7.2.10 Issue #434 Forward This Newsletter To A Colleague

Are You Leading Your Team to Average or Excellence?
by Sally McKenzie CEO
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Excellence can be an intimidating concept. After all, an entire industry has been built searching for it since Tom Peters released his bestselling book in 1982. With all the guides, books, formulas and motivational speakers that have dedicated countless pages of wisdom and endless hours of inspiration, we’ve learned this: Achieving excellence comes down to hard work, commitment, and most importantly, leadership.

At the root of excellence - or even “very good” - is change. And change in any organization, be it a corporate giant such as Microsoft or your own dental practice, is a huge undertaking. In fact, studies have shown that 60-90% of the efforts to change the way things are done never make it to fruition. Why? Because the culture of almost every business is “hardwired” from the top down. In other words, if those driving the train don’t change course, everyone else is just another cart on the same track, along for the same journey, and on their way to the same destination, yet again.

But the beauty of the dental practice is that if you, doctor, are not satisfied or don’t like the direction of your practice, you have the power to change it. In reality, only you have the power to change it. Yes, you need your team to be actively involved. But real change begins with you. From there comes the development of the plan, which involves asking a few fundamental questions, starting with: What’s your vision for your practice? What does a really good dental practice do differently? How do we get there?

Next, is fact finding. Talk to your patients about their experiences. You don’t need to conduct a formal survey, although it’s helpful if you can. At a minimum, ask how your practice can do things better. Just remember that only a handful will be honest with you - and those that do share less than stellar comments are doing you a huge favor in offering their candid opinions. Here’s why: studies indicate that if one person complains, at least seven have had the same negative experience and each of them has told nine others about the problem, meaning that at least one negative comment about your practice has been shared with 63 others in your community – not exactly the word-of-mouth marketing you want out there.  

From there, begin to assemble the building blocks of practice excellence by examining each individual system and how it fits into the vision of the office that you have chosen to create. What does the new patient experience involve in a practice that is dedicated to setting itself apart from the others in the community? How do patients feel when they call a practice that is committed to excellence? How is the team involved in carrying out the practice culture that the doctor wants to create? Once the broad-brush concepts are identified, take an honest look at how your team currently handles specific systems. Don’t sugar coat it.

Next, ask your employees for their input. What do they see as the strengths and weakness of practice systems and protocols? What changes would they recommend to improve them? What protocols could be developed to reduce stress and improve the patient experience, practice productivity, and the total culture of the office? Develop your plan for each area and put it in writing. Focus on the specifics of each practice system, and create a timeline for addressing individual areas.

Remember, keep it manageable and establish realistic goals. Efforts to change frequently fall short because businesses attempt to take on too much too soon and quickly become overwhelmed. Some system changes can be implemented in a few weeks while others may require up to a full year.

Finally, recognize that there are many dental teams that simply cannot make the necessary changes on their own. Oftentimes, doctor and staff are too close to the situation to be able to step back and objectively consider what is truly working and what needs to be corrected. In those circumstances, it’s critical to seek outside help from a professional.

Next week, what to do when the desire for change and the reality of achieving it are worlds apart.

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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Nancy Haller, P.h. D.
Leadership Coach
McKenzie Management
coach@ mckenziemgmt.com
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Productivity Climbs with Trust and Accountability
By Nancy Haller, Ph.D. , Leadership Coach

Question: What is the #1 factor in productivity, morale and retention?
Answer: The relationship between employees and their boss – TRUST

Question: What does it mean to be the boss?
Answer: Being a boss means making sure everything goes right – ACCOUNTABILITY

The value of a professional service business like dentistry is stored in its people. Your dental knowledge and skills are important factors of your success. But whether you hobble along or have a booming practice depends on the character and performance of your employees. From patient service to referrals to bottom line profits, employee performance has an impact on everything! For top-notch dental teamwork you need trust and accountability.

Trust is the foundation that allows people to work together effectively and efficiently as a team. And accountability is the way you build that foundation. Trust enables everyone to be at their best. If you can trust others more, you can receive more help. You can be more relaxed and do the things that make you happiest. In turn you can accomplish more. Accountability means having to accept responsibility. Although everyone is accountable for their own behavior, the boss is ultimately responsible for employee performance.

Trust and accountability start with communication. As the practice leader you are responsible for demonstrating exceptional performance. It’s in the words you use and the way you do things. Your employees are watching all the time. You set the bar, and what you allow to happen is what you teach. If you let employees fall below the standard, you train them that it’s ok to be mediocre. This is Management 101.

Stop letting yourself off the hook and get out of your comfort zone. If you want a higher functioning team, you need to make management a priority. That means setting aside time each week to build relationships with your employees. Depending on the size of your staff, the time requirements will vary. However, this aspect of your practice is just as important as a patient appointment. Devote at least 30 minutes per day to consciously managing your people more effectively.

I can imagine the reactions some of you have to this guideline – Are you nuts? You want me to give up 2.5 billable hours a week to do what?!? I am very serious about this. The good news is that you are likely to experience the gains quickly. It may be fewer errors and interruptions or increased billings. I expect you’ll see greater attention to detail, maybe more enthusiasm.

What You Should Be Doing During “Management Time”

  • Talk with employees about the work. Have lots of small conversations about what needs to be done and how they are doing it.
  • Schedule one-on-one meetings. Keep them brief, perhaps 15 minutes. Gauge how much time each person needs.
  • Ask questions. Be curious. Use descriptive language and be encouraging.
  • Spell out expectations in specific and detailed terms, then track performance every step of the way.
  • Most importantly, follow through with real consequences based on whether the actual performance meets the expectations you established. Problems need to be addressed promptly, and successes need to be rewarded quickly.

Remember that you are there to bring out the very best in your employees. By adding value to them first, you help yourself. Building and maintaining trust within any organization pays off with many benefits. Efficiency happens when people really trust each other. Problems are dealt with easily and efficiently. Service goes up and costs go down. Without trust, workers slow down and lose focus.  Problems become huge obstacles. Employees scramble and blame others. Time is wasted. Service plummets. Costs go up.

Dental practices that are able to create an environment of high trust enjoy an incredible sustainable advantage. When there is trust, employees have no need to be defensive. They focus on accomplishing the mission of your practice. They direct their energy toward the patient, and to the team. There aren’t squabbles or turf battles.

Nearly every problem in your practice can be traced to problems with employees. And those problems relate directly back to you. Only you can fix the problem. Step up and admit that you are the one in charge and be the boss. Take charge of changing your own behavior and turn the tide toward a more productive practice, a practice of trust and accountability.

Questions or problems with your employees? Contact Dr. Haller at coach@mckenziemgmt.com.

Dr. Haller provides training for leadership effectiveness, interpersonal communication, conflict management, and team building.

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

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Carol Tekavec, RDH
Hygiene Consultant
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Hygiene Services-Controlled Release Antimicrobials and Fluoride
By Carol Tekavec, RDH

Hygiene services are often mistakenly thought of as simply consisting of “BWs” and prophys.  While “professional cleanings” and bitewings are staples of treatment, there are obviously many more services that hygienists perform every day. In fact, practices where hygienists are not performing interceptive periodontal treatment or providing other adjunctive services are typically practices where the hygiene department is low in production. Let’s look at two treatments that hygienists can provide to help patients become healthy, while also adding to the practice’s bottom line.

Controlled Release Antimicrobials
D4381-Localized delivery of antimicrobial agents via a controlled release vehicle into diseased crevicular tissue, per tooth, by report. FDA approved subgingival delivery devices containing antimicrobial medications are inserted into periodontal pockets to suppress the pathogenic microbiota. These devices slowly release the pharmacological agents so they can remain at the intended site of action in a therapeutic concentration for a sufficient length of time.

ADA Current Dental Terminology codes are not product specific. Therefore, although a code may apply to a particular product, it was not designed to refer to that product. With this in mind, the use of several agents currently on the market might be described by this code. These include but are not limited to:

  • Perio Chip-Chlorhexidine wafer
  • Actisite-Tetracycline fiber
  • Arestin-1 mg Minocycline delivered in a syringe
  • Atridox-Doxycycline mixed in a syringe
  • Perio-Protect - which is a custom fabricated tray used with an agent determined by the dentist - might also be described by this code

Antimicrobials can be useful adjuncts to scaling and root planing to help patients return to, or maintain their periodontal health. Despite this, insurance carriers vary in their contract language as far as benefits for D4381 are concerned.  While a few may cover these services at the time of SRP's, many carriers will cover D4381 only for “refractory pockets” with a one month to one year waiting period following scaling and root planing. These carriers also may look for a diagnosis of at least Chronic Periodontitis, Moderate or Severe, with 5mm or deeper pockets on the teeth being treated, plus bleeding on probing. They may also limit their coverage to two teeth per quadrant.

It is important to note that “irrigation” is not considered to be accurately reported with D4381. The primary reason appears to be that irrigation is not considered to be “controlled release.” In fact, “irrigation” does not have any attached code.  How to code irrigants? Here are some considerations:

  • The Current Dental Terminology definition of Periodontal Maintenance-D4910 does not mention irrigation, therefore the ADA Code Revision Committee does not appear to think it is a “part” of the procedure.
  • Conversely, the American Academy of Periodontology in their “Parameters of Care” for periodontal maintenance, state that it includes “antimicrobials as necessary.”
  • Because the CDT codes are the designated code set for dentistry, and despite the AAP parameter, it appears that D4999-Unspecified Periodontal Procedure, by Report, may be appropriately used for irrigation.
  • It is unlikely that any carriers will cover the procedure when reported separately, regardless of the code used.
  • Network dentists may not be able to charge separately for irrigation under their contracts.
  • Offices may opt to include the fee for irrigation into the larger service being performed rather than trying to find a way to charge separately.
  • The use of irrigants can be an important difference between D1110-Prophylaxis-Adult, and D4910-Periodontal Maintenance.

Coding and insurance payment issues aside, if an office has determined that the delivery of antimicrobials is in the patient’s best interest, these medicaments can be included in the treatment mix. Fees for D4381 often run at around $150 per tooth. If a hygienist identifies only one patient per month who needs two teeth treated; 12 months  x $300= $3,600 additional practice income for the year.

Fluoride
The concept that office fluoride application is “just for kids” has fallen by the wayside. The ADA Report of the Council on Scientific Affairs, May 2006, Evidence Based Clinical Recommendations: Professionally Applied Topical Fluoride, set guidelines for the appropriate use of fluorides for various age groups and associated risk factors. Among their recommendations:

  • Fluoride is appropriate for persons with moderate caries risk, described as over age 6 with 1-2 incipient or cavitated carious lesions in the last 3 years, or other risk factors such as poor oral hygiene, poor family dental health, etc.  For persons under age 6, fluoride may be appropriate even if there are currently no caries, but other risk factors apply.
  • Fluoride is appropriate for persons with high caries risk, described as over age 6 with incipient or cavitated carious lesions in the last 3 years and multiple factors increasing risk, such as poor oral hygiene, suboptimal previous exposure to fluoride, presence of exposed root surfaces, etc.

Insurance carriers frequently cover fluoride treatments, but may have age specifications in place.  A common restriction is that fluoride will be covered for persons up to, not through, age 14, two times per year. Older persons may also be covered when fluoride is reported on the same claim form as restorations, or when a brief report of patient issues is included in section #35 of the claim form. With this in mind, many patients can benefit from professionally applied topical fluoride on a regular basis, and many of their insurance plans may pay toward this service!

Offices may develop a Preventive Fluoride Policy to set a format for when fluoride will be applied, according to the dentist’s philosophy. 

For example:

  • Low-risk patients of any age - fluoride varnish annually
  • Moderate risk children and adults - fluoride varnish every six months
  • High-risk patients of any age - fluoride varnish every 4 months

Before instituting any changes in what an office has previously been providing, a staff meeting should be held to go over what the changes are going to be, why they are being instituted, and how they are going to be explained to patients. It is important that all staff members understand and are able to verbalize the benefits of any new treatments or increased frequency of treatments. Fees for D1206-Fluoride Varnish often run at around $40. If a hygienist identifies only two adult patients a week who could benefit from fluoride; 48 weeks x $80 = $3,840 additional practice income.

Carol Tekavec CDA RDH is the Director of Hygiene for McKenzie Management. Carol can improve your hygiene department in just one day of training “in your office.” Interested in knowing more about how to improve your hygiene department? Email hygiene@mckenziemgmt.com

Carol is also a speaker on dental records, insurance coding and billing, patient communication and hygiene efficiency for McKenzie Management.  Interested in having Carol speak to your dental society or study club?  Click here

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