It’s Not Personal, It’s Just “The Dentist”
As you scan the schedule for the coming week, you see that some of your “favorite” patients will be in for appointments. You also note that there are a few more new patients, which always quickens your pulse a bit. After all, it’s rewarding to know that you’ve been “chosen.” You look forward to catching up with existing patients as well as getting to know those you will be meeting for the first time.
So when two people cancel at the last minute on Monday and another doesn’t show on Tuesday morning, a measure of frustration begins to percolate across the team. But the week is still young, you reason. On Wednesday, one of the new patients suddenly has a “work emergency” and must reschedule, and another patient was confused and thought his crown and bridge appointment was next week not this week. That slight measure of frustration on Tuesday has now escalated to a full blown production panic attack as your blood pressure is now pinning the needle on the anxiety meter.
By the time the week wraps up at the close of business on Thursday, after tallying all of the cancellations and no-show appointments, it’s fair to say that production has taken a beating. Compounding the frustration, it seemed as though every other patient was strolling in late. Did the time change occur again and no one told you? Has everyone abandoned common courtesy? Is there a full moon? Sure, people are busy. Life and work are demanding. But why do so many patients think it’s okay to blow off their dental appointments?
Doctor, it’s not personal. It’s just the dentist. In other words, they do not understand the impact that their appointment failures, cancellations, and late arrivals have on your practice. They do not value your care because they don’t understand the value of your care. So how do you turn this around? First objective: Get patients in the chair at the appointed hour.
I will be the first to acknowledge that eliminating no-shows, cancellations, and late patients entirely is impossible. However, there are many things every practice can do to significantly minimize the number of schedule upsets. It all begins with one simple concept: appointment confirmations.
Now before you roll your eyes, groan in frustration, and assert that your “Cracker Jack” team has neither the time nor the patience to engage in this mind-numbing exercise in futility, let me say, things have changed. Or should I say the process for successfully fulfilling this responsibility has changed, and the results are more than impressive.
The digital age of communication has opened a host of faster, simpler, and more effective means of ensuring that patients are in the dental chair at the appointed hour. How? It begins with the communication tools that patients prefer, namely, email and text messaging. In fact, a national survey conducted by Sesame Communications revealed that nearly 80% of patients – 79.5% to be specific – stated that they preferred text message and email reminders. And the best part is that these tools can be automated to ensure there is zero drain on staff time, the messages are consistent, and the communication is delivered according to individual patient preferences.
How big? Consider this compelling statistic. According to Sesame Communications, in the first 36 months of implementing automated appointment reminders, no-shows were reduced by 22.95% in dental practices, driving $31,456.88 in incremental production.*
Next week, maximize patient/practice relationships while minimizing staff time.
*Attendance rates on 21,566,375 appointments scheduled at 491 practices
For more information on this topic, visit my blog: The Lighter Side
Interested in speaking to me about your practice concerns? Email firstname.lastname@example.org
Are Adjustments Killing Your Collections?
Are adjustments killing your collections? Your first thought may be, “Adjustments don’t affect my collections – they affect my production.” Or may be you are not sure exactly how any adjustments affect anything. You would not be alone. Collection Adjustments are adjustments that are posted to an account that increases the patient’s balance. You could call it a “debit” adjustment; it is a “plus.” Examples of these adjustments would be:
We see the Posting Error adjustment often. It tells us many things: the production was not balanced by provider at the end of the day or the production was not entered into the computer in a timely manner because the information was not provided by the clinical team. Doctors are the biggest offenders of this. They wait until the next day to tell the business team what they performed on Mrs. Smith. Some practice management software will allow you to make the change after the fact and others will not, especially if it is between the end of the month and the first of the month.
Other than the Posting Error adjustment, these adjustments reduce the amount of money that was deposited into the bank; therefore, they are considered Collection Adjustments. Another exception to the rule would be a “small credit balance adjustment.” The patient has abandoned the practice and appears to not be returning. The Business Coordinator wants to “inactivate” the patient, but the patient has a small credit balance. There are no plans to refund the patient due to the small amount, so this adjustment is posted to bring the patient’s balance to zero.
To understand how the Collection Adjustments should be applied, the difference between the total amount of cash, checks, credit and debit card payments that are deposited to the bank account MINUS the adjustments = NET collections.
Production Adjustments are all those PPO adjustments that take place, procedures that have been “downgraded” to lower reimbursing procedures, professional courtesies, cash discounts, senior discounts (we prefer to call them “courtesies”), uncompleted treatment that was posted earlier, etc. All these adjustments affect how much the patient was charged for treatment.
The difference between gross production and all the adjustments = NET production. Your practice collects the net production totals and not the gross. If there are no adjustments posted, then the gross and the net are the same figure. Since your practice collects on net production, the more that is adjusted the less is collected.
Case Study: Here is some interesting food for thought. Have you noticed that your Production Adjustments for this year have jumped up much higher by percentage than your gross production compared to last year? This could be a sign of problems in many areas. More PPO write-offs, more professional courtesies, and more denials that you won’t bill the patient for (such as professional cleanings that were performed too soon, x-rays that were taken too soon to be covered, etc.)
For example, a practice was averaging about 20% of their total gross production in production adjustments, as they were posting their office fees. All of a sudden, their adjustments jumped up to 34% of their gross production. What in the world could have happened? Professional courtesies, senior courtesies and other discounts have not changed. It was the PPO adjustments. The doctor had started performing more composite restorations opposed to amalgam restorations. Even though the fee was higher for the composites, the fee schedule was much lower and the adjustments were 50% instead of 33%. Over the course of a year, this made a huge difference in the amount the practice collected because the adjustments were higher for the resins compared to the amalgams.
Second Case Study: A client noticed that his collections had dropped off, even though his production was higher than the previous year. This made no sense! We determined that when the new financial coordinator took over, it was “assumed” that she knew what she was doing since she had worked in another dental office. Instead of collecting the patients’ portion at the time of service, she was just letting them walk out the door. When the insurance company paid, she simply wrote off the balance as a PPO adjustment. It took some detective work to figure this out, comparing EOBs to the adjustments posted and noticing that the amount of patient checks coming in compared to the previous year was much less.
As a business owner - review your monthly adjustment reports! If you don’t know how, call support for your software and ask them to go over it with you. In most cases it’s a matter of training to assure that your business team is working as productively, effectively and accurately as possible. Never assume that a new employee knows how to do something. They are bringing the same tool-box that they used in their previous office, and you need to discover what’s in there!
The Dental Environment and Treatment Acceptance
Dear Belle - On Monday the schedule fell apart, starting with a patient who was scheduled for scaling and root planing with the hygienist. She was running behind and the doctor was working on a child with a toothache in the room next to the reception area. The patient waiting came up to the desk and said he had to leave because the smell and the noise brought on a migraine. This is not the first time this has happened; it is difficult to discuss future treatment with patients because of the noise of the drill and the lack of a private quiet space. Patients are sensitive to what they see, hear and smell but the doctor says I am not firm enough. What do you think? - Bettie B, Dental Manager
Office design has a lot to do with patients being comfortable enough in the practice to have treatment performed. Sometimes the practice does not have much choice because there is no room to expand. While recently visiting a practice that had not been updated in years, I could see the doctor and the assistant working on a patient as I sat in the reception room. I am not a dental phobic, but being able to see what they were doing made me feel as if I were intruding on someone’s private business. Newly designed practices often have a consultation room or area built in, because studies have shown that patients want privacy when discussing health care issues.
A private area can be created by screening off part of the front desk so that the patient cannot be seen by anyone in the reception area. After presenting treatment options the conversation often moves to how the patient will pay for services. Patients don’t want to share this information with anyone within hearing distance either. For many offices, once the patient gets to the front desk, the treatment consultation is over for the clinical dental team but not for the patient. Many dentists want to improve their treatment acceptance percentages but have not realized that the most important component to doing this is private time with the patient.
The treatment coordinator should attend the diagnosis and treatment option presentation so that he/she can take over the presentation in the consultation area. It is important that the patient sees this person as “knowing what was said” and understands the procedures well enough to answer any questions.
Creating an environment that is appealing to the senses of the patient will invite the patient to return. An overpowering medicinal smell that is often overlooked by dentists and their team can be an anxiety-producing experience for the patient. No one wants to spend a lot of time in an uncomfortable environment. An automatic room deodorizer mounted on the wall that periodically infuses a shot of aromatherapy into the air is recommended to eliminate dental odors. Ask patients what they smell when they come into the office. If they say “it smells like a dental office” then a change is in order. Patients can be a good source of feedback.
It is recommended that the consultation room be sound-proofed as much as possible. Listening to the high-speed drill, model trimmers or patient outcries will not hasten a patient to sign up for more of this experience. Put yourself in the patient’s place and ask, “If I were making an important financial and long-term health care commitment, where would I like to discuss the matter?”
Want to learn more about the treatment acceptance process? Call McKenzie Management today and sign up for the Treatment Acceptance Training course for a fresh approach to communicating with your patients.
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