6.4.10 Issue #430 Forward This Newsletter To A Colleague

Insurance Plans Putting You on the Defensive?
by Sally McKenzie CEO
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I recently had a conversation with a dental office business employee who told me she feels like she's spending a lot of time being defensive and having to justify the doctor's services. The practice recommends what the patient needs, not just what the patient's dental insurance plan covers. And this employee, who is relatively new to the practice, is struggling when patients question the necessity of treatment not paid for by insurance. The employee is frustrated because she can't understand how a patient could have insurance and not know what it covers. Welcome to the world of dental insurance!

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Circumstances such as this can put employees in an uncomfortable position. And, not surprisingly, many dental teams believe that it is the patient's responsibility to understand their dental insurance plans. The problem with this philosophy is that it creates too many situations like the one above where the staff and even the doctor have to defend or justify treatment recommendations. Although patient expectations and demands for dental services have increased, dental services covered by insurance plans are significantly limited. Understandably, the lack of coverage is very frustrating for both patients and practices. And with the recent economic struggles, more and more patients that didn't give much thought in the past to what their insurance did or did not cover are questioning the need for certain procedures or delaying treatment.

What's more, many patients can't understand how it is that medical insurance pays out large sums of money over extended periods of time to cover treatments for illness, but dental insurance typically provides a mere $1,000 to help offset the cost of basic services. And that amount has not changed in decades, which further fuels the misperception that dental care can be delayed or even ignored. Worse yet, some patients look to the insurance company as the "dental expert." If the insurance only covers two cleanings a year, that must be all that they would need. If the insurance plan will cover fillings but crowns are the best treatment plan for the patient, many opt for the insurance company's "recommendations" rather than the doctor's.

Frustrating as it is, the sooner practices take on the responsibility of educating their patients about the limitations of dental insurance, just as they educate them about proper oral health care, the stronger the practice/patient relationship will be. Moreover, this is the perfect opportunity for the practice to reclaim its role as the dental care experts.

Your financial coordinator should sit down with the patient and review what's covered in their dental plan according to a prepared script in which the situation and options are clearly articulated and the coordinator is ready with the answers to those frequently asked patient questions and concerns. Discuss the calendar year cap, deductibles, co-pays, coverage for preventive care, etc. The greatest benefit of a script is that you know precisely how to respond and you are well prepared. Doctor and team can better manage the messages to ensure they are clear and professional.

Additionally, it's important to consider not only "what" you say but also when you say it. Patients need to understand that they have a limited dental benefit a specific amount of money that they can put toward their dental care each year. It is nothing like medical insurance; however, that doesn't mean that you, the dentist, can ignore gum disease or other infections of the mouth. After all, if a patient had an infection or disease in their heart or lungs or any other part of their body, they would not expect their physician to ignore it because insurance wasn't expected to cover the treatment.

As a health professional you have an obligation to diagnose and prescribe necessary and desired care for your patients, regardless of what the insurance company says it will cover.

Next week, turn the insurance barrier into a building block.


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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Dr. Nancy Haller
Dentist Coach
McKenzie Management
coach@ mckenziemgmt.com
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Be An Undercover Boss Without Going Undercover
By Nancy Haller, Ph.D., Leadership Coach McKenzie Management

Did you happen to watch this past season's new reality series Undercover Boss? I only saw the last episode (and now a few re-runs) but it's one of the most intriguing shows for leadership lessons. Each week the CEO of a company goes undercover for a few days in his own organization and works a variety of jobs to observe and gather feedback. While incognito, shoulder-to-shoulder with employees, they discover real problems and real star performers.

It would be impossible for you to go undercover in your practice. But think about what you might see if you could get a sneak peak at what employees really do when you're not looking. How do they interact with patients? Are they living up to your standards and the responsibilities they agreed to when hired?

Unless you resort to bugging devices or secret video, you'll have a hard time being the unobtrusive fly-on-the-wall. How then do you find out about the good and the bad in your office? Based on a lot of conversations with dental leaders, one common way is to check everything they do. But this proverbial micromanaging strategy will drive employees away while driving you crazy.

Fortunately there are ways to obtain honest, nothing-held-back input from those you trust with your business. And it doesn't have to include unethical taping or disguises (although mystery patient calling services are invaluable). The way to learn about what your staff are thinking is simple ask them.

In 1982 Tom Peters, co-author of the acclaimed book In Search of Excellence, coined the phrase: "managing by wandering around." He saw MBWA as the basis of leadership. One of the best known and highest paid management gurus, Peters believes that the "technology of obvious" still works today, nearly 30 years later. In MBWA practice, managers spend a significant amount of their time making informal visits to work areas and listening to employees. The purpose is to hear suggestions and complaints, collect qualitative information, and "keep a finger on the pulse of the organization."

It's essential for you to know what's happening in all areas of your practice. Therefore the goal is to create an environment where employees will answer your questions honestly. Tell me what I really need to know What's standing in the way of us providing exceptional dental care? What do you need to do your best work possible? Leadership is a relationship, a partnership, and your business is a people business. It evolves with trust and credibility. Be consistent in showing desire for their input and acknowledging the feedback. Follow-up consistently because building trust is not a one-time event. It needs to be maintained and nurtured.

Take a genuine interest in employees and in their work. Find out about their hopes and dreams, because those are the very factors that affect their motivation and their ability to get their work done.

Strive to have them see you as a person who listens. Demonstrate the image of a coach, not an interrogator. Be open and responsive to questions and concerns. Ask for suggestions to improve operations, service, referrals, etc. Thank them for their input. As already stated, follow-up is crucial. Act on what you learn or let employees know why not. The last thing you want is for people to think "I made the suggestion but nothing ever happened." That can cause a decrease in morale and sabotage your real intent in MBWA.

Appreciate the efforts that your employees make. Catch them doing things right and recognize them publicly. Be sure they know how much you value them and the positive actions they make on your behalf.

Great leadership and management is about getting out there and talking with the people who make your practice and using their feedback and insight to make your office run more effectively. Being an "undercover boss" is nothing more than helping your employees to see you as someone they can trust, someone they can share their honest thoughts and opinions about their position and the organization without fear.

Trust is the foundation for practice success. It is built and maintained by many small actions over time. As the dental leader, what you do is the cornerstone of that foundation. Lay the groundwork carefully for what you want your practice to be, now and in the future. Give your practice a dose of "undercover boss" treatment.

If you want to strengthen leadership and teamwork in your office, contact Dr. Haller at coach@mckenziemgmt.com

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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David Clow
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Self-Help Healthcare
By David Clow

The national debate over changes in healthcare policy involved a number of different delivery models, provider points of view and government roles - but two of the principal voices that need to be heard were largely missing.

Dentists seemed not to have been taken appropriately into account. With billions of dollars at stake and millions of new patients receiving assurance of improved coverage, the value of dentistry as a preventive measure would seem to be of greater importance than ever, and certainly a worthwhile topic for media coverage. The links between quality oral health and overall systemic wellness are well-documented already; doubtless, new connections will be discovered that make them even clearer. Dentistry merits a place at the table when we're preparing to spend fortunes remediating illnesses that need not happen in the first place.

The Patient Protection and Affordable Care Act includes extensive mention of dentistry, mostly in the context of training, service provision funding, etc. The ADA, almost a year before the Act was passed, explained to the president that "Oral health is not elective; it is an integral component of overall health and well being," and further, said that "for too long we have ignored the dire unmet oral health needs of a growing number of Americans unable to access dental care due to economic status, geographic location or a myriad of other barriers." Their recommendations including "adequately funding community-based prevention measures, such as water fluoridation, school-based sealant programs, and oral health promotion and education programs," were adopted into the bill, but coverage of them in the media was hardly visible at all. People still don't understand as they ought to that dentistry equals proven preventive care.

The other voice that was missing was that of the dental patients. Plenty of people delivered their opinions as taxpayers and as voters, some quite loudly. But anyone from either side of the political debate over public healthcare spending could have raised the quality of discussion by emphasizing the patient's role in the whole healthcare question. A nation consumed by rising healthcare costs cannot long avoid the issue of a patient's own responsibility in the issue. We cannot reconcile rising national investment with declining personal discipline; we cannot excuse ourselves from common sense and rely on the safety net to catch us. All the education programs in the world won't matter if patients remain indifferent or uninformed. Someone standing up at an impassioned town hall meeting asking about dentistry might have been laughed out of the room for saying it, but there would have been no greater common-sense suggestion for the national health picture than one reminding people to floss their teeth; if only we could calculate the cost of fixing damage that could be prevented with a daily one-cent investment in clean gums.

Jump into the Discussion
You might not talk politics with your patients, but you can make this connection to your mutual benefit. Many of us feel a little helpless as we confront the national-level questions about policies and programs, and while there's no shortage of opinions about it, there's far too little actionable intelligence that serves us in our day-to-day decisions about taking care of ourselves. We don't need more Op-Ed commentaries, lobbyists, experts debating or conflicting arguments about whether the Founding Fathers would reimburse for a CAT-scan. We do need some calm face-to-face counsel about our own roles in our own health.

Dental health is the tip of an iceberg. Under the surface of a neglected mouth and inflamed gums lie a frightening range of problems that only get worse with time. Information alone isn't the solution; often the more information we get, the more worry we feel, and the more denial we live with. What we need most is trust. There's the increasing prospect for many patients that we'll never have a close personal relationship with our physicians. It's very realistic that our dentist might be our first and best resource for practical healthcare advice, encouragement and a push in the right direction. It's a role you can play with authority and conviction, given your willingness to do two things:

  1. Take the time. Make sure that your average appointment incorporates just a few minutes for you to look, talk, and share your observations and suggestions with your patient. Clarity from you makes it easier for them to sleep at night.
  2. Step out of your "dentist" box. I'm your patient, and your advice can have a great effect on me. Don't limit yourself to being concerned only with my teeth.

The dentist who provides this level of personal care can be a true healer, and have enough loyal patients to run a very successful practice.

On behalf of McKenzie Management, David Clow consults with dental professionals on practice culture, case acceptance, and patient expectations.

David Clow is a writer/consultant for Fortune 100 companies. His book, A Few Words from the Chair, is the first book written by a patient for dental professionals and students and is available here.

Listen to David’s FREE podcast. Click Here

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