11.9.07 - Issue # 296 Forward This Newsletter To A Colleague
Insurance Benefits
Leader Traits

Time to Give Thanks to the Insurance Companies
by Sally McKenzie CEO
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This Thanksgiving give your patients something they can truly appreciate – their dental insurance. I know that sounds like an oxymoron. You’re more likely to use the words “insurance” and “frustrations” in the same sentence than you are “insurance” and “appreciate.” Nonetheless, this time of year you can help your patients maximize their insurance benefits, which is something you’ll both be thankful for.

Many dental insurance plans are just sitting there with benefits unused and poised to go to waste as soon as the clock strikes midnight December 31. In fact, dental insurance companies count on making millions of dollars off of patients who never use their insurance benefits because unbeknownst to the consumer, many of these plans provide coverage up to a certain dollar amount annually. But insurance companies certainly aren’t going to encourage customers to use benefits, and most patients are too busy to sift through their policies to determine what might remain on them. So it’s up to dental practices to get the word out to patients and fast.

You could send them a letter to inform them of their unused benefits, but this time of year patients are getting a lot of junk mail and you don’t want your message to get tossed into the “I’ll get to it after the holidays pile.” So you need to do something to ensure that your message gets noticed and your letter is opened. This is where Elexity comes in. I’ve talked about the many patient communication options available through the Elexity Patient Management system before, and this system is the perfect tool for informing patients of unused insurance benefits. It’s fast, efficient, and best of all your patients will take notice. 

Here’s how it works. First identify those patients with unused insurance benefits who are in need of treatment or preventive care. With the help of the Elexity Patient Management System, the doctor or office manager pre-records a personal message from the practice letting the patient know that they have unused benefits and encouraging them to schedule an appointment.

For example, “Our computer estimates that you still have unused dental insurance benefits available to you. Unfortunately, you will lose those benefits if you do not use them by the end of the year. We want to help you secure the insurance coverage available to you on every dental procedure you schedule, and this is an excellent time to take care of any hygiene visits or dental treatments that you might have been putting off. Give us a call today, and together let's make sure you get the treatment you need in time for the Holiday Season. As a special incentive for scheduling your appointment, we are offering a free home whitening kit if your treatment is completed by December 31, 2007. Please call (give phone number and name of appointment scheduler) to schedule your appointment.”

Over a period of a couple of weeks, phone calls are placed automatically to all of the patients identified as having unused insurance benefits. The calls appear on the patient’s caller I.D. to come directly from the practice, but Elexity handles the details, which means - aside from taking a short amount of time to record a message - doctor and staff have to do absolutely nothing, except scheduling and treating patients that is.  In addition, the Elexity system enables the practice to send an email to the patients that reinforces the telephone message. Once again, the message appears to come from the practice, but Elexity handles the details, so there’s no drain on staff resources. 

To round out the effort, the office follows up with a personal letter detailing the unused benefit amount available to the patient and any specific treatment that remains diagnosed but not scheduled. The letter further encourages the patient to give themselves the gift of good oral health this season while making the most of those unused insurance benefits. Patients appreciate the fact that their dental office would take the time to inform them of this unused benefit. They don’t like wasting money any more than you do.

Next week, ensure patients are thankful for you and your team throughout the coming year.

Interested in speaking to Sally about your practice concerns? Email her at sallymck@mckenziemgmt.com.
Interested in having Sally speak to your dental society or study club? Click Here.

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Dr. Nancy Haller
Dentist Coach
McKenzie Management
coach@ mckenziemgmt.com
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How would your leadership have to change if everyone who worked for you was a wealthy volunteer?

What do you want from your employees? People who are merely satisfied or a staff that’s truly charged up by their work?

Many dental leaders still believe that a fair day’s pay for a fair day’s work should cover the basics, with a pleasant office environment filling in the rest of their employees’ needs. While this approach makes for an adequate practice, it is unlikely to inspire your employees to give more than minimal service.

Keep in mind that fair wages are necessary to prevent dissatisfaction. In other words, you can’t ignore money. But neither should you mistake pay to be a true motivator. If your compensation and benefits are within industry and geographical standards, you need to look beyond money if you want more from your team. Becoming a more effective leader is the single most important action you can take to increase your productivity and profitability.

In employee survey polls, the most highly rated and common responses fell into these categories:

  • Positive, caring relationships: "We appreciate that our boss cares about us and our families. They recognize us on special days like work anniversaries and birthdays, and are supportive when we have family issues."
  • Recognition of achievement: "Our boss expresses appreciation when we do a good job or come up with a good idea."
  • Pride in the organization: "Our boss is very professional and well-respected in the community. We are proud to be a part of this company."
  • Opportunities for growth and advancement: "We are given the opportunity to increase our level of responsibility or change positions within the organization."

Be aware of your impact
Employees look for indications that their leaders are competent, visionary and trustworthy. The more positive they feel about your leadership, the harder they work, the more they contribute and the more likely they are to stay with your practice. Because they're always scrutinizing what you say and do and analyzing your words and actions, even trivial comments and behaviors have an impact. For a leader, there's no such thing as a casual conversation. Be sensitive to the effect you might have.

Communicate regularly and clearly with your staff
Developing a positive professional community begins with you. As the dental leader, you shape the identity of the practice and set the pace for how relationships develop. It is up to you to communicate the importance of unity in the office and to help employees feel valued. This is especially true during tough times. You'll gain employees’ trust and confidence, which will lead your practice to success. By keeping staff informed, you communicate that you think they are a valuable part of the team and important to patients. In return, most employees will go the extra mile for you over and over again.

Recognize good work
Show appreciation for jobs done well and acts of kindness, and stress the importance of listening to and considering each person's ideas. When a day runs smoothly, tell your clinical assistant what a good job she’s done, and be genuine. When collections are going well, let the billing staff know that you appreciate it. In a bigger office, consider awarding an Employee of the Month, nominated by peers and announced to all employees. Any award will be greatly enhanced if you take the time to celebrate it.

Be interested in employees’ interests
Know when your employees have special events in their lives - good or bad - and discuss it with them. For larger practices, circulate a newsletter to keep everyone aware of important personal issues such as birthdays and anniversaries of employment. For smaller practices, put up a bulletin board where important issues can be posted. Show interest in your staff and express concern for them, even if it's just a brief minute of conversation. It lets people know they are valued and appreciated.

Model the right behavior
Demonstrate through your own behavior how you want employees to act. Be trustworthy, dependable and supportive. Encourage respectful communication, especially when there are differences of opinion. Strong practices engage in open, ongoing communication. They share information with the right people at the right time, and they also make time for meaningful conversation. One way to do this is to have an informal employee discussion over lunch every week or two. This is a great opportunity to update employees on new initiatives and to brainstorm strategies for improving the practice.

Remember – your employees really are ‘volunteers’ who have chosen to work with you. Pay them back – focus on building positive work relationships that will make your practice a more rewarding and productive place for everyone.

To become a better leader, sign up for Dr. Haller’s Advanced Leadership Training Course.  Email training@mckenziemgmt.com.

Interested in having Dr. Haller speak to your dental society or study club? Click Here

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Carol Tekavec, CDA RDH
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Informed Consent for Bisphosphonates

Your patients are taking bisphosphonate drugs.  Ads for Boniva® ,Fosamax® and Actonel®  are shown on TV all the time.  What are these drugs and why are so many people taking them?  Are there particular concerns for patients when it comes to dental treatment?  What should staff do concerning the informed consent process and bisphosphonate usage?

What are bisphosphonates and why are so many people taking them?

Bisphosphonates include, but may not be limited to: Aredia®, Zometa®, Boniva®, Actonel® and Fosamax®. They are prescribed to treat osteoporosis and osteopenia.  Osteoporosis is a progressive disease of the bone which can lead to bone fractures. Osteopenia is a less advanced condition that may be described as preliminary demineralization of the bone.  Both conditions are caused by a deficiency in the mineral density of the bone architecture.

The World Health Organization defines osteoporosis as bone mineral density 2.5 standard deviations below peak bone mass as observed in a 20 year old person of the same sex. Osteoporosis has no specific symptoms but is typically diagnosed by a bone-mass screening or after a fracture has already occurred.

Individuals who are suffering from some cancers, such as myeloma or breast, lung, and prostate cancer, may develop osteoporosis.  Endocrine disorders such as diabetes and thyroid problems can also cause osteopenia or osteoporosis.  It is very common in women after menopause.  While the condition is common, it can also be painful and crippling.  It can cause a collapse of the vertebrae, as well as hip and other fractures.  Impaired mobility and other serious general health complications can occur. 

Prevention is preferable; with a diet high in calcium, calcium supplements, exercise, no smoking, and vitamin D; however, for those already suffering from the condition, bisphosphonates can be beneficial. The drugs are useful in “strengthening” bones to prevent fractures and pain.  Osteoporosis itself has no specific symptoms but is typically diagnosed by a bone-mass screening or after a fracture has occurred.  Bisphosphonates are useful in “strengthening” the bones and preventing fractures and pain.

Are there any particular concerns for patients who take bisphosphonates and also receive dental treatment?

Yes! It is possible for a serious jaw condition called  bisphosphonate osteonecrosis  or osteonecrosis of the jaw (ONJ)  to develop subsequent to dental treatment.  Symptoms can include:

  • Pain and swelling
  • Infection
  • Loosening of the teeth and/or tooth loss
  • Poor healing of gum tissues
  • Numbness
  • Exposed bone in the mouth
  • Drainage from a dental treatment site and
  • “Sequestra” or areas of dead tissue, primarily bone that have separated from healthy tissue. This dead tissue may work its way out of the gum and bone area, or it may have to be removed.

These problems may occur along with or after dental treatment, or they may occur spontaneously on their own, bringing the patient into the office for care.  ONJ may be associated with tooth extractions or localized infections which present with much delayed healing.  According to the Journal of the Academy of General Dentistry, Jan.-Feb. 2007, certain treatments should be avoided for persons receiving bisphosphonates.  These include extractions, implants, and some types of oral surgery.  However, even a standard “cleaning” (D1110-Adult Prophylaxis) might set up a situation where an infection ensues in a bisphosphonate patient.  Of further concern is the fact that the effects of bisphosphonates last for many years and that stopping the drugs does not necessarily result in a “safe” time period for dental treatment. 

In fact, right now scientific evidence does not support the discontinuation of bisphosphonates for any length of time in order to promote osseous healing. According to the June 2006 issue of Dimensions of Dental Hygiene, the half-life of I.V, bisphosphonates is years in duration, with the medication being deeply deposited in the bone matrix. The half-life of oral bisphosphonates is thought to be similarly lengthy. (More information can be seen at the American Academy of Periodontology website as well as the American Association of Oral Maxillofacial Surgeons)

What should staff do concerning the informed consent process, treatment, and bisphosphonate usage?

Patients taking bisphosphonates should avoid extractions and implants.  Endodontic treatment and the least traumatic methods possible for prophies, periodontal scaling, and other treatments should be used.  It is thought that systemic antibiotic premedication might be beneficial prior to dental treatment, but dosages and drugs are not agreed upon by the dental and/or medical community.  However, chlorhexidine mouthrinses are recommended before, during, and after dental treatment.

Staff must be sure that bisphosphonate patients understand the complications that may occur with dental treatment.  Therefore, the office medical history form should include questions related to these drugs. In addition, a detailed, topic specific informed consent form should be presented and signed by the patient prior to dental treatment. Progress notes, or general consent forms, while better than nothing, are currently not considered to be as useful as topic and treatment specific consent forms.  Conditions and/or treatments should be explained in as simple terms possible so that patients can actually understand what they are consenting to.  One page forms with a section for the patient and a witness to sign are advisable.

 A signed consent form does not ensure that a patient will not later sue a dentist, however having the form puts the “ball in the patient’s court”.  The patient has to explain why he/she did not understand what was being presented, rather than the dentist having to defend his/her treatment.  My Informed Consent Form booklet contains a consent form for 31 different topics and/or procedures, including treatment occurring for a patient who takes bisphosphonates.  You do have patients that are taking these drugs.  Informed consent is a must.

With 33 years in the dental field, Ms. Tekavec is the president and owner of Stepping Stones to Success. She is a well known author and lecturer.  She has appeared at all of the nation’s top dental meetings, as well as providing programs for local dental societies and study clubs.  Still practicing clinically, she is a consultant with the ADA Council on Dental Practice and was the columnist on insurance for Dental Economics magazine for 11 years.  She has written over 200 magazine and journal articles as well as designing a “Patient Brochure” series.

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