12.11.09 Issue #405 Forward This Newsletter To A Colleague
Managing Hygiene
Employee Orientation
Increase Your Revenue

Who’s Dropping the Ball on Recall?
by Sally McKenzie CEO
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Hygienists, I have a few questions for you. Who is responsible for keeping your schedule productive? Does someone in the practice confirm your patients’ appointments? Does the practice regularly monitor and adjust for necessary hygiene days? Let’s look at the first and second questions. Who is responsible for keeping the hygiene schedule productive? And are hygiene appointments confirmed? Both of these are essential to a successful dental practice, and neither is the responsibility of the hygienist. I strongly recommend that practices designate a Patient Coordinator. This point person is responsible for keeping a steady flow of patients streaming into the hygiene treatment rooms. The hygienist is a clinical producer.  The recall system is a business operational system.

The Patient Coordinator position has an enormous impact on production/overhead. The responsibility should be assigned to one business person – NOT the hygienist. In addition, this person should not be a “floater” who is expected to fill in here, there, and everywhere. The coordinator is professionally trained to make calls. They are given uninterrupted time to carry out their responsibilities, and this is their mission:

  • Make a specific number of patient phone calls each day
  • Schedule a definite number of appointments
  • Ensure that a precise number of patients complete treatment
  • Develop a schedule that ensures the hygienist achieves a daily or monthly financial goal – at 3x their wages
  • Manage the unscheduled time units in the hygiene schedule

This person should be able to handle a patient base of 500 to 1000 on an average of 15 hours per week. Reactivating a few inactive patients pays for the position quickly. Monitor results. Each month, divide the number of patients due for prophies that month by the number performed. Shoot for a goal of around 95%.

Next, does the practice monitor and adjust the hygiene schedule? Hygiene schedules frequently appear  to be overbooked. At times hygiene is so crowded there isn’t an appointment to be had for weeks. Consequently, if patients can’t get appointments in a timely manner, they start shopping around for a new dentist, which translates to bad news for the practice. However, little attention is paid to those holes in the schedule, and that translates into lost hygiene days. If the practice has more hygiene days than patients to fill them, revenues go down and overhead goes up. But how do you establish that seemingly elusive perfect balance in the hygiene schedule? It’s as easy as ABC.

  1. Determine the number of recall hygiene appointments necessary for the year. Count the number of patients on six-month recall and multiply that by two. Count the number of patients on four-month recall and multiply that by three and so on for the remaining recall patients.
  2. Calculate the total number of hygiene appointments needed yearly.
  3. Count the number of new patient appointments needed in the last year.
  4. Determine the number of weeks per year that your practice provides hygiene services.
  5. Calculate the average number of hygiene patients seen by one hygienist per day over the last six months.
  6. Calculate the number of patients to be treated in a week. Take the total of yearly hygiene appointments needed (B) add new patient appointments (C) and divide by the number of weeks worked (D).
  7. Determine the average number of hygiene days needed each week by dividing the number of patients to be treated in a week (F) by the number treated per day (E).
  8. Now determine the number of days worked in a year by each hygienist. Divide that aggregate total by the number of weeks per year that hygiene services are provided (D).
  9. The answer is the average number of hygiene days per week you need to offer your patients.
  10. To accommodate increasing patient demand, increase your number of hygiene days per week by 1.1 times. For example, if you determine you need 7.9 patient days per week you can increase it to 8.69.

Another means of measuring the need for additional hygiene time is to assess how long patients have to wait for appointments. If the waiting time is consistently three weeks and is beginning to slip into the fourth week, it may be time to add one more day of hygiene.

Understanding how the hygiene numbers stack up in your practice will provide you with clear information to determine if your doctor is meeting patient demand with existing resources, or if he/she needs to add hygiene time. It also will give you solid data on the efficiency of your hygiene department.

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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Employee Orientation Checklist

With the national average of dental employee turnover being every 18 months, it is highly likely that the New Year may bring new employees to your practice. Having a hiring system in place to prevent employment nightmares that may have plagued your practice in the past are prudent. The excitement of finding the right person and quickly training them to perform their duties often leaves out important details. Having an Employee Orientation checklist is helpful to ensure that important segments are not left out or overlooked.

1. A formal welcome to the practice from the doctor and the team. This could be a letter of welcome from the doctor and lunch at a favorite restaurant with the entire team. At the lunch, each team member should have the opportunity to introduce themselves, explain their position in the practice and say what they will do to help the new hire assimilate as quickly as possible.

2.  An Employee Policy Manual with an explanation that the manual is a guide to the office and the employee policies. Each employee should have the same understanding in regards to vacations, medical benefits, pension plans, continuing education, maternity leave, jury duty, paid holidays, dental benefits, etc. so that questions can be addressed before they become misunderstandings. Ask the new hire to read the policy manual and sign an acknowledgement that they understand and will abide by all the rules. It is also recommended that the doctor or the business administrator go over the items bulleted below to ensure that the new employee has full understanding and that they have had the opportunity to ask questions about each item.

3. Employee training is offered for a period of 90 days. During this period of time the new hire is introduced to the practice environment and trained to do their particular job duties with the understanding that the work performance and attendance is being monitored by the doctor or the business administrator. A gradual improvement should occur daily as the new hire integrates into the practice.

4. The practice mission statement is to direct the team toward the same purpose or vision of the practice. A shared vision is important for the practice success. This mission statement is the core to developing teamwork. Knowing the primary goal of your practice, what most represents how you feel about your patients and what sets you apart from the other practices in the area will help you develop this statement.

5. All information necessary to create an employee file is gathered. This list includes the following information that is to be kept in a locked file to protect the personal information of the employees:

  • Tax forms W-4 and I-9
  • State required work permits for those under the age of 18
  • Emergency contact numbers (at least two)
  • Name of physician and phone number
  • Medical records for vaccines – consent form for Hepatitis B vaccine and other vaccines available and recommended to health care workers by state
  • Medical records for work restrictions such as allergies or physical limitations
  • Membership cards for medical, life and dental coverage
  • Copies of current licensing and continuing education courses attended
  • Job description with areas of accountability spelled out
  • Performance evaluation form and salary review form
  • Request for time off form
  • OSHA including infection control and bloodborne pathogen procedures
  • HIPAA regulations regarding patient and employee personal information
  • Medical and dental benefits if applicable
  • Life insurance and pension information if applicable
  • Work schedules to include patient hours and staff hours
  • Practice and personnel security including harassment policies
  • Disaster preparedness plan in case of fire, flood, earthquakes, etc. which would address escape procedures and routes, and rescue and medical duties of employees who will be responsible to perform them
  • Customer service and patient contact information including handling phone complaints
  • Required office attire for the job position
  • Pay and overtime policies, pay days and methods of payment such as check or auto deposit
  • Employee application
  • Résumé and information regarding two checked references

Without this system in place, you will quickly forget what was said to the new hire and as time goes on and more people are hired, it will be quite evident that something different was said to each one. Employees remember and often compare with each other. Keep the peace in your practice and stick to the system.

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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Less New Patients = Lots Less Revenue

Dr. Guy Gregory – Case Study #321

Dr. Gregory is a client of McKenzie Management and has experienced significant growth in his practice over the past 12 months.  At the same time, due to the economic downturn and the effect it is having on his new patient numbers, he isn’t as productive now as he was 8-9 months ago. He wanted to know why. Let’s see what is happening.

Dr. Gregory’s practice statistics before MM in 2008:

  • $75,000/mo in collections
  • Doctor producing $4,750/day in gross production
  • Hygienists averaging $1,750/day with an assistant
  • 25 New Comprehensive Patients/mo
  • Collecting 94% of net production

Improved systems and training after MM during the first six months of 2009:

  • Collections increased 34%
  • Doctor’s daily average increased 28% to $6,080
  • Hygienists stopped carrying the expense of an assistant and still exceeded their new goal of $1,600 per day
  • New patients increased to 29/month
  • Now collecting 109% of net production

So, you may be wondering: “Wow – that is great! What is the problem?” Let’s view the statistics during the last five months of 2009:

  • Collections are up only 4%
  • Doctor’s daily average increased only 1%
  • Hygienists experienced a 4% decrease in daily production
  • New patients fell off by 26% compared to 2008
  • The Schedule Coordinator is still collecting 109% (that’s the good news) – but she is still collecting old debt from 2008

What Happened?
After Dr. Gregory’s consultation, he learned how to improve his treatment recommendations to his patients.  As a result, for the next six months all his new patients as well as his hygiene patients were saying “yes” to treatment.  This increased his production and collections significantly. As these same patients returned for their subsequent professional cleaning or periodontal maintenance appointments with the hygienists, there was no additional treatment to be diagnosed.  It had all been treated during the previous six months!

Due to a lack of marketing protocols, the practice’s number of new patients also dropped off significantly.  Was this due to the economy? I am sure that this didn’t help any, but without a consistent marketing plan to bring in new patients, eventually all of the patients’ needs will be addressed.

Fortunately, the hygiene department has only experienced a slight decline in production because hygiene needs are repetitive and ever-revolving.  This is one of many reasons why your hygiene department is so valuable to you; it provides passive income that is dependable, as long as there is a recall system in place that is retaining 95% of your hygiene patients.

Why New Patients Are So Important
As in this illustration with Dr. Gregory, 50% of a doctor’s production comes from the hygiene department during exams, and the rest comes from treatment needed by new patients. Once all the treatment plans are completed for the existing patients, the only treatment that remains is for emergency patients and new patients. If the number of new patients is less than 20-25 per month on average per doctor, doctor production is going to decline compared to the practice production when it was closer to 30. Dr. Gregory saw 11 less new patients per month compared to the 29 that he was averaging the first six months of 2009, and he felt the effects.

Another example of what happens when there are fewer new patients in a dental office would be that of a “mature” practice. Over the years, all the existing patients have had all their treatment completed. Without a healthy number of new patients, it is the hygiene department that keeps the practice alive. Again, “mature” doctors feel that they don’t need to advertise and grow their practice. However, when it comes time to sell, the numbers will not illustrate any significant growth and maybe even some decline.  These statistics will not be favorable when establishing a selling price for the practice.

Market - Market - Market
Dr. Gregory invested 3% of his collections into a direct marketing campaign with a well-respected national company that specializes in dentistry.  He understands that it is not a “one-shot” deal.  Marketing must be repetitive, and meet as many needs of the potential patients as possible to reap positive results. It is a major investment but it is also necessary when he took note of the decline in new patients.

Learn a lesson from Dr. Gregory. Take action - don’t wait around until your doctor chairs are empty and you have cut the number of working days to 3 instead of the usual 4 because you don’t have patients.

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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