6.8.07 - Issue # 274 Forward This Newsletter To A Colleague

Nancy Caudill
Senior Consultant
McKenzie Management
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Catch and Release Your Employees

A McKenzie Management Case Study

Dr. Deborah Kassell – Case Study #54

This practice is a general family practice that may be just like yours.  Dr. Kassell’s concerns are also applicable to any dental practice, whether a specialty or general practice. When I initially spoke with Dr. Kassell on the phone prior to my arrival, she shared with me her financial concerns and struggles with meeting payroll and paying her practice bills in a timely manner.

 “Nancy, for the first 3 years of my practice, it grew steadily with new patients, an acceptable cash flow that allowed me to pay my staff, myself and my bills.  I was pleased with my growth.  For the past 2 years, I continue to see more new patients and I have added another day of hygiene.  However, I am struggling with meeting my financial obligations and have not purchased any new equipment or added more staff other than the additional day of hygiene. What is happening?”

Dr. Kassell’s practice facts:

  • 5-year old start-up practice that is barely surviving with 20 new comprehensive exams a month and 4 days of hygiene.  The practice thrived for the initial 3 years.
  • Practice Coordinator has been with the practice for 2 years; chairside assistant has been employed 4 years and the hygienist since the practice opened.
  • Practice participated with 3 PPOs and did accept the assignment of benefits for all other insurance plans with the exception of HMO plans.
  • Monthly net production:  $62,500
  • Total accounts receivables (not including credit balances) $174,300
  • “Over-the-counter” payment percentage of net production was not being tracked


  • No job descriptions or system protocols.  No statistical monthly tracking of staff performance.
  • Treatment plans were entered into the computer but not formally presented to the patient.
  • Statements were sent monthly or whenever there was time.
  • The patient portion was not being calculated for the appointments being scheduled so the patient was not asked to pay at the time of service.

There were also many observations about her practice that were very positive.

  • Patients enjoyed visiting with the staff and Dr. Kassell.  It was a friendly and professional atmosphere.
  • The dentist was excellent at presenting a concise and understandable treatment plan to each patient.  Her assistant was well-trained and was very effective in answering the patients’ questions about procedures and treatment.
  • Her hygienist was comfortable with “pre-heating” her patients to possible treatment that may be recommended by Dr. Kassell.  She used the intraoral camera extensively.
  • The “New Patient Experience” was well accepted by all the new patients and I heard many compliments from the patients as they were leaving.

OK…so what is wrong with this picture?  With so many positive points, what is happening here?  Do you know?  Is this happening in your office? 


  1. Jamie, the Practice Coordinator, MUST learn to perform the following tasks:
    1. Present the treatment plan as sequenced by the doctor and assistant, along with the patient’s investment.  Offer financial options, such as Care Credit and schedule the patient for the first appointment, informing them of their “portion” to be paid at that time.  Give the patient a signed copy of the treatment plan.  Write the patient’s portion on the back of the appointment card “as a courtesy”.
    2. Statements MUST be sent out weekly or when an insurance payment is posted and the patient still has a balance.
    3. Insurance claims MUST be followed up on within 15 days
    4. Past due account follow-up phone calls MUST be made monthly and handled accordingly
    5. She MUST collect the patient’s portion at the time of their visit and not wait to send the statement after the insurance company has paid.
  2. A monthly monitor must be completed and reviewed that illustrates Jamie’s performance in order to hold her accountable for her tasks.
  3. A review of her performance must be conducted with Dr. Kassell to discuss training issues, challenges and positive reinforcement.
  4. Within a reasonable amount of time (3-6 months) a decision must be made regarding whether or not Jamie is the right employee for this position.


WOW!  Item #4 is aggressive and confrontational, isn’t it?  No, it isn’t.  Dr. Kassell owns a business and she must make business decisions in order to keep her business profitable.  If she is not profitable, she can’t keep her doors open and continue to do what she enjoys, which is practicing dentistry.

Dr. Kassell’s practice thrived for the first 3 years because she had a Practice Coordinator that understood the necessity for patients to pay for the services that they received.  When she left and Jamie was hired, Jamie was an exceptionally friendly face at the front desk and all the patients liked her immediately.  However, managing the financial aspect of the patient accounts was not her strong suit.  Over the past 2 years, less and less money was being cash-flowed.  Since there were no monitors completed to illustrate these facts, Dr. Kassell didn’t know what was happening. 

Doctors….PLEASE get training for your business employees in order for them to perform at their maximum potential.  As hard as it is, DO NOT KEEP an employee that is not suited for the position that they were hired for.  It will eventually break your bank and you could be the one looking for another job!

If you would like more information on how McKenzie's Practice Enrichment Programs can help you IMPLEMENT proven strategies….. email info@mckenziemgmt.com.

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