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  Sally McKenzie's
 Weekly Management e-Motivator
  8.13.04 Issue #127

From Delinquency to Dollars in Hand

Sally Mckenzie, CEO
McKenzie Management

       Admittedly collecting on delinquent accounts is about as much fun as rush hour traffic, so the task must be assigned otherwise it will never get done. The financial coordinator, who is responsible for setting up financial arrangements with patients, must be responsible for delinquent account follow-up. She needs to be both compassionate and firm with patients – too pushy and she’ll run smack into the force field, too lenient and the delinquents will run her over.

Give her space and time to get the job done. She

cannot be expected to make these follow-up calls in between scheduling appointments, meeting and greeting patients, and filing insurance claims. This responsibility requires uninterrupted time in a private area. If the office has only one person in the business portion of the practice, her hours may need to be adjusted to allow her to make calls in the early evening and on days when the doctor is not seeing patients.

Start making calls today. Delinquent account calls begin at 31 days – not 60 and definitely not 90 days after the balance is due, as the weeks drift by, so too do the chances of collecting on the account. A survey conducted by the Commercial Collection Agency indicated that after just three months, the probability of collecting drops to 73%. After six months, the probability of collecting drops to 57%. After one year, the chance of ever collecting on a past due account is a dismal 29%. Like it or not, you can’t afford to let these accounts sit.

Avoid the tendency to just run down the names. It’s common practice to print out the list of overdue accounts and plunge in with the first name on the list. Instead, focus first on those individuals that owe the most money and are most likely to pay. Those are the calls more likely to reap the greater collection successes.

Before picking up the phone take a few minutes to prepare.

  1. Review the patient’s past payment history.
  2. Double-check to ensure there is no error on the part of the practice in billing or insurance filing.
  3. Be prepared to document the conversation.
    Every contact with every patient should be professional. As disgusted as you personally may be with the string of excuses, you represent the doctor and the practice. If you become unprofessional or condescending, the patient is more likely to dig in and wait to see who blinks first. After all, they have the payment money you want. Kindness goes a long way.
  4. Call in the early evening when most people are home from work.
  5. Be kind but firm with the patient.
  6. Ask if they have received their statements and confirm their current address.
  7. If they claim they are not receiving their statements, send another expecting payment immediately along with a polite letter confirming their commitment to pay by the specific date.
  8. If statements have been received, ask them why they have not paid and when you can expect payment.
  9. Do not accept vague commitments, e.g. “I’ll pay in a few days,” or “later this month.” Assign them a specific date to have payment delivered. “Mrs. Jones, we’ll look for your payment on or before Aug. 31.”
  10. Document all conversations with the patient and keep as part of the patient’s payment history.
  11. Send a written confirmation of the patient’s payment commitment along with a statement to the patient.
  12. Follow-up on payment promises. If Mrs. Jones said you would receive a check by August 31, and it’s not in the mail that day…you’re on the phone.

While persistence can and often does pay off, in some cases the patient has absolutely no plans to ever pay the practice. After all other steps have been exhausted send a letter to the patient telling them that time has run out and the account will now be turned over to the collection agency or your attorney.

But remember, there is no time like the present. Make it your practice policy to collect at the time of service.

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

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What’s Your Conflict Style?

Dr. Nancy Haller
Executive Coach
McKenzie Management

        If conflict makes you nervous, you aren’t alone. We live in a world where violence and even war are seen as viable solutions to conflict. With so much negative attention, it’s no wonder that we shy away from conflict. However, the problem isn’t conflict; it’s when we ignore conflict and let it build that dissension arises.

Conflict occurs when contradictory values, perspectives and/or opinions come together.

Without alignment or agreement, diversity of beliefs can lead to potential problems. Yet conflict is inevitable in any dynamic relationship. It signals change and, hopefully, growth. Conflict can clarify important issues, result in solutions to problems, increase authentic communication, and help individuals to learn more about each other for greater understanding in the future. Conflict is destructive when it takes attention away from important activities, undermines morale, polarizes people and groups, intensifies differences, and leads to irresponsible or harmful behaviors.

Early indicators of conflict are recognizable, and there are strategies for resolution that are available and DO work. In other words, although inevitable, conflict can be minimized, diverted and/or resolved. I’ll cover those in another article. First it’s important to take an assessment to identify your style of dealing with conflict.

Indicate how often you rely on each of the following strategies by circling the number that is most accurate, from 1 (rarely) to 5 (always).

1. I argue my case with my employees to show the merits of my position.
1 2 3 4 5
2. I negotiate with my employees so that a compromise can be reached.
1 2 3 4 5
3. I try to satisfy the expectations of my employees
1 2 3 4 5
4. I try to investigate an issue with my employees to find a solution acceptable to us.
1 2 3 4 5
5. I am firm in pursuing my side of the issue.
1 2 3 4 5
6: I attempt to avoid being "put on the spot" and try to keep my conflict with my employees to myself.
1 2 3 4 5
7. I hold onto my solution to a problem.
1 2 3 4 5
8. I use "give and take" so that a compromise can be made.
1 2 3 4 5
9. I exchange accurate information with my employees to solve a problem together.
1 2 3 4 5
10. I avoid open discussion of my differences with my employees.
1 2 3 4 5
11. I accommodate the wishes of my employees.
1 2 3 4 5
12. I try to bring all our concerns out in the open so that the issues can be resolved in the best possible way.
1 2 3 4 5
13. I propose a middle ground for breaking deadlocks.
1 2 3 4 5
14. I go along with the suggestions of my employees.
1 2 3 4 5
15. I try to keep my disagreements with my employees to myself to avoid hard feelings.
1 2 3 4 5

Write your scores next to the number for that statement. Then total up the columns. Your primary conflict style is the category with the highest total. Your secondary style is the category with the next highest total.

  Style A Style B Style C Style D Style E
  6 2 4 3 4
  10 5 11 8 9
  15 7 14 13 12
_____ _____ _____ _____ _____

Here’s what your score suggests.

If you are Style A, you use Avoiding. It is likely that you tell yourself that it’s not worth the effort to argue, but conflicts worsen over time. Stop being a turtle or an ostrich. Get out of your shell, take your head out of the sand. Learn to be assertive.

If you are Style B, you are Accommodating. You tend to give in to others, sometimes to the extent that you compromise yourself. Conflict worsens over time, and causes conflict within you because there is an element of self-sacrifice in this approach.

If you are Style C, you are relying on Competing as a conflict strategy. You try to get your way, rather than to clarify and address issues. Competitors love accommodators. Although conflicts seem minimal on the surface, turnover and negativity are likely in your office.

If you are Style D, you are Compromising. You use a mutual give-and-take process to resolve conflict. This is most effective if two people both want exactly the same thing and it can be divided up or shared. Otherwise, it’s better to work a little longer to find a mutually pleasing solution.

If you are Style E, you are a Collaborator. Congratulations! You try to get everyone working together, meeting as many current needs as possible. In all likelihood, you cultivate ownership and loyalty.

Obviously there is no one best way to deal with conflict. It depends on the situation. However, successful dental practices operate on teamwork. Strive to develop a collaborating culture in your office. Encourage your staff to acknowledge, deal with, and appreciate their disagreements. Deal with conflict up front. It will lead to open communication, higher productivity, and increased professional and financial success.

If you would like to improve your ability to manage conflict constructively, contact Dr. Haller at


Hushed Whispers
Loud and Clear

From the Patient’s Perspective

         Wars are won or lost based on its effectiveness. Business arrangements fail or succeed and marriages flourish or wither because of it. Patients will love you or simply tolerate you depending how well you handle this. It’s the one characteristic that can almost instantly distinguish the excellent from the

average. Communication. This is the bricks and mortar of every relationship you build with your colleagues, your team, your family, and, most importantly, your patients.

Today’s dentists have made huge strides in how they communicate with patients. The dental patient is recognized as a partner in the diagnostic process and volumes have been written about the importance of handling seemingly every communication situation from phone calls, to written correspondence, to email, to treatment presentations, to collections discussions, to patient financing conversations. But just when you think you’ve got the perfect script for every scenario, communication snafus come up in the most innocent and unlikely places.

They are the tense conversations between you and your staff that you thought the patient wouldn’t notice, the casual discussions about so-and-so held in the hall out of the room but not out of earshot, the exasperated sighs and rolling eyes when such-and-such walks out without paying their bill again, the latest office/patient “news” exchanged between team members. And then there is what I call the “dissected frog” discussion. This is when doctors and/or staff discuss or, in some cases, disagree about how a procedure should proceed right in front of the patient, treating the individual not as a person, but rather a “specimen” to which something is being done. There’s the patient, Mrs. Jones, sprawled out on the chair, just watching the verbal match take place before her, left on the periphery as if she weren’t even in the room.

All the while, she is wondering, “Should I be concerned? Is there a problem? I really wish they had settled this before I walked in here. Do the doctor and staff really know what they are doing?” Disagreements and inappropriate discussions among doctors and team members make patients feel very uncomfortable. It’s like walking in on an embarrassing situation. But the patient can’t just turn around and walk out. What’s worse, when the patient senses that the staff is distracted or in disagreement, their feelings of vulnerability and anxiety surge.

As rare as you may believe these situations are in your practice, they are far more common than you realize and the patients don’t forget them. If it occurred the day they were in, as far as they are concerned, it’s modus operandi in your shop. Without even realizing it, doctors and staff routinely discuss other patients’ care and engage in personal gossip about patients and staff. They will argue about specific treatment, tell stories about the families of patients and staff, and share opinions on everything from politics, to sex, to religion all right in front of the patient.

Although the patient may have instruments, suction, and other items in their mouth and can’t talk, it doesn’t mean they don’t hear everything that is said. Hearing range is not only the operatory. Staff also can be heard if they are in a close hallway. If the patient is wearing earphones to listen to music or television they may have quietly turned it off.

Monitor your conversations and discussions. Always assume the patient can hear every word that is exchanged and follow some basic rules for professional communication.

  1. Never have a disagreement in front of a patient. It makes the patient nervous and undermines confidence in the doctor and the staff.
  2. If one doctor or a member of the staff needs to discuss treatment with another doctor or another staff member, have the discussion in another room so the patient can’t hear you.
  3. Try not to disrupt the doctor while he is with a patient. The patient should feel like he/she is the most important person in the doctor’s life at that time.
  4. Doctors and staff should always be aware that the patient can see and/or hear you at all times as long as you are in the operatory or nearby hallway.
  5. Always show respect for your team members and other patients whether they are present or not.

Share your comments, questions, and “patient perspectives” at




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Dear Sally,

I have an employee who has been with me for 8 years. Her performance is mediocre at best and of course she feels she is entitled to a raise every year. I just don’t know what to do?

Dr. Raisnomor

Dear Dr.,

There’s no doubt that the most difficult personnel issue to address, particularly from an emotional standpoint, is long-term employees. Some dentists, like yourself, feel trapped. They’ll reason that,
“She’s been with me for ‘x” years.” “She knows all the patients and I think that helps the business.” And then year after year after year you feel obligated to this entitlement for fear she might leave.

Doctors in this type of situation should adopt a basic policy stating that raises will be given based on the performance of the employee and….the business. You can’t afford to give raises when business isn’t improving.

The best time to adopt this policy is after you have given the employee his or her next raise. Methods to measure employee performance as well as practice expectations should be developed and communicated to the employee. Let me know if you need help with this area.


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