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6.20.08 Issue #328 Forward This Newsletter To A Colleague

Expensive Practice Fairy Tales: Once Upon a Time There Was a Helper
by Sally McKenzie CEO
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Some days you just feel like those dreams you had of a wonderful, rewarding career have given way to something far different—definitely not the “happily ever after” that you once envisioned. The reality is that this is work, the grind, and some days it’s just not fun. Stuff goes wrong, people call in sick. You’re short-staffed. Everyone is stressed. This is not what you signed on for.

Wouldn’t it be great if you could just hire another person—a helper—who could step in when needed? Why, this person could help answer the phones, help clean treatment rooms, help scrub instruments, and help file records and documents! Everyone could get so much more done and it would sure be less stressful at times. No more scrambling to cover the bases. No more stressful days. A helper is the answer, or so you think.

“Helpers” are often viewed as some sort of special being, like fairy godmothers. Dental teams craft delightful little fantasies based on the seemingly abundant possibilities that helpers have to offer. They are often the subject of wonderful dreams about greater efficiency and less stress; just throw more people into the mix and that will ease all the worries and concerns of the dental office world. The possibilities are only as limited as the team’s imagination and the doctor’s bottomless bank account. I hear it all the time: “Oh, but Sally, we just know we will be so much more efficient with another person; the position will surely pay for itself.” Of course it will, and you’ll be spinning gold from straw, too.

Don’t get me wrong. I love a good fairy tale as much as the next person and I am definitely all for ensuring that your practices are adequately staffed. Unfortunately, however, many of you base your belief that you need additional help on some flight of fancy about creating a workplace utopia in which there are no stressful days or strained situations—because you have plenty of people on staff. They will all do the right things at the right times to make sure that everything works out juuust right.

But before you leap with checkbook wide open and start your search for the perfect little helper, I suggest you consult with reality, even if only briefly. Look at wages paid in your practice, including the hygienist’s (but excluding the doctor’s). They should be no more than 20% of gross income, not including payroll taxes and benefits. If the current gross salary expense is around 22%, you’re already over the tipping point. Adding another person could increase gross wages to 27%. Where are you going to get that extra 5% or 7%? Are any staff members volunteering to take a pay cut? Doctor, how ‘bout you?

Unless the practice has a goose with connections to the gold market, you need a plan. You want more than a “helper.” You want a producer. For example, if that helper is a Patient Coordinator who will increase practice revenues by making sure appointments are kept, that enchanted new face in the office can increase practice production—the pixie dust of a happy team. Or if the individual is a hygienist who will enable the practice to meet the demands of a growing hygiene schedule (provided it’s not riddled with no-shows and cancellations), the investment is a wise one.

The negative financial impact should only last for about 60 days. Beyond that, production should increase, and the wage percentage of gross income should return to the normal range of 19% to 22%.

In addition, create a “producer mentality” among the team. If tasks aren’t getting done and the team is stressed, it’s possible you have certain employees with the “it’s not my job” attitude. Everyone must understand the bigger picture. What is the practice in business to do? What is the mission? What are the practice goals? What is each employee’s objective? When everybody clearly understands the mission and goals of the practice and realize that they are expected to do what is necessary to achieve those goals, they are more likely to step in when it’s crunch time.

Next week: Can you really afford to add staff?

Interested in speaking to Sally about your practice concerns? Email her at
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
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Smart Leadership in Turbulent Times

Like many business leaders, you’re probably feeling the pinch of a tough economy. The nation’s unemployment rate is over 5% and expected to climb higher in the months ahead. Gasoline and food prices are at record levels, too. Perhaps patients are postponing treatment or downgrading to cheaper alternatives. What do you do?

Well, if you want to advance in your practice, you absolutely have to bridge the gap between where you want to be and where you are right now. The only way to improve your practice is to get into ACTION, especially in these turbulent times.

Practices that survive are those that capitalize on savvy leadership—leadership that understands patients’ needs and employees’ engagement. Leaders who build on these tenets are best positioned for future growth.

The first and perhaps most important investment you can make is to take an honest look at your leadership. To your staff and to your patients, you are the practice. Your employees view the practice through the relationship they have with you. So how do you improve those relationships?

Spend more time—and more time talking—with the people who work in your practice. In conversations, show that you are concerned about them. Seek their ideas. Encourage risk-taking.

One of the main challenges in a down economy can be a depressing office environment. Strive to create an upbeat atmosphere. Solicit ideas for a low-cost, morale-boosting lunch from your staff. Schedule a brown-bag staff meeting during which time everyone shares humorous stories. Find other ways to lighten spirits and reward your team for their hard work without increasing overhead.

As for patients… During economic downturns, they will be more careful about spending. Factors such as price and value take on greater significance. However, people's underlying needs do not change and dental leaders who continue to meet those needs will prevail. Here are some basics about what patients look for:

  • Making a positive emotional connection with the dental team.

Imagine what it’s like being a patient walking in the front door of your office. Would you be greeted with a warm “Hello!” and a friendly smile? Would you feel special, valued and appreciated? Would you be asked about how your work is going, or if your college student had come home for the summer?

Those are qualities that ensure patient loyalty even if a patient decides to postpone a crown replacement for a while.

  • Feeling that their needs are understood.

How do you react when patients object to treatment recommendations? It’s tempting to assume they need convincing, and then talk up the hi-tech “proof” or try to motivate them with warnings about how bad things will get if they don’t follow through with the dental plan. But until you really listen, you won’t understand their objections or gain compliance.

Listening enables you to find out about your patients’ reality—what is important to them, what motivates them, what issues prevent them from moving forward. Once you understand those things, you are in a better position to educate, clarify and gain trust with your patients.

  • Perceiving that the dentist is authentic and has integrity.

Your financials may not be where you want them to be, but nothing will send your P&L statement into the ground faster than pushing services that patients don’t need. Furthermore, patients watch and hear how you treat your staff. Be sure that you’re showing examples of respect and kindness as well as sound ethics.

  • Feeling treated like an individual, not like just another patient.

Be careful to see each patient as unique. Avoid clichés and generalizations. Statements such as “I see this all the time” may be intended to connote experience but the impact of those words can convey “You’re no different from the hundreds of other people I see” instead.

  • Feeling that their time is respected and finding it easy to schedule appointments.

Have you considered expanding your office hours or adjusting them to meet high-demand time slots? Even if you’re not a morning person, offering 7:00 AM, before-work appointments show patients that you want to make life easier for them. Even consider offering late or evening appointments. Use the shifts in your availability as opportunities to market your practice. Be aggressive in keeping your name in the public eye.
Stop blaming the insurance companies, the economy and the "season.” Focus on the thing you DO have control over: yourself. Stop bringing your emotional baggage to work. Move out of the “just enough” syndrome and raise your monetary bar. Visualize the future with more financial freedom, whether for recreational activities, travel or simply more work satisfaction and joy. Pay attention to the emotions that accompany these inspiring images. Repeat this exercise several times per day.
This long-term view will lead to big payoffs, not only as your practice navigates these difficult times but even more when the economy picks up. Set yourself up for a significant competitive advantage. Engage your staff. Engage your patients. Become a more resilient leader. Start today!
The potential to become a better leader is well within your capability!

Dr. Haller is available for team building and dental leadership coaching. She can be reached at

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

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Carol Tekavec
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No Special Codes for CAD/CAM Restorations

Are there special codes for CAD/CAM restorations? Many dentists and staff would prefer it. CAD/CAM technology is expensive, and it has an implementation learning curve that also must be considered. Of course, CAD/CAM technology is quicker; patients may receive one-day service for inlays, onlays and crowns. This convenience alone suggests the appropriateness of a designated code sequence for CAD/CAM. Because CAD/CAM technology is cutting edge, a higher reimbursement from insurance carriers might be reasonable.

The reality is, however, that there are no special codes for CAD/CAM restorations. The ADA coding system is revised every two years. (The current codes are good for 2007–2008. New codes will be available in my ADA-licensed Dental Insurance Coding Handbook: 2009–2010 Addendum in a few months.) Although it is under the jurisdiction of the ADA, the Code Revision Committee contains representatives of both the dental profession and insurance carriers.

Under HIPAA (Health Insurance Portability and Accountability Act) regulations, the ADA CDT code set contains the only dental codes available for use on claims and records, which are to be used by everyone—dentists and insurance carriers alike—when reporting dental treatment. (Medical codes may be used to report medical procedures on the appropriate medical claim forms, when submitted by either physicians or dentists.)

Crowns, bridges, veneers, inlays and onlays, no matter how they are made, are all covered by CDT 2007–2008 procedure codes. Some of these codes mention the generic material used, such as resin-based composite or porcelain-fused-to-high-noble metal. However, the codes do not reflect a specific brand of product or material, or a certain technique. This means that there are currently no codes to describe providing a service by means of a laser, nor are there any codes to describe the manufacture of a crown by means of computer-assisted technology, such as CEREC. There are also no codes to apply to a certain brand of porcelain or resin.

Some Codes and Definitions
An inlay is defined by the ADA as an intracoronal restoration made outside the mouth to correspond to the form of the prepared cavity. It is then cemented or light-cured into the tooth. An onlay is defined as a restoration made outside the mouth that replaces the cusp or cusps of a tooth. It is not considered correct to report an inlay code along with an onlay code. The onlay code is inclusive of the inlay.

Inlays and onlays are currently reported using codes D2510–D2664. Crowns are reported using codes D2390 and D2710–D2799, including those made with indirect composite. Veneers are reported using codes D2960–D2962. Any restoration that does not fit a designated code description can be reported using D2999 with a narrative. (Remember that “99” codes are often flagged for review by an insurance consultant. This may delay the claim but, after the review, may qualify the claim for payment.)

CEREC and other CAD/CAM restorations may include different variations of expected restorative configurations for inlays, onlays and crowns. For example, some CAD/CAM configurations are described in the literature as “overlays.” The word “overlay” is mentioned in the ADA definition for an onlay, but is not described as a separate restoration.

CAD/CAM dentists may use the word “overlay” to describe a restoration replacing the MDFO surfaces of a tooth. Codes that might apply include D2712-Crown-3/4 Resin Based Composite, Indirect; D2783-Crown-3/4 Porcelain/Ceramic; and D2999-Unspecified Restorative Procedure, by report. CAD/CAM or not, dentists should be aware of the current CDT codes for indirect resin-based composites. D2650–D2664 can be used for reporting indirect resin based inlays and onlays, indirect resin crowns can be reported using D2710-Crown-Resin Based Composite.

Some dentists may think that separate CAD/CAM codes would result in better payment for these procedures from insurance carriers. After all, CAD/CAM technology is expensive and intricate. However, it is likely that the opposite might happen. Without a lab fee expense, CAD/CAM restorations might be argued to be actually less expensive than lab-fabricated restorations. (Some labs also utilize CAD/CAM technology, which could further complicate the argument.)

Although some maintain that separate codes for CAD/CAM restorations should be developed, it is not expected that this will happen for the next code revision. Certain criteria exist for new code developments which, among other things, include new materials or a service that is seeing an increase in frequency.

Even though new materials are being developed all the time, and CAD/CAM technology is certainly on the rise, those who have suggested code changes have not seen them adopted. Individual dentists who are not satisfied with current codes may always make suggestions for new codes at the website. Such suggestions would be too late for 2009–2010 revision, but they could be considered for 2011–2012.

With 34 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 dental societies and study clubs. Still practicing as a hygienist 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 is the author of the Dental Insurance Coding Handbook, and a bestselling patient brochure series.

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