Virus Circulating in Dental Practices

Sally Mckenzie, CMC
President
McKenzie Management
sallymck@
mckenziemgmt.com

      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.

A 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.

Tap 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.

Next week, establishing a collections system that keeps the finances and the patients in excellent health.

If you have any questions or comments, please email Sally McKenzie at sallymck@mckenziemgmt.com.

Interested in having Sally speak to your dental society or study club?
Click here

Tech Tips For Today!

Designed to improve management techniques through your technology platform

Mark Dilatush
VP Professional Relations
McKenzie Management
mark@
mckenziemgmt.com

      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

calculated 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 dental practice.

Patient retention
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.

The 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 practice.

Reports required

Report #1
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 without appointments
What to record: The total number of patients due in next month.
Where to record: Start making a column in an Excel spreadsheet.

Report #2
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 month.
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.

Calculation

Example. 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.

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 picture.

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.

Interested in having Mark speak to your dental society or study club?
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Why A Diagnosed Based Hygiene Department Profits Everyone

Dr. Allan Monack
Hygiene Clinical Director
McKenzie Management
allan@mckenziemgmt.com

         Your 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 an

individualized treatment protocol that you and the patient accept.

Why 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.

You 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.

Designing 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.

Why 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.

What are these barriers that discourage you from doing the very best you are capable of?

1. NO ESTABLISHED GAME PLAN: You fail to have a written protocol on how to communicate and treat your patients after diagnosing a problem.
2. INADEQUATE EVALUATIONS: You fail to do the necessary diagnostics such as periodontal charting, plaque and bleeding indexes, mobility and occlusal evaluations.
3. LACK 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.
4. LACK 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 without surgery.
5. FINANCIAL 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.

Interested in having Dr. Allan Monack speak to your dental society or study club? Click here

Jury Duty

Hi! Sally,
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 day?
Kathleen

Hi Kathleen,
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.

I have a provision in my employee policy manual for MM employees and it reads:

It 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.

You must notify the President within forty-eight (48) hours of receipt of the jury summons.

On 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.

Hope this helps.
Sally

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