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Think it’s Time to Fire a Team Member? Read This First
By Sally McKenzie, CEO

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Dealing with problem employees is never easy, which is why most dentists do their best to avoid it as long as they possibly can. They tell themselves these team members will eventually get it together, so they ignore any issues they’re causing in the practice, whether their poor performance is hurting practice production or leading to conflict with other team members.

Yes, most dentists want nothing to do with disciplining or, even worse, firing employees, but unfortunately it’s a necessary part of your role as practice CEO. If you don’t address concerns and employees continue to display poor attitudes, deliver lackluster performance and less-than stellar customer service, it’s doing nothing but hurting your practice. You’ll start seeing increased turnover, reduced patient retention numbers and a shrinking bottom line, which I’m sure doesn’t describe the successful practice you envisioned when you first decided to become a dentist.

As difficult as it might be, there comes a time when you must address the problem employees who are holding your practice back. Maybe that comes in the form of additional training or offering feedback on how they can improve, but keep in mind there are times when employees, whether they’re new or have been with your practice for years, simply must be dismissed.

And there are plenty of reasons you might want to consider dismissing employees. Here are a few:

- They refuse to follow established office policies
- They’re dishonest, argumentative, or difficult to get along with
- They fail to carry out responsibilities and seem to have no idea what it means to be part of a team
- They gossip about patients, the doctors or other team members
- They always seem to be rolling their eyes during team meetings or delivering snide comments
- They can’t be bothered to show up to work on time and are always late coming back from lunch
- They share information they know is confidential
- They rarely follow directions
- They’re secretive about how they perform their responsibilities, making it seem like they’re irreplaceable

I’ll stop there, but the list goes on and on. No matter what issues they’re causing in your practice, I suggest you deal with problem employees using a clearly established progressive discipline system. How exactly does that work, you ask? Basically, the penalties become stronger if the employee misconduct or poor performance is repeated. Discipline might start with a verbal reprimand, proceed to a written reprimand, then suspension, and ultimately termination – with everything documented along the way.

Unless the employee’s behavior is so bad you need to take immediate action, this process should take place over a 60-90 day period, giving the employee plenty of opportunity to make the necessary changes. Be sure to explain to the team member, both verbally and in writing, the specific issues that are not satisfactory. Then, document exactly what needs to change.

Sit down with each employee to develop an agreement that clearly spells out those changes. This agreement should be in writing, signed by both you and the team member and then placed in his or her file.

In a perfect world, employees who go through the discipline process will see exactly what they’re doing wrong and be willing to make the necessary changes to meet and even exceed your expectations. Yes, that would be great, but it isn’t what usually happens. Poor attitude or a lack of skills will continue to play a role in performance, and that means you’ll likely have to terminate these employees. Make sure you’re prepared.

Part of that means monitoring the employee’s progress and providing regular feedback as he or she works to make improvements during the disciplinary procedure. Remember to document every step and every conversation. This clearly shows you didn’t just decide to terminate a team member on a whim; even after given the opportunity, the employee chose not to correct the problems identified. You simply took the next and final step in the progressive discipline plan.

You didn’t become a dentist because you wanted to deal with these types of human resources issues, but if you choose to ignore them it will only hurt your practice and the rest of the team. I know this can be difficult, so if you need more guidance don’t hesitate to reach out. I’ll help get you through the process so you can find and hire team members who know what it takes to move the practice forward, instead of holding it back.

Next week: How to fire a team member

For additional information on this topic and more, visit my blog: The Lighter Side

Interested in speaking to me about your practice concerns? Email sallymck@mckenziemgmt.com
Interested in having McKenzie Management Seminars speak to your dental society or study club? Click here.
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Belle DuCharme, CDPMA
Instructor/Consultant
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Are you a FREE for Service Dentist?
By Belle DuCharme, CDPMA

Front Office Training Case Study #FO580

For this case study, the software reports sent to McKenzie Management prior to the office’s training showed an unusually high accounts receivable total in the 90-day plus aging category, along with suspicious adjustment totals. Essentially this means that services charged out had not been collected within the 30-day time frame considered required to sustain a thriving practice. As monies owed age from 30, 60 and then to 90 days plus past due, it becomes increasingly difficult to collect. Only about 20% of monies aged past 90 days are ever collected.

“Dr. May Bent” (names have been changed) included the following note in her pre-training questionnaire:

“I would like my front office team to be able to collect the money owed and I would like someone in charge who can teach them what to say at the desk. We don’t have job descriptions either and they both want to be the Office Manager. Please help them understand what to do to collect at the desk.”

While there are several issues here, we will look at the most important one and that is lack of revenue. Working with “Hanna and Betty” during the training became complicated when we approached the subject of who did what during the business day. They shared the job tasks but neither liked to answer the phone or call insurance companies about unpaid claims. The question as to why the accounts receivable was so high was answered by both with many excuses, but no accountability to the bad results.

“We don’t always have the time to get the insurance breakdown so we just tell the patient we will bill insurance then send a statement afterwards. When patients get the statement, they don’t like the fact that they weren’t told how much they would have to pay so we write some or all of it off to make them happy” explained Betty.

Hanna piped in and said that Dr. Bent often tells the patient she will take care of them by writing off the amount that insurance doesn’t pay or waiving the balance if no payment is made.

Dr. Bent was in-network provider for Delta Dental, Aetna and Blue Cross and had agreed by signing the contracts to collect the coinsurance from the patient. Per Delta Dental Insurance companies, one of the largest in the nation, the following statements are taken very seriously:

Accepting your insurance as payment in full and disregarding your coinsurance, copayment or deductible results in overbilling the insurance company. It's against the law in many states and is viewed by the dental profession as unethical. It’s also a violation of the dentist's contract with Delta Dental.

Dentists are not reducing their fee when they do not collect patient payments. Instead, these dentists are charging inflated fees to the insurance carrier to make up for the money they lose from waiving the coinsurance/copayment amounts.

Enrollees who knowingly agree to the dentist's scheme are participating in this deception.

Neither Hanna nor Betty knew that they were doing anything considered unethical or possibly illegal by writing off coinsurance. They both agreed it was certainly easier to do and the patients never get mad when you write off the balance. When explained to them that it was not an option to write off the coinsurance because of the contractual agreement that included the patient as a participant in payment for their services, they agreed they needed to collect.

Betty and Hanna’s poor collection skills didn’t stop there, they also did not collect from fee for service or cash patients without first offering them a 20% discount. If that didn’t work, the next was to offer them an in-house payment plan if they didn’t qualify for CareCredit financing. This was not working because patients were not paying as agreed, forcing the accounts receivables to grow and cash flow to stop.

We discussed that offering discounts to patients was assuming the fees were high enough to absorb loss of profit. Without a professional fee analysis to determine if their fees were justified for the area, it wasn’t known whether the practice could afford to offer discounts and 20% was considered too high to offer as a discount to anyone.

Developing collection scripts for Betty and Hanna helped them to understand what to say and why, and most importantly the reasons for collecting at the time of service.

To learn what to collect and how to collect, contact McKenzie Management and enroll in Front Office Business Training.

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

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