Do You Have ‘Taskwork’ or Teamwork?
General Motors CEO Mary Barra and the automobile company she runs are taking a beating over the ignition switch fiasco that, at this writing, has led to considerable fallout for the corporation that taxpayers bailed out just a few years ago. As Ms. Barra has faced scrutiny during hearings on Capitol Hill, in the course of her testimony she has lamented the “silos” in the organization and a “culture” that was focused more on cost. No question, GM is a huge company, and what we are witnessing is yet one more example of what system failure looks like on a titanic scale.
But culture and communication are serious issues that can lead to serious outcomes in every organization and every business, regardless of their size. The dental practice is no exception. Individual employees commonly carve out their niches. “Beth” is responsible for one area. “Emily” takes full ownership of another, while “Mike” is in charge of his. So what’s the problem? There’s a delicate balance between taking ownership of your responsibilities and building walls or silos, as the case may be.
The “silo effect” occurs in the workplace when individuals are focused almost exclusively on their own areas. Think of farm silos - they stand next to each other, each performing individual functions, but there is no link between them. That’s not a problem out on the farm, but in the workplace it’s a different story. The silo effect is another way of describing that old workplace problem of the right hand not knowing what the left hand is doing. Each person is performing his or her job, with little attention paid to the big picture or how each system intertwines with the others or how a seemingly wise decision at one point in the process could have catastrophic outcomes at another.
The silo effect can occur in the dental practice when there is a lack of communication or common objectives among the different areas - the clinical staff and the business staff, the doctor and the hygienists, etc. Individuals have tasks to achieve, but there’s minimal focus on overall goals or teamwork.
The business employee unknowingly schedules the emergency patient at a time that puts significant strain on the doctor and the assistant. The doctor recommends a patient pursue an extensive treatment plan, not realizing that the patient already carries a significant balance on their account. The collections coordinator is to increase collections, but is frustrated by the doctor’s actions. “I can’t control accounts receivables when the doctor is recommending costly treatment to patients with outstanding balances.” The doctor, meanwhile, wants to increase treatment acceptance and is now offering more elective procedures. But there’s no effective communication between the silos.
The hygienist provides care to the patients who show up, but her production continues to fall short. She has been told that she needs to see more patients and if she does she will get a bonus, but she can’t achieve that without the help of the others. No one is willing to help confirm appointments - not their job, they say - so the hygienist can’t increase her production or the practice’s.
Resentment builds on all fronts, including with the business staff. “I have enough to do with my own job. I can’t be sitting on the phone all day. Let her make those calls. After all, she’s the one who will get the bonus, not me.” Each person is so focused on her/his individual duties that it seems no one has any concept of the bigger picture - but in many offices, that bigger picture has never been painted. Consequently, the collective interests of the practice as a whole suffer.
If there are common goals or a common purpose, they don’t have a chance in this type of environment until the silos are torn down and individuals focus on how they fit into the shared success of the entire office. That begins with the doctor creating and communicating his/her vision and goals for the practice.
For some, this is a significant hurdle to overcome. After all, dentists are not trained to create visions or develop goals for systems that they barely understand themselves, let alone lead teams. Dentists are trained to treat patients. It’s certainly no wonder that for many doctors the sentiment is, “If I’m doing my job and the rest of the staff are doing theirs, what else do you need to do to be a team?”
Next week, breakdown the walls; build the team.
For more information on this topic, visit my blog: The Lighter Side
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Are Patients Accepting Treatment Options or Opting Out?
You have an amazing website where patients can see real life testimonials and information regarding your latest new technology, and you have patient centered incentives like digital x-ray, teeth whitening for life, massage chairs, lemon scented towels, easy parking, convenient hours and a no-waiting policy. You even have a private consultation room to present treatment options without interruption from the phone and patients checking in and out. Congratulations – however, treatment acceptance is still flat at 55-65% and that is for just the basic stuff, not the veneer cases or the implant restorative that you dreamed about doing.
No two dental offices are the same, so this situation requires some analysis. The perception of Dr. J was that patients were accepting almost 100% of his treatment options, but there was a change in decision at the front desk. Analysis at the desk revealed one full time business coordinator with a clinical background answering the phone, checking-in and checking-out patients, and presenting treatment.
I asked the business coordinator: “When is the last time you used the consultation room?” She responded with, “Unfortunately, not for a long time because I can’t leave the desk unless someone in the back office is not busy and they can fill-in for me. My job is to keep them busy back there so I fill the schedule with little to no open time. It isn’t difficult to appoint patients for fillings and single crowns, especially when these procedures are covered partly by insurance, but for the cosmetic procedures I just tell them I will send a treatment estimate and a pre-determination to their insurance.”
Without the time and privacy to present the benefits and demonstrate the long term value of restorative dentistry to the individual health of the patient, the opportunity to perform anything but basic care goes out the door with the patient.
According to the ADA in the Dental Tribune February 2014 edition, dental spending “stays flat” and has since 2008. The reason stated is that working age adults are visiting the dentist less frequently, with fewer people covered by employer-sponsored dental benefits. According to Stephen Hoopes, an analyst from IBISWorld Industry, consumers lacking dental insurance range from 26-42%. Within this group are people who value dental care but think insurance is the only way to get it. The good news is there is projected growth in the dental insurance industry with the enactment of health care reform provisions. The shift to the long term value of the benefits of good dental care aimed at those without insurance should be considered in all marketing strategies.
Further analysis of the demographics of Dr. J’s practice revealed that 60% of his practice was contracted with PPO policies, leaving 40% out-of-network and cash patients. His treatment acceptance for services considered as “enhancing the quality of life” or “cosmetic” were equally low in both groups. Dr. J’s philosophy of “A patient is a patient regardless of how they pay me” is a good one, but leaves many patients feeling slighted by the lack of time given to them to understand how they could afford good dental care.
The hard working business coordinator for Dr. J stated that most of the patients did not want to apply for funding with CareCredit. When asked how often she presented this valuable payment option, she responded with “It is a time issue and I just refer them to the CareCredit website or I give them an application to take home.” CareCredit provides excellent handout information, a very easy application process from the office, and training for the dental staff. CareCredit has made it possible for thousands to get the dental care they want with affordable monthly payments. Without help with this process, many patients simple do not take the time to apply. If you don’t think it is important, they won’t either.
It is easy to understand why many practices become focused on what the insurance will cover, because the majority of their active patients are in-network for contracted services. Don’t let your 60% become 100% of your focus. Want to learn more about your practice and how to improve treatment acceptance using the tools available to you? Take a Professional Business Training Course or the Treatment Acceptance Course offered by McKenzie Management.
Are You Ready for a New Direction without PPOs?
I venture to say that we are all tired of hearing about the economy. For several years it was a good excuse, and often the reason why practices were suffering - but I would propose that we can’t use that excuse anymore. Now it’s time to evaluate your practice and determine why you aren’t getting the results that you deserve financially.
Are you standing at the dental crossroads? You can continue to do what you do now and get the same results, or you can look for alternatives that will give you different results. Maybe you are simply tired of practicing the same way you have for years and are ready to “take a chance” and try a different direction. Since I am not a clinician, I am not relating change to your clinical approach to dentistry. I will leave that up to you. However, I will take this moment to encourage you to reach out and implement new services that you may not be offering, such as implants and orthodontic services.
This article is directed to those of you who are accepting one or more PPO plans and are ready to think differently. I am a proponent of “patients in the chair.” Something is better than nothing, especially for a younger practice. But what about those of you who have been practicing a while and have a strong patient base that continues to grow every year? Are you noticing that your incremental financial growth is minimal compared to the amount of hard work that you put into it?
PPOs – love them or leave them. As you know if you are a PPO provider, the fee increases, if any, have been minimal at best over the past several years. At the same time, your dental supplies continue to increase in cost, your lab fees continue to increase and let’s not even think about your wonderful team that works so very hard to keep you on schedule and keep patients in your chairs. They also want a larger piece of the collections pie. When working under the confines of a PPO fee schedule, the only way that you can increase your revenue per hour is to work faster. Let’s look at a simple math equation:
Your PPO plan allows $160 for a 2-surface posterior composite restoration. Your patient needs a DO on #14 and an MO on #15 to replace leaky margins around old silver fillings. It will take you an hour to complete this work. Your total billable amount is $320 to the insurance company. You cannot charge any more than this because of your contractual agreement with the insurance company. $320/6 = $53.66 for every 10 minutes that you work.
Let’s say that you are performing the exact same procedures on another patient without a PPO plan. Your office fee is $260 for a 2-surface posterior composite x2 = $520. Since it takes you the same amount of time, the materials cost the same and the rest of your overhead is the same, your hourly production for this patient is $520 and $86.67 every 10 minutes. This is an increase of $33.01 every 10 minutes! You would need to perform the PPO procedures in half the time to achieve the same return on your investment of time. I encourage you to apply the same math to other common procedures that you perform daily. You will be surprised at the difference in your 10-minute increments.
What does this mean to me? Maybe it’s time to take a step outside your comfort zone and consider peeling away the layers of PPO plans that you have in your practice in order to be more profitable. The first step is to take a good look at your practice and confirm that you are providing GREAT customer service for your patients. Your customer service is so good that your patients are willing to pay a little extra to continue to seek your services. They don’t really know the difference between good and not so good dentistry, but they do recognize great customer service such as:
-- Always being seated on time
Before you make any changes with your PPO plans, confirm that you can say “yes” to the items above. Now you are ready to review your PPO contracts and start making changes. Choose one that has a low reimbursement AND does not comprise of a large number of your active patients. You will “practice” with this group to get your team accustomed to responding to patients’ questions and concerns.
What I have found over years of consulting and assisting offices with making PPO changes is that if you have done your homework and prepared your practice and your team, the number of patients that you lose because you “don’t take their insurance anymore” is minimal. If you are at a crossroads, decide if it’s time to make a change. Contact McKenzie Management to help you become more profitable!
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