5.21.10 Issue #428 Forward This Newsletter To A Colleague

Too Much Work, Too Little Return
by Sally McKenzie CEO
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I’m sure you’ve seen the commercials for the in-home lap pools. The idea is that you either swim against a continuous current or are tethered to the wall. Regardless of the design, the idea is that you are swimming, swimming, swimming and getting nowhere. Yet you are expending an enormous amount of energy in your efforts. It reminds me a lot of the state of many dental practices these days. They are burning up a great deal of energy and getting virtually nowhere. They’ve been treading water for so long and just trying to stay afloat that they think this is the way it’s supposed to be.

I can assure you it’s not. And as we close in on the half-way point of the year,  there is no better time than now to cut the tether that has you and your team working, working, working and getting nowhere. Too many practice owners wait until the end of the year to take a close look at practice performance and systems. Only then does the picture become clear: they’ve been expending an enormous amount of energy on broken and outdated systems that have held them back the entire year… or longer.

Those that review their numbers every month can see the tide shifting and make adjustments. But if you don’t know what you are looking for, if you don’t understand what needs to be adjusted or how, you’ll keep swimming upstream, using time, money, and resources only to stay exactly where you don’t want to be. I recommend a different and much more rewarding course that will keep you not only swimming in the right direction but your head well above water as well.

The first step, consider the depth of your situation. When production, profits, and progress seem to have stopped or slowed, there are likely more than a few issues pulling you under, such as: 

  • Business staff turnover is common in the practice.
  • There are no established training protocols when business staff are hired.
  • Production goals, collections goals, and scheduling goals have not been established, or they are unclear at best.
  • The practice does not use system performance measurements or it measures some systems but not all.
  • The team does not know how to measure specific systems or how to evaluate success or failure of them.
  • Job descriptions, if they exist, are unclear. Multiple staff are “responsible” for multiple systems, so instead of accountability, there is finger pointing when things go wrong.
  • Holes in the schedule and no shows are common.
  • No one follows-up with patients who have unscheduled treatment.
  • Unscheduled treatment is not tracked.
  • The clinical team has never evaluated its clinical efficiency and does not know how to do so.
  • Fees are seldom reviewed or compared to similar practices in the area.
  • Services have not been expanded in some time.
  • The practice has no established vision or goals.
  • Practice profits are suffering and the doctor is stressed.

Each of the points above is interdependent on the next. For example, staff turnover may be a major problem because there are no clear job descriptions. Or the employee is trying desperately to figure things out as s/he goes along because there are no training protocols in place. Practice profits are suffering because there are no clear goals established for production, collections, or scheduling - merely vague directives from the doctor.

Specificity is essential to success in every dental practice. The old “everyone does everything” doesn’t work in today’s demanding workplace. Certainly, you need backup systems and protocols so that other staff can step in when necessary. But individual employees need to know what is expected of them individually.

If you do not have specific expectations of a particular system, you cannot communicate those expectations to your employees. It should come as no surprise, then, that the employee doesn’t quite know what to deliver. Once an employee has been given the necessary training and understands how the expectation for a particular system fits into the practice goals, and if they’ve been given the necessary training and tools, they can be expected to deliver accordingly on your expectations.

Next week, find out which key systems directly impact whether your practice will sink or swim this year. 

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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Jean Gallienne RDH BS
Hygiene Consultant
McKenzie Management
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Prophylaxis Based or Periodontal Therapy Based Practice?

Are you curious if your office is producing at industry standard when it comes to interceptive periodontal therapy treatment? If you did 10 periodontal maintenances and no root planing last month, this is good if you only saw a total of 30 patients for the month. However, if you are seeing more patients a month and that is all that the hygiene department produced when it comes to an interceptive periodontal therapy, then the numbers you should have are not there.

33% of total hygiene production should come from ancillary services, including interceptive periodontal therapy. Running a report from your computer to see exactly how many periodontal maintenances were done in your office last month will allow you to see where you stand.

You may find that your hygiene department is doing almost all prophylaxis coded 3-month recalls, even though many of the patients have a history of root planing. This is very common because previously, the periodontal maintenance code (4910) was not being paid by insurance companies, and as a result, many offices were overusing the prophylaxis code (1110). Now, some insurance companies will actually pay for four periodontal maintenances and only two prophylaxes a year. This depends on the insurance limitations and benefits the patient’s employers are willing to pay for. 

All of your existing patients should really be on a periodontal maintenance recall and need to be coded correctly. If you were to start changing the code on your existing patients, that have been through root planing in the past, to the periodontal maintenance code and charging more for their treatment, then you may have a lot of very upset patients. 

These are the patients that you need to really evaluate and possibly have them in for scaling and root planing. If they are healthy prophylaxis and 3-month recall is working for them, then keep them as a 3-month prophylaxis. If there is heavy bleeding during instrumentation or bleeding upon probing, then look at where you would want to do root planing and see if the pockets are there. Remember that 2 and 3 millimeter pockets are considered within normal limits. It is not just the pocket depth, but also the clinical attachment loss that may make the difference. So, not only should 6 probing pocket depths be recorded at every recall, but so should recession. Also, keep in mind that healthy gums don’t bleed.

Most insurance companies are going to want two quadrants of root planing before they will pay for the periodontal maintenance code, however there are some that do not require this. When it comes to insurance, there is no way we can know what the benefits and limitations are for the thousands of plans out there.

Those patients that receive only one quadrant of 1-3 teeth (4342) or one quadrant of 4 or more teeth (4341) are maintained based on what the individual patient needs when they return for their first recall appointment. You may want the first recall scheduled at a 3-month interval. You may find that when you chart the patient’s probings and recession, they are now actually a prophylaxis and not a periodontal maintenance patient. This is another time when the clinician needs to really evaluate the health of the patient, to determine what is the best recall and the correct code to be used based on the patient in their chair at the time. You may find that most patients that have 1-3 in only one quadrant will be a prophylaxis. If the patient does present the need for a periodontal maintenance appointment, make sure you inform them that it may only be covered at a lesser fee of a prophylaxis. If you go ahead and do it without letting the patient know that it may not be covered, you can end up with an upset patient on your hands!

You may also want to make sure that the patient is not only verbally aware of the difference between a prophylaxis, but also perceives what is done differently at a periodontal maintenance appointment compared to a prophylaxis. Keeping your patients informed of their benefits to the best of your knowledge will help to reduce loss of patients in the future. This does not mean that treatment is based on insurance limitations. This means that informing the patient as much as possible is a good practice.

As you start to evaluate your patients and their needs to help them improve their periodontal health, you may find that your production numbers go up, and more importantly you may see the gingival health of your patients improving.

Interested in knowing more about how to improve your hygiene department? Email hygiene@mckenziemgmt.com.

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Dr. Nancy Haller
Dentist Coach
McKenzie Management
coach@ mckenziemgmt.com
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How Much Resiliency Do You Have?

I had the good fortune of being invited to deliver a leadership program in France earlier this month. It had been 20 years since my last visit to Paris and I was very excited about the opportunity to attach some personal travel with the business aspects of the trip. Within a few days I had adjusted to the nine-hour time difference, resurrected some French language skills and learned the Metro system. Things were going smoothly…until departure time when I was caught in the Icelandic volcano fiasco. Cancelled flights. Delays after delays. There was nothing I could do except to say C’est la vie.

What’s the connection to dental leadership? Resiliency. You may not be dealing with disruptions in air travel, but when your chairside fails to show up at work it can feel just as maddening.

Succeeding in the competitive world of dentistry requires creativity, imagination and, most important, mental toughness. Resiliency - the ability to “bounce back” when circumstances are difficult - is the key factor to surviving in these enormously challenging times in which you live and work. Remember that you have no control over others, but you have full control over your behavior and your thinking. And by managing your thoughts and actions, you put yourself in a better position to succeed.

It’s easy to manage yourself when things are going well. But how do you handle the times when things are beyond your control? In the case of the missing chairside, your initial thoughts may be, “Oh (*expletive deleted*) this is going to be a miserable day!” Your mood follows suit. You feel defeated. This sets off a chain of events. You might brood or even snap at your front desk staff when she brings you the schedule. Your negative thinking leads to negative actions. It even leaks into your interactions with patients.    

If you expect to have a peak performing practice and team, you’ve got to put a “psychological tourniquet” on your thinking. Unexpected or unwanted events are part of life. And while you don’t have control over what happens to you, you do have control of how you respond to those events. Evaluate your situations objectively.Yes, it will be a challenging day but it’s not the end of the world.”

Your thoughts affect your emotions and your actions. It’s normal to be angry, disappointed, or anxious when a member of your dental team calls in sick, or worse, just doesn’t show up. But the starting point toward better leadership isn’t with your feelings. That’s because emotions are almost impossible to change directly. If you’ve ever tried to tell yourself not to feel something or to feel something different, you know what I mean.

Similarly, telling yourself the opposite of what you have been negatively saying to yourself rarely works. “Oh great, I don’t have a clinical assistant today. It’s going to be a terrific day” is just as inaccurate as “It’s going to be a miserable day.

Resiliency is about finding alternative ways of looking at adversities when they occur. Start by remembering other times when you were short-staffed and how understanding your patients were. Even if your dental experience in working alone is not particularly stellar, there must be moments in your past when you achieved something and did it well. Drawing from those basic and pure images – mental scenes when you accomplished a task better than you expected – enables you to shift your thoughts and to change your mood.

If you have been experiencing lowered productivity and/or a tendency to become overstressed with life’s inevitable downturns, evaluate your thoughts. Challenge automatic beliefs. Start thinking like a winner and find the silver lining in every cloud.

If you want to break out of negative thinking and build resiliency, contact Dr. Haller at coach@mckenziemgmt.com. She’ll help you to develop your leadership performance. 

Dr. Haller provides training for leadership effectiveness, interpersonal communication, conflict management, and team building. If you would like to learn more contact her at coach@mckenziemgmt.com

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

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