6.11.10 Issue #431 Forward This Newsletter To A Colleague

Use Insurance Plans As Your Building Block
by Sally McKenzie CEO
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On a daily basis, you and your staff must manage the realities of inadequate dental insurance coverage that most patients have. I recommend that you take the direct approach in tackling this challenge, starting with a conversation between your financial coordinator and the patient in which you look at the realities of the patient’s plan together, something along these lines:

mailto:info@mckenziemgmt.com

According to the insurance information you have provided, your employer has purchased a plan that offers the following benefits and coverage.” Discuss those with the patient, for example: “The plan that you have has a small per calendar year balance of $1,000. That amount will help you secure some of the care you need but it will not cover everything. Your plan requires a deductible and a co-payment of $____ on fillings and crowns. It also provides for two preventive cleanings each year to encourage you to secure preventive care.

It’s essential for patients to understand what the dental insurance provided by their employer or spouse’s employer covers, but even more importantly, they need to know that the insurance company will not dictate the level of care you offer patients.

Managing the patient’s expectations regarding their insurance is only the first step. The next is helping them bridge that gap between dental needs and desires and financial realities by providing financial options. The financial coordinator sits down with the patient and explains the various payment options. For example, “The total fee for your treatment, which includes (provide a complete list of treatment and care that will be provided to the patient during the course of the treatment plan) is $4,200. Your insurance will cover $800, which leaves a balance of $3,400.” From that point you can offer a variety of other options, including:

  • Treatment financing through CareCredit
  • Encouraging the patient to build a credit on their account in advance
  • Allowing the patient to pay for multiple appointment procedures in installments, paying an equal portion each time they come in for an appointment
  • Accepting all major credit cards

Scripts are ideal for addressing this type of situation and ensuring that the financial coordinator is not stammering and stuttering when dealing with the tricky topic of payment. They enable staff to clearly educate patients on treatment financing options that can bridge the financial divide. For example, your financial coordinator might follow a script such as this:

“Mrs. Smith, we offer three convenient payment options to help you secure the care you need. The first is a patient financing program offered through CareCredit. It allows qualifying patients to secure no-interest loans for up to 18 months. The second option would allow you to build a credit on your account and then begin treatment. And the third option would allow you to break your payments into equal installments. We also accept all major credit cards.”

Addressing the financial issue clearly and specifically will ensure there are no misunderstandings as well as plenty of options to put your patient at ease about the financial issue. This approach also allows you to avoid inadvertently insulting the patient by assuming that they cannot afford treatment, yet you recognize monetary realities. Most patients will appreciate and respect your candor.

Moreover, when the financial coordinator fully understands how patients can benefit from various financing options, they are well prepared to help the patient logically justify proceeding with treatment. A well-prepared treatment  or financial coordinator who can clearly articulate the various payment choices just may lend a powerful boost to your treatment acceptance numbers.

Finally, remember to regularly reiterate your commitment to offering the patient the best dental care available, regardless of insurance constraints. They will understand that you are fulfilling your obligation as a medical professional, and they will better understand what they cannot expect from their insurance provider.

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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Michael Moore, Esq.
Director McKenzie
HR Solutions
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Cliques And Queen Bees Equal Loss Of Sleep
And Profits - Part I

By Mike Moore

I’ve written of the dysfunctional office before, but I’m always hearing of new ways that things go bad when the boss isn’t in control of the staff. The same situations continue to appear with somewhat different guises, but always the same in terms of impact on the practice’s bottom line.

As a doctor, you can have the best advice and counsel on practice management but if you do not foster a collegial and professional atmosphere in the office, all of your efforts will be undermined. Not only that, such situations can easily lead to claims of wrongful discharge, discrimination, and retaliation - not to speak of unemployment compensation claims and other nasty sequelae.

The two most prevalent offenders that the office has: the “clique” or the “queen bee.” These are bad enough separate, but if the office has a queen bee who creates a clique as well, you the doctor are in trouble.

The clique is pretty much self-explanatory. This is the office in which there are a couple or more staff who are bound together to see that nothing gets done of which they don’t approve. Usually, the clique is composed of the most senior staff. Woes betide the new member who doesn’t abide by the unwritten code of conduct that the clique imposes.

The queen bee is the long-term employee who, over the years, has gathered to herself more and more responsibilities. She views herself as the “right arm” of the doctor - and in most situations the doctor has acquiesced in her view. As long as she does her job professionally, the doctor is okay. However, repeatedly we’ve had doctors come to us in desperation because they just discovered that the queen bee has been poisoning the office, chasing good staff away, and often covering up her own failures.

Very recently, a new twist on the “clique” situation came to my attention. We are now finding that associate doctors are just as vulnerable to the destructive potential of cliques as a new front desk assistant. If the doctor’s exposure to a legal claim is substantial when a staff person brings it, consider how devastating the consequences are if an associate dentist is forced out and seeks legal counsel. Because every doctor who has or considers having associates should be acutely aware of this, I’m citing one associate doctor’s own history of what is happening in her office:

The office has a receptionist and two dental assistants who are continuously scheming to get me to quit. It seems they feel I am intruding on their turf because I am a new dentist and they have worked there much longer than me. Because the owner only works two days per week in his practice and is not there when I am working, I have emailed him explaining the unethical and unprofessional manner in which these employees conduct themselves. He refuses to intervene or take any action to stop their bad behavior. He says because he is not there and he has not witnessed the behavior, we should work it out among ourselves. They know he does not back me up, so they do not listen to anything I say - even though the practice owner has stated that I am supposed to be in charge when he is not there.

The receptionist has stolen from me (which I can prove), hidden and shredded my paychecks (they are now mailed), hidden faxes, phone messages and my mail, is rude to my patients, and has intentionally told patients the wrong days and/or times for their appointments.

The two dental assistants make negative comments about me within earshot of patients. They try to intimidate me by bringing in both of their husbands, so that the five of them can sit around and insult me just loudly enough so that I can hear their inappropriate comments. The assistants have also intentionally handed me the incorrect irrigation solution while assisting me, which could have compromised my patient's treatment. They also challenge my treatments/procedures in front of patients, which makes my patients very uncomfortable. Several patients have told me they can feel the tension in the office and have asked my why these people have not been fired.

In this associate’s case, we have the worst of all possible scenarios. First, we have a “queen bee” - the receptionist - from whom the other staff takes their cues. We have the clique actively obstructing and sabotaging the doctor’s work and creating potential dental malpractice claims against the owner. We have an office environment that has become so toxic that patients are questioning it. This means that patients are leaving, or even if they are staying, they are not referring their friends to the office. If we dig a little deeper, we will no doubt find that profits are down because of the inefficiencies that result from such a situation.

Next week, in the second part of this article, I will address the potential for a major legal claim if the associate is forced out, and further discuss the importance of an effective employee policy.

Mike Moore is ranked among the best in employment law and has been named one of the top 10 lawyers in Ohio. As Director of McKenzie's HR Solutions, Mike is the creator of the Employment Policy and Handbook, geared to providing dentists who are unsophisticated in the legal arena with a step-by-step policy manual.

Click here to hear Mike present “7 Elements of an Effective Employment Policy.” Email Mike at mike@thedentistsnetwork.net.

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

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Belle DuCharme CDPMA
Instructor/Consultant
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Building Rapport to Treatment Acceptance
By Belle DuCharme

Trust is very important to gaining patient confidence that will lead to the patient purchasing treatment in the dental practice. Having knowledge, training and the proper licensing will not get you doing dentistry until the patient says “yes.” Rapport is something we feel on an emotional level and not something we can touch, smell or see. Rapport is the next step to trust. So how do we make the connection with people that is referred to as rapport? 

The first step to building rapport is to be and to employ people who genuinely like people enough to want to make a difference in their lives. The second step is to be able to put aside your personal conversations that are spinning in your head, such as the need to meet a production goal, to empathize with your patients’ concerns about their health. The third step is to be an “active listener” and an observer of human behavior. Listening actively is giving that person 100% of your attention and giving feedback to let them know that you are truly engaged.  A technique called “mirroring” or matching your language, tone, energy level and body pose to the patient is also helpful in building a bond of communication. If you are acting with the thought of personal wealth by building rapport, it will be evident to the patient and will build distrust instead.

Last year I met a dentist who bragged that he had purchased a very successful practice and that there were a lot of “wealthy” people in the practice and in the surrounding neighborhood. His driving ambition was to make a lot of money as his predecessor had. He became upset when patients left without an appointment. His patient’s feedback given to the Scheduling Coordinator when she followed up was that the dentist came across as “pushy and money hungry.”  Telling people what they need and pushing them to appoint will work sometimes, but usually not in the long run and it is not the way to build long term trusting relationships.

It has been said that about 70% of communication is body language. A person leaning toward you with eyes directly upon you is open to receive information from you. A person who has crossed their arms in front and is leaning back may have tuned you out completely or is showing resistance to what you are saying to them. A person who will not look you in the eye or whose eyes dart about the room or to their watch are not listening and getting impatient to leave. You have failed to create rapport with these people. If you are genuine in your approach to patients it will be evident and lead to better communication.

Often, it is not the dentist but a staff member who has won the trust and rapport of the patients. When a patient asks the Business Coordinator, “would you have this work done here?” it is demonstrating trust in this person’s assessment of the patients’ needs. 

Start with making the new patient feel like a VIP. Think of it as someone special is coming to dinner and you need to make a great impression. You have out your best china and silver. The house is squeaky clean and there are fresh flowers in each room. And then think of it as sitting down and having a friendly chat to get to know this person. Ask the patient what they want and then give them information on what you can do to meet their needs. Don’t push for an answer but say “When you are ready, we will start.”  With this approach the patient will often feel that you are interested in their health, not their wealth.

Doing dentistry follows because patients who feel good in your office want to stay in your office.  They trust that you have their best interest at heart in helping to get and keep them healthy.

A couple of things to consider preparing to get to know your patient:

  • Respect the patient’s privacy and do not discuss personal issues and treatment in earshot of other patients.
  • Have a consultation room or a place where you can sit down and face the patient “eye to eye.”
  • Don’t push for a decision. If the patient needs time, then honor that. If the patient is not appointing, offer to follow up later to answer any questions or concerns.
  • Ideally the dentist should meet the patient first to have a comprehensive examination, but if this is not possible at least make an introduction and direct the other staff members in taking records.

Patients have many choices when choosing a dentist. Make a lasting impression so that the patient trusts that they have made the best choice in you.

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

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