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  04.14.05 Issue #162


Treatment Presentations: Whose Job Is It Anyway?

Sally Mckenzie, CEO
The McKenzie Company

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You've traveled this long, dusty road more times than you care to remember. You know where the potholes are, but you still haven't figured out how to avoid them. The conditions are typical. The patient needs considerable dental treatment. You face the inevitable question: Do you spend hours preparing a blockbuster show complete with models, slides, radiographs, photos, etc. only to have the patient appear interested yet never schedule more than the bare minimum? Or do you save yourself the time, energy, and frustration and simply recommend what you anticipate the patient will pursue?

Your vision is to present ideal dentistry to every patient in your practice, but your reality has convinced you that vision may be more of a hallucination. If treatment acceptance in your practice isn't in the range of 85%-95%, it's time to consider whether you have the right person doing the right job.

Dentists often assume that if a patient requires extensive treatment they expect to hear that information from the dentist directly. While that may be the best approach in many instances, it isn't in all. Oftentimes, low treatment acceptance is rooted in the patient's lack of dental education and understanding. The dentist may firmly believe that Mr. Smith comprehends what is being proposed and will proceed with treatment only to discover that he has multiple questions that he is trying to clear up with the scheduling coordinator. Mr. Smith didn't really get this part or that aspect of what he was being urged to do, and he didn't feel comfortable raising the questions with the doctor.

This is where the treatment coordinator steps in. While the dentist must discuss certain issues to meet informed consent standards, such as the nature of the problem, recommended treatment, potential complications from the treatment or complications if no treatment is available, many other details can be addressed by the treatment coordinator.

For example, the treatment coordinator can spell out for the patient the number of appointments that will be necessary, what to expect at each appointment, the length of time that will be required for each appointment. She/he also can cover issues of concern that the patient might have such as worries regarding pain or discomfort. And she can discuss the all important issue of treatment financing.

Patients perceive that the coordinator has the time to answer questions and listen to concerns. They can raise difficult or awkward questions that most would never consider posing to the doctor, such as:

Does the dentist have enough experience with this procedure and are they good at it?
Is there a guarantee attached to this type of comprehensive work?
Have many of the doctor's patients had this treatment?
If you were me would you have this done?

What's more, patients often see the coordinator as someone who can understand their financial concerns and their need for financial options.

Clearly, this isn't a job for just anyone. Your treatment coordinator needs the right mix of personality personality traits, clinical expertise, and people skills. Assign the responsibility to a member of the staff or hire an employee who offers the following:

  • Is quick to build rapport with patients.
  • Has an understanding of dentistry and dental procedures.
  • Believes in the doctor and his or her skills.
  • Is well organized.
  • Is able to comfortably discuss fees and financial arrangements with patients.

Provide professional training for the treatment coordinator, and assign the individual the following responsibilities:

  • Educate patients about dentistry.
  • Conduct case presentations.
  • Complete new patient introductions.
  • Follow-up on unscheduled treatment.
  • Build insurance information files that can be accessed easily.
  • Present fees for the recommended treatment plans and establishing payment terms with patients.

Treatment presentations require considerable time and preparation. While the dentist plays an integral role in case acceptance, numerous details can be effectively delegated to a trained member of the team. It may be the road less traveled for many practitioners, but it could be the best route to increased treatment acceptance.

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.

How To Get Your Patient To Say "Yes"...To Your Total Fee

Tom Limoli

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Dental plans sure aren't what they used to be. Well, maybe they are? Let's all beat that dead horse one more time and maybe it will come back to life.

"I remember when dental insurance first came on the scene. The patient had a $1000 annual maximum and that got two crowns and two cleanings each year. Now it's 2005 and the annual maximum is still $1000. Don't the insurance companies know that barely covers a crown? When is the insurance industry going to change the annual maximum?"

Get over it. It's the patient's plan. The patient's employer selected the plan. And the base plan has a $1000 annual maximum. If they want more coverage they can purchase it. The more one pays for the plan the richer the benefits. In other words, you get what you pay for. Nothing more. Nothing less.

So how do you get the patient to say YES to treatment and most importantly YES to your total fee? It's easier then you think if you will just take a break from beating on the poor deceased horse.

The patient must understand that their dental plan is a financial benefit to help them offset the cost of care. The plan is not intended to pay your fee.

If we want the patient to accept responsibility for their plan we must first stop telling them about their plan. When you tell the patient about their individual benefit plan you come off as being the responsible authority. It's not your plan. It's not your responsibility.

Too many offices unknowingly waste valuable time on the phone, so called, researching benefit plan specifics. This is not helping the patient and most importantly not helping your bank deposit and bottom line. The patient's benefit plan need not become your administrative and financial responsibility.

As an example lets say the patient needs a root canal and crown on tooth number 6. Your fee for the root canal is $650 and the crown is $900. The patient must acknowledge and agree to be responsible to your office for the total fee prior to insurance consideration. Then and only then will the patient's benefit plan be there to help them offset the cost of dental care.

Ask the patient point blank, "how will you be handling your commitment to our practice for $1550?" At this most critical moment of truth don't simply look at the patient for you must look through them. Look and see deeply into the dark recesses of their soul for they must say the magical phrase "I Have Insurance." The patient must initiate the subject of insurance benefit.

Once the patient makes the acknowledgement follow up with something along the lines of "That's wonderful that you have a plan of benefit. Many patients in our practice do not have insurance. We will do all that we can to help YOU make this treatment as cost effective as possible by working with YOUR benefit plan to help YOU offset the total cost of dental care."

The patient must make the correlation that the benefit plan is helping them offset the cost of care. The benefit plan is not paying part of your fee. We have the ability to make this happen when we make the patient bring up the subject of their dental benefits.

Start building your toolbox now. Get a fresh grip on presenting financial arrangements with the patient and stop being so anxious to tell them about their benefit plan.

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.

Talk About Business!

Debbie Rae,

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In dental and dental hygiene schools across the country students are taught how to perform clinical procedures. Few dentists and even fewer hygienists have a business background and know how to run a successful business or manage people. By necessity, most dentists discover upon opening their own dental practices that they must learn basic business skills if they want to stay in business and maintain an excellent team of dental professionals.

Because hygienists are generally employees rather than business owners, many never feel the need to learn business skills. It is not until the hygienist's pocketbook or job security is affected will they feel the need to become an active participant in the business and discuss ways to achieve daily production goals.

One cannot really blame hygienists for their ignorance about the business side of dentistry since they are taught only how to perform clinical procedures in school. However if this hygienist can learn how to think like a business person then your hygienist can too!

The McKenzie Company teaches dental teams nationwide how to monitor over 30 practice statistics , learn what the numbers mean, where to get the numbers and how to affect positive change to become a successful and profitable dental practice. McKenzie clients share such things as practice production totals, collection rates, accounts receivable and overhead expenses with the entire team. By sharing with team members they gain a better understanding of why the doctor wants the hygienist's schedule kept to a daily production goal or why promoting the doctor's treatment to patients is so critical.

Employees soon learn that without having enough money coming in from patients and /or insurance companies, paying for services rendered, there is nothing left for such things as staff lunches, new uniforms, health insurance premiums, better equipment, or staff raises!

While employees may never "care" as much about the business as the owner, the thought of taking a cut in benefits or a wage freeze should cause a team player to pay better attention to the business side of the practice and how they can directly make a difference or... it may be time to find a new team player.

The McKenzie Company believes in specific job descriptions and setting measurable goals to evaluate individual performances. Team members are empowered and held accountable for the success of the systems that are in their job descriptions. For instance, the hygienist is held accountable for his or her production and reports at the monthly team meeting on how the hygiene department performed last month in comparison to set goals and same time last year. Reporting one's progress or lack thereof to fellow team members can either be a proud moment or an embarrassing moment where suggestions for improvement should be expected.

Three goals, for example, that The McKenzie Company may set for the hygiene department all fall in the 33% range. First, not including doctor's exams, the hygiene department is expected to produce 33% of the total office production. Secondly, each hygienist is expected to provide 33% of their production in periodontal procedures such as 4910, 4342 and 4381. And finally, the hygienist compensation should be no more than 33% of his or her production.

To begin having your hygienists focus on the business, request that they retrieve these production analysis reports from the practice's management software prior to your monthly meeting and report the results to the team. Have it as part of your monthly meeting agenda.

If your practice philosophy is that bitewing x-rays are taken once a year then have the hygienists report on how many year-to-date adult and child prophy's compared to sets of bitewings were actually done. The answer should be in the 50% range.

Another good exercise to do quarterly or when raises or fees are increased is a production per hour analysis. If the hygienist is paid $30/hour and the prophy is $75 then her salary to production will not fall in the 33% range. That's okay if the next hour she is performing a perio maintenance or a quadrant of root scaling.

The hygiene department is a department within a business. Good business principles require that every business know the success of each department.

Next opening up the lines of communication puts the business headed in the "right" direction for everyone.

Debbie Rae, RDH MBA is a Senior Consultant with The McKenzie Company. If you have any questions or comments or interested in having Debbie speak to your dental society of study club, please email Debbie at or call 1-877-777-6151 ext. 29

Sally's Mail Bag

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Hi Sally,

Thanks for your always helpful newsletter. Taking a line from Field of Dreams, just because they (the manufacturers) build it, doesn't mean it is always wise to come (purchase it). For example I purchased the whole package for $18,000, went to hands on training and did everything recommended and purchased every recommended accessory. In a very short time the company was sold and then re-bought and then went out of business. Now no repairs avaliable. This equipment and brand was highly recommended by some top names in dentistry. Now the whole concept has fallen by the wayside. What am I talking about? Air Abrasion-now an apparently dead issue. I recently was talking with a dentist that has $90,000 worth of lasers but no fiber optic lighting for his handpieces. I worry about new dentists getting lead astray down the technology path by the slick salesmen. I totally agree on getting the whole package but not every package. And then there was the electronic anesthesia machine supposed to replace the shot. It came out twice about 15 years apart. The first ones didn't work and the company took it back. The second release didn't work and they wouldn't take it back. It is in the corner on top of my air abrasion unit. After the air-abrasion disaster, I asked my son if there was any dental equipment that he thought we should have. His answer was that since we use the handpiece for 90% of our work maybe we ought to have the finest ones available-and so now we do. So before buying that technology maybe we should do a lot of research and calculating and making sure that if it will pay for itself it does it before it or its maker becomes obsolete.
Thanks again for the all the good direction you give us.



Hi G.B.,

Thank you for sharing your experience. We speak to dentists every day whose "house has termites and is falling down but they want to put new shutters on the house". It's very very important to pay attention to the old saying, "Do you put the cart before the horse." Not only do you have to have a way to pay for the technology but the dentists should determine how fast they will realize a return on the investment. Of course, having a service to sell myself, I think they should make sure their house is in order first to maximize the use of any equipment.

Thanks for sharing.


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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*Good through 4/21/04


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