05.01.09 Issue #373 Forward This Newsletter To A Colleague
Spouses in Dentistry
Insurance Assignment?
Creative Financial Arrangements

Spouses in the Dental Practice
Thorny Issue or Bed of Roses

by Sally McKenzie CEO
Printer Friendly Version

The day before Nicole and Dr. Dan celebrated their first wedding anniversary Dr. Dan came home from work and explained to his wife that he had good news and bad news. The good: A difficult employee was no longer with the practice. The bad: Dr. Dan needed his wife to step in and help in the office part-time.

Dental spouses become dental employees for a number of reasons. In some cases it is out of necessity, or the office is temporarily shorthanded, or finances warrant that the spouse step in so the practice can avoid incurring additional payroll expenses. In other cases, the couple feels strongly that it is in the best interest of the business for the spouse to work in the practice. In some instances both are dentists and are building their practice together.

Some couples readily admit they would not choose to work with their spouse for many reasons. Yet in dentistry, couples frequently run the practice together. In those situations in which the couples work well together a few key characteristics tend to emerge. First and foremost, they genuinely respect and appreciate each other. They enjoy spending a lot of time together. They can handle dealing with the practice headaches, joys, and frustrations day-in and day-out. A good sense of humor is helpful and a great deal of patience is a must. But, above all else, in those practices in which doctor and spouse work effectively together, practice systems are clearly defined as are employee responsibilities and duties.

Clearly defining the role of the dental spouse is one of the most critical elements to building a positive and effective team environment. Dental teams must clearly understand who has the authority in the practice.

There are certain things that the staff will go to the spouse for and other things they will go to the doctor for, but both doctor and spouse need to be singing from the same page. They can’t go to one person and get one answer and go to the other and get another answer. Moreover, doctor and spouse can never argue about protocol or policy in front of the team. If the two don’t agree, those differences need to be ironed out away from the staff.

If staff perceive that the spouse and not the dentist is the final authority, it creates confusion among the team, particularly if it is clear the doctor and the spouse are not in agreement on practice policies and procedures.  Bottom-line: There can only be one person who runs the office.

Separate home and office. Understandably, it can be difficult to leave work at work. The key is to draw the line on practice talk. Perhaps you agree that you will talk about work on the ride home, but once you walk in the house office talk stays out. In addition, if there is an issue that needs to be resolved. It should be handled before you leave the office for the day. Establish regular administrative meeting times to address practice issues away from the family and the practice. This is for strategizing, just like management would meet with the president of the company. It shouldn’t be over dinner at the kitchen table.

Avoid the temptation to bring work home. While it is common to bring business issues home, dental spouses also can mistakenly bring personal issues into the practice creating distractions for the entire team.

For those of you just coming into a practice, watch and learn first. Make the effort to understand why the practice follows certain procedures. We’ve seen spouses come into a practice pledging to “clean things up” yet they understand very little about the business. We’ve encountered spouses who didn’t comprehend why the doctor couldn’t just cut staff salaries. We’ve seen others who insisted that staff shop for the “right price” for dental supplies in an effort to skim pennies –literally – off supply costs without ever considering how much staff time that exercise would cost. And we’ve seen spouses complain to staff routinely about how much things were costing the practice as if it were their fault.

Use financial information wisely. Spouses that come into the practice to manage finances should be trained and clearly understand what is considered a healthy overhead. Financial information should never be used as a weapon against the staff.

Next week, barely surviving or truly thriving in the family business.

Interested in speaking to Sally about your practice concerns? Email her at sallymck@mckenziemgmt.com.

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

Forward this article to a friend.

In 30 days, you could be depositing more money. What are you waiting for?


Nancy Caudill
Senior Consultant
Printer Friendly Version

Is My Attitude Towards Dental Insurance Effecting My Practice?

Dr. Allen Franco – Case Study #521

Dr. Franco contacted McKenzie Management with a frequently asked question…”Since I am not as busy as I would like to be right now, should I sign up to be a ‘participating provider’ for a particular plan?” The answer depends on the current state of the practice and the local economy as well as the future vision of the practice.  Dr. Franco had a hygienist 3 days a week and his practice had been operating 3 years.  They were averaging 8 to 12 new patients a month, did not accept assignment of benefits nor did they participate with any PPO’s.  His fees were also higher than many of the dentists in his area.

Dr. Franco purchased his practice from a retiring dentist who also did not accept insurance assignment.  The purchase was made during the economic incline and everyone was happy, including dental consumers.  Dr. Franco followed in the footsteps of his predecessor, as he was also not interested in getting involved with the time-consuming paperwork that is required when working with insurance processing and follow-up.  He also wanted to avoid his patients making treatment decisions based on “What will my insurance pay?”

The business decision he made three years ago regarding how he would manage his practice, coupled with a decline in the nation’s economy affected the practice dramatically over the past six months.

Production and collections dropped 25% over the past six months. New patients dropped from 20 a month to an average of 7 a month.  Gross wages for his team increased to over 33% of his net collections per month instead of 26% last year. Hygiene demand per week dropped due to patients leaving the practice to go to an office that “accepts” their insurance plan.

What are his options?
Dr. Franco could continue not to participate with any plans and start accepting the assignment of benefits for all insurance companies that will reimburse the practice.  This would allow the patient to invest less money of their own at the time of service and only contribute the estimated portion for their treatment.

Reduce the practice fees for his restorative and prosthetic procedures.  These are the areas that he feels may be higher than many of his colleagues in the area.

Participate with PPO plans that are given to employees of the largest employers in his area.  Should he elect to take this step, he hopes that having his name on the “lists” will bring in more new patients.  Also, by participating, more of his current patients will stay with him instead of seeking another local dentist that will accept their plan.

What does he need to know if he elects to participate?
Because the allowable fees will be lower than his office fees, this means that in order to maintain his hourly production goals, he will need to either work faster, lower his overhead and/or adjust his goal.

It is very important to review the contract with the PPO plan to have a good understanding of what the plan considers to be “not covered” and “not allowed”, as well as other clauses, such as missing tooth and waiting periods.  Dr. Franco’s business team must be well-versed on the plans in order to be better prepared in communicating the approximate patient portion, even though the financial policy clearly indicates that the patient understands that they are responsible for any amount that the plan does not cover.  Bottom line – review the contract carefully and understand how it will effect the practice.

Dr. Franco should not expect that by signing the contract with a PPO, the floodgates would open with new patients.  His name must be added to the website and won’t show up in the printed list until it is published again….and there is still no guarantee of additional new patients.

Each patient that is a member of the plan and has currently been paying full fee for their services will now enjoy the lower fees and patient portion as well.  It is imperative to run a computer-generated report from his dental software to see how many patients he has in the practice that will be affected by this change.  A mathematical estimation can be made based on an average fee per patient to determine what the financial ramifications will be.

Conclusions
Many practices are very successful while working with PPO plans every day.  The key is maintaining the daily goals for the dentist and the hygienists by effective scheduling and efficient utilization of team members.

Dr. Franco must make strategic changes in his current office policies regarding dental insurance.  It is imperative that his practice be as profitable as possible, making it necessary to alter his personal feelings about dental insurance and “play the game”.  However, before taking this step, it was recommended that all his current business systems be evaluated to be certain that they are efficient and the team is trained in excellent customer service and developing a plan to lower expenses under the existing circumstances before taking this major step.

If you would like more information on how McKenzie's Practice Enrichment Programs can help you IMPLEMENT proven strategies, email info@mckenziemgmt.com.

Forward this article to a friend.



Belle DuCharme CDPMA
Instructor/Consultant
Printer Friendly Version

Front Office Finesse For Troubled Times

With the rolling recession and layoffs affecting many people, now is the time to rethink the ways that “we have always done it” and look internally for ways to improve our practices to weather the storm.  Many businesses have eliminated positions and eliminated the need for the position by becoming more streamlined and requiring remaining staff to learn new skills.  It is vitally important that you seek to improve existing skills, not only in technology, but most importantly patient communication. To become “indispensable” to the team, step out of the comfort zone and become an exceptional front office employee.  Enrollment is up at many colleges and schools with people who have been laid off and want to change or enhance their careers and those that are taking this opportunity to get a “leg-up” to prevent a layoff. 

Recently, I had the pleasure of meeting with a group of long-term dedicated front office ladies from an assortment of different practices, both general and specialist, who expressed frustration with the economy and with trying to help patients get financing.  If patients did not have good credit for outside funding, what could they do to creatively find ways to finance these patients without taking risks?  The conversation started with emotional recounts and ended with empowerment.  Finding new ideas, new tools and support for the work that you do builds confidence and job skills. 

Our meeting revealed that there were many systems in their individual practices that were affecting patient acceptance of treatment and contributing to higher than normal accounts receivables.  During the meeting, we decided to make a list of the most critical issues that were affecting the practices and then make a determined effort to solve these problems during training.  The following represents a list of what the group felt was the most pressing issues from their practices.

  • Patients not qualifying for financing but were long-term patients with past history of compliance.  Can we finance these patients and how?
  • Patients that have been in the practice a number of years but now are not paying their statements in a timely manner.  How do we speak to them without offending?
  • No definitive financial policy is in place.  So how do we enforce collection?
  • Untrained staff members who say “we will bill you” and let the patient leave.  These are senior staff members with positions of authority in the practice and this is what they have always done.
  • A pile of unresolved insurance claims with missing documentation that is holding up payment.  Business staff don’t want to interrupt clinical staff to get information.
  • Higher than normal accounts receivables and no time to make calls or no desire to call people during this recession.  Are there right and wrong ways of speaking to patients during a recession?
  • It feels like the practice is getting smaller because of the holes in the schedule.  How do we know if the practice is shrinking and what do we do to stop the decline?

As you can see, there are a lot of issues to analyze and work through and that is why practice specific training is so valuable.  To address the concern of patients not qualifying for outside funding, it is important to remember that if a patient finance company does not find the patient credit worthy, the practice, being a small business, can not make unqualified loans and accept the risk of non payment either.  Ask if the patient finance company would consider the loan if a co-signer was included or if they will approve a smaller amount.

 If the patient is known to you and has shown compliance with appointments, followed recommended treatment and has paid in the past, you could offer one of the following:

  1. Phase the treatment into appointments and then divide the total of that phase by the number of appointments and have the patient pay at each appointment.
  2. Have the patient pay 1/3, 1/3 and 1/3.  At the time treatment is presented, ask for a third of the total.  Get the next third at the appointment for impressions or prep and the last third at delivery, post op or bite check, etc.  Tell the patient that the 1/3 is due before seating so that they will be prepared to pay.
  3. Offer to accept payments and hold in escrow prior to treatment so that treatment is paid prior to performance of service.  This would work when there will be placement of an implant that requires a healing period prior to final restoration.
  4. Give the patient a return offer at the end of the treatment for $50.00 off any service in the future.

The current economic situation is having an effect on many practices. Some of your systems are not working like they used to.  Without professional training or help, it can render a practice “helpless” and vulnerable to these outside effects.

If you would like to learn more about McKenzie Management’s 2-day Front Office Training Program, email:  training@mckenziemgmt.com.

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

Forward this article to a friend.

McKenzie Newsletter Information:
To unsubscribe:
To discontinue receiving the Sally McKenzie management newsletter,
click on the link at the very bottom of this page for instant removal,
To report technical problems with this newsletter or to request technical help,
please send a descriptive email to: webmaster@mckenziemgmt.com
To request services, products or general inquires about The McKenzie Company activities
please send a descriptive email to: info@mckenziemgmt.com
If you would like to have any of your dental practice concerns answered personally by Sally McKenzie,
please send a descriptive email to her at: sallymck@mckenziemgmt.com
Copyrights 1980-Present The McKenzie Company - All Rights Reserved.