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10.10.08 Issue #344 Forward This Newsletter To A Colleague
Mystery On-Site Visits
Hygiene Consultant
Dentist Coach-Micromanagers

A Private Eye For Your Practice?
by Sally McKenzie CEO
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Where have all the new patients gone? Have you found yourself asking that question lately? It used to be that you could count on a certain number regularly streaming into the practice, but for the past 6 to 12 months you’ve noticed a change, and it’s killing your bottom line.

You prefer to gloss over the facts, disregard the bloodletting and tell yourself that you just need to market your practice more. Blast the airwaves with a cute new jingle. Line the newspaper with some clever prose. Offer a free something or other. It sounds like a good idea because it’s a nice distraction from the real problem: someone or something is cutting new patients out of your practice. I suggest you save your advertising dollars and turn your focus inward. Doctor, it’s time for an internal investigation. Let me explain.

If new patients are not in your chair, they are in someone else’s, and there’s likely a very good reason—perhaps several—as to why. More marketing and advertising might give you a temporary boost, but I can virtually guarantee you’ll be facing the same shortfall a couple of months down the road. You need to discover the “why” behind the loss.

Is something happening when prospective patients call? Is there an issue with your fees, with your location, with parking? Are your policies so regimented they are not worth the trouble for patients? Is the staff unaccommodating? Do they unknowingly give the impression that you don’t want new patients? Your livelihood and your practice depend on knowing why numbers are down.

What if you could send in your own private investigator of sorts? Someone who would quietly evaluate your practice and give you feedback as to what the experience is like from the patient’s point of view—like a “mystery patient”? In the medical community, “mystery patients” have been around for several years. Dentistry is embracing the concept more and more as practices come to realize that they are profoundly dependent upon a satisfied patient base and a steady stream of new patients.

And now McKenzie Management gives dentists the opportunity to view their practices from a patient’s point of view! This program allows you to be an omniscient observer of sorts. You are able to get a much better understanding of how you, your team and your practice come across to patients from an objective standpoint. But most important, the assessment enables you to identify exactly where you and your team can make immediate improvements.

The mystery patients can be used to evaluate staff phone skills and face-to-face interpersonal skills, as well as clinical staff/patient relations, to determine if any of these could be having a negative effect on the practice. The mystery patients sent into practices are experienced and trained specifically for the dental office environment. Moreover, they are fully prepared to evaluate the total experience, which is essential in helping dentists to retain patients, gain referrals and identify training needs.

Telephone assessments are used to evaluate staff strengths and weaknesses in communicating with patients over the telephone. Walk-in visits, in which a prospective mystery patient stops in to talk to front desk staff about the office, are used to evaluate how those face-to-face interactions are handled (critical because nearly 70% of patients leave a practice because of poor customer service). Non-invasive clinical visits enable the dental team to gather feedback on the patient’s perspectives from a clinical standpoint.

Certainly, it requires a fair amount of courage to hire a “private eye” for your practice. Human nature is such that most dentists want to believe that all of their patients are happy, that new patients are clamoring for an appointment and that their staff is simply wonderful. However, the numbers often indicate otherwise.

Yet with information comes power, in this case the power to change. Fortunately, once shortcomings are revealed, they can be promptly corrected. In many cases, staff simply don’t realize how they come across to patients. They don’t understand that their actions are having a negative effect on the office; once they are made aware, in most cases they are ready and willing to make necessary changes. But dentists have to be willing to investigate the problems in order to implement solutions.

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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Managin Your Practice and Your Future Growth is NOT just a roll of the dice.

Angie Stone RDH, BS
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To Alternate Or Not To Alternate? That Is The Question.

A common practice in hygiene departments across the country is to alternate charging a patient for a prophy appointment and a periodontal maintenance visit. In many instances, the office will charge out a prophy procedure two times per year and periodontal maintenance two times a year when the patient has had active periodontal therapy. This method of billing is incorrect due to misuse of the ADA procedure code and could be considered fraudulent if codes are altered specifically to get insurance benefits.

The reason offices have adopted this system is because many insurance plans will not pay for more than two periodontal maintenance visits per year. They have discovered that if standard prophys are billed in between periodontal maintenance visits that some insurance policies will pay for all four. Although this is advantageous for the patient, it is a losing situation for the dental practice. The patient is receiving a service 4 times a year and two of the visits are charged out at a lesser fee. I believe it is fair to say that there is not another medical profession that will downgrade the price of a provided service in order to have the patient receive insurance benefit.

Over years of doing this favor for patients, dental practices have conditioned patients to expect this behavior. When the office attempts to change protocol existing patients get upset that they are being charged more, which they don’t understand because the service has not changed. It is now the responsibility of dental practices to turn this procedure around and educate patients as to why this is not correct. So, how do we do that?

The first step is to stop billing insurance plans in this fashion immediately. People who have not experienced this billing routine will not know the difference and therefore will not be disturbed. Those who have been billed this way may be upset.

The response given to those patients is, “We have recently been re-educated regarding the billing of hygiene services that are provided after a patient has undergone active treatment for periodontal disease. We are no longer allowed to adjust the fees as we have in the past. We are sorry for any inconvenience this may cause you; however, we need to follow correct billing protocol. ” The office may even consider sending a letter from the doctor to patients who have been allowed to pay for services this way. That way the issue is addressed with every patient at one time.

If we review the description of a prophylaxis and a periodontal maintenance procedure, we see the two are very different from each other. According to the current CDT, a prophy consists of removal of plaque, calculus and stains from the tooth structures in the permanent and transitional dentition. It is intended to control local irritation factors.

The CDT states that a periodontal maintenance procedure is instituted following periodontal therapy and continues at varying intervals, determined by the clinical evaluation of the dentist, for the life of the dentition or any implant replacements. It includes removal of the bacterial plaque and calculus from supragingival and subgingival regions, site-specific scaling and root planing where indicated, and polishing the teeth. If new or recurring periodontal disease appears, additional diagnostic and treatment procedures must be considered. A patient who has undergone active periodontal therapy is no longer a candidate for a prophy.

A prophy, as defined, will not provide the necessary preventive care this patient requires. Therefore it is in the best interest of the patient to receive periodontal maintenance at each and every hygiene visit.

Given these descriptors it is obvious that a periodontal maintenance appointment involves much more than a prophy, hence the larger fee. If the fees are alternated each time, the patient is getting a more involved service 4 times a year and only paying full price for 2 of the visits. If we do a little math here, we can see how this may affect hygiene production.

Let’s say that the office fee for a prophy is $80 and the fee for a periodontal maintenance is $110. The patient will be charged $380 for professional hygiene services annually if the fees are alternated. If they were not alternated, the annual fee would be $440. This is only $60 per year more for the patient to pay if their insurance does not cover those treatments. However, if the office has an active patient base of 1,000 patients and we say that statistically at least 1/3 of those should have perio maintenance, that dollar amount is going to be fairly large. 300 patients paying $60 more per year would bring in $18,000 in production for the hygiene department.

If nothing I said earlier in the article would persuade your office to stop the practice of alternating prophys and periodontal maintenance, maybe the numbers will.

Need help with implementing new systems in your Hygiene Department to ensure patient acceptance and compliance? Email

Interested in having Angie speak to your study group or at your next seminar? Contact her here.

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Dr. Nancy Haller
Dentist Coach
McKenzie Management
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Are You a Helicopter Boss?

Like the colloquial term that originated with parenting a few years ago, helicopter bosses hover closely overhead… rarely out of reach… whether their employees need them or not… doing things for them that they should be doing for themselves… anxious about every decision employees make… constantly correcting… incessantly interjecting advice—even when not asked.

If you’re a helicopter boss, the consequences are negative for everyone, including you! Although your intentions are good, that rotor of yours is making a racket in your practice.

Now I know that if you’re an over-involved boss you’re not going to come down to terra firma quickly. The traits that I’m calling “helicopter” actually helped you to make it through dental school, establish your practice and build the business. It’s likely that you are driven and passionate about the work you do,

Unfortunately, when it comes to managing employees, micromanaging bosses are the least effective. Although it's tough to give up control, showing employees that you trust and respect their abilities can lead to top performance. Sometimes you just need to let employees make mistakes so they can learn and grow. Most of the time they’ll do just fine if you get out of the way.

Employees who feel that they are contributing to the practice work harder. They allocate their time wisely. Above all, they have greater job satisfaction and are more loyal to you. Here are some tips about how to back off and let your worker bees do their business.

1. Invest in smart hiring. Employee Assessment Testing Online offered by McKenzie Management is a hiring tool to identify the right person for the job. Not every employee can be left to her/his own devices. But if you look for people who bring significant skills and experience to the table they are more likely to be conscientious and productive. Consider pre-employment testing as a component of your hiring procedures.

2. Establish clear expectations and job descriptions, then hold employees accountable. If you don’t have accurate job descriptions, get some. Sit down with employees individually on a regular basis to review their work performance. Set goals together along with time frames for accomplishing those goals.

3. Provide the resources for achieving goals.
Once you figure out what employees need to accomplish, determine what they need to get the job done. Whether it is time, education/training or coaching from you, give them the tools to succeed.

4. Focus on the outcome, not the process. If you want the job done right, it doesn’t necessarily mean it has to be done your way. One of the most important steps that a helicopter boss can take is to stop correcting and/or improving everything an employee does.

Call me naïve, but my experience in business is that most employees really want to do a good job. In most cases, if a team member isn't doing a good job it’s often because they don't know how.

Think about what kind of instruction is necessary. Is there a way to give less information about how you want it done and more clarity about the outcome you expect? In this way, you empower employees to find solutions to issues themselves. Then give positive feedback. Successful leaders notice what employees do right, and give them immediate recognition for doing a good job.

5. Be an advisor to your staff. Leadership coaching is provided through McKenzie Management.

Allowing your employees to go their own way doesn’t mean you abandon your role as the dental leader. Employees need your support and certainly your feedback about whether they’re meeting your expectations. Find ways to reward and compliment them for positive actions.

Smart dental leaders want the best for their employees because it’s best for their practice. They help employees grow into resilient, loyal team members. They teach them to believe in themselves and to assume higher levels of decision making and responsibility. It does take time in the short term to train the employees, but it is so worth the commitment in the long run. You’ll end up with more time in your day to devote to dentistry, and your employees will be more productive when freed from your hovering.

If you’re a “Black Hawk” boss, contact Dr. Haller. She’ll help you land and discover new ways of invigorating your team. She can be reached at

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

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