Internal “Redecorating” May Be In Order
When it comes to patient retention,
dentists and their teams commonly blame external factors.
In reality, it’s the internal practice policies that are most
likely to send patients packing. Consider how often you hear these
questions, “Do you offer evening or Saturday appointments?”
“Can I make payments for the treatment?” “Wouldn’t
a filling work just as well as a crown?” “Will my insurance
cover all that?” Patients, either directly or indirectly,
are telling you what they want and need in order
to stay with your practice. Unfortunately, few doctors and their
in until the problem is screaming at them from the schedule.
Take the example of “Mary” a business employee who recently
contacted McKenzie Management in search of the patient retention
solution. She had long been following up with inactive patients
to better understand why they left the practice. Specific reasons
emerged again and again. The practice hours were inconvenient. The
doctor’s fees were too high. The practice was too far away.
Insurance doesn’t cover enough, etc – all of those reflect
the most common reasons why patients leave practices.
was searching for just the right words, the perfect phrase to convince
patients to return. But patients aren’t interested in her
prepared script. They don’t want to be passified. They want
action. If that dental team’s focus were truly on addressing
the needs and expectations of the patients, Mary wouldn’t
have to spend her days searching for eloquent phrases and
catchy lines in an effort to keep active patients from
becoming inactive charts.
Mary’s situation, the information she has gathered, which
essentially are customer complaints, must be shared
with the doctor. If the doctor and the team sincerely want to improve
patient retention they need to implement an immediate plan of action.
Look objectively at patient retention numbers
and take responsibility for improving retention. Listen to what
patients are saying, and stop blaming external factors.
adjusting practice hours for 60 days, promote
the change to patients, monitor patient reaction, and measure
retention carefully. If the response is positive consider making
the change permanent. If the doctor refuses to adjust practice
hours, then he/she needs to take responsibility for the loss of
fees to determine if they are appropriate for the patient
population. If the fees are within an appropriate range yet patients
perceive that the fees are too high the entire team must take
responsibility for educating patients at every opportunity on
the excellence of the care provided and the value of receiving
dental care in terms of overall health and wellbeing.
the fees charged are, in fact, too high and the doctor will not
adjust then he/she should offer patient financing options.
In addition, the team as a whole must continuously emphasize to
patients what sets the practice apart, why the dental care provided
here is worth the extra investment. Superior service is
a must. If the doctor and team are not proactive in addressing
this patient concern they must take responsibility for practice
affordable payment options available to patients. If patients
indicate that their insurance will not cover their dental needs
and wants, provide a treatment financing option such as CareCredit.
Patient financing companies provide several affordable plans that
benefit both the patient and the practice. In addition, they encourage
patients to pursue higher dollar treatments.
Understand and clearly articulate payment options to patient.
It is the responsibility of the financial coordinator to understand
the financing options that are available to the
patients as well as assist the patient in making those arrangements
with either the practice or the patient financing company.
The bottom-line: If you don’t like the sheets on your bed,
you can change them… but you may have to be willing to consider
a different pattern.
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
Dr. Nancy Haller
months ago I came back from a weekend management meeting and on
Monday expressed to Carol how I wanted the recall system run. I
didn’t want to schedule patients six months in advance any
more. I just found out that she never did this. I am very upset.
How should I handle this?
Dr. Tucson, Arizona
Clearly you and Carol need to talk. However, the biggest challenge
in communication comes when we are under stress,
when we have an expectation that is not met. Frequently we have
a sense of loss that we convert to hurt and often anger. If we try
to talk in the heat of the moment, we can say things
that we later regret. Therefore, I applaud your wise decision to
wait and think this through.
the core of your question is a timeless management debate…
Do employees want to do a good job and be productive, or do they
want to get by with as little work as possible?
experience and research indicate that the former is more likely
to be true, most of the time. People are inherently good
and want to succeed, even if it is not obvious to others.
And studies also have shown that the number one factor affecting
an employee’s performance is his/her relationship
with their supervisor or boss. Before you do or say anything
to Carol, be careful that you are not misjudging her actions.
Remember that she is more likely operating from a positive intention
despite falling short of meeting your needs and expectations. She
is communication regarding the effect that a person’s behavior
has on another individual and/or group. The term ‘feedback’
was originally borrowed from electrical engineering. In the field
of rocket science, for example, each rocket has a built-in apparatus
that sends messages to a steering mechanism on the ground. When
the rocket is off target, these messages come back to the steering
mechanism that in turn makes adjustments and puts the rocket back
on target again.
then tells us whether we are ‘on course’
– keep doing what you’re doing, it’s working –
or provides us with information to put us back ‘on course’.
The problem is most people associate the term ‘feedback’
to mean criticism rather than information. As such,
it is met with reluctance or anxiety, or simply avoided. Yet, the
process of giving and receiving feedback is one of the most important
communication tools you have to keep your office efficient and profitable.
are some steps for feedback.
through the main idea you want to express. Organize supporting
thoughts or facts so that they lead to your main point. By being
concise and clear you increase the likelihood that you have a
positive impact and your message will be heard.
POSITIVE AND CALM. Make good eye contact. Start the conversation
by identifying something (s) you sincerely appreciate about the
person. Then define the current issue in concrete terms. Address
behaviors, not personalities. Be direct in a non-aggressive manner.
Stick to the issue at hand. Avoid bringing in other business or
Ask the person for their feedback. By requesting their input,
you build a “win-win” atmosphere. Remain non-judgmental.
Show concern and avoid interrupting. Listen for main thoughts
or ideas, particularly with people who include a lot of detail
or tend to ramble. Paraphrase what they have said if you need
clarification, or simply to confirm understanding.
a dialogue script for talking with Carol.
do you have a few minutes to talk? (Always ask permission
to talk. Be sensitive that the other person may not be
available to give you full attention at that time.)
First, I want to thank you for being so diligent in scheduling
patients. I really appreciate how attentive you are to keeping
the appointments in order.
you remember when we discussed the new recall system? (Pause,
clarify as needed.)
was surprised when I realized that you were still scheduling patients
six months out. Can you give me some idea about why you aren’t
using the new recall system? (Stop and listen. Ask open-ended
questions to draw out thoughts and feelings).
there anything I could have done differently/better
to help you? (Try to understand it from Carol’s point of
talk again in a week and see how you are doing
with this. Thanks Carol.
By communicating in this way with employees, you are on
the road to increasing quality results!
DOES YOUR OVERHEAD
Reluctant Office Manager
Belle M. DuCharme, RDA,
Director/ The Center for
Dental Career Development
office manager, Jane, came to me for advanced business administrator
training from a mid sized town in Colorado. She confided
to me that she doubted whether she was right for the job because
she did not have the respect of the clinical staff.
“I don’t have a background in dentistry so they don’t
respect me.” After questioning Jane about the operating systems
in the office, I explained to her that the clinical staff was not
taking her seriously because she had made some faulty decisions
that were costing the practice patients and revenues. She continued
to pre-book hygiene appointments
solidly for six to eight weeks out without blocking time for new
patients and perio procedures (root planing). The majority of the
patients in the practice were between thirty and fifty years of
age, yet the percentage of patients in perio was only 6%.
This is indicative of a hygiene department in distress and need
for reevaluation. New patients had to wait six to eight
weeks for an appointment. The practice was averaging 20
new patients a month but was unable to schedule them on
a timely basis. This is poor customer service. When they
finally came in for their appointment, they would complain loudly
to the hygienist or the doctor. The computer system in the office
. Jane had not been formally trained on the system and did not know
about the unscheduled treatment list and the ASAP list. The ASAP
list allows you to immediately access patients
who are available to come in for an appointment on short notice.
The unscheduled treatment allows you to view patients who have treatment
plans but have not scheduled appointments or had to cancel and have
not rescheduled. Whenever there was a cancellation or no-show it
went unfilled because she was not prepared to call
anyone. Posting was not being done from the treatment plan. She
had cancelled e-claims in favor of printing paper claims
because she was having a problem with errors. She wasn’t aware
that she could get help from Dentrix
Support. This slowed the cash flow and created a mountain of
paper work. Posting of charges to accounts and filing of insurance
claims was backed up for a week at a time because the doctor insisted
on doing his own charting and determining the fees.
I explained that the patient must have a written treatment plan
in advance of treatment so that they can make an
informed decision about the costs and the treatment options. Accounts
receivables were 40% at 90 days where they should not be over 15%.
As you can see, the challenges were great.
customized Jane’s training to include understanding
system and agreeing to get a trainer in to show Jane the practice
management systems and to get e-claims back on track. I gave her
a list of reports that needed to be run on a monthly
basis and how to read the reports. We
analyzed the recall system and made the necessary changes to accommodate
new patients and perio patients. I recommended that McKenzie
Management’s, Hygiene Consultant evaluate the practice.
Jane was taught to enter a treatment plan and to post from it to
the ledger. We discussed changing the system to include clinical
notes made by the dental assistant and the use of routing slips
to make sure charges were accurately presented to the patient at
check-out so we could improve the over the counter collection
statistics. If a patient encounters a smooth and efficient front
office staff they are more apt to trust that their dental care will
be delivered in the same fashion.
“sink or swim” syndrome is prevalent
in many dental offices. Throwing a new employee into the daily working
environment of a busy dental practice without proper training
is costly to the practice and stressful to all concerned, including
For Dental Career Development, our mission is to teach you how
to manage systems that create productive and efficient team dentistry.
Belle M. DuCharme, RDA, CDPMA, Director
YOU LIKE TO HAVE
Exceptional Front Office Employees?
than it is?. . .
. . . but not sure
where to start?
My name is Monique and I love your newsletter. I am the treatment
coordinator, financial coordinator, office manager and jack of all
trades for a dental office. I get to work with my best friend (the
doctor). We've been friends for quite some time and we've been through
some good times and bad. I love the doctor dearly and I work extra
hard to keep the office running as smooth as possible. However,
I haven't had a raise in almost 4 years. Since we're so close I
am having trouble approaching him for a raise. I've done some research
and found that other offices are paying their treatment coordinators
MUUUCCCHHH more than I'm getting (and these ladies aren't half as
committed as I am to this practice). The doctor is a very generous
person with all the other staff. I know I need to bite the bullet,
sit down with the doctor and just ask for the raise, and yet I don't
want this issue to cause a rift in our relationship. I just can't
see myself surviving on less than twice what I make now. I am the
only one in the office that owns a home and a single parent. I don't
want his pity, but times are tough and money is scarcer every pay
check. I was even going to ask for 3 times as much in case there
was any negotiating he'd settle for twice my salary. I truly am
not a greedy person. How can I express to him that I REALLY need
the extra cash to survive? I don't want to leave this office - I
don't even want to be less committed to it. What should I do?
awaiting some advice.
It’s apparent to me that you have not had a performance review
in that 4 years for if you had the issue of salary increase would
have come to light. Therefore I would recommend that you simply
approach him and say: “Dr. X, as you are aware it’s
been 4 years since I last had a performance and salary review done.
What is a good time for you and I to sit down and discuss this?”
If he says he is not going to give you a review, which I can’t
imagine, then you have a choice which is to stay and continue to
work as you are or to give him notice and leave the practice. I
am positive there are MANY doctors out there that would be happy
to give you a raise every 2 years! This is not about friendship
outside the office....this is your relationship with him as employee
and employer. He doesn’t know how you feel so, it is only
fair that you communicate your desire to have a review. Don’t
communicate to him that you need extra money. He doesn’t want
to hear about your financial situation and you don’t need
to justify to him why you are asking for a performance/salary review.
No employee will remain motivated or remain employed without seeing
advancement. Remember if you don’t ask…you don’t
Hope this helps,
US TRAIN YOUR
Center for Dental Career Development
Business Education for Dental Professionals
737 Pearl Street,
La Jolla, CA 92037
OUT OF YOUR
Hygiene Clinical Consultant for
CAN HELP YOU
develop a profitable
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