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  05.12.05 Issue #166

Are Your Patients Satisfied or Disgruntled? How Would You Know?

Sally Mckenzie, CEO
The McKenzie Company

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Why do your patients stay? Why do they leave? Do you know? More importantly, do you care enough to ask? One of the keys to building and sustaining a successful practice is understanding what attracts patients and keeps them returning. Is your office conveniently located? Is your schedule flexible? Are your employees friendly? Is your reputation for quality unsurpassed? Learning why patients choose your care certainly is important.

But the greater eye-opener is learning what leads a certain percentage to walk away and never return. What are their concerns? Is there a specific problem? Do they feel they are treated poorly? Do they find parking in downtown New York City easier than navigating a spot in your lot? Few patients will ever verbalize a complaint or concern. In fact, it is said that only one in 26 will ever utter a word of discontent. The rest just go on fuming and eventually walk away.

Thus, dentists and teams blissfully go along believing that all is well, repeating the same mistakes again, and again, and again. After all, how could you possibly fix a problem that you are oblivious to? You can't.

Ironically, many dental teams will assert that "If a patient had any real concerns or problems we would know." Sure you would, just like you would know their birthdates, or their medical histories, or their dental objectives. Teams that operate under this omnipresent, all-knowing fantasy are the ones least likely to ask patients for feedback and the most likely to benefit from doing so. Talking to your patients reveals priceless information that could yield significant opportunity for practice growth. For those of you ready and willing to learn a thing or two, I recommend a simple patient questionnaire.

The knowledge gained from a straightforward patient survey can yield major returns for the entire team. If you have concerns about how employees are interacting with patients, find out if those worries are valid. If you are considering a major change to your practice, such as relocating or opening a second office, discover how your patients would react before you're standing alone in the middle of your field of dreams. If a few patients have expressed concerns about the new financial policy find out how many others feel the same.

When surveying your patients follow a few basic rules:

  • Rule #1: Resist the temptation to slap together a few questions and mail your homemade survey out to the masses. You will likely only hear from those who have strong positive or negative opinions of your practice. What's more, homemade surveys often lead the witness and create false, unreliable readings. Remember, garbage in - garbage out.
  • Rule #2: Invest in a statistically valid survey instrument. A professionally developed survey tool is designed to ask questions that will elicit the most valuable and revealing information. For example, the question, "Do you find the office décor appealing?" may prompt one response from a patient. Whereas, "Does the office décor make you feel comfortable?" may reveal different yet far more useful information. In addition, professionally developed survey tools build redundancy into the questions in order to measure the consistency in the patients' responses further ensuring an accurate reading.
  • Rule #3: Look for professional survey tools that are concise, simple. and vary the questions so that patients provide both short answers and select from multiple choice answers.
  • Rule #4: Distribute the survey to 50 repeat patients who visit the office. This will ensure that you collect a statistically valid sample.
  • Rule #5: Implement reasonable suggestions promptly. This demonstrates clearly to patients that not only do you want their input, you are prepared to act on their suggestions.
    A professional survey is the cheapest private investigator you'll ever hire. It will reveal more about your practice and your patients' likes and dislikes than you ever considered possible.

To order your Professional Survey go here.

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Ways to Attract More Fee-for-Service Patients

By Howie Horrocks, President
New Patients. Inc.

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There are many marketing approaches you can use to get the patients you really want. But in my years of working with dental practices I've found that the following are the consistent winners.

Start With Internal Marketing

1. Talk to your mailing list and it will talk back. Your first and most cost efficient action is to start with your own patients. Marketing to those who are already familiar with you is easier and much more profitable than marketing to strangers (though you still need to do some external marketing). The bottom line is; you should develop regular communication to your patient base.

This could take the form of a practice newsletter or simply a personal letter from you sent quarterly or, preferably, each month. If you don't yet have your patient list computerized , I urge you to make this a priority. Most word processing software allows you to write one letter to your patients and "mail merge" this letter to hundreds or thousands of patients. Mail merge simply prints the name and address of each patient onto the single letter so your communication is more personal. It's easy and fast.

Don't make this complicated or expensive by thinking you need to hire a design firm to produce a four color, nine page magazine each month. A simple one or two page newsletter is just fine. You can upgrade the quality as you go. The important thing is to start sending something now. Internal marketing is about "upselling" which means selling more dentistry to those who are already buying dentistry from you. Someone who is already happy with your product can be sold more of it and more often. Both you and they will benefit tremendously.

One client of mine stopped sending his newsletter for several years thinking that it was too much trouble for too little return. At my urging he began sending it again and was surprised at the response. There were days he had 10 patients call to set appointments with each mentioning that the newsletter was what jogged their memory. He learned his lesson! The newsletter will never disappear again.

What to Say

Educate your patients on teeth whitening, bonding, veneers, air abrasion, lasers, intraoral cameras, porcelain crowns, white fillings and a host of other dental topics. Cover one topic per month and be sure to give them a reason to call such as a limited time offer relating to that month's topic. Keep in mind, you can't just say that veneers are great or that inlays are better than fillings. You've got to tell them what veneers and inlays will do for them (correct stained, chipped and misshapen teeth and replace unsightly amalgams) while at the same time giving them a reason to call you now and not next year ("Call before August 1st and receive a complimentary cosmetic evaluation which will determine if veneers or inlays are right for you.")

These letters or newsletters are not meant to take the place of any recall efforts you are already making. Your hygiene recalls are a separate operation, employing postcards and phone calls. The monthly letters or newsletters above are designed to provide information and benefits on major dental treatments and services as well as invite them to call and refer their friends and family into the practice.

2. Seeking referrals. You can and should be asking for referrals from your existing patients. This goes for the staff too. Over and over again I've proven to myself that the vast majority of patients are more than willing to help you. They are not put off when you ask them to help. However it is sometimes uncomfortable to simply ask.

Why not give the patient something to take with them that they can pass along to their friends or family members? Hand them a dental health certificate and ask that they give it to someone - "Nancy, you're a great patient. Why don't you give this to one of your friends or anyone you care about? It will allow them to receive a dental exam at an introductory offer." I recommend you make this handout more substantial than a simple business card. If it's too small or flimsy the patient may just toss it. Give them something that looks professional and 5 star quality. Make it look important (because it is.) When their friend or family member arrives (not just schedules but actually shows up) send the referring patient something valuable or useful like two tickets to a first run movie, or a restaurant gift certificate along with a personal note of thanks. Or send flowers, coffee mugs or something else people would value.

Let's say you get referred a huge case that ends up being many thousands of dollars. You may want to reward the referrer with a $300 day spa or $500 Nordstrom shopping certificate. Whatever you do the referring patient ends up getting a benefit, which means they are more likely to refer again. Send these rewards to their work address (not home). That way more people get to find out how generous you are. Bottom line: Don't let patients leave your practice empty handed.

Next Week: More Internal and External Marketing Techniques.

Howie Horrocks is the Author of More Unlimited New Patients . To order

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Insurance and Radiographs

Tom Limoli, Jr.

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Look Beyond What Can Be Seen - It just might surprise you...

Much has already been written concerning Evidenced Based Dentistry and its associated Parameters of Care. For those just now returning from Mars - evidence based parameters of care is nothing more than the scientific analysis of when you do what you do as compared to how you do it if you actually do anything? Or to put it simply - are we doing the appropriate treatment at the appropriate sequential time for the specific needs of an individual patient.

Parameters of care are very different and many say should not be confused with or influenced by a benefit plans parameter of payment . This two lane road moves in both directions as parameters of payment should not govern or direct parameters of care.


A benefit plans parameter of payment is guided primarily by the strength of the plan purchasers' almighty dollar. The more one pays for a plan - the richer the benefits available to the enrollees. High dollar plans have high dollar benefits. Conversely, low dollar plans don't have a whole lot of covered benefits. One might benefit prophylaxis every six months while the other acknowledges the procedure one, two or three times a benefit year.

So which plan actually costs more? Which plan has the overall greater benefit to the patient? Are the two actually one in the same ? Are higher preventive benefits actually reducing the need for more costly restorative, periodontal and/or surgical therapies? These are the questions asked by plan purchasers as well as dental researchers.

This quagmire is more accurately brought to light than with the simple irradiation of a few bitewing films.

The patients benefit plan may say: "Bitewing radiographs are reimbursed twice in a calendar year." To most dental offices this means: "Take bitewings every six months when the patient comes in for a prophy." Many offices, following this thinking, have been audited and asked to refund thousands of dollars previously reimbursed for these radiographs. Why? Because there was no documentation in the patient record indicating why the radiographs were ordered and/or what was found (diagnosed) by the doctor upon reviewing the prescribed films.

There is no liability for payment by a patient or insurance company for simply taking radiographs. There is liability for payment when the dentist puts on the hat of radiologist and determines that there is, or is not, suspected pathology and subsequently enters those findings in the patient record as a separate dated and signed report, or, even better, as part of the treatment record for that day's visit. Read carefully: If there is no documentation of radiographic findings, there is no liability for payment. In this situation, if payments have already been made, the office may indeed be required to refund those monies.

The need for radiographs is not being determined by the benefit plan; the criteria are based solely on the clinical needs of the patient as documented in the patient's record.

The ADA Council on Scientific Affairs in JADA, Vol.132, February 2001, p.234 specified:

"Routine use of radiography as a part of periodic examinations (evaluations) of all patients is an inappropriate practice. Because each patient is different from the next, radiographic examination should be individualized . The nature and extent of the diagnosis required for patient care constitute the only rational basis for determining the need, type and frequency of radiographic examination."

The panoramic film is sometimes considered to be a superior diagnostic tool by both general practitioners as well as specialists. Healthcare professionals consider the jaws, associated components, their function, and related pathology to be entirely within the realm of the dental profession. Given the magnitude of this responsibility, it is clear that the first step on the way to a thorough diagnosis might well begin with a "global" radiographic interpretation of all related anatomical landmarks. Not that the panoramic can, or should, replace indicated bitewings or the selected use of a periapical, but the scope of interpretation through many individual films simply cannot match the global aspect of the panoramic film, nor the simplicity of orienting the patient to understand where we are viewing and what we are identifying.

So how does all this relate to your office bank deposit? Should it be legislated that all radiographs be paid by all plans whenever they are deemed necessary and appropriate by the treating dentist? What entity will determine appropriate care? What science will be used? Should frequency and benefit limits ever be placed, considered or enforced?

The patient must acknowledge and be accountable to you for their total cost of care prior to considering the dollar value of any insurance benefits. Yes, the total fee. If not - evidence based parameters of care will in fact become the benefit plans parameter of payment. But then again, some might think that this could be a good thing.

Tom Limoli, Jr. is the author of "Dental Insurance & Reimbursement Coding and Claim Submission Manual". If you're not sure what code to use to bill the patient's benefit plan then this book is for you. To order click here.

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Marketing Secrets

Howie Horrocks

Reveals 400 pages of already tested, proven patient-attracting ads,
brochures, TV spots, press releases, direct mail letters, radio ads, how to do it right, like marketing to seniors, marketing on the internet, and why you must include the right amount of facts and emotions into your marketing.

In addition you will learn what to say in a simple letter that gets business people near your practice to choose you, how to double the effectiveness of your ad with only two lines of copy, and best of all find out how to write a patient letter that will yield a remarkable ROI!

All you have to do is pick up these secrets and before you know it, your own practice will be receiving the business you've always desired.


Sally's Mail Bag

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Dear Sally,

When I first started practice 22 yrs ago I did have a patient survey. One of the most common concerns, as you entioned, is office hrs. We worked Mon - Thur. 8 -5 and hr off for lunch. ½ a day on Friday. People wanted some times on Saturday. I, being the new guy, wanted to satisfy a perceived need and decided I would open the office for 4 hrs on Saturday morning. We did a mailing to inform everyone of the change, had a sign in the reception room and told people as they came into hygiene to come in on Saturday to get x-y-z done. Good idea we thought. Some days were good but some days were really bad. If memory serves me right we had 52% more cancellations on Saturday than any other day. The summers were by far the worst. Sometimes reaching 80%. People thought when in the office that the Saturday appointment sounded great, no time off work. But when it came down to either coming in or going to the beach, the pool, baseball game, golf or partying the night before, guess what won.

I stopped Saturdays after a year and stopped Fridays after 5 years, ½ a day Thursday after 10 years, so 31 hrs a week right now. We are more productive than ever while we are in the office. The Staff and I are much happier. The # one reply we get is customer service. I think Nordstrom's and Chic-fil-a, both have great customer service, but I still have to go when they are open and no I can't get that chicken sandwich on Sunday, nor a brown belt and shoes at 8:00 AM before work.

Yes every practice needs happy patients, but I think the real key is a stable staff that are as committed, as the doctor, to the practice.

In conclusion, I think happy patients and a happy dentist (because it is all about me, right?) starts with a happy staff.

Dr. Richard
Charlotte, NC

P.S. Great newsletter and I have been to 2 of your seminars in the SE.
Keep up the good work.

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