Remember Those 2014 Goals You Set Back in January?
Welcome to September. We are but a few weeks from the start of the last quarter of the year. And if past history is any indicator, you will likely lose several hours of productivity with all the parties, celebrations, and holidays that blanket the calendar in November and December. Oh, but Sally, there’s plenty of time. The end of the year is months away.
Well, yes there is plenty of time if you know how your current systems should be performing and are monitoring and making adjustments as you read this. For example, at this moment, your collections should be at 98%. If they are not, what’s your plan to improve them? Case acceptance should be at 85%. Do you know where yours stands? Hygiene should be producing 33% of practice production, and 80% of emergency patients should be converted to comprehensive exam. As for the schedule, it should have no more than 30 minutes of hygiene openings per day.
Did I hear you say, check, check, and check for those last three? Probably not. That last one in particular can be a serious challenge for many practices, as recall is commonly among the weakest systems in practices that are struggling. Unscheduled treatment is typically a close runner up.
You should be accessing the practice management system reports that are readily available, including the “Unscheduled Treatment” reports. These allow you to see who has unscheduled treatment in the files - revenues waiting to be tapped. With this information in hand, the objective is to get patients back in the practice. This may require a paradigm shift of sorts for your scheduling coordinator. Instead of being reactive - scheduling patients when they call - it requires that s/he be proactive and place the calls to encourage patients to schedule. But don’t send your scheduling coordinator out to line-up production without a clear and specific plan of action and a well-developed script to guide the conversation.
Moreover, keep in mind that encouraging patients to schedule their appointments isn’t the sole responsibility of the business staff. As patients return for hygiene appointments, it is essential that both the hygienist and the doctor emphasize the importance of pursuing treatment that has been diagnosed but not delivered.
Next, when was the last time you took the pulse of your patient retention? Far too many practices are losing more patients than they are retaining. Determine the number of patients the practice is losing each month. From there, you can evaluate the various systems, such as recall, that directly impact patient retention and establish realistic goals to improve them.
Take a close look at the “Production by Provider” Report every 30 days. This shows the number of each type of procedure performed over a specified period of time. Your business assistant should run this year-to-date report every month for each doctor and hygienist, so they can determine how their production compares with the same time periods last year as well as with production goals that have been established for this year.
In addition, consider new treatment services. Practices that are struggling are likely doing what they’ve always done, i.e. crowns, fillings, and prophys year-after-year. Dentists who are doing interceptive perio, endodontics, veneers, whitening, and implants not only expand their patient base and improve their production, but they also renew their professional enthusiasm for dentistry.
While you’re at it, take a close look at your clinical efficiency. We find that many dentists get up from their chair numerous times during patient procedures, or have their assistants leave the treatment room to retrieve items that should have been set up in the first place. Clinical time and motion studies reveal three more reasons for production shortfalls: 1) slow treatment room turnaround; 2) underutilization of chair-side assistants; and 3) poor planning for armamentaria and procedural protocols.
Finally, give some thought to your fees. Calculate your production per hour (PPH) along with a PPH analysis of every procedure you offer. This is much easier to determine than many realize. Take the amount of your fee for a specific procedure and divide that by the number of minutes it takes to do the procedure. That number is your production per minute. Now multiply the production per minute number by 60 minutes. That number is your production per hour (PPH). Once a year, consider implementing fee increases following an analysis of comparable fees in your area.
Next week, do you have the six key factors for success?
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What Happens When Your A/R is Poorly Managed?
Doctor, have you ever reviewed the report that shows all the patients and insurance companies that owe you money? And if you have, do you really know what you are looking for? For example:
Allow me to be more specific. There is a software program that allows you to assign a designation to a patient and/or the account. It can be a symbol, number or letter. By simply assigning this designation to an account, the Accounts Receivables (or Aging Report) can be generated without including the accounts with this designation. As a result, unless the report is printed to include “all designations”, you are not looking at the true balances that are owed the practice.
Other softwares allow you to assign “billing types” to accounts. The Aging Report can be generated to not include specific billing types. As a result, not all the accounts are listed. Another software program has the option to set up various Account Types such as Bad Debt, Collections, Cash Only, etc. The Accounts Receivables Report can then be generated to either include or exclude these account types; therefore, not revealing all the accounts that owe money to your practice.
Why Hide Accounts Anyway?
Another reason I hear is that doctors don’t want to write the uncollectible accounts off so they are “hidden” to never be seen again. Why is this so bad? Because you are not realizing the actual “net” production of your practice on a monthly or annual basis. The work was performed, no money or some money was collected and you are not seeing the uncollectible adjustment to reflect the uncollected debt.
Industry standards for bad debt write-offs are 1-2% of gross production. We typically don’t see this much written off. Could be because it is hidden? A report can be generated for the hidden dollars but you have no idea what the time period was that it was considered “dead”.
How Should Bad Debt Be Handled on the A/R?
2. Accounts should be reviewed monthly to determine if all efforts have been made to collect the debt, such as phone calls, emails, reduction in balance if paid in full, etc. If it is determined that the account is uncollectible, it should be written off to properly reflect the more accurate “net” production. Remember that you bill based on net production and not gross production. Software programs also allow statements that are sent out to your patients to not include these flagged accounts. So no A/R and no statements.
3. Monitor the amount of dollars that are written off monthly and annually to confirm that you are within industry standards or what you feel is reasonable. Most dentists feel that nothing should ever be written off, but that is not realistic. Determine a percentage that you can live with.
4. Create an alert indicating that the account has been written off, just in case you get lucky and the patient wants to return or the collection agency finds them and sends you a payment.
…And What About Those Orthodontic Accounts?
If you own a practice that performed orthodontic and restorative dentistry and the patients are seen for both categories, establish an “ortho” account that uses the patients’ names in ALL CAPS. Flag this account as an orthodontic account so you can generate an A/R report without the orthodontic accounts for the restorative part of the practice and a separate A/R report for only my orthodontic patients. If this is done in your office, be sure and instruct the financial coordinator to post the payments correctly to the correct account for accuracy.
Take a few minutes and review with your business team how they are handling your bad debt. Review the various ways that the A/R Report can be generated to show the “hidden” accounts. Maybe you don’t have any!
Taking the Stress out of Staff Meetings
“I hope Dr. V doesn’t work over into our staff meeting today, like he did last time,” lamented the Office Manager.
Every day around the globe, millions of meetings are being held in businesses with the purpose of improving operational systems and team morale - yet dentists typically hate staff meetings because they are viewed as counterproductive. Even a once-a-month two hour meeting is met with resistance because it “takes up production time.”
The most successful meetings are those in which the participants take some ownership and are eager to be accountable for the results. Many staff members have confided in me that staff meetings are usually about things that the dentist views as needing to be improved, and a general blame is put to all - even the people not involved in the issues. Some have said their meetings are like a group performance review but without the details of who, what, when and how for improvement.
Some dentists say it is easier to deal with things themselves than to deal with the people that work for him/her. This shows poor leadership and business skills on the part of the dentist. Taking the stress out of staff meetings and getting positive results requires planning. The following will help get you on the right path:
1. Have a Continuous Improvement Agenda Form posted at the staff lounge area a month prior to the meeting date. This gives all staff members an opportunity to make suggestions. On this agenda there will be fill in the blanks for the following:
2. Everyone is encouraged to participate in a “safe” atmosphere of exchange of ideas.
3. Ask everyone to offer at least one idea and time the speaker for two minutes to ensure all get an opportunity to talk. Every practice has its own culture and there are those who are always eager to express an opinion and those who rarely speak and “fly under the radar” because they feel it is safer.
4. Don’t start the meeting with sensitive or negative subjects. Start with a patient’s compliment or a good review online. Thank the staff for all that they do and show appreciation by asking for their valued feedback on the practice. End the meeting on a positive note.
5. Speak in private during a performance review or when putting a staff member on notice for a breach of policy. If there are performance issues with any staff members, do not use the staff meeting as a “stoning” session.
6. Tell your staff you are looking forward to the meeting and hearing their thoughts and suggestions. Make sure there are refreshments for them and/or lunch if appropriate.
7. Have everyone mute their cell phone and do not allow texting during the meeting.
8. Complete the meeting about 5 to 10 minutes before seeing patients to give the staff time to recover. A meeting evaluation form would be great to give out to receive information about how the meeting can be improved in the future. This gives the team a chance to be heard. Answers can be anonymous.
9. By allowing people to sit where they choose, you will see who gravitates to whom, who is left out, which groups seem upbeat and which wear frowns or appear to complain. When trying to improve team performance this can be an eye-opener.
10. Have a list of business statistics to discuss, such as:
Need help gathering any of the above information? Don’t hesitate to call McKenzie Management for all your questions and concerns. Professional Office Manager Training is a course worth taking to hone your staff management skills. Sign up today and start looking at your necessary staff meeting with anticipation instead of dread.
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