04.03.09 Issue #369 Forward This Newsletter To A Colleague
Communicating With Patients
Going "Chartless"
Consultant Case Study

Tackling The Not-So-Tough Questions That Keep Patients From Treatment
by Sally McKenzie CEO
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With so many demands on busy dental teams to stay on schedule by getting patients into the chair, through their appointments and on their way, it’s easy to understand why doctors and staff may be somewhat reluctant to spend any more time than they feel is absolutely necessary on seemingly non-pressing issues, particularly patient communications.

After all, most dental teams believe they are thorough and that they tell patients everything they need to know. If patients ask questions, the staff answers them without hesitation. Unfortunately, during a typical busy day, employees don’t communicate as well as they like to think they do. Worse yet, they don’t even realize there is a problem, which can cost practices dearly in patient retention.

The fact is that patients want more information than they are usually given. They also want information that they are reluctant to ask for. And here’s the tricky part: It’s up to you to make sure that patients get the information you probably don’t even know they want.

The good news is that your efforts will make a huge difference in patient opinion of the doctor and the practice. Patients who have their questions answered are far more satisfied with their care and the dental staff than those who don’t. In actuality, addressing this often overlooked patient need is much easier than teams realize.

Step back and assess if you and your team are more focused on the procedure than you are on the patient. Are you genuinely interested in ensuring that patients have a complete understanding of things, or would you really rather just get down to business and expect them to trust your good judgment? Be honest. Are you of the mind that if patients have concerns or questions they would surely raise them?

Understandably, many dentists are firmly convinced that if patients have any concerns or questions they wouldn’t hesitate to speak up. Think again, Doctor. Oftentimes patients have questions or want more information but they either feel foolish raising the issue or they don’t want to bother you, the busy doctor. They are not sure how to ask the question exactly or how to raise the issue, but something is gnawing at them.

Consider long-time patient Jim. He needs a crown and has agreed with your treatment recommendation the last couple of times he’s been in the practice. But he just doesn’t seem to be getting around to actually scheduling the visit. It’s highly likely that he has some unanswered questions and concerns that are gnawing at him and, for whatever reason, he’s not comfortable bringing them up, at least not without some prompting.

It may not be necessary at every visit, but make sure your patients know that you are always open to their questions. You want to know if they have even the slightest concerns. It starts with your asking them a few simple questions: “How do you feel about this?” “How does this fit into your plans for your overall health?” “Do you have any more questions or concerns that you’d like to discuss?”

Maybe Jim is anxious about the procedure because of a negative experience years ago. Perhaps he’s concerned about what it’s going to cost. His wife’s company has been laying off employees the last few months, maybe, and Jim’s trying to watch the family budget. Or maybe he’s simply the kind of person whose attitude is that he’s not going to address the problem until he absolutely has to.

Whatever the reason, Jim’s not moving forward with necessary treatment. He’s playing Russian Roulette with his oral health and, as healthcare providers, you and your team need a clear understanding of why. If you know the answer to that, there’s a strong possibility you can address it and help Jim to move forward on treatment.

Next week, when patient relations go south, smooth talk them back on track.
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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Belle DuCharme CDPMA
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Stuck In the Stone Age Of Paper Charts?

Still struggling up the paper chart mountain? You might as well write it on stone because that is as “with the times” as you are. Recently, I read an article in a local newspaper that “fluffy” toilet paper is not made from recycled product but from living trees because living trees produce a softer touch. To save trees, I will live with regular tissue. What is going to make you quit the paper and go chartless in your practice? As senior trainer for McKenzie Management’s Advanced Training Courses, it is apparent to me from the feedback of business teams that they are being held back on this technological advance by their employers. Hungry to use more than the typical 20–30% of their software program, they ask me, “How can I get my employer to go chartless and start using the clinical chart, treatment phasing and the periodontal module in the computer?” If saving a tree is not sufficient motivation, how about saving money?

Doing double entry becomes troublesome when time management is a barrier to better productivity. In many practices, doctors don’t seem to mind that the business team has to keep records on paper and digitally for accuracy. These same practices often employ extra staff to pull charts and then file them back at the end of the day, along with letters, radiographs, etc. Paper is becoming more and more expensive—as is the square footage to store all those charts. There is a lot of waste in this system. What are people waiting for? The doctor is afraid of losing all of the information should the computer go down. Or, When the computers are down we cannot get into the files, but if we have the paper charts, we‘re saved, say the trainees.

How many offices have emergency generators for electrical blackouts? If the fear is a computer crash on a daily or weekly basis, you need to get a computer support person in there who can troubleshoot your network or wiring issues. It is always wise to have someone with these talents as a member of your team or at least have a relationship with a company that has agreed to respond to your call promptly. But most offices say that they rarely have such problems (or they are short-lived at most) and that this is a small annoyance when you consider the efficiency of managing data electronically. Replacing paper with digital is not a trend that is going to end. Eliminating the need for a paper chart is something that is achievable now. We will still have to deal with paper but it will be a molehill and not a mountain.

What is the best plan to achieve this change without upsetting the flow of the office? Look at every piece of paper and form used to create the paper chart and then match it to its digital counterpart in the software program. Most offices have the appointment scheduler and the ledger posting under control and thus have eliminated the large paper appointment book and the pegboard system of tracking charges and payments. This is the first step. Keep up with software updates to keep your system support ongoing. If you have an old computer system, you will most likely need to upgrade to a system with full operating modules that handle insurance estimating, e-claims, tracking, and treatment planning and maintain a recall system and patient retention information. Your system must be compatible with the digital program that you intend to install. You must have security for the transfer of patient data and a fail-proof back-up system that is off site for best protection.

In the clinical operatories, computers and monitors are necessary for the clinical team to enter treatment plans and to record clinical notes. Hygienists must have a computer and monitor in order to record periodontal charting and recommended treatment notes. Having a system that allows for full integration of digital x-rays and intraoral photos is necessary to make accurate diagnosis and impressive treatment presentations.  

Changing old habits is the biggest challenge, but realize that there is a learning curve to anything new. Keep focused on the benefits that going chartless will bring. Some of these benefits are

  • reducing payroll and paper supplies overhead
  • never losing or misfiling a chart again, and accessing it at anytime, anywhere in the office or via remote access
  • better communication, and no more worries about misspelled words, poor grammar and illegible handwriting
  • a more sterile environment—paper charts collect bacteria and cross-contaminate staff and patients
  • space savings—you no longer have to pay to store charts or to shred them many years later
  • better retention of records with scanners to keep everything organized in one central location
  • faster filing of claims without the hassle of copying, stapling, envelopes and postage
  • better treatment presentations for patients and education for staff with digital x-rays and photos that can be enhanced for increased visibility and understanding

So get out of the Stone Age of paper charts and get into the cleaner, more efficient digital solution. For help implementing new systems, contact McKenzie Management today.

For more information about McKenzie Management’s Advanced Training courses, email training@mckenziemgmt.com, call 1-877-777-6151 or visit our website at www.mckenziemgmt.com.
Interested in having Belle speak to your dental society or study club? Click here.

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Nancy Caudill
Senior Consultant
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Why Is Dr.Lewis So Successful?

Dr. Tim Lewis—Case Study #452

As a practice management consultant, there is nothing more gratifying than to have a doctor and team reach their goals! The purpose of this article is to help other practices look at their success or their struggle by making a comparison to Dr. Lewis’s practice goals. Keep in mind that this is not about reaching a specific production dollar amount compared to other practices. Each practice has its own unique production/collection goal.

How To Determine Your Monetary Goal:
Establishing a monetary goal is the most important standard that you should set. How do you and your team know how well you are doing if you don’t have a goal to reach every day? It would be like playing a basketball game and not keeping score. There is nothing to celebrate at the end of the game. Dr. Lewis learned to set these goals and put in place a course to achieve the goals.

First, review your employee gross wages for the past 12 months and your net collections. Gross Wages / Net Collections = Gross Wage Overhead. Salary standard in the industry is 19–22% of net collections for a general practice. In most cases, you can now establish what your collection goal needs to be for the next 12 months, assuming that no drastic changes are planned for staffing, new facility, etc. (Remember that practice management overhead is not the same as what your accountant calculates.)

Let’s say that your Gross Wage Overhead for your team is at 24% and you want it to be 20%. First, determine what your production adjustments were for last year. These are adjustments that reduced your patient fees such as employee discounts, insurance adjustments, senior citizens courtesies, etc. If your adjustments were 20%, you will need to divide your collection goal by the inversion of 20%, or 80%.

  • Monthly wages / 20% = Monthly Collection Goal
  • Collection Goal / Inverted % of production adjustments = Gross Production Goal

Because your Schedule and Hygiene Coordinator schedule to a production goal and not a collection goal, this step must be performed to correctly calculate your daily goal.

Determine what your hygiene goal should be based on one of two factors:

  1. Daily salary x 3 = Daily Net Production
  2. Production should be 1/3 of total practice production

Keep in mind that the more they produce the less the doctor needs to produce!

Monthly Gross Production Goal – Monthly Hygiene Goal (daily ?? x number of days worked) = Doctor Monthly Goal. Divide the Doctor Monthly Goal by the number of days worked = Doctor Daily Goal.

This math can be done on a yearly scale if you prefer not to re-calculate the goals every month. I would recommend that you calculate it yearly to save time and avoid changing the daily goal each month.

What Dr. Lewis Learned:
Once the goals are in place, it is a matter of establishing system goals in order to achieve the production and collection goals. Here are some examples:

  • How to market internally to your existing patients to increase the number of new patients
  • How to properly evaluate the team for efficiency by incorporating Job Descriptions and having the right team member for the assignment
  • How to conduct a “New Patient Exam” to build rapport with the new patient
  • How to diagnose necessary treatment and educate patients about their treatment at a level appropriate to patients’ education levels so they actually understand what is said
  • How to educate patients about their periodontal condition to improve case acceptance
  • The importance of spending “quality” chair time with the new patient to increase trust and rapport = higher case acceptance
  • When a patient is presented to the Schedule Coordinator, all the clinical questions have been answered to their satisfaction. The Schedule Coordinator’s primary task is to schedule the doctor to the daily goal, not to answer clinical questions that should have been answered in the treatment room. Probing questions must be asked by the doctor and clinical staff to overcome any objections that might crop up at the front desk.
  • The importance of Patient Retention in hygiene and increasing the number of active patients in order to grow the practice. The Hygiene Department is a profit center, not a liability.
  • The importance of celebration every day that daily goals are met. Team members want to be recognized for their accomplishments.

How Does This Apply To You?
Doctor, as the captain of your ship, it is important to know where you are sailing and how you are going to get there. Setting daily, monthly and yearly goals are critical to mapping a successful course. You must have a trained crew that understands what they need to do every day. Recognition for a job well done is invaluable to the morale of the office and encourages teamwork for meeting common goals.

If you would like more information on how McKenzie's Practice Enrichment Programs can help you IMPLEMENT proven strategies, email info@mckenziemgmt.com.

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