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1.11.08 Issue #305 Forward This Newsletter To A Colleague
Hygiene Deficit
Treatment Acceptance
McKenzie Case Study

The Hygiene Schedule: What You See Isnít Always What You Get!
by Sally McKenzie CEO
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Many of us are experiencing our share of post holiday buyer’s remorse. In the insanity of the holiday season, we spent more than we should, but there were so many great deals at the time. And the specials, oh the blockbuster specials, the list of “must haves” just grew and grew.

For example, that special offer on the cell phone for your teen. What a great buy, until you add on tax, activation, handling, license agreements, warranty charges, battery pack, etcetera. Or that satellite radio deal for your significant other, the special offer was so good you just couldn’t pass it up. Then your credit card bill arrived and you weren’t charged that reduced fee after all, no, it was double that. Surprise! The car rental best buy you found online for your winter holiday getaway wound up costing you $400 not $200 as you had bid through that wildly popular Internet site – those taxes, insurance, and special fees certainly add up. No, things aren’t always as they seem, are they?

And that jam-packed hygiene schedule isn’t as booked out as it looked to be earlier, nor is it bringing in the revenues you think it is. Patients, well, they can’t get a hygiene appointment for months. But the looming question remains. If hygiene is so darn busy, why isn’t that translating into production? Why isn’t hygiene production bringing in a greater share of the practice profit?  No one is considering the law of supply and demand. Practices insist that they schedule to meet perceived rather than actual patient demand.  

Let me explain. It’s a delicate balance determining the number of hygiene days the office needs to ensure that patient demand is met, as well as ensure that the hygienist produce 3 times her/his daily wage and bring in 33% of total practice production. So how does a practice achieve that balance? Follow this formula.

  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.

Next, look at the hygienist’s percentage of production. She/he can’t achieve 33% of practice revenue without some help, namely a solid recall system and a trained patient coordinator to ensure that the hygiene schedule is full.

An effective recall system is more than a postcard reminder; it’s a necessary education and marketing tool for the practice that should 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. In addition, explore other patient reminder/patient communication options, such as those offered through Elexity.

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 a few steps to ensure that your hygiene department is as productive as it is busy, and you’ll find that the reality pays far greater dividends than the illusion.

Interested in speaking to Sally about your practice concerns? Email her at
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Belle DuCharme CDPMA
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Treatment Acceptance and the Consultation Area

The design of the business office and its’ affects on the patient’s motivation to buy treatment is discussed in the Advanced Business Training Programs and New Dentists Start-Up program.  During the analysis of practice space, it is often noted that a private area to discuss treatment, payment options, insurance disputes or any other related discreet matters, is not provided.  For many offices, once the patient gets to the front desk, the treatment consultation is over for the dental team but not for the patient.  Many dentists want to improve their treatment acceptance percentages but have not realized an important component to doing this is private time with the patient.

With protection of personal information being a top concern of most people today, it is vital to provide an area of privacy for the patient to be able to make an important decision that will affect their total health for years to come. A designated consultation room provides a professional atmosphere free of distractions and unwanted listeners.

The Treatment Coordinator or Financial Coordinator who has been attending the diagnosis and treatment option presentation will now take over the presentation in the consultation area.  It is important that the patient sees this person as “knowing what was said” and understands the procedures well enough to answer any questions.  Having this person show up at the point where the patient is escorted to the consultation room has the appearance of a “closer” that one would find at a car dealership or a timeshare spiel.

In dentistry, we sell services. An implant is anchored in the bone and now visually is an intangible. That beautiful new crown or bridge blends into the mouth and the benefit of being able to chew again is apparent but not as stimulating as the “new car smell” or pictures of a five star resort in Hawaii. Selling benefits of the services offered in the dental practice is the challenge based on the patients’ trust that the dentist can deliver as he/she has stated.

The consultation area should have the following components:

  • A window on the door or exterior wall so that the patient does not feel trapped.
  • A calming water feature or soothing background music if a window is not in the room.
  • Another thing to consider if the room does not have a window would be to seat the patient near the doorway.
  • A round table that is big enough for four people and room to display models and other visuals.
  • Padded chairs with arms so that patients can easily get in and out of the seat.  Have available a chair without arms for the overweight patient.
  • Displayed on the wall, degrees and certificates of the dentist and team members, where the patient can view them.
  • Computer and monitor to bring up patients digital radiographs and photos for reference.
  • Video education products to enhance the education of the patient and to demonstrate to the patient that the practice is up to date and dedicated to excellent dentistry.
  • Reference materials such as flip charts, brochures, case books with testimonials and success stories for further patient education should be available.
  •  Brochures can be given along with the patient’s treatment plan and financial option sheet in a nice folder to take home.  Recommended to be in the folder would be a description of the benefits of the proposed treatment to this patient based on the motivating factors discovered during the new patient interview.

Creating an environment that is appealing to the senses of the patient will invite the patient to return.  An overpowering medicinal smell that is often overlooked by dentists and their team can be an anxiety producing experience for the patient. None of us would want to spend a lot of time in an uncomfortable environment. Some offices bake cookies or burn aromatherapy candles to mask the odors. Better yet is an automatic type of room deodorizer mounted on the wall that periodically infuses a shot of citrus into the air. Check with your dental supply representative for the name of the product.

 Ask the patients what they smell when they come into the office. If the patients say it “smells like a dental office” then a change is in order. The patient is a good source of marketing information for the dental practice because with each visit they notice what the team has become accustomed to.

It is recommended that the consultation room be sound proofed as much as possible.  Listening to the high-speed drill, model trimmers or patient outcries will not hasten a patient to “sign up” for more of this experience.

If space allows, the room should also have elements that research has shown makes people feel good.  Suggestions would be:

  • Pictures of smiling happy patients professionally produced.
  • People with their pets or just the pets.
  • Calming nature scenes with inspirational messages.
  • Artwork such as paintings or sculpture.
  • Fresh flowers

These items would be positive distractions and can also open the door to conversation connecting to the patient on a personal level.

Put yourself in the patient’s place and ask, “If I were to be making an important financial and long-term health care commitment, where would I like to discuss the matter?”

 For more information on Treatment Acceptance training and the Advanced Business Programs call McKenzie Management today.

Why not improve your performance in 2008.   Attend McKenzie Management’s Front Office or Office Manager Training.  Email or call 877.777.6151
Interested in having Belle speak to your dental society or study club? Click Here.

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Nancy Caudill
Senior Consultant
McKenzie Management
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Is There More Month Than There Is Money?

Dr. Jim Caviness – Case Study #131

Dr. Caviness’s concerns:  “It is a struggle for me every month to make enough money to pay my personal bills.  Some months I can write myself a payroll check and some months I can’t!”

Many dentists, like Dr. Caviness, share this lament. The problem is that Dr. Caviness has failed to include himself as part of the big picture and making emotional decisions instead of informed decisions.

Dr. Caviness’s practice facts:

  • 15-year old practice in the same location
  • He is averaging $80,000 a month in net collections
  • Approximately 22 new patients a month
  • Does not know overhead costs

The team members enjoy working with Dr. Caviness; however, it was noted that he was anxious and vocal about not making enough money.  This left the team confused when they knew they were reaching their daily goals 75% of the time. However their goal was $96,000/month leaving them short $16,000/month.

To make matters worse, Dr. Caviness recently purchased a new home in an affluent neighborhood. His mistake was emotionally assuming that the practice was going to make more money to offset this larger mortgage payment!  Unless there is a definitive business plan to improve practice systems, the practice overhead stays the same, the collections stay at 83% of goal and he cannot afford to pay himself more to meet his new mortgage payment.

In addition, the doctor put in a 150 gallon fish tank in the reception room area and he just hired an additional clinical assistant.  It was evident that Dr. Caviness did not know the answers to these questions:

  • “What is your gross salary overhead for the existing team members?”
  • “What is your total practice overhead?”
  • “How much money do you need personally per month?

What He Needed to Know:

  • Salary Overhead: Dr. Caviness could not afford to hire another clinical assistant based on the monthly collections.  Standard in the industry is 19-22% of total collections for team salaries (not including payroll taxes and benefits which are an additional 3-5%).  His salary overhead costs were  28% or $22,400 of $80K/month in collections.  However, if the practice were reaching their goal of $96/month, payroll would be 23%.  When a new team member is hired, a salary review should be conducted in order to make an informed decision on whether or not you can afford to hire and how much you can afford to pay this person. Some thought must be given to the job description of the new hire in regards to how they will be able to increase collections in order to justify the increased expense. Just because an employee says, “Doctor, I need more help.”, does not alwaysmean the addition of a new employee.  It could be inefficiencies in the systems, for example.
  • Total Overhead:  Standard in the industry for a general practice is 55-60% of net collections.  Total Overhead includes the following expense categories:  Lab – Dental Supplies – Office Supplies – Team Gross Wages – Team Benefits – Facility – Miscellaneous.  Dr. Caviness’s total overhead was 76%!  This left doctor with 24% or $19,200/month.

The practice was NOT producing/collecting enough money to support the practice expenses and Dr. Caviness added more fuel to the burning fire by purchasing a home that he could not afford at the moment without a business plan to reduce overhead and increase revenues..

In Dr. Caviness’s situation, the additional expenses have been incurred and he can’t do it over.  The practice is going to have to “step up” to increase production and collections in order to allow the practice to increase his salary.

Dr. Caviness determined the amount of money per month to satisfy his personal obligations and determined at 35% of monthly collections what that monthly amount would need to be.

The practice systems were reviewed, obstacles were revealed with solutions, and Dr. Caviness realized that it was important for him to diagnose necessary treatment and leave it up to his competent staff to “sell” the dentistry. Reaching his goals as well as knowing “the numbers”, will help him to make informed decisions in the future.

There are limitations on what a practice can produce so don’t make the mistake of thinking that you will work harder and therefore make more money.  Know your numbers so you can make good buying decisions that will affect the rest of your life! 

If you would like more information on how McKenzie's Practice Enrichment Programs can help you IMPLEMENT proven strategies….. email

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