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  03.24.05 Issue #159


Technology: Pathway to Profitability or Financial Sinkhole?

Sally Mckenzie, CEO
The McKenzie Company

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From digital X-rays and photography, to electronic charting, to practice management software and clinical hardware, dental practice technology has exploded and the aftershocks continue to reverberate with each generation of the newer, better, faster models. Companies line dental meeting exhibit halls with expertly designed technology displays and skillfully choreographed presentations so enticing even the casual browser wishes they could purchase it all. The wares promise to fill essential practice needs, simplify procedures and operations, reduce stress, and increase productivity. And in most cases, the products can deliver that and more, there’s just one small catch. Read on.

Too often when dentists make major technology purchases for their practices they convince themselves they only need half the product. Consequently, that wonderful new hardware, software, or state-of-the-art tool delivers a miniscule 10% - 30% of what it’s capable of delivering.

After a while, it is relegated to the corner of the room along with the other “dust bunnies” tucked here and there around the office. Or perhaps it will be stuffed in the back of the closet with a growing collection of gadget skeletons. In other cases, it’s software that the staff simply abandons or finds ways of working around because it won’t function as they need it to. No business, dental or otherwise, can afford to invest thousands of dollars – in some cases it is upwards of $50,000 - in its technological infrastructure only to discard it out of frustration.

But how do you ensure that every piece of equipment and software is delivering a 100% return on your investment. Rather than purchasing half the product, make sure you walk away with the entire package. Let me explain. As dentists, you are expert clinicians and superior problem solvers. Unfortunately, because you are so effective in these areas, you often convince yourselves that you can figure out how to use just about any product or device. You further persuade yourselves that you will create time in your nonstop schedules to teach the staff and make them experts as well.

The technical term for this type of thinking is what we in practice management refer to as “delusional.” As the primary producer in the practice, the chief executive officer, and in some cases the human resources director, you don’t have time to serve as vice president of information/practice technologies and corporate trainer too. Consequently, dentist after dentist will invest tens of thousands of dollars in new technology and software only to render their systems virtually useless because they habitually fail to spend money on training.

For those dentists that are willing to pay to educate staff, many will insist that it be crammed into a few days for fear of sacrificing valuable production time. However, training dollars are much better spent if the instruction is conducted every six to eight weeks over the first year so that staff can master one element of a system before moving on to the next.

Rather than overextending the budget on technology to the point that you don’t feel you can afford training, develop a plan that will allow the office to truly maximize this major investment. With your team, take a step-by-step approach to determine how the technology can be integrated most effectively into the practice.

  1. Start with a technology vision for the practice. How do you want the practice to use technology? How do you want the patient to benefit from technology?
  2. Conduct your technology inventory. Examine what you have in hardware, software, and networking capabilities.
  3. Set your priorities. The cost of technology has come down considerably, but it remains a significant investment for virtually any practice.
  4. Don’t try to do it all at once. Plan to integrate technology in stages.
  5. Train staff.
  6. Budget for technology on an ongoing basis.

Next week, Technology: How much is enough?

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

Interested in having Sally speak to your dental society or study club? Click here.

Looking for a pot of gold? Check out your own "back yard."

Dr. Nancy Haller
Executive Coach
The McKenzie Company

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I just saw the movie The Wizard of Oz for the umpteenth time. It’s my favorite. A classic story about the search for happiness…somewhere over the rainbow. More recently I stumbled upon Russell Conwell’s book, Acres of Diamonds, where a farmer sells his land to travel in search of riches only to find that the back acreage he sold was filled with diamonds all along.

The moral of both stories? There is no place like home…you have the answers to your dreams within your reach right now!

And if you aren’t selling to existing patients, you’re overlooking the pot of gold in your own practice!

Granted, the word ‘selling’ yields a negative, visceral response for many dentists. Images of unethical used car salesmen are common. I’ve heard dental coaching clients tell me they feel ‘dirty’ when they think of ‘selling’ their services.

Certainly today’s patients are savvy about sales pitches. No one wants to be sold. For the consumer, being ‘sold’ conjures up negativity…being convinced to buy something you didn’t want or need.

But I’m not talking about the dreaded, obvious ‘sales pitch’. Selling authentically goes beyond technique and moves into how you think, and act.

  1. Expand your definition and perception of ‘selling’. Use the word ‘influencing’ instead. To ‘influence’ is to alter someone’s conduct or thought. To educate.

    Example: Mr. Jones is your new patient. He believes that aside from a simple cleaning with your hygienist, his teeth are in good shape. He doesn’t think he needs any treatment even though he hasn’t seen a dentist for “many” years. On examination, you discover the need for deep root scaling, three crown replacements, and six veneers. You know all of this work is necessary. How will you ‘influence’ Mr. Jones to proceed?
  2. Be consultative. Rather than to ‘hard pressure’ Mr. Jones, provide him with sincere guidance. This isn’t a ‘sales’ pitch. Let him see your passion and dedication for good dental health. Educate and advise him. Remember, what you say is not as important as how you say it. Be sensitive in your communication and delivery. Present options to Mr. Jones. Find out what’s important to him by asking questions. If he says ‘no’ to treatment, be curious. Keep him talking and listen to what he says. Your goal is not to ‘sell’ him anything at this point but to explore his hesitancy or resistance. It is only when you understand the reasons behind his ‘no’ that you can work with him to develop a plan.
  3. Build rapport and trust with all your patients, new and old. No matter how technologically advanced the dental field becomes, your success in converting diagnosis to treatment still depends on the strength of your relationship with the patient. Make it a point to learn something about each and every one of them. Keep notes in their charts so you will remember to ask about a special hobby or family member when they come in for a follow-up visit. Sing your own praises. Find out what you’re doing right and let your patients know. One of my current dental coaching clients surveyed his patients with a simple 10-item questionnaire. The results were eye-opening about what they most expected from him – someone who listens, cares and is honest. He is going to send letters underscoring these practice values and thanking patients for their confidence in him.
  4. Stop blaming the insurance companies, the economy, the "season". Focus on the things you DO have control to modify…yourself. Move out of the ‘just enough’ syndrome and raise your monetary bar. Visualize the future with more financial freedom, whether it’s recreational activities, travel or simply more work satisfaction and joy. Pay attention to the emotions that accompany these inspiring images. Repeat this exercise several times per day.
  5. Ask for what you want. The same coaching client I mentioned previously has a wonderful phrase he says to patients when they praise him, his work, his staff. The greatest compliment you could give me would be the referral of a family member or friend”. Short and simple, no need to say more. Commit this phrase, or a similar one, to memory. Make it a deliberate part of your business philosophy. These types of responses should be a standard from each and every employee in your office.

Like the Scarecrow, Tin Man and Lion, it takes brains, heart and courage to succeed in business today. Practice these five principles and you’ll find your way down the Yellow Brick Road!

Send your feedback and questions to Dr. Haller at

Posterior Resins and Composites

Tom Limoli
Atlanta Dental

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It is not uncommon in today’s marketplace for both the dentist and patient to prefer a resin based or composite restorative material rather than traditional amalgam. Amalgam has been around since the dark ages. For you historians of early alchemy, the composition specifications of dental amalgam are approximately 65% silver, 25% tin, 6% copper and 2% zinc. Trituration is the process of mixing together these alloys with mercury to produce the amalgam compound. If and when the composition is properly placed, polished, burnished and cared for by the patient - these restorations will last a lifetime.

As a whole, the benefit industry still considers dental amalgam the benchmark of plan design. This is not to say that amalgam is in any way superior to the many hybrid resins and composites of today’s technology. It is simply the standard of plan reimbursement.

I can hear G.V. Black screaming from the grave. “How dare those insurance companies only pay for amalgam? Sounds to me like an insurance company conspiracy. Quick, someone notify the tooth fairy. We need her help…We have got to get some new laws passed”. Sorry, HIPAA is not going to solve this problem.

I laugh in utter amazement at the number of useless legislative proposals that intend to place treatment blame on anyone other than the doctor of record. Both political forces are looking to do nothing more than trying to please their constituents by redirecting the wayward finger of blame. How is it that legal documents (benefit plans) are now rendering care? Let’s face it, they aren’t. Dental professionals are rendering treatments. Corporate entities and benefit plans are nothing more than money managers and administrators. Nothing more.

As the dentist you are the captain of the ship. It is your responsibility to diagnose the clinical condition and treatment needs of the patient. Diagnosis can not be delegated. Without you and your clinical expertise dentistry becomes a craft of smoke and mirrors rather than a healing art.

Your entire office needs to let the patient understand that their individual benefit plan addresses only the basics of preventive and restorative care. All services charged above the scheduled amount as designated by the plan of benefits are to be paid by the patient. Acceptation is noted with the participatory plan.

You need to communicate not only with your team but also as a team.

To be both competitive and cost effective in this evolving marketplace your office needs to deliver superior QUALITY dentistry. No “HMO dentures.” No “gross scaling.” No inferior care. Poor qualities with shoddy materials are nothing more than an invitation to malpractice litigation.

Understand the realities of a free market economy. It’s just like that rental car I had last month in Houston, Texas. The client paid for and provided a two-door Chevrolet sedan but I opted for the upgraded SUV Oldsmobile Bravado. Who paid for the upgrade in service? Was it the client? The airline? The rental car company? General Motors? No, I paid for the upgrade. This example is no different than today’s generation of benefit plan design.

Tom Limoli, Jr. is the author of “Dental Insurance & Reimbursement Coding and Claim Submission Manual" to order click here. Tom can be reached at 404-252-7808 or at

Sally's Mail Bag

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Dear Sally,

I would appreciate your advice. I just took over an office and I have closed out one payroll period.  The office average gross was 550k over the last 3 years but we did not come close to that last year and the retiring doctor is still here. To get to my question, I held a staff meeting this past friday and I discussed basic issues.  I supplied lunch and we met in the office.  I have 7 women working here (2 hygiene).  I asked the previous owner, and he said he did staff meetings during lunch and they were not paid.  However, on their time cards everyone added the staff meeting as being paid.  I do not thnk they should be paid as I feel it is part of development-What do you think?

Dr. Ian Distress

Dear Dr. Distress,

A meeting held as part of your business in which employees are asked to participate is considered work and they should be paid. But, if I may, I would like to offer some advice. Don't have the meetings over lunch. Participants are too concerned of where the salt, pepper and mustard are located. They aren't focused. You need one two hour meeting a month and the best time is first thing in the morning or at the start of the afternoon AFTER lunch. Yes, you will lose production but it is important to believe that the long term benefits will help to increase production. I also don't believe it is fair to pay hygienists their "production" salary during a staff meeting when they aren't producing. In other words, if a hygienist is paid $30/hour to do hygiene services she would be paid $15/hour to participate in a meeting. However, this is something that should have been disclosed at the time you took over the practice. If they weren't paid before, perhaps they will be comfortable with this arrangement.

The problem I see for you is that you are probably the "young whipper snapper" dentist and they are still giving loyalty to their former boss. Right now the playing field is not level. The only way I know to level the playing field is to have one of my consultants in the office, who is more of an expert than anyone in there, to present fair and reasonable and obtainable recommendations and objectives so everyone's knowledge level is the same.

If you would like to know more about how we can make this happen for you, please email me personally at

Good luck,


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