Circulating in Dental Practices
A pandemic appears to be spreading
out there. Not quite epidemic proportions, but enough symptoms,
enough cases, enough circumstances that clearly point to a growing
“sickness.” Over the last several months, as the economy
has been in a state of seemingly perpetual teetering between positive
economic forecasts and not so positive economic performance, collections
have been growing more and more anemic in many practices,
particularly in those that historically have not had clear collections
policies and procedures.
practice that has trained patients that it is acceptable to receive
dental care without having to pay for that care at the time of dismissal
is a strong candidate for financial problems in a good economy
– in a lackluster or poor economy they are a virtual shoe-in
for major monetary strain. When collections slip, the practice suffers
and can be seriously crippled. Bills don’t get paid, team
members don’t get raises, the doctor doesn’t receive
compensation, practice improvements are put aside, stress is high,
tempers are short. In effect, the entire practice is sickened.
No business, dental or other, can function and not expect
people to pay for services rendered. When was the last
time you fueled up your car and the person behind the counter said,
“Would you like to pay for that today? Gas prices are pretty
high right now, you might want to wait two-three months before you
pay this one.” Rather absurd isn’t it?
The vast majority of today’s patients, in most markets, are
surprised if the staff does not ask for payment at the time of the
visit. A few actually wonder if there isn’t something “wrong”
with the care delivered or if for some reason it has a lower value
because it wasn’t important enough to pay for today.
And still others are thinking, “Well doc must be raking in
the bucks if he doesn’t need to be paid.” Sound collections
begin with the realization that most patients will meet your payment
expectations provided you clearly explain what those are.
Begin with a Written Financial Policy.
This policy is a priority because it is the cornerstone of your
collections system. The policy does not require a heavy handed tone;
rather it is a straightforward explanation of the office’s
procedures and payment options – plain and simple. Ideally,
the goal is to collect most if not all of what patients owe at the
time services are rendered. However, if you plan to allow patients
to carry balances, establish specific parameters and don’t
stray. Determine how long you are willing to wait for payment. A
policy that extends credit to patients indefinitely is too lenient
and is a liability for your practice. A policy
that is too strict, such as one that does not accept insurance and/or
does not provide any payment options, is a deterrent to patients.
the right person for the right job. Financial policies
are only as effective as the person in charge of collections. Certain
people just cannot bring themselves to ask for payment from patients
no matter how small the charge. They simply are not cut out for
the position. Effective collections requires someone who is assertive,
polite, tactful, confident, and goal oriented. The person asking
for payment must understand it is their job to collect from patients
and be accountable for their results.
week, establishing a collections system that keeps the finances
and the patients in excellent health.
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
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to improve management techniques through your technology platform
VP Professional Relations
Last issue, [see
article], I discussed the reporting mechanisms and responsibility
of the person (or persons) responsible for your recall system. You
might want to look back at the article and print it for reference
by clicking on the link above.
This week I want to keep moving forward with your recall
system and teach you how to use your computer system to
calculate patient retention. This measurement should be
monthly and posted in a simple Excel spreadsheet so the
whole team can see their progress over time. After all, the whole
team contributes to patient satisfaction and retention in every
The simplest explanation of calculating patient retention is to
simply divide the total number of patients seen on recall by the
total number of patients due to be seen. Some offices don’t
want to know what their actual patient retention is. Picture
an ostrich on a beach.
first time you calculate and begin to track your patient retention
(month over month), don’t get upset by whatever the calculation
brings. After all, you didn’t know the number yesterday. Over
time, as you track it each month on a spreadsheet, an average patient
retention will come forth. Add up the total percentages of the last
six months and divide by 6 to get an average patient retention number.
If you do this exercise each month, I will certainly be impressed
and you will have a better handle on this particular area of the
Recall report run (patients due) for NEXT month
When to run: At the end of the previous month
How to run: Run a recall list report and ask for everyone due into
the office from the first day of the month (next month) to the last
day of next month.
What to include: All patients with and
What to record: The total number of patients due in next month.
Where to record: Start making a column in an Excel spreadsheet.
Production reports should be run for the LAST whole month
When to run: On the first of every month
How to run: Production by ADA code for all providers. The date range
should be the first of last month to the last day of the previous
What to include: All providers
What to record: Total all prophy codes and your 4910’s
Where to record: Start making a column in an Excel spreadsheet.
Put this number to the immediate right of the “patients due”
result from above.
Let’s say you ended up with 150 recall patients due to be
seen NEXT month. Then, at the end of the NEXT month you calculated
that you actually saw 100 recall patients. Divide 100 by 150. The
result will be 66% patient retention.
- Dr. Smith Patient Retention Monitor
The elapsed time to run the reports and put the information into
a simple spreadsheet should take less than 10 minutes. So, “it
takes too much time” is not an acceptable excuse.
As you begin to see the monthly results unfold, add six months at
a time and divide by 6 to see your average patient retention. It
is simple to add another column to a spreadsheet if you would like
to track your trailing average patient retention. This will “smooth”
out the rough months and the great months to give you a better overall
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?
DOES YOUR OVERHEAD
A Diagnosed Based Hygiene Department Profits Everyone
Dr. Allan Monack
Hygiene Clinical Director
goal is to make our patients as disease free as
possible and maximize their oral health. Sometimes refocusing your
thinking is needed to achieve that goal. When a new patient is introduced
to your practice, you take a detailed medical and dental health
history, perform a comprehensive examination, and order all necessary
diagnostics. After reviewing the information, you have gathered,
you discuss the findings with the patient and develop
treatment protocol that you and the patient accept.
don’t you do the same at your recall visits? Shouldn’t
an evaluation be done before the professional cleaning?
Shouldn’t all the necessary diagnostics be available also?
You should establish the protocol that will enable you to identify
problems and treat your recall patients in the proper sequence to
maximize their oral health. If you believe that you need to eliminate
infections before you repair the damage done by the infectious process,
you can establish a proper treatment plan that will help your patients
maximize their dental health.
wouldn’t place a crown before treating the periapical abscess
associated with that tooth. Why should you do a professional
cleaning before correcting periodontal pockets? You have
skilled hygienists who are trained to identify and conservatively
treat periodontal disease. You should give them the responsibility
to diagnose periodontal disease and communicate their findings with
the patient. You need to establish a treatment protocol to correct
the periodontal problem prior to performing a professional cleaning.
a non-surgical treatment protocol for the different stages and types
of periodontal disease is recommended. You knowing when to refer
the patient to a periodontist is also critical in the success of
your progam. Develop a maintenance interval and monitoring protocol.
You need to know how to integrate chemotherapy, antibiotics, and
mechanical debridement to achieve the best results. Obviously, unless
the patient recognizes they have a periodontal problem and accept
treatment nothing is accomplished.
do many practices not follow through with this protocol? Their mind
set has been “prophylaxis” based instead of a “diagnosis”
based hygiene department. Clean first-evaluate later.
Talk about anything. Don’t talk about the problems. You erect
barriers for yourselves and your staff that prevent you from helping
your patients maximize health. Instead, encourage and empower your
staff to achieve the desired results. Don’t ignore your findings
or feel the patients will resist your efforts to help them. Give
the patient a reason to value their recall visit.
are these barriers that discourage you from doing the very best
you are capable of?
ESTABLISHED GAME PLAN: You fail to have a written protocol
on how to communicate and treat your patients after diagnosing
EVALUATIONS: You fail to do the necessary diagnostics
such as periodontal charting, plaque and bleeding indexes, mobility
and occlusal evaluations.
OF COMMUNICATION SKILLS:
You don’t prepare answers to questions the patient is likely
to ask. The staff needs to know how to respond to their concerns
in a concise and consistent manner. You need to practice the answers
to these questions so the patient can identify with their problem
and understand what needs to be done to treat it.
OF KNOWLEDGE: Understand what is disease and what is
within normal limits. Understand the reasons periodontal disease
starts and progresses. The dental profession has greatly increased
our understanding of the etiology of periodontal disease. There
are exciting new techniques that will reduce periodontal pockets
CONCERNS: Understand insurance codes and establish proper
fees in order to create the value of the service you are providing.
Most important, overcome these barriers to establish a proper
diagnosis based hygiene department. Make a commitment to your
patients to inform them when treatment is necessary. The benefits
for your patients are a healthier oral environment with less need
for surgical periodontal therapy. The patient will appreciate
the value of the care received at the recall appointment and have
a better understanding on how to maintain their own periodontal
health. The practice benefits by an increase in production, a
greater utilization of the hygienist’s skills, and satisfaction
that your patients will be healthier.
in having Dr. Allan Monack speak to your dental society or study
YOU LIKE TO IMPROVE YOUR HYGIENE DEPARTMENT?
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
than it is?. . .
. . . but not sure
where to start?
your overhead expenses
your accounts receivable
... made easy!
you need to know about cash flow is in this
information-packed book written by
Sally McKenzie, CMC
I enjoy your monthly newsletter! It is the very best. Your no non-
sense practical tips are really helpful. Keep up the good work!
I have a question. One of my employees was called for jury duty
on one of her scheduled working days. Do I have to pay her for that
Thanks for reading and the compliment. We all work very hard to
bring you the best and latest in valuable information for your practice.
Paying an employee who will be out of your employment for Jury Duty
will vary by state law. So to be sure, check with the particular
laws in your state.
have a provision in my employee policy manual for MM employees and
is your civic duty as a citizen to report for jury duty whenever
called. If you are called for jury duty, we will permit you to take
the necessary time off and we wish to help you avoid any financial
loss because of such service. If you have completed your Introductory
Period, McKenzie Management will grant you unpaid leave to serve
your duty and/or reimburse you for the difference between your jury
pay and your regular pay, not to exceed eight (8) hours per day,
for a maximum of ten (10) business days, if such reimbursement is
required by law.
must notify the President within forty-eight (48) hours of receipt
of the jury summons.
any day or half-day you are not required to serve, you will be expected
to return to work. In order to receive jury duty pay, you must present
a statement of jury service and pay to the President, which document
is issued by the court.
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