McKenzie Newsletter 419

Don't Increase Staff Until You Do This
by Sally McKenzie CEO
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The schedule is fuller than it’s been in months. The phone is ringing. The staff doesn’t have time to stand around and place bets on how many patients will no-show today. And you, doctor, are ready to leap for joy as yours is among the many practices that are starting to see the economic clouds of the last several months show signs of parting. The irony of it all, as the cliché goes, is that you could cut the tension with a knife. The team is feeling the stress of increased busyness. Consequently, instruments are piling up. Appointment confirmations are falling by the wayside. And you are starting to hear those familiar rumblings, “Doctor, we simply cannot get everything done without more help.” It would be music to your ears if it wasn’t a potential major blow to your wallet.

As the economy slowly improves, the last thing you want to do is create greater overhead pressure on your practice. It’s likely that over the last few months you’ve trimmed staff or staff hours. Before you rush to line your employment rolls again, take a close look at the effectiveness of your systems. This is the ideal time to consider streamlining duties and evaluating the time spent on tasks, as well as examining the mechanics and/or the materials involved in performing tasks.

For example, how much time is spent with patients at the front desk? Check-in and check-out takes approximately 10 minutes per patient. There are 480 minutes in an eight-hour workday. If your practice is seeing 15-22 patients per day, which would total 150-220 minutes of patient contact, one person should be able to handle front desk duties. If the doctor has 14 or more scheduled patients a day, not including hygiene exams, he/she needs a second assistant. However, if the procedures are streamlined, one assistant can efficiently maintain two treatment rooms for a general dentist using two operatories and seeing 13 or fewer patients a day. Moreover, if your state allows for expanded functions for assistants, start maximizing those resources. Patient dismissal should take two minutes, while disinfection of treatment rooms and cleaning/sterilization of instruments should take less than five minutes.

Now, you may evaluate your systems and still feel that it’s time for more help. If so, make sure you understand the impact on your bottom line. Look at wages paid in your practice including the hygienist’s but excluding the doctor’s. They should be no more than 19% to 22% of gross income, not including payroll taxes and benefits. If the current gross salary expense is around 22%, adding another person may increase gross wages to 27%; this would put your practice well over the industry standard for payroll.

If you still feel that you absolutely must increase staff, take steps to ensure that your investment pays for him/herself. Your team may be clamoring for a “helper,” but what you want is a “producer.” For example, if the new hire is a patient coordinator who will increase practice revenues by making sure appointments are kept, that shiny new face in the office can enhance practice production – a definite plus. Or if the individual is a hygienist who will enable the practice to meet the demands of a growing hygiene schedule – provided it’s not riddled with no-shows and cancellations, the investment is a wise one and the negative financial impact should only last for about 60 days. Beyond that, production should increase, and the wage percentage of gross income should return to the normal range of 19%-22%.

Additionally, there is no better time than now to cultivate a “producer mentality” among the team. For example, if the doctor is away at continuing education, the assistant may have time to pick up the phone, follow the appropriate treatment presentation script and book unscheduled treatment – helping the practice meet monthly production goals. To reinforce the “producer mentality” encourage employees to develop producer-focused job descriptions, incorporating into the description exactly how the role fits into or contributes to the success of the entire practice. And ensure that before you rush to hire another person, you’ve fully maximized both your practice systems and your team.

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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Frustrated with HIRING the WRONG people? Remove the guesswork. Employee Testing On-Line

Belle DuCharme CDPMA
Instructor/Consultant
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Front Office Communication - Conversational Predicaments

Maintaining a professional demeanor and building rapport can teeter on a delicate balance when speaking to patients on the phone or face to face at the desk. In conversations with front office staff it has been revealed to me what a challenge it is to retain control in a conversation. One seasoned business manager, Carol, was perplexed over what she could have said differently in a conversation with a patient over an unpaid bill. The patient called the dentist at home and complained that she had been treated “rudely” by Carol. Carol admitted that she lost her patience after a long day and was simply trying to do her job by collecting overdue revenue. “Frankly, I don’t remember exactly what I said but if it hurt her feelings then I am sorry for that,” explained Carol. The damage was already done and now Carol felt uneasy when having to make collection calls.

Scripting and practicing what you are going to say is a smart way to approach office communications. If Carol had followed a script for collection procedures she most likely would have stayed on track and not insulted Mrs. Brown. Before making outbound calls, make sure you have researched the account and know the following:

Who is the responsible party on the account?
Was there insurance involved in the payment?
Was there a payment plan or other financial notes in the chart?
Were statements received and was there a due date on the statement?
What payment options and timelines are you willing to offer the responsible party?
What is your mental state? Are you ill or tired? Calling tomorrow and achieving results is better than calling now and making two people uncomfortable.

Other conversational slip-ups common to the dental office are:
Forgetting The Patient’s Name
Routinely take pictures and place in the patient page in the computer or devise a plan to associate the name and face – “David looks a lot like David Letterman” - or put notes about the patient’s interests, hobbies or family to help jar your memory. Say the patient’s name back to them when you speak and engage listening skills to hear it the first time.

Using Dental Jargon And “Talking Down” To The Patient
The patient must understand dental benefits at their level of understanding before agreeing to have the services performed. Trying to sway the patient with your knowledge and using technical language may look impressive, but it can leave the patient confused and insulted.

Telling Tasteless Jokes
Often the teller thinks they are entertaining but more often than not, they are out of line. Do not tell any jokes because by nature they are meant to poke fun of someone or some group.

Being Trapped By “Motor Mouth the Tireless Talker”
You don’t want to offend this person because they are clueless of their affect on others. Devise a rescue plan with the other team members. On signal, have a team member call you on the phone or come up to the desk and say you are needed in the back office. Or, say to the patient, “I’ve taken far too much of your time and I have to call some patients. Perhaps we can talk at your next visit.”

Communication systems for patients and staff are customized to the practice during the Advanced Front Office Training and Office Manager Training at McKenzie Management. There are no two offices that are alike and yet all offices must have clearly defined office communications to achieve positive results and limit those awkward “oops” moments.

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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Nancy Caudill
Senior Consultant
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Is Your Practice Infected?

Dr. Jeramy Close – Case Study #211

Do you find yourself looking at your business bank balance and wondering where all the money is? You are busy, the business team is on their toes and you have the best clinical team in town. What is the problem? You have no idea where to even start to perform your due diligence. Dr. Close called us with this very concern. On the surface, his practice appeared to be healthy and successful. However, his financial statement was not reflecting the same health. How could he learn what disease the practice was suffering from and what was the cure?

Where To Start?
It is impossible for a dentist to know the answer to this. If he/she did, there would be no practice management firms successfully resuscitating ailing practices from an early demise. The first step in healing a suffering practice is to contact a professional practice “detective.” This is exactly what Dr. Close did – smart man!

I arrived at Dr. Close’s beautifully landscaped office first thing Monday morning. I was armed with my magnifying glass, my calculator and 30 years of experience in detecting the source of a practice’s financial disease. His business team was more than helpful in escorting me to a quiet area equipped with a computer holding the practice software and a ream of paper. I began my search.

Where Is The Disease Contracted?
In most cases, members of the business team were taught by the employees whom they replaced. Those previous employees were taught by those before them, and so on. In the “old days” there were no computers, making it impossible to maintain statistical data on the health of the practice, including outstanding insurance claims, aging reports, past due recall and production-relevant reports. Insurance claims were tracked manually by keeping a copy of the claim in a file until the check was received and the EOB (explanation of benefits) was attached to the claim and marked as “paid.”

Patient ledgers were maintained by the use of a “3-way” posting system, using a day-sheet, carbon paper, a ledger and a receipt. Statements were generated by making copies of the ledgers in the copy machine and mailed in window envelopes. It was extremely time consuming to determine the total Accounts Receivables, let alone the ratio of the A/R compared to the net production. Unfortunately for many team members, many of these protocols are still in place, in spite of the fact that the results can easily be obtained utilizing the software. As a result, there are many system failures that go undetected.

In Dr. Close’s case, he had no idea what his Accounts Receivables were, whether or not the insurance claims were being paid or if statements were being generated and how. As far as he knew, post cards were being sent to his recall patients but he hasn’t seen any of them since he stopped selecting them himself 15 years ago.

What to Look for:
The health of a practice is not difficult to determine when one knows what to look for, as well as what is the “standard in the industry” for a financially success practice. Here is a list of what I found in assessing Dr. Close’s practice statistics, based on the information retrieved from his practice software.

Aging Report – revealed that the total A/R, NOT including credit balances, was 1.6x the net production of the practice. The goal should be 1x or less. This was an excess of $68,000 that was unpaid to the practice.
In addition, there was 20% that was over 90 days, instead of a healthier amount of 12% or less. Here was $34,000 not working for the practice.
As part of the Accounts Receivables, there was $9,500 in outstanding insurance claims over 60 days uncollected.
The largest loss to the practice was unscheduled treatment. After generating a 56-page report just for the past 12 months, over $760,000 worth of treatment was diagnosed and presented to his patients but never “sold” and completed! He had always “felt” like he was effective in his treatment presentations because the patients were always nodding their heads when he told them what he found.
The second largest loss was in the area of past due recall patients. Dr. Close’s practice was over 15 years old but he still employed only 1 hygienist working 4 days a week. The past due recall report revealed 421 past due patients, just in the past 12 months. He wondered why he was storing so many patient records in his garage attic at home!

At an average of $123 per hygiene appointment and not including the exams, this is a loss of $51,783. There is a good chance that this bleeding has been occurring over the past several years as the practice aged.

How to Establish a Cure?
Now that the diagnosis has been made, business systems must be put into place to begin the healing process. Monthly statistics must be monitored to determine the degree of healing that is taking place month after month. Training is necessary for the business team to manage the systems. Daily and monthly team meetings are imperative to protect the practice from new “diseases” by engaging everyone in the well-being of their practice. Call us today to invite one of our consultants to take your practice’s temperature and confirm that you are disease-free or infected. Don’t wait – if you are infected, it only gets worse!

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

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