11.6.09 Issue #400 Forward This Newsletter To A Colleague
Monitor Practice Revenue
Changing Negative Habits
Improve Patient Handling

Do You Need the 'Budget Bug'?
by Sally McKenzie CEO
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Weight management - or mismanagement as the case may be - is practically a national pastime with everything from CrossFit routines, to body sculpting, to personal trainers, to over the counter miracle pills. There is no shortage of guides, strategies, and fix-it products in the marketplace all “guaranteed” to help us win our seemingly endless battles with “muffin tops” and “beer bellies.” Of the numerous products out there, I have to admit that I am fascinated by one particular weight loss tool that is becoming increasingly popular. It’s the personal calorie monitor. You strap it to your arm and wear it like a wristwatch or mp3 player. This little device displays the number of calories you burn and consume. It’s fascinating, particularly if you’re one who enjoys sweating - so to speak - the small but important details.

I can’t help but think that such a device would be ideal for the dental office, however, this one would measure dollars burned. You could strap this little wristwatch “budget bug” onto every employee’s arm, and it would monitor the amount of practice revenues individuals are gaining and/or losing daily - production, overhead, collections. It would check your scheduling efficiency. Provide regular reports on patient retention. Sound an alarm when the hygiene department is producing below its specific goal, etc.  

Actually, your computer software system is rather like a “budget bug.” You can’t fasten it to your wrist, but the reports - if you pay attention to them - can show you where you are gaining revenues or burning dollars. They can tell you if you can afford to give raises this year, or if half the team is overpaid. The key is to regularly check your status, and therein lies the challenge. Most practices have access to key reports and data, but don’t use the information to monitor and adjust systems.

Risa needs a kidney. Blood type O donor needed.

For example: accounts receivable. Few dentists really know what their accounts receivables are. Yet the AR report shows how much money is owed the practice from patients, insurance companies, or other third parties - a rather important detail. It should never be more than one month’s production. Meaning, if you typically produce $50,000 per month, patients should never owe you more than that amount, and preferably, they owe you less.  If patients owe you more than one month’s production, you’re burning through practice revenues.

Many dentists interpret AR numbers incorrectly. Before you take those figures at face value, make sure you’re reading them right. Otherwise, you may be thinking you can splurge on special holiday dinners and treats for the team this year, when in fact, you’re in line for a budgetary starvation diet. For an accurate picture of where your practice stands, the report should include every account with an outstanding balance, the date of last payment, and a note indicating if payment was from the patient or the insurance company. To ensure you have complete information, run the Outstanding Insurance Claims report. This lists all insurance claims that haven’t been paid. If a claim has been denied, zero it out, so that it goes off the report. Otherwise, you’re getting faulty information.  Combine the Outstanding Insurance Claims report with the Accounts Receivables report.

The AR report also should “age” the receivables showing the “current” column, which is  revenues produced in the last 29 days that have not been collected, as well as a breakdown of accounts that are 30, 60, and 90 days past due. The goal is to have a minimum of 45% over-the-counter collections for the month, and no more than 55% in the current column awaiting insurance reimbursement.

Be sure to add credit balances back to the total accounts receivable. Finally, add up all monies over 90 days delinquent. The percentage should not be over 15% of your total accounts receivable. If accounts receivables exceeds your monthly production, that’s a red flag indicating that problems need to be addressed promptly in one or more of the following areas:

• Insurance system
• Billing system
• Financial policy
• Presentation of financial arrangements
• Inability of financial coordinator to ask for money

Not only is the information essential for the doctor to monitor cash flow, the Accounts Receivables report provides the financial coordinator with necessary information that enables her or him to customize the messages on patient statements and when making necessary collections phone calls.

Next week: losing money? Maybe it’s time to “read the directions.”  

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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Leadership Lesson 101: Changing Habits Will Make You Gag

Reflexes are involuntary physiological responses. They are hardwired into our nervous system. You have no choice because nerve receptors react to stimuli. The gag reflex is an example. Although habits are voluntary behaviors, they are similar to reflexes. Think about all the things you do automatically. I doubt you gave much thought to driving to your office today. The complexity you felt as a 16 year old has receded into the background of your consciousness. Now you navigate all those intricate steps comfortably, frequently without much thought.

As we age, the ability to adapt and move outside our comfort zone becomes more difficult.  But if you don’t force yourself to grow, you will never achieve the highest level of performance. Many dentists who are in their own comfort zone will not challenge themselves, even though they know that they could achieve a lot more. They tell themselves that it’s too time consuming or counterproductive to upset the "apple cart," so they stay with the status quo. The upshot is average performance and average results.

When it comes to developing more effective leadership skills, you must be willing to experience the G.A.G. – Going Against the Grain. New actions require intentionality, energy and discomfort. You will feel awkward at best. Yet the more you deliberately practice new behaviors, the greater your potential to take your practice to the next level. Dentists are notorious perfectionists. On the positive side, this bodes well for precision, accuracy, and follow-through. However, perfectionists are fearful of uncertainty or ambiguity, of giving up control and letting go. They demand immediate results from themselves (and others), and are unwilling to go out on a limb and take the chance of being embarrassed. Unfortunately, this prevents true learning.

Many of us prefer to stay in the comfort zone and then, over time, the comfort zone becomes more uncomfortable than ever before. How ironic! The act of avoidance that offers a temporary sense of security becomes unrelenting insecurity. And, thus a disabling condition of stagnation sets in. If you don't step out of your comfort zone and face your fears, the number of situations that make you uncomfortable will keep growing. Over time, you run the risk of feeling "surrounded" by previously avoided situations. It is difficult to go against the grain. Here then are some ways to make learning easier to swallow:

  1. Recognize and accept that learning or doing something new is uncomfortable. The discomfort is normal. While it’s natural to want to avoid that feeling, commit to do one thing differently each day.
  2. Manage your emotions and your mood state. Anger, worries, doubts, depression, and other negative emotions interfere with learning and performance. Practice deep breathing when you feel overwhelmed and pressured. 
  3. Be sure you maintain healthy habits. Exercise, eat nutritionally, and get sufficient sleep. The stronger you are physically, the faster you will incorporate the new learning.
  4. Mentally and emotionally, prepare yourself for the change by anticipating what it will be like. Visualize the completion of your goal and imagine experiencing the adrenalin rush of the "I did it" feeling. Envision the benefits of a smoother running office, more income, and more time off to spend on recreational activities. 
  5. Nurture self-confidence. Your thoughts shape your future. Almost all anxious thoughts are irrational. Instead of worrying about possible failures and slip-ups, recognize your strengths. Remember times when you have succeeded. Reflect on experiences when you overcame adversity.
  6. Give yourself “time out” from learning. Build in time to escape through music, games, or reading. 
  7. Get support from family and friends. Get a mentor or hire a coach. Learning is hard work and you need encouragement. Feeling connected with others also reduces inner tension. 
  8. Avoid regret or self-blame. It will only prevent new learning.
  9. Use humor. Norman Cousins said that laughing is "inner jogging." He called it a work out. Several studies show that laughing lessens the need for pain medication and shortens recuperation time. 
  10. Celebrate progress. Reward yourself when positive change happens. By recognizing even small accomplishments, you build motivation to sustain learning. 

Dr. Haller provides training for leadership effectiveness, interpersonal communication, conflict management, and team building. If you would like to learn more contact her at coach@mckenziemgmt.com

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

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Jean Gallienne RDH BS
Hygiene Consultant
McKenzie Management
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Educating Patients About What to Expect and What is Expected of Them

In my last article, I discussed the benefits of hiring a patient coordinator and having one person responsible and accountable for the recall system. This person makes all of the calls and sends the written correspondence. However, it is up to the entire team to help support the recall system. The responsibilities of the hygienist and doctor are still great when it comes to supporting office protocol, educating patients about office policy, and the recall system. During the hygiene appointment, all new patients should be taught about office protocol and policy and it should sound similar to this:

“Mr. Jones, I want to go over a couple of things with you so you are aware of what to expect at your future hygiene appointments. At your next hygiene appointment, the hygienist will take your blood pressure, do an oral cancer exam and look around your entire mouth for any suspicious areas where there may be decay. Probings will be done again and you know from the numbers we did earlier on you that you want to hear 2’s and 3’s. This is to make sure that your mouth is getting healthier or staying healthy. Once a year we will take the four bitewing x-rays that check for cavities and let us look at the bone levels in the back of the mouth. About every 3-5 years we will take a full mouth series of x-rays depending on what is needed based on your individual oral health. The doctor will come in and do an exam and if there is ever a time that you would like to have something specific checked, please let us know.”

The patient should also be informed of how long the appointment will last by both the hygienist and the scheduling coordinator. If this were a patient that has just completed root planing, the hygienist should also go over what to expect when they return for the periodontal maintenance appointment. This would include all of the above, and the following would be added to sound like this:

“Mr. Jones we have now completed your active phase of periodontal therapy, and next you will go into the maintenance phase of your treatment. In three months, it is recommended that you come back for the periodontal maintenance appointment. This appointment will be in-between what we just did and a cleaning. It depends on your periodontal health that day as to what we will do for you. If an area needs to be numb or anesthetized we will get that area numb. Your quality of home care that you provide to yourself will make the difference of how and what you need when you come in.”

All of this will be gone over with the patient during the appointment. Towards the end of the appointment, the hygienist will go over the recall system and what is expected of the patient:

“Mr. Jones, this is a reminder notice that we will be sending to you approximately 2-3 weeks prior to the month you are due to return. When you receive this in the mail (or if the practice is using email or text messages) please give us a call so we can schedule a time that is convenient for you.  If you would go ahead and address this envelope to yourself, then about two weeks prior to your appointment we will mail it out to you. Please check your calendar and call us immediately as appointments fill up quickly and it is imperative for your health to stay on the recommended periodontal intervals.”

Regardless of the type or method of your recall system, the point is to explain how your system works and what you expect of the patient.

When the doctor comes in to do the exam on the patient, they should also reinforce the recall system. Both the hygienist and the doctor should also say the month that the patient will be due for their next appointment. If it is around a holiday, they should mention that so that the patient is aware, in case they are going out of town or are having company. This will get them thinking about their future schedule.

The more informed and educated patients are about what is expected of them and what to expect at future appointments, the more important the appointments become and last minute cancellations and no shows can be decreased. 

Interested in knowing more about how to improve your hygiene department? Email hygiene@mckenziemgmt.com.

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