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  9.17.04 Issue #132

You’ve Given, Now It’s Time to Receive

Sally Mckenzie, CEO
McKenzie Management

       Many dental teams are brimming with caring and compassionate and high feeling types who will gladly bend over backwards to be helpful and accommodating to patients only to nearly decimate the financial stability of the business. How? Staff members – including the dentist – unintentionally yet routinely send the message to patients that it is perfectly acceptable not to pay for treatment until some later date when they’ve paid all their other bills and they have a few bucks left over to make a payment. Consequently accounts receivables are threatening to drown the practice in a sea of red ink.

Doctors should avoid the temptation to engage in payment discussions with patients as many fabulous clinicians forget that they are not equally magnificent financial negotiators. Leave the job to a well-trained financial coordinator who is fully prepared to handle patients’ monetary concerns, questions, as well as present payment options that will benefit the patients without bankrupting the practice.

Keeping accounts receivables well under control requires effective collections. And effective collections requires someone who is assertive, polite, tactful, confident, and goal oriented. Mary may be a wonderful member of the team, but entirely too wishy-washy when it comes to collections. If Mary is your only option, train her. If Sue is better suited for the position assign the responsibility to Sue and train her. The person asking for payment must understand it is their job to collect from patients and be accountable for their results.

The ideal accounts receivables threshold of one month’s production is well within reach if you take steps to clean up the typical messes:

  • Insurance – File insurance claims electronically and immediately. Electronic claims submission significantly improves the payment turnaround time. The financial coordinator should know the amount anticipated from the insurance company. However, the patient should be expected to pay the bill and receive reimbursement from the insurance company. Too many practices that accept assignment of benefit do not bill the patient until after the insurance company pays. This implies to the patient that they are not fully responsible for their bill – wrong message to send.
  • Collect today – Make it practice policy to collect the entire fee today unless specific financial arrangements according to the financial policy have been made in advance for more costly procedures.
  • Billing –If not daily, bills should be sent out weekly. Don’t wait to send bills once a month. Include a self-addressed envelope and state the date that payment is due. Bills that are 30 days past due should include a personalized delinquent message. For example, “Dear Mrs. Jackson, we did not receive your payment on Sept. 15 as requested. If you are experiencing financial difficulty please contact our office. Otherwise, we ask that you take care of this account balance by Oct. 1. Sincerely Julie Moore, Business Manager.
  • Financial Policy – Establish the policy, communicate it to patients and staff, and live by it.
  • Options – Provide reasonable payment options in the policy, such as patient financing, that make it easy for patients to agree to treatment and even easier for the practice to receive payment.
  • Accountability – Make one employee accountable for collecting money, generating accounts receivable reports, and following up on delinquent accounts..

Patients that balk at the notion that you deserve prompt payment are also more likely to be the last minute and no show patients that wreak havoc on both your schedule and your bottom line. The vast majority of your patients have been wondering when you were going to get in line with every other business in the marketplace today. They are more than willing to oblige with your prompt payment expectations.

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

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Sharpening Stones

Dr. Allan Monack
Hygiene Clinical Director
McKenzie Management

        It is perplexing that many general dental offices that I consult with do not maintain the most critical equipment in the hygiene department, scalers and curettes. They are often dull or past their effective life expectancy, sharpened infrequently or worse yet…sharpened wrong and I rarely see a sharpening stone on the hygienist’s instrument tray. When the instrument looses its edge so does the hygienist! It is critical that the hygienist remove calculus and infected cementum efficiently and effectively.

Dull curettes and scalers can actually remove only the outer layer and burnish the remaining calculus making it more difficult to remove.

There are a vast number of ways to sharpen instruments. Some of the techniques include: moving flat stone, stationary flat stone, sharpening cone (for curved cutting edges of sickle and curettes), the Neivert Whittler, mandrel mounted stones, honing machines, and honing channel systems. You must be comfortable with the technique you choose to employ. A myriad of sharpening tools can be purchased to obtain great results.

The following is a list of commonly used sharpening instruments:

Arkansas: This is a natural stone. It comes mounted or non-mounted. It must be lubricated with light oil to be effective. It has a fine texture and is used for routine sharpening. It comes in the most varied shapes of any sharpening stone.

India: This is a synthetic stone. It comes non-mounted. It needs light oil lubrication also. The texture can be fine or medium and is also used for routine sharpening.

Ceramic: This is obviously a synthetic that is usually non-mounted. It can be manufactured in many abrasive variables to satisfy many needs. Usually, the standard types are fine and medium. The fine texture is used for routine sharpening while the others can be used for reshaping.

Composition: These come mounted and have grooves and curvatures that only allow the instrument to sharpen in a correct manner. The texture is course so it is easy to over prepare the curette or scaler and shorten the effective life of the instrument.

After eight strokes the scaler or curette commences to be dull. It is strongly recommended that a sterile sharpening stone be placed on each setup. You can use the guided sharpening instruments to do major reshaping, but you need a small stone on your setup tray to keep your instruments working at maximum efficiency. When they become narrow and thin, it is recommended to replace the instrument. An option is re-tipping. With the replacement policy of most manufacturers, it is better to trade in the old instruments than to re-tip.
Testing for sharpness can be achieved in a variety of manners. Some examples include: a plastic test stick or a light to check for reflection of dull surfaces. Test the sharpness of your curettes and scalers frequently during the procedure and correct dullness as soon as you discover a dulling of the instrument. The hand instrument is placed on the plastic stick at a fifteen degree angle and the curette should engage the stick. Check along the length of the working end. You can be dull near the tip and still be sharp in the middle of the curette. Light reflection can quickly discover areas of dullness by reflecting light off of the working edge of the scaler or curette. The edge of a dull instrument will be wider than a sharp edge and reflect more light. It is easier to detect dullness with the reflective light than the plastic stick. However, they take up more space in the operatory and don’t belong on the instrument tray.

There is nothing like having the proper equipment to make your life easier and save you time. Keep the curettes and scalers in peak condition. It will save you time, be more comfortable for your patients, and give you the best chance to reverse the inflammation caused by the irritants found in the calculus left on roots and cementum by inadequate removal.

If you have any questions concerning your hygiene program submit them to me at and I will answer them in future articles.

Interested in having Dr. Allan Monack speak to your dental society or study club? Click here


Building Trust Between Patient and Doctor

“My Previous Dentist Said I Didn’t Need a Crown on That Tooth.”

Belle M. DuCharme
RDA, CDPMA, Director
The Center for
Dental Career Development

         Patients do not know much about the clinical end of dentistry but they do know when people are treating them fairly and honestly. Patients need to assess the doctor and his practice as being worthy of their trust before embarking on a course of treatment.

Through our Advanced Dental Business Training Program, let’s look at the case where the doctor was running behind thirty minutes. His next patient sat in the reception room quietly waiting his turn. When asked if any one had told the patient of the delay, it seemed everyone was

too busy to notice. Looking up the patients’ account, we find that he had been charged $100.00 for a failed appointment two months ago. He had apologized and paid the fee. In total, he had spent $12,000.00 in the last three years in the office for restorative and cosmetic procedures. Recently, his wife had joined the practice as a new patient. This is an example of a patient who trusts the practice, yet was being ignored in the reception room. Studies show, if a patient is not seated within five to ten minutes of his arrival he starts to become anxious. Patients need to be told, within this period, of possible delays. Showing commitment to the patient and a respect for his time builds trust. A large component of trust is a doctor’s clinical ability and his knowledge of the latest techniques and technologies. Just as important is the honesty conveyed by the doctor and the staff to the patient. I came across a quotation in a communication publication, author unknown, that states :

“We accept ideas more readily from those whom we view as authoritative and trustworthy and from those who treat us with respect and concern than from those who appear ill-informed, manipulative, or inconsiderate. Credibility affects the success of persuasion.”

Building trust is a multi-leveled process of treating patients with integrity from the first phone call through treatment presentation, acceptance, delivery and placement into the recall system. A breach in any area can cause the patient to leave the practice. The main factors in establishing trust with a patient are as follows:

  • Competence. Patients trust that you are a licensed and professionally qualified dentist who will make an accurate diagnosis and deliver excellent care.
  • Confidence. You, as a dentist feel 100% confident in your treatment recommendation and your ability to deliver the care the patient needs.
  • Frankness. The patient feels that you are giving them the total picture and not keeping important information from them about the treatment or options available.
  • Fairness. In my experience, many issues having to do with trust are linked to the patient’s perception of the value they are receiving versus the cost.

In my next article, I will explore the ways in which the dental team can build trust based on the above bullet points.

For more information, call THE CENTER FOR DENTAL CAREER DEVELOPMENT at 1-877-777-6151.

Belle M. DuCharme, RDA, CDPMA

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Dear Sally,
It is our office policy to charge $25 per hour for broken appointments without 24 hour notice. In the past I always sent a warning letter for the 1st occurrence, even though it is stated as policy in our new patient letter. I recently told my staff, no more warning letters. My time is valuable. I feel that I am busy enough now, that if the patient doesn't like it, I can afford to lose them. Yesterday a patient phoned, upset about the charge. She was charged $50 after forgetting to come to a 2 1/2 hr appointment. She wanted to speak with me. How would you handle that?
Dr. Thompson

Dear Dr. Thompson,
I would advise not to charge for broken appointments because it can cause the anger you are seeing with this patient and you legally can’t collect it anyway. While I understand where you are coming from....completely, i.e., the rules are the rules and it’s not fair what they are doing, there is a more subtle way of getting them out of the practice than punishing them (which is how they view it). My experience in consulting with practices that have done what you are doing, i.e., letters, only begins to spread a reputation that is negative. While you may be very busy now, there may come a day when you won’t be because patients have left the practice because you are so rigid. My suggestion is to speak with her and listen to why she “broke”, “failed” the appointment. It is important for appointments to be confirmed the day before and speak to a patient. If the patient has not shown up within 10 minutes of their appointment, your receptionist calls and keeps calling till she reaches the patient to find out the reason. On the 2nd occurrence that she feels this patient has lied to her as to why they haven’t shown up she would say, “Mr. Smith, obviously we are having difficulty scheduling an appointment that is convenient for you and your office. We don’t have any open appointment times now but I have your information here and should we have an opening I will give you a call.” Providing you are not in the middle of treatment, this patient may not be called back but this is a non confrontational way of dealing with it than charging the patient.
Hope this helps.



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