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  06.02.05 Issue #169

The Hygiene Schedule: Appearances aren't Everything

Sally Mckenzie, CEO
The McKenzie Company

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Things aren't always as they seem are they. That special offer on the new cell phone isn't so special when you have to fill out multiple forms to get your promised rebate. The great deal on the snow skiing vacation isn't so wonderful when the only time you can schedule it is in July. That price break on a hot, new product isn't such a bargain when you have to purchase a package of 25 rather than the one that you need. And that jam-packed hygiene schedule probably isn't as full as it appears, nor is it bringing in the revenues you think it is.

Practices often perceive that their hygiene schedules are so full that if patients don't book their appointments six months in advance, well, they can just forget it. They're not getting in, plain and simple. Then low and behold the doctor is sweating overhead numbers because hygiene salaries are outpacing hygiene production by leaps and bounds. Maybe it's time your practice started scheduling based on the realities of supply and demand.

Let me explain. You want to ensure that you have an adequate supply of hygiene days so that new and existing patients do not have to wait weeks or, worse yet, months for hygiene appointments and you want enough patient demand to ensure that the hygiene department accounts for 33% of your total practice production and your hygienist is producing 3x her/his daily wage. Follow this formula to ensure that your supply meets demand:

  1. Count the number of active patients - those seen in the past year for oral health evaluations.
  2. Multiply that figure by two, since most patients come in twice a year for oral hygiene appointments.
  3. Add the number of new patients receiving a comprehensive diagnosis per year. For example: your practice has 1,000 active patients + 300 new patients = 1,300 x 2 = 2,600 possible hygiene appointments.
  4. Now take that number and compare it to the hygienist's potential patient load.
    If the hygienist works four days a week, sees 10 patients per day, and works 48 weeks a year there are 1,920 hygiene appointments available.
  5. Subtract that total from 2,600. You are losing nearly 700 appointments per year - 680 to be exact - or 14 patients per week. In this scenario, the hygiene department should be increased 1.5 days per week.

If your practice schedules patients when they are due rather than pre-scheduling appointments, examine how far ahead patients are booked for appointments. If there are no openings in the hygiene schedule for a solid three-week period and some patients are being bumped into the fourth week, begin increasing the hygiene department's availability in half-day increments. If you find there is more hygiene time than necessary develop a patient retention strategy and focus greater attention on filling those extra days.

Unless your hygienist doubles as a superhero, she/he is going to need assistance achieving the goal of 33% of practice revenue. That help comes in the form of a solid recall system, a trained patient coordinator to ensure that the hygiene schedule is full, and advanced hygiene training.

Patients are very busy people, if they don't perceive the importance of keeping their regular oral hygiene appointment, they won't. Use your recall system to do more than just remind patients of a "regular check-up" educate them and emphasize the importance and value of every oral hygiene appointment. Send professionally printed recall notices that fit into an envelope with an educational brochure that informs them about a new or existing service that they may want to consider. The patient coordinator personalizes the notice by writing a short, personal note directly to the patient.

The coordinator also is responsible for ensuring the hygienist is scheduled to meet daily production goals and for confirming all appointments at least two days in advance. Finally, the practice should have a clear policy regarding cancellations and broken appointments that is shared with all new patients and regularly mentioned to existing patients.

Take just a few steps to ensure that your hygiene department is as productive as it is busy, and that full schedule will quickly become a reality and not just an illusion.

If you would like more information on our Advanced Hygiene Training Programs, please email Sally at

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Striking a Happy Medium (or Media) in Dentistry

Scott McDonald

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While almost everyone now accepts that some external marketing is helpful, very few know enough about choosing external marketing media to make an informed decision. This little primer is not a comprehensive list of media choices, nor is it a list of priorities. McKenzie Management can provide you with a detail Marketing Report that will suggest specific media outlets, frequency (rate of repetition), and even costs. The dominant "lifestyle groups" or "demographic/psychographic cluster groups" are described in detail in this Report.

Yellow Pages
When I first started speaking on Dental Marketing for the California Dental Association, yellow page advertising was the first BIG medium of dentistry. "If a little works well, then a LOT will work better," went the common wisdom. Not so!

We have seen dentists snap up the "double truck" positions in the yellow pages (full pages that face each other) with gusto and NO idea how well or poorly these ads will deliver. In fact, full-pages are not as effective as those smaller ads that also have alphabetical phone listings also on the page. The effective size of the ad and its position are a function of several factors including the "lifestyles" of the people who read the ad. Ironically, the poor and less educated are often more influenced by a large ad than are those with money and more education.

Direct Mailers
There is so much variety in this tool it is hard to know where to start.

The traditional direct mail piece for dentistry is a "self-mailer" (no envelope) that offers a free or very discounted entry-level service like an examination and X-rays. This is effective with some lifestyle groups but it can hurt the practice as well. The biggest slam against this format is that it attracts "shoppers" who want no long-term contact with the practice. We have found that inducements that are specific to the target market work much better. Want families with children? Value-added offers that include a premium work well. Want older fee-for-service adults? Offer a certificate worth $200 toward ANY treatment after they have paid for an examination, cleaning, and X-ray. Each lifestyle group will have a mailer format and offer that will work best for that group. Post cards, envelopes, brochures, and newsletters each work with some groups but can be ineffective with others.

Mailing Lists
There is a theory that the best target for an advertisement is new move-ins. This is a good theory but a bad practice. New residents are often inundated with ads and mailers. They often move from a location not far from their previous home and still retain contact with the previous dentist. As an alternative, we believe that a demographically selected group will be a better target for a mailing than one directed at residents. For example, do the issues of age, income, housing type, children, marital status, or property value make a difference to you? Then don't send mailers to those you either don't want or who don't want you.

This can be wildly useful in the right setting with the right audience and a complete waste of money in others. This is a function of population density, lifestyles of listeners, and the marketplace. Every radio station will be strong in one demographic group at one time during the day (defined as a "day-part' media-speak) and weak in others. Radio stations are selected FIRST upon the format of the station as it relates to the target market and SECOND upon its Reach (how far the signal travels) and Penetration (the number and percentage of the target market hears the message). THIRD is the issue of budgets. Some very expensive "flame throwers" offer good deals if the right ad-buy is negotiated.

Television and Cable
Closely associated with the means of purchasing Radio time, the specific programs are measured against their proven cost-effectiveness of reaching a particular audience. Ironically, cable television can allow for a more targeted buy because competing cable providers may serve the same community.

The difficulty with Television and Cable is the commitment one must make to creating the commercial itself. It is an easy way to let $10,000 slip away.

Newspapers are purchased based upon their circulation AND penetration. Often the section of the paper in which an ad should appear is determined by the penetration of that section with the market we are considering. Regionalized issues may or may not be a desirable option because our target audience may not read that section.

Keep in mind that Radio, Television, and Newspaper advertising should never be considered a short-term advertising media. They require a commitment of several months.

We have considered many old (billboards) and new (internet banners) technologies for dentistry. All of them work BUT none of them will work for everyone. That is why some good old-fashioned market research will go a long way toward building your practice.

Scott McDonald is the former Marketing Manager for the California Dental Association, national lecturer and author and provides demographic marketing and site analysis recommendations for McKenzie Management. For more information email or visit our website at

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When Did The Technique Become The Coded Procedure?

Tom Limoli, Jr.

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Traditionally, third party payers have contractually reimbursed only for completed procedures. They did not reimburse for individual subcomponents or techniques required to complete the global procedure. As an example - with all bonded restorations, the bonding is nothing more than the technique used to complete the procedure. As such, the technique sensitive procedures are simply coded as the completed procedure.

I do not recommend to the dental profession separate fees for bonded and non-bonded restorations. When taking into consideration the usual fee for the completed procedure, examine the number of bonded and non-bonded restorations that are routinely performed. The single fee should equally address both restorative techniques. The additional cost of the bonding agent is reflected in your total fee charged for the restoration.

According to previous versions of the American Dental Associations Current Dental Terminology:

"Local anesthesia is considered to be part of restorative procedures."

Well guess what? The CDT-2005 states that local anesthesia is usually considered part of the procedure.

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 are 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.

The recent articles that have graced the pages of dental periodicals and journals are praising organized dentistry's attempt to nickel and dime the American consumer by giving dentists what they feel they really want. More codes for more money from the evil blood sucking insurance companies. After all - look at all the neat codes the physicians have at their disposal. If we have more codes look at how much more money we can make. Look at how misguided the few are that lead the many down the road to ruin.

Compare the wonders of the two edged sword as concerns the medias fascination with the "extreme makeover" concept. Only a few are guided by the shallow vanity while the many fear the overall repercussions when the patient finally realizes, down the road, that they are the same emotional patient they were prior to investing thousands for their silken vale of empty happiness.

Will dentists across America now begin charging separately for that which they know is part of a separate completed procedure? Are they going to start charging based on the technique? Will we as payers be forced to address the separate charge or simply allow our insured patients to fall victim to our lack of fiduciary accountability and responsibility? Do we deny the charge and let them collect from the patient or do we disallow the charge and reduce reimbursement for the completed procedure so as to address the fee for local anesthetic?

I think not. All will be well. We don't need to throw out the baby with the bath water just yet for I don't think the bulk of America's dentists are going to abuse their patient base. Yes, there will be the greedy few. But then again, isn't the enemy of our enemy really our best friend?

Tom Limoli, Jr. is the author of " Dental Insurance & Reimbursement Coding and Claim Submission Manual " to order click here.

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Lorin Berland, D.D.S.

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