11.13.09 Issue #401 Forward This Newsletter To A Colleague
Reading Computer Reports
Common Hiring Misfires
Surviving Employee Departure

Want to Know Why You're Losing Money? Read the Directions
by Sally McKenzie CEO
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I suspect that we all know someone who never – or seemingly never – reads the directions. They buy a new computer, technical device, or household item, and because they see themselves as pretty smart individuals, they don’t think they need to read the directions. They start hooking up components, attaching this piece to that, pushing buttons, clicking here and there, and then they become frustrated when it doesn’t perform as expected. It’s not until there are problems that they resign themselves to consulting that handy little instruction manual. 

I dare say that dentists, many of whom pride themselves on their meticulous attention to detail, are similarly guilty of this, particularly when it comes to reviewing important practice stats. Many give little more than a cursory glance at key computer reports. Some will quietly confess that they are not entirely sure what any of them really mean. But they are convinced that if there were a problem with a system, they wouldn’t need a report to direct them - they would certainly be able to spot it without the “directions.”

Truth is, until problems develop and they start feeling the pinch of dwindling production, or until they are sweating the proliferation of hygiene openings or are panicked because they don’t have the money to pay their bills, those reports are of little importance. Yet if they are used correctly and routinely, those reports are the directions - your personal guide to a successful practice. And if you actually read them carefully, you can ensure that critical steps in your systems are never overlooked or disregarded in the rush of the day-to-day routine.

I strongly encourage doctors to regularly review key reports including the Accounts Receivables and Outstanding Insurance Claims Reports to monitor exactly how much money is owed your practice. In addition, watch the details of your production, new patient flow, and patient retention using the Production Report. Depending on your software system this report may be called Production by Provider, Practice Analysis, or Production by ADA Code. It is very useful for tracking new patient comprehensive exams. Just be sure those members of your team who are responsible for posting procedures to a patient ledger use the ADA code 00150 for new comprehensive examinations.

Each month, run the report for exactly the last 12 months. It should show specifically how many new patient exams were performed in your practice in the last year. Write that number down. Next, run an Overdue Recall/Continuing Care Report for the same timeframe. You’re looking for every patient who was due back into the practice during the past 12 months. Write that number down. Your results may show 300 new patients and 200 existing patients overdue for recall. You’ve effectively calculated patient flow ratio. What’s more, you now know exactly who has not been scheduled and you can immediately implement a patient reactivation strategy.

The Production by Provider Report should also enable you to monitor individual provider production for each dentist and hygienist. It is important to track individual production numbers to determine productivity. Next, get treatment out of the patient record and on the schedule. Monitor the Unscheduled Treatment Plan Report or similar report. To ensure that this report is accurate, all treatment plans must be entered into the system by the treatment coordinator.

If your Unscheduled Treatment Plan Report indicates that treatment acceptance is below 85%, consider treatment acceptance training and scripts. In addition, evaluate whether your practice makes it easy for patients to pursue the treatment they want and need. Certain software programs allow you to determine almost immediately if a patient is eligible for treatment financing through CareCredit, which can eliminate the money barrier almost instantly. Some systems will allow you to run a Production Forecast Report that can be an excellent tool in determining slow periods, so that you can develop a plan of action to address the potential production shortfalls.

Take time to read the “directions” to your practice - i.e. the computer reports. If you do this you will be well-prepared to pinpoint problems before they become crises, tweak systems well before they collapse, and enable everyone to see in black and white exactly how their job affects the productivity of the entire practice.

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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Hiring Techniques for Dental Managers

Staffing issues are still the number one concern for dental practices, with the recession woes of lost production coming in a close second. Even with fewer jobs available offering full-time hours and benefits, the average turnover in dental offices continues to be about every two years. Because it costs thousands of dollars to recruit, train and assimilate the new hire into the practice environment, it is critical that dentists and managers use diligence in hiring right. 

Working closely with many dental practices across the U.S., patterns are observed of repeated errors that can easily be prevented if the time is taken to change old habits in hiring. After analyzing hiring practices, the following represent a sampling of a common thread in many practices.

Practice #1
Hiring Misfire: Dr. Brown’s dental office had four different front office people in 18 months. The last front office person was fired because she threatened patients to pay via very nasty email messages. After several complaints about her attacks, she was quickly let go.   

Alter this course by communicating with your Business Coordinator about your philosophy regarding your patients and money. In Dr. Brown’s case, he had instructed all of the front office people to work on the overdue AR and “get the money” instead of setting up treatment plans and payment options for patients to follow. If the accounts are overdue, research the amounts to make sure the charges are legitimate and that there are signed treatment plans on file that show the patient understood what their cost would be and how it was expected to be paid. Do not threaten patients with collections, rather, create a billing system that patients understand before treatment is performed and stick to that. Collections are a last resort and not for every patient who has a balance. Many newly hired business coordinators leave the practice early in their positions because they are overwhelmed with negative feedback from disgruntled patients.

Practice #2
Hiring Misfire: Dr. Smith’s dental office hired without creating a written job description. The ad read: Dental Assistant/Front Office, PT but possibly FT in future. Dentrix knowledge a plus but will train. Must take x-rays and be a team player. Dr. Smith was told by the team that a “helper” was needed in the front and the back so the ad was placed on an internet site. Cindi, a dental assistant right out of school, was hired and was to be trained in the front office and the clinical area. Cindi decided quickly that she liked working in the front office better than the back and would say she was busy when asked to work as a dental assistant. The business coordinator loved that Cindi did the confirming, scanning, new patient packets and all the other miscellaneous tasks that she disliked and would say to the clinical staff that she needed Cindi more than they did. A dispute arose over where and when Cindi was needed and tension became noticeable to Dr. Smith.

Alter this course by having a written job description for all staff and especially for a new hire with a position that was just created in the practice. Spell out specifically in the job description what the duties and hours spent at each task will be. Goals for training and learning new tasks should have a time line so that the new hire can become accountable and not say “no one showed me that.” When job duties are not spelled out it gives the new hire a feeling that they can choose.

Practice #3
Hiring Misfire: Dr. Jane was a hard working, self sacrificing dentist with a new practice, and wanted to hire people like her. When she worked through lunch and often past closing time, she felt good, but her staff was exhausted and stressed. They liked her personality so they never said anything. The newly hired second dental assistant complained after the first week and then quit after the second month when she noticed no overtime paid on her paycheck. Dr. Jane dismissed her as being a trouble maker and started her search for a new assistant.

Alter this course by knowing the employment laws in your state and adhering to them in your practice. If not, it is only a matter of time before someone will report the unfair practices.  Be realistic in the expectations of your staff’s ability to perform well, and respect the law in regard to nutrition breaks. Ask each team member in private if they are willing to work overtime, and if so how often.

If you would like more information on McKenzie Management’s Advanced Training Programs  to improve the performance of your team, email training@mckenziemgmt.com.

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Nancy Caudill
Senior Consultant
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How To Survive When Your Employee Leaves

Dr. Jake Black– Case Study #222

The telephone rings in the office of McKenzie Management.  Dr. Black is on the line, obviously anxious and unsure of where to start his conversation. “Hello. My name is Jake Black and my front desk person just turned in her notice today. I have no idea what she does up there or how she does it. What am I going to do?”

All employers have had a key employee leave. Some leave because of a personal relocation, others because of “better offers” and many because of a change in their family status.  And let’s not forget those that finally get on the doctor’s last nerve and he/she finally snaps and asks the employee to leave. None of these scenarios are pleasant but systems should be in place for the practice to continue without too many hiccups through the transition period to a new employee.

This article is intended to address a departing business employee. It is not to imply that the clinical team members are not key employees, as all team members are vital to the success of the practice. 

The “Must Have” Checklist
Dr. Black was fortunate because his business employee (he only had one) was leaving due to the relocation of her spouse, rather than due to other more unpleasant possible reasons for departures. This made the training of a replacement much more cordial and helpful for the new employee. However, Dr. Black realized that he knew nothing about the daily activities of the business area – he wasn’t even sure what practice management software he was using! Understanding that he had no knowledge of how his practice is managed, a checklist was created for the departing employee to complete prior to her last day:

  • All the pass-codes and log-ins for the computer, insurance websites, collection agencies, etc. that are used by the business person.
  • Written instructions on how to work all the various equipment in the business office, including the answer machine, printer/copier, scanner, etc. In conjunction with these, the repair contacts, suppliers for paper, toner, software support, etc.
  • A copy of all the stationery and other paper supplies that must be ordered periodically and where they are ordered from.
  • Computer back-up information if not performed by the doctor – external hard drive, off-site through the Internet, etc.

The “How To” Checklist
Now that Dr. Black is at least capable of starting his computer, calling the repairman, retrieving the messages from the answer machine, reordering his letterhead stationery and all the other tasks that will eventually need to take place, it is also important to have the protocols on how the various business procedures are performed:

  • Generate weekly statements
  • Generate insurance claims (e-claims and paper)
  • Manage the recall system
  • Manage the accounts receivables
  • Keep the patient records current (when to purge the inactive records)
  • Post payments
  • Make appointments
  • Run the reports to complete the monthly practice performance statistics
  • Print routing slips
  • Create a treatment plan from the computer

For an orderly and easy-to-read format, create a “form” for each of the above tasks and keep in a 3-ringed notebook, along with an example of each report when applicable.  Using the “Print Screen” option on your computer can also be very helpful when describing various menus and windows that must be completed.

Don’t get caught!
It was soon very obvious to Dr. Black that asking Susie (his business manager that was leaving) to prepare all this information for him prior to her departure was impossible during normal working hours, as her normal workday needed to be managed. Understanding the need for this information, he offered to reimburse her for the extra time that she spent. You can avoid getting caught by asking your existing business manager to create these two checklists as her working hours allows over the next two months.  Not because you are expecting her to leave (make sure that she knows this!) but as a “survival” technique in case of an emergency. Think of it like this, you create a computer back-up every day to save your valuable data. You won’t have any data to back up if you don’t know how to create the data in the first place!

As a side note, these checklists also make wonderful training tools should you find yourself needing to add additional business team members to your existing team.

A word about the clinical team
I know that I wasn’t going to discuss your survival when a clinical team member leaves, but I changed my mind!  Please ask your clinical coordinator to create the same “Must Have” checklist for all the contacts she has, as well as a “How To” protocol sheet for tray set-ups, sterilization, supply storage, inventory control and other various tasks that she performs daily, weekly and monthly. You will be glad you have it when the time comes to “survive.”

If you feel it would be helpful to invite a McKenzie Management Consultant into your practice to help you and your business team to establish these checklists so you will survive the inevitable, please contact us!

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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