McKenzie Newsletter 409


	Perfect 10 in 2010 Referring to a Specialist Help Them Say Yes

Top Five to Make a Perfect 10 in 2010
by Sally McKenzie CEO
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2010 is here and most dentists are more than ready to embrace the promise that a new year has to offer. Last week we covered five of the top 10 steps you can take to ensure that 2010 is a perfect 10. This week, we’re looking at the numbers, starting with establishing a realistic financial goal for your practice.

Let’s say you want to achieve $700,000 in clinical production. This calculates to $14,583 per week (taking four weeks out for vacation). Working forty hours per week means you’ll need to produce about $364 per hour. If you want to work fewer hours, obviously per hour production will need to be higher. Follow these steps to get there.

#5 - Create A Clear Plan Of Action For Production

Establish daily production goals and schedule to meet those goals.
Make certain that your scheduling coordinator fully understands exactly how much time is needed for each procedure. You’d be stunned how many business employees simply have to guess the number of units that should be allocated for procedures.
Prescribe a treatment plan for patients that includes everything that needs to be done - appointments necessary, the cost of treatment, an estimated length of treatment time, and any treatment options.
Designate a treatment coordinator who is responsible for presenting treatment plans to patients and is expected to secure at least 85% case acceptance.
Implement an interceptive periodontal therapy program.
Provide superior customer service that will encourage patients to refer friends and family.
Each month run the year-to-date Practice Analysis Report and compare it to the same period last year.

Now consider what needs to happen in the treatment room, which brings me to #4.

#4 - The Patient Needs What The Patient Needs
Continue to diagnose patient needs and wants according to your practice philosophy, not on what you perceive they can afford. Present treatment plans that convey to patients that you are presenting options to address immediate needs, long-term needs, as well as patient desires. In addition to recommending treatment according to both patient needs and wants, continue to educate patients. Emphasizing the importance of oral health and its impact on overall health has never been more important.

#3 - Monitor And Measure As A Team And Study Practice Reports
Regularly review key reports including the Accounts Receivables and Outstanding Insurance Claims reports to monitor exactly how much money is owed your practice. In addition, watch the details of your production, new patient flow, and patient retention using the production report. Depending on your software system this report may be called Production by Provider, Practice Analysis, or Production by ADA Code. It is very useful for tracking new patient comprehensive exams.

The Production by Provider report also should enable you to monitor individual provider production for each dentist and hygienist. It is important to track individual production numbers to determine productivity. Some systems will allow you to run a Production Forecast Report that can be an excellent tool in determining slow periods, so that you can develop a plan of action to address the potential production shortfalls. In monitoring each area and discussing the results, staff better comprehend the impact of one system or another on the success of the practice as a whole. They are then far less likely to sit back and watch problems continue, further strengthening the culture of accountability and minimizing the “it’s not my job” mentality.

#2 - Watch Overhead Carefully
The industry standard for overhead is 55% of collections. If you are currently at 60-65%, you are comfortably within reach. If yours is higher, take action. Some practices report their overhead as high as 85%. They are making a mere 15 cents on the dollar! The first step in controlling overhead is to establish the following budget targets:

Dental supplies - 5%
Office supplies - 2%
Rent - 5%
Laboratory - 10%
Payroll - 20%
Payroll taxes and benefits - 3%
Miscellaneous - 10%

#1 - Make This Your Best Year Yet
Ensure that you and your team are achieving peak performance. Schedule a McKenzie Management consultant in your practice this year and watch collections increase substantially. Enjoy case acceptance as high as 85%. Consistently realize your daily production goals. Retain 95% of your patients. Achieve 33% perio production and boost overall practice production by as much as $160,000 a year. Give me a call and we’ll make sure that 2010 ranks a perfect 10 for you and your practice.

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.

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Belle DuCharme CDPMA
Instructor/Consultant
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Protocol for Referring Patients to a Specialist

“I actually stopped referring to my local periodontist because they told my patients that they could do a better cleaning in their office and we would not be able to provide the same service! Ironically, all of my hygienists had more years experience than those in the perio office.” (California dentist)

Because the basic referral process often requires additional appointments, additional diagnostic procedures and administrative tasks for financial arrangements and insurance processing, it is not uncommon for communication to breakdown along the way. For instance, if your patient has unresolved periodontal disease and has not shown significant improvement with scaling and root planing, the use of anti-microbials, and is compliant (or non-compliant) to periodontal maintenance, it is time to consider referring the patient to a periodontist. But before sending the patient to this specialist, it is important that standards of patient care between the general practice and specialist be clearly drawn to prevent the patient from being in the crossfire of miscommunication.

Referring the patient out of the office for care should be treated with sensitivity and should be monitored by your Treatment Coordinator. Tracking patient retention in practices has shown a number of patients do not return to the general practice after being referred to a specialist for a specific condition. Fear of the unknown or misconceptions about the treatment and the costs often cause patients to postpone going to the periodontist. Some patients go to the consultation appointment but are not sure of what to do, therefore remain in limbo, not seeing the specialist or the general dentist.

It is common for the general practice to assume that the patient is going to go to the specialist and that a report and or a phone call will follow after the treatment. Follow-up as to whether the appointment was kept with the specialist is crucial. When that patient shows up later in recall and questions arise as to the status of treatment, it is difficult at that time to make a positive impression of caring to that patient.

Before referring patients from the general practice to a specialist practice, it is important that the two dentists know each other and have shared philosophies regarding patient care and expected outcome of procedures and prognosis for long-term success. A discussion as to how the recall appointments are to work between the two practices and agreement as to what dialogue will be used by the team to communicate to the patient is vital to patient acceptance and trust. If unity is missing between the two practices, the patient feels pressed to choose where they are most comfortable receiving care.

For better communication between the general practice and the perio practice, it is suggested that the following information be communicated to the periodontal practice prior to the arrival of the patient.

Is the patient new to the practice or established? What recall interval has the patient been on in the past?
Has the patient been assessed by the hygienist or dentist for periodontal disease? What were the results?
Has the patient had scaling and root planing in the last two years? List the dates and quads involved.
Has the patient had any type of periodontal surgery in the past? List the dates and procedures.
Does the patient wear removable prosthetics?
Does the patient wear an occlusal guard?
Does the patient use an electric brush or water pik?
What (if any) anti-microbial has been administered to the patient? List type, sites and resolve.
Send a current periodontal charting via email, fax or mail.
Send radiographs taken and identify type and dates. Send via email or mail.
If there is any special information regarding the patient’s insurance or financial situation, have the practice call and speak to the Treatment Coordinator.

If a patient complains of mistreatment at the specialist office, do not discount their concerns or send them to another specialist without looking into the situation. Call the practice in question and report your concerns to the dentist. If it is in the patient’s best interest to see this specialist, it is worth a phone call to settle a miscommunication. If you are a specialist and you notice a sudden drop in referrals from a dentist who has sent you many patients in the past, it is time for a phone call or a lunch date to reestablish your relationship.

Remember that only 4 out of 100 people actually complain of poor customer service. They usually say nothing and leave you wondering what happened. To improve treatment acceptance and business protocols, sign up today for one of McKenzie Management’s Advanced Business Training courses and get a head start on a successful New Year.

If you would like more information on McKenzie Management’s Advanced Training Programs to improve the performance of your team, email training@mckenziemgmt.com

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Carol Tekavec
CDA RDH
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Help Your Patients Say Yes to Treatment

Now more than ever, dentists and staff are looking for ways to boost their office’s production numbers. Patients who were previously prepared to start or complete dental treatment may now be dragging their feet due to fears about the economy and perhaps losing a job. Patients who still have jobs and dental coverage may be less inclined to receive services not covered by their plans. What to do?

Be sure that everyone in the office is committed to helping patients receive the most complete information and education possible about the treatment the dentist is recommending. When patients really understand what is being recommended and why, they tend to accept it. Staff needs to take to heart that old adage: “Patients make paydays possible!” Every opportunity to explain treatment and sequences should be taken. This does not mean that the dentist and staff should “talk-down” to patients or constantly interrupt the general flow of conversation. It simply means that chances to boost a patient’s dental I.Q. should always be utilized and expanded.

For example: Molly comes in today for her cleaning and check-up. She tells Mindy, the hygienist, that she has heard about implants and that her mother is interested in getting implants to replace her missing teeth. Mindy is busy and running a little behind, but she knows that it is important to take the time to give Molly some information about implants. She begins by explaining a little bit about how implants work, talks about the dentist and her abilities along those lines, and finishes up by giving Molly a high-quality, “real answer” implant patient education brochure. While she is working on Molly, she continues to give pieces of information about implants, and by the end of the appointment, Molly has gotten quite an education. Now she can tell her mom what she knows, and perhaps a new patient, Molly’s mom, will soon be coming in to the office!

Help staff educate patients by practicing “what to say and how to say it.” For example: One of the most common patient misconceptions that dentists and staff have to battle is the idea that a prophylaxis, root planing, and periodontal maintenance are “the same thing - the dentist just charges more.” If your patients believe this, then you have problems. The obvious fact that the experience of a prophy, root planing, and/or periodontal maintenance should be very different goes without saying. But perhaps even more importantly, patients need to have complete information before embarking on root planing and subsequent periodontal maintenance so that there are no surprises.

All staff members should be able to explain that a prophy is for people who do not have any bone loss or infection around their teeth, a root planing is for a person who is suffering from periodontal disease due to bacteria and diseased deposits on the tooth roots, and periodontal maintenance is for persons who have received periodontal treatment and need to keep from having their health go downhill. Staff members need to be able to know what to say about these services when patients ask questions, and they need to know how to say it so that patients understand. One good way to get on the same page with staff explanations is to use verbiage found in educational brochures. Staff members can talk things over with the patient and the brochure can be used to reinforce staff explanations.

Don’t let any treatment fall through the cracks because a patient cancels or breaks an appointment today - patients who cancel or break appointments need to be followed so they are not forgotten. Whoever takes the cancellation or notes the broken appointment needs to either make an entry into the practice management software or into a “tickler” file. Most practice management software allows for listing patients who have cancelled or failed appointments. A subsequent report (daily, weekly, monthly) can be printed letting staff know who needs another appointment and why. Even practices that do not have computerized formats for this can easily follow up on cancelled or broken appointments. A simple recipe file box with 4 x 4 index cards can be used. The person’s name, phone number, and treatment needed (codes, fees, etc.) can be placed on the card and filed alphabetically. Each day, or as frequently as the office decides is appropriate, a person can be assigned to go through the cards and call anyone who has not rescheduled. This needs to go on until all patients either reschedule, or let staff know they do not intend to come back.

Be sure that all treatment is being charged, coded, and sent in to the patient’s benefit plans correctly. Don’t make mistakes here! Does your office have a current coding handbook? You need to have access to all current codes and as much information as you can get about how insurance carriers may be expected to pay toward these. Coding correctly also makes it less likely that a claim will be delayed or denied. Get it right the first time! A few simple steps can help your patients say “yes” to treatment. Don’t make the mistake of neglecting to use some of the most inexpensive, yet effective, ways of doing this - patient education, staff scripting, and following through with written information.

Carol Tekavec CDA RDH is the president of Stepping Stones to Success and is listed in Dentistry Today’s Top Clinicians in Continuing Education. She is a practicing dental hygienist, and has presented programs at all major U.S. dental meetings.

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