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  Sally McKenzie's
 Weekly Management e-Motivator
  7.30.04 Issue #125

Rounding up the Collection Misfits

Sally Mckenzie, CEO
McKenzie Management

       It is the best of times and the worst of times. More patients are seeking dental services. They are better educated about dental opportunities available. Reality TV is showcasing dental miracles regularly, and more patients are looking for their own “extreme makeover.” But while interest in dentistry is soaring, payments may be sinking, as a number of dental practices feel the pinch of a consumer culture in debt up to its dentition.

Enter delinquent accounts. As every dentist

knows, they are the collection misfits that somehow continue to dodge and dive below the radar, sucking profit from the practice like a summer swarm of mosquitoes feasting on fresh flesh.

In some cases they are the emergency patients that never returned. In others they are the practice hoppers that make the rounds bashing the last dentist and complaining about the current dentist. In still others they are nice patients who never seem to have their acts together. You know the ones; they forget appointments, don’t return calls, but eventually get around to paying their bills, apologizing all over themselves the entire time.

A few others really don’t care if they pay you or not, they’re more worried about the bank repossessing their car or house or the hit from the utility company that charges interest for late payments. Some delinquent accounts will belong to long-term, loyal patients that have found themselves in the throws of a catastrophic situation. Regardless of the circumstances or personal decisions that lead to a delinquent account it is money owed to the practice.

The first line of defense against delinquent accounts is a clear financial policy. The policy is in writing and has been given to every patient. It establishes clear payment parameters. It does not put the practice at risk by extending interest-free loans to patients. It provides specific options for patients. And it is not routinely circumvented by Dr. Lets Make a Deal who decides to privately negotiate payment plans with patients. But the policy can only shield the practice so much.

In actuality, even the most effective collections systems are not immune to the occasional payment scofflaw. And virtually every practice, except those demanding cash up front, has to chase down these financial misfits, some of which can be more slippery than others.

Enter the lucky member of the dental team who finds themselves saddled with that nasty responsibility that accompanies delinquent accounts …follow-up. It’s the stuff legends are made of, the most unsavory business task in the dental practice. Few are up to the challenge, and fewer still are properly trained to handle the job well. But with the right personality and clear objectives, delinquent account calls don’t have to feel like a life sentence to the Valley of the Shadow of Death.

Next week, from delinquency to dollars in hand.

If you have any questions or comments, please email Sally McKenzie at

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Make Time To ‘Sharpen The Saw’

Dr. Nancy Haller
Executive Coach
McKenzie Management

Do you have more tasks in your day than time to complete them?

Do you feel backed up with more and more to do?

Do you often feel you don’t have any time for yourself, or your family and friends?

Are you stretched to ‘the limit’?

If you answered ‘yes’, your work-life balance has gotten out of control.

In the best seller, The Seven Habits of Highly Effective People, there is a story about a Woodsman feverishly trying to cut down a tree. When asked why he didn’t stop to sharpen the saw to ease his workload, he replied, “I don’t have time…I’m too busy sawing”.

If you’re honest with yourself, the irony of that tale is self-recognition. At one point or another, we all have worked frantically rather than purposefully. In part it’s because the pace of life has accelerated.

Sure, there have always been conflicts between work and personal life, but technological changes and the way we do business today are different than even just 20 years ago! There are more working women who juggle child-care and job demands. Business competition, longer work hours, more time in the car, more traffic, the deterioration of boundaries between work and home all add up to increased pressure.

Work-life balance does not mean that you have an equal balance between the number of hours you spend at work and those you devote to home or personal activities. Life is much more complex and fluid. Priorities shift throughout our life, and responsibilities change from day to day. But your work and personal life need not be in competition either. The foundation of effective work-life balance requires equilibrium between what you do (achievement) and what you value (enjoyment). Without both, life is unrewarding.

Get out of the trap of “as soon as”, and stop postponing the things that are important to you until that magical “some day”. When you ‘sharpen your saw’ you will be a person that not only gets things done, but also enjoys the doing. In turn, this attracts people to you. They want you on their team and they want to be on your team.

If your work-life balance needs re-balancing, take some time to identify and explore your values…the things that bring you the most joy and passion. Base your life on the values that are consistent with how you want to live your life.

Here is a sample list of values. Read through them and add more. Then circle the top 20. Put the list aside for a day then go back and narrow the list to 10. Make notations as to why a particular value is so important to you. What purpose does it hold in your life?

Honesty Trustworthiness Friendship Relaxation
Recognition Independence Wealth Health
Knowledge Family Fun Risk
Marriage Control Comfort Peace
Safety Fame Nature Caution
Structure Generosity Timeliness Helpfulness
Conservation Beauty Recycling Preservation
Approval Caring Creativity Closeness
Adventure Uniqueness Conformity Money
Loyalty Work Ethic Talent Religion
Love Companionship Solitude Quiet
Growth Justice Freedom Fixing Things
Music Harmony Objectivity Flexibility
Politics Life Challenge Change
Animals Children Students Teachers
Reading Writing Painting Computing


  • Make personal and professional self-care a priority.
  • Honestly assess your emotional, psychological, and spiritual health on a regular basis.
  • Make appropriate accommodations or adjustments -- such as limiting your caseload or consulting with peers and experts -- in light of professional stressors and risks that you are experiencing.
  • Identify sources of support and use them. Avoid isolation.
  • Take regular vacations or other appropriate breaks from work. The dentist is the fundamental “tool” of dentistry, and you need to keep yourself sharp.
  • Develop realistic and reasonable expectations about workload and your capabilities at any given time.
  • Pursue opportunities for intellectual stimulation inside and outside of dentistry.
  • Monitor carefully the substances and/or processes you use for relaxation or entertainment.
  • Seek consultation when professionally or personally challenged.

As I listened to the flight attendant review the safety guidelines on a recent business trip, there was yet another metaphor – ‘if oxygen should be required, put your mask on first then assist others”.

It’s time to ‘sharpen the saw’.

If you have any questions or comments, please email Dr. Haller at


Optimizing My Continuing Care System

Debbie Rae, RDH, MBA
McKenzie Management

Dear McKenzie Management,
We currently pre book appointments 6 months out for their next prophy etc and we are on the Dentrix system. When someone does not pre-appoint, or somehow falls off the Continuing Care “bandwagon”, how do we avoid them disappearing for long periods assuming they are actually interested in continuing care?
Dentrix is certainly capable of printing a list of upcoming patients due, or past due for

whatever period chosen. Although it’s convenient to print the list of "target patients" who fill gaps in hygiene, at some point the list becomes out of date. At that point is a new list run, but all the critical info about phone calls made and cards sent that was scribbled in the margins of the old list is gone? Certainly it is possible to log calls in the computerized patient journal. But then info can only be pulled for one patient at a time. You therefore can't survey a giant pool of patients and begin your calls with those who you know are most likely to schedule. Cards on the other hand make for a nice way to track all that information, but then we have to track the cards. Then there are calls. How many is too many? Do we block the caller ID when we call? Home first, then work? Leave messages or not? The hygiene questions seem ongoing with no consultants ever having predictable answers. Can you help?
Official Townie

Dear Official Townie,
At McKenzie Management we teach our clients who have Dentrix NEVER to print out a copy of their Continuing Care List when they are working the recall system. I agree with you that this list becomes obsolete the moment a patient schedules an appt. All the notes regarding conversations or attempts to reach the patient should be entered in Dentrix using the CC Status and Office Journal.

Every time a contact is attempted, even if there is no answer (caller ID nowadays) the Recall Coordinator is to change the status and make an Office Journal entry. This is easily done by highlighting the patient’s name in the CC list using the Status and Office Journal in that window’s toolbar. Furthermore, the CC window can be minimized and maximized to use the Appointment Book or other Dentrix modules.

I also recommend changing the original CC Status too. For example: CALL 1
No Ph -send card

We specifically teach team members to use the REMINDER type of Office Journal note for ALL recall notes because it is a RED exclamation mark and stands out in a patient’s Office Journal. BTW this REMINDER note is where we teach our hygienists to enter the “clinical reason” that both the doctor and the hygienist discussed with the patient in the operatory as to why they want the patient to return in 3-4-6-9 or 12 months for their next professional cleaning. It’s not just that 186 days has passed and their insurance will pay for it again, right???

This same clinical reason is handwritten on our McKenzie Recall Notices that are mailed in an engraved envelope customized to match the office stationary, self addressed by the patient, that contains an ADA mini brochure that addresses a concern or topic discussed with the patient during that hygiene visit. ALL done in the clinical operatory. Using this type of recall notice rather than cutesy postcards with a cartoon character or a peaceful sunset, elevates the hygiene visit to its level of importance and patients will keep pre-appointed hygiene appointments or call to schedule one if not pre-appointed.

During our weeklong on-site visit to our clients’ offices, we customize at least 6 or 7 CC setups so that all the Recall Coordinator has to do is change the Due Date Range each month. These setups list patients only WITHOUT appointments, specific CC types, billing types that do not include patients in Collections and in an order where all family members are listed together alphabetically despite having different CC dates and/or CC Status.

Each week of every month a new CC list is generated, although NOT printed, and a new set of patients is contacted. This process will catch those individuals who do not respond to your recall notices or attempts to reach them.

First week - Due this month
Second week - Due last month
Third week - Due 2 months ago
Fourth week - Mail retention and inactive letters

Wait 30 days in between contact attempts. The Office Journal note enters the date automatically. Letters sent from Dentrix are automatically entered in the patients’ Office Journal and dated. Clients have found that patients respond quicker to a human voice rather than a letter so we suggest calling at diversified times throughout different days. Once you have exhausted trying to reach the patient early morning, noon, afternoon and evening with no answer, a letter is indicated. Two letters only, then either inactivate or CLEAR their CC date out of their Family File. This will remove them from your overdue CC lists. Patients can always be made active again and should be told they would be welcome to return at any future date. Remember, an inactive letter is sent only after ... sending patients a reminder notice, calling at diversified times, sending a retention letter and then an inactive letter. Six or seven months have passed since you began your initial efforts to bring them back into the practice.

Hope this information was helpful.

Debbie Rae, RDH, MBA
McKenzie Management



Have You Increased Your Hygiene Days Per Week In The Past Year?

How To Have A Sucessful Recall System
By Sally McKenzie

Unfortunately, patient retention is not guaranteed by preappointing, sending postcards, letters, or even phone calls. But an effective use of an integrated retention system can significantly improve your ability to keep patients returning. This step-by-step guide to the systems used by today's most progressive practices includes: letters that get responses, telephone monitoring techniques to ensure patient retention, tools to monitor your success, and scheduling tips for a productive hygiene department.

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Sally's Mail Bag

Dear Sally,

What are your thoughts on digital radiography?

Dr. Ray

Dear Dr. Ray,

Today, X-rays remain a fundamental diagnostic tool of every dentist in America. How you choose to take those images can greatly impact your practice. I recently read in the June 2004, Dental Products Report that more dentists were choosing to implement digital radiography into their practices this year than any other technologies available to them. I know that’s true of our clients. I think digital X-ray is dentistry’s fastest growing technology. From a dollar and “sense” point of view, we find that most practices are already spending more money than it takes to own Digital X-ray. How much are you spending on film, mounts, chemicals, duplicating supplies, and labor? Let’s do the math! Based on the 1999 ADA figure of 45 cents per film for film, chemicals, and mounts, if you took 2 FMX, 6 BWX, 5 PAs a day, your monthly costs are $526.50. Most of the digital systems available today can be leased for as little as $325 a month. So as you can see, you’re already spending the money. Digital X-ray is ‘Replacement Technology’. In addition there are benefits for your patients such as lower radiation exposure, shorter appointments, improved education and understanding through image visualization and you can spend more time chairside, discussing treatment plans, and building stronger relationships. Let me say, that if I owned a dental practice…I would have digital X-rays.

Best regards,

Office Managers
Financial Coordinators
Scheduling Coordinators
Treatment Coordinators
Hygiene Coordinators

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Dental Trade Alliance - "One Voice, One Vision"
AUGUST 4-8, 2004

Saturday, August 7
8:00 - 8:15 am Edward B. Shils Entrepreneurial Education Fund Presentation (speaker tbd)
8:15 - 10:45 am "Future Vision of Dentistry"
Richard Fishbane, Vice President, Research, Strategic Dental Marketing Inc.
Dr. Tim Adams, Clinical Director, Las Vegas Institute of Advanced Dental Studies
Dr. Arthur "Kit" Weathers, President, CE Magic
Sally McKenzie, President, McKenzie Management & Associates
Dr. Howard Farran, President, DentalTown Magazine

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