has no choice but to estimate payment based
on a default set of category percentages or not estimate at all.
Updating your coverage tables takes literally seconds when you are
posting insurance checks. The EOB (explanation of benefits) is right
in front of you. This is the PERFECT time to update your tables.
Mistake #2 – Duplication of insurance plan/employer
This is the most common mistake with offices that DO put coverage
table information into their computer but can’t figure out
why it estimates properly sometimes and not properly some other
times. You normally find this problem in offices where there are
different or many staff with data entry responsibilities. Someone
keeps adding insurance plans and employers that
already exist in the database. In this case, an
insurance coverage table for employer “A” could already
exist. If the person doing data entry adds another employer “A”
into the software, a whole new coverage table/bluebook has to be
built over time to get accurate estimating information. There are
usually three culprits that cause duplication. They are misspelling,
non consistent abbreviation, and adding before looking to see if
the plan already exists.
Mistake #3 – Erroneous Plan Type associated with the
Your practice management software estimates based on the “type”
of plan. Some examples would be indemnity, PPO, %PPO, flat fee PPO,
Capitation, Medicaid, etc. If you have a staff member who is unfamiliar
with these plan types and is doing your data entry, this may be
part of the problem. If you find one of your plans not estimating
properly and you have determined it’s not mistake #1 or #2
– take a look at your play types.
There you go! The challenge is before you. If you are having a tough
time keeping your insurance estimation in line – take ten
to fifteen minutes of time to investigate why.
I welcome any and all readers to email
me with specific questions, problems, requests and challenges.
Who knows? Maybe your inquiry will lead to a new Tips For Today
article! Don’t worry, your inquiry will remain anonymous unless
you want credit for the question.
in having Mark speak to your dental society or study club?
you DON’T do anything to improve your
history is bound
to repeat itself.
Find out how you can make the
most of your practice...GO
Acceptance Of Periodontal Therapy
Dr. Allan Monack
Hygiene Clinical Director
article I discussed the importance of the patient recall examination.
I will now give you the skills for predictable patient acceptance
of the treatment they need. The proper sequencing of events leading
up to the final diagnosis and treatment plan presentation will give
you the greatest opportunity to have the patient agree to treatment.
The role that the hygienist plays is a key element in this process.
It is by helping the patient to discover and co-diagnose
their problem that will lead to the
patient’s comprehension and acceptance of the treatment required.
The hygienist needs to inform the patient what to expect from the
various diagnostic tests. The objective of these tests is to gather
the necessary information needed to make a treatment recommendation.
The hygienist or dental assistant will take radiographs and diagnostic
casts, chart periodontal pockets and bleeding points, take intraoral
photographs and pulp vitality tests, score plaque index, review
medical and dental health changes, perform halitosis measurements,
review cosmetic concerns, and do other diagnostics that are appropriate
for that particular patient. It may seem like a lot of things needed.
Who has enough time during the recall visit to perform all these
procedures? Sometimes its necessary to forego the prophylaxis in
order to prepare the patient for the needed dentistry. Obviously,
not everything I mentioned needs to be done every time
the patient presents for recall. After performing a cursory examination
and discussing any concerns the patient may have, the appropriate
diagnostics will be apparent.
It is important that the patient understands what the different
diagnostics are indicating. This should be explained before
the tests are taken. The patient should participate in
the discovery where possible. The patient can be involved in the
gathering of information as the intraoral photographs, periodontal
charting, and other tests are being done. As long as the patient
understands the parameters of the diagnostics, they will discover
whether everything is normal or if corrective therapy is indicated.
Since the most common area of concern during the recall examination
is periodontal health, let us use this example to demonstrate the
proper sequence of discovery, diagnosis, and treatment acceptance.
It is important that the patient can identify with the periodontal
charting as it is being done. I recommend giving the patient a hand
”This is a calibrated pocket probe. It will tell
me whether there are gum pockets present in your mouth that were
caused by swelling, attachment loss, or both. A normal depth is
3mm or less without bleeding on probing. Pockets greater than 3mm
or bleeding need to be corrected to avoid an unhealthy situation.
We now have treatment that can reduce or eliminate these pockets
without surgery in many instances. A staff member will record my
findings as we probe your mouth. You can watch the probing as we
If there is no one to assist in the charting use a tape recorder
or voice activated computer charting system. It is important for
the patient to hear the pocket measurements as
they are discovered.
This technique is called co-diagnosis. The patient
discovers their problem at the same time as the examiner. Now they
cannot deny the problem is in their mouth. Once the periodontal
charting is completed, go over the findings with the patient. Explain
the treatment needed. Try to anticipate the patient objections and
concerns during your explanation. Ask the patient if they have any
questions about their condition. Try to answer their questions as
simply as possible. Understand the protocol the office has established
for different degrees of periodontal disease.
Now is the time to have the doctor present for the examination.
The hygienist explains in front of the patient
the findings to the doctor and what the preliminary diagnosis is
and how the treatment should proceed. The patient hears the problem
and possible treatment for the second time. The doctor needs to
confirm the diagnosis and treatment. Then the doctor should ask
the patient if they have any questions concerning therapy.
Answer every question the patient presents and ask permission
from the patient to schedule the therapy. The doctor should
not speak until the patient responds! It is important to get the
patient's input at this time. If they accept the need for treatment,
they will respond positively. They may have more questions which
are almost always barriers to treatment that must be overcome.
After the patient agrees to therapy, the patient is escorted to
the financial coordinator and the scheduling coordinator. The hygienist
again explains the treatment to the financial coordinator in
front of the patient, especially what needs to be done,
the appointment interval, and the importance of completing the treatment
in a specified time period. The staff should reinforce that they
are confident the therapy will improve the patient’s periodontal
health. Make the patient feel the decision to proceed with treatment
is worth the effort to a healthier mouth.
takes a team effort to get the patient to accept necessary periodontal
treatment. At staff meetings you should develop the communication
skills needed to explain the diagnostic test parameters, overcome
patient barriers to treatment, and discuss how the therapy will
be performed. Role playing will enable the staff to deal
with objections and discuss the various treatment modalities
by reinforcing the same message to the patient. The patient wins
because they are healthier. The staff wins because they see positive
results from the treatment. The doctor wins because he has a highly
motivated staff, healthier patients and increased production.
YOU LIKE TO IMPROVE YOUR HYGIENE DEPARTMENT?
Management’s Hygiene Clinical
Practice Enrichment Program is designed to improve Hygiene
Clinical Skills and develop and implement a step-by-step Interceptive
Periodontal Therapy Program that will immediately bring greater
productivity, with enhanced patient care. For more information...GO
PAST ISSUES OF OUR E-MOTIVATOR NEWSLETTER?
2004 In Your Practice
you invest time, money, and energy taking a QuickBooks class from
your community college, check out the QuickBooks In Your Practice
workbook. Written by Susan Gunn, this workbook is the result of
frustrated clinicians wanting a workbook designed specifically for
their professional practices. A mandatory reference for any practice,
this workbook allows practices to care for patients, not figure
out their accounting software.
I am thinking about selling dental related oral
hygiene products in my practice but when I asked the staff if they
wanted to do this, I ran up against some resistance from my staff.
Can you help me out here?
Don’t make the mistake of asking staff if
they want to sell products chairside …
It’s your call ...”If you’re
looking for my advice on whether or not you should sell products
in your office, don’t expect a simple yes or no. While it’s
true that well-executed product sales can mean a considerable windfall
to otherwise static or declining profits, it is not the right answer
for every practice. To start with, hold your finger on your own
pulse for a moment. Are you a true believer? What I mean by that
is, do you believe that there are products available to you that
would be of benefit to your patients?
sale of legitimate products to patients who’d benefit from
them, is a practice-building arrangement that’ll be appreciated
by many … and disregarded by the rest. When handled as it
should be, chairside product sales should not amount to the lowering
of anybody’s standards. Hype and arm-twisting are left out
of the mix completely. Instead, it’s staged more like “here’s
the product that’s helped some of our other patients and here’s
why.” Straightforward and plain-spoken – if you want
it, we’ve got it.
be lulled into a false sense of security, though. Success is a team
effort, and as such, when you direct your clinical staff to sell
products chairside, you have the responsibility of making sure they’re
properly trained to do so, and can heartily buy into the products
they’re endorsing. They, on the other hand, have the responsibility
to do their part – demonstrating that they are champions of
both practice and patient – without ever showing a smidge
a practice sells products, the typical mark up is about 50%. For
whatever reason, some clinical staff are embarrassed by that, finding
it objectionable. What these naïve individuals are forgetting
is that this profit margin is in line with markups on crown and
bridge as well as other services that they already encourage patients
to take advantage of. Just as important, though, there is nothing
embarrassing about a dental practice making money. And if they expect
to get paid, they’ve got to understand that the practice is
a business, not a philanthropic organization. Hope this helps.
US TRAIN YOUR
Center for Dental Career Development
Business Education for Dental Professionals
737 Pearl Street,
La Jolla, CA 92037
issue is sponsored
in part by: