4.23.10 Issue #424 Forward This Newsletter To A Colleague

Ensure that Your New Employee Succeeds
by Sally McKenzie CEO
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The last thing most doctors want to do is dismiss an employee. They are not alone - virtually every good employer will agonize over having to take that step. It’s the stuff sleepless nights and angst-filled days are made of. Consequently, many dentists will tolerate low morale, inappropriate behaviors, utterly ineffective systems and considerable personal misery - not to mention a huge drain on financial resources. I suggest that you do all you can to avoid ever finding yourself in that position to begin with. Rather, you can take steps to ensure that every new hire is well prepared to succeed, beginning before you ever say the words “You’re hired.”

First, resist the urge to hire under pressure. I know that when a two weeks’ notice lands on your desk, panic sets in and you want to fill the void as quickly as possible. If ever there were a case when the proverbial phrase “haste makes waste” were true, this is it. The person you hire needs to do more than fill a spot. This isn’t a temporary fix to an immediate problem. You are making a long-term commitment. She/he is going to affect you, your team, your patients, and your profit for, quite possibly, a very long time. Easy answers and fast fixes now can metamorphous into complicated problems and staff issues down the road. Treat the hiring process with careful and deliberate planning and preparation.

Follow these steps:

  1. Assess the systems before you bring in a new employee. If you’re hiring a new office manager, take a look at business operations first. Have the systems been breaking down? This is your chance to fix them.
  1. Plan to provide training. Success or failure of both the employee and the systems they are accountable for hinge on this. You want your new employee to succeed and this employment arrangement to work out. Give the new hire the tools and the training to achieve their best and you’ll both benefit significantly. 
  1. Take 15 minutes and think about what you want the person in this position to do. Do you want someone to warm the chair and collect a paycheck?  Or do you want an accountable, ambitious, individual willing to learn new things?
  1. Once you’ve given some thought to the position, update or write a job description for the job, tailored to attract the employee you need. Include the job title, job summary, and specific duties. This is a simple yet critical tool in the hiring process. It clarifies what skills the applicant must possess and explains what duties they would perform. 
  1. Cast a wide net. Develop an ad and place it on multiple websites and in multiple publications, such as newspapers, as well as business and dental journals. The goal is to reel in as many applicants as possible. Promote those aspects of the job that will have the greatest appeal, including money. Ads that do not include salary are ignored by 50% of job prospects. Sell the position. Tell the reader what’s in it for them. Keep the copy simple but answer the reader’s questions – job title, job scope, duties, responsibilities, benefits, application procedures, financial incentives, and location. Direct prospects to your website to learn more about your practice and the position. This is not the time to dwell on negatives such as long hours and difficult patients.
  1. Incorporate testing as part of the interview process. When you’ve narrowed the applicants down to a couple of excellent candidates, take advantage of online testing tools that enable you to determine who is the best fit for the position and your practice.

Next week, once they are a member of your team, don’t leave them twisting in the wind.

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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Frustrated with HIRING the WRONG people? Remove the guesswork. Employee Testing On-Line

Dr. Nancy Haller
Dentist Coach
McKenzie Management
coach@ mckenziemgmt.com
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Peak Performance Coaching

While curious, dentists for the most part are skeptical of working with a coach. For many, coaching means there is “something wrong.” With this misunderstanding about coaching, it’s natural that dentists are reluctant to engage a coach. Some equate coaching with psychological counseling. Rightly so, they don’t want someone probing into their childhood issues, resurrecting painful emotions about the past, and diagnosing what’s wrong with them. 

In contrast, working with a coach in the corporate world means you’re “high potential.” Pending opportunities for promotion are on the horizon. Companies invest significant dollars to develop their employees. Why? The ultimate goal of coaching is to improve business results. Whether it is increasing customer loyalty, retaining valuable employees, or managing the change that is inherent in business today, coaching enables leaders to impact bottom-line benefits - growth in revenues and profits. So too in the dental world. Running a practice is complex. Increasing competition, diverse employees, and demanding patient populations require an extensive skill set if you are going to succeed.

Coaching is really about doing things more effectively, about honing your abilities to the utmost. Take into account that mastering the art of leadership requires learning to do what may not come naturally to you. Additionally the strengths that helped you to be successful can become weaknesses through over-use and over-reliance.

If you grew up playing sports, you had a coach. He or she was there with the team. That person didn’t play in the game but helped you and your teammates improve the way you played. The coach challenged you to do things differently, to be better.

Consider a professional sports team. Perhaps football. Large sums of money are spent recruiting the best players. These athletes are put through technical training. They learn the plays and strategies to win. Now imagine that they play the entire season without a practice session or a coach. No team owner would ever expose his/her investment in that kind of risk. However, it happens all the time in the dental industry. 

The first 100 years of the field of psychology has been focused on anxiety, illness and pathology. However, over the past decade, psychology has shifted. Now there is compelling experimental evidence showing that a simple adjustment in your daily life can increase your quality of living. Coaching is about making those little adjustments to bring out the best in you.

  • Is there a gap between where you are now and where you want to be?
  • Would you like to grow your practice and yourself to the next level?
  • Could you benefit from having a coach to help you with: time management, employee problems, strategic thinking and planning?

McKenzie Management’s Dentist Coaching Program is tailored to those who have an understanding of their strengths and obstacles. Delivered by telephone, the program is purchased in four, one-hour blocks of time. Generally the Doctor and I talk once per month. At the end of each conversation, we establish goals and action steps to be accomplished before the next coaching session. The structure of the session is focused on outcome. This process is more successful when we identify specific commitments and time lines. Everything we discuss is completely confidential. That is the only way coaching works.

The coaching model I use is called “Assessment-Challenge-Support.”
That is…

  • Assessment: What is your challenge? What strengths will assist you, and what areas will you need to develop?  
  • Challenge: What new skills are important to learn to meet this challenge?
  • Support: In what ways can I be helpful as you strive to ‘stretch’ and grow?

While it's certainly true that you don't have to have a coach, consider for a moment what you might do if you did have a coach.

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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Carol Tekavec, RDH
Hygiene Consultant
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Coding for Hygiene Services

Last time we talked about the hygienist as a production and profit center for a practice. Now we will cover several ADA codes associated with hygiene services and see how they might be used. ADA Current Dental Terminology (CDT) codes are essential for reporting services on insurance claims. However, they also provide “shorthand” for offices when it comes to record keeping, treatment planning, and fee development. While it is well known that insurance benefits are limited when it comes to many preventive, periodontal and even diagnostic services, using accurate coding can streamline office communication while ensuring that patients are receiving the benefits for which they are entitled.

It goes without saying that treatment should always be based on patient’s needs, not their insurance contract. However, when we help our patients plan for their procedures by providing information about possible insurance benefits, they are more likely to go ahead with a proper and complete treatment plan. Here are a few “hygiene codes” and common insurance considerations. Keep in mind that there will always be exceptions to any general guidelines.

D1110-Adult Prophylaxis 
This code applies to a professional dental “cleaning.” It is defined as, “Removal of plaque, calculus and stains from the tooth structures in the permanent and transitional dentition. It is intended to control local irritational factors.” This code is believed to describe scaling and polishing for patients in a healthy oral state, as well as in any condition other than those presenting with deposits that hinder a comprehensive evaluation (D4355-Full Mouth Debridement to Enable Comprehensive Evaluation and Diagnosis), or those that qualify (4mm or deeper pockets and/or other issues such as bleeding, mobility, furcations, and recession) for a D4341-Periodontal Scaling and Root Planing, Four or More Teeth per Quadrant, or D4342-Periodontal Scaling and Root Planing, One to Three Teeth, per Quadrant. Most carriers also consider the code to apply to patients with gingivitis, due to the “local irritational factors” wording in the D1110 definition. An old code, D4345, which referred to scaling in the presence of gingival inflammation, was discarded many years ago.

The code name indicates that the procedure is appropriate for an adult, however the definition mentions “permanent and transitional dentition.” Therefore, this code can be accurately applied to individuals of various ages. Insurance contract guidelines may designate age restrictions, such as for patients over the age of 14 or 16, but that should not be the rule for the dental office. If the service provided is the equivalent of an adult prophy, then age should not be a deciding factor. Despite this, patients and their parents should be advised that a carrier may only pay toward the “child” procedure D1120-Prophylaxis-Child, based on their contracts language. Most carriers cover D1110 twice per year, sometimes with a 6-month interval requirement.

D4341 and D4342-Periodontal Scaling and Root Planing
These codes are described as D4341-Periodontal Scaling and Root Planing - Four or More Teeth per Quadrant, and D4342 - Periodontal Scaling and Root Planing - One to Three Teeth per QuadrantMost plans are now covering a portion of the fee for these codes when the patient presents with pockets, or clinical attachment loss (CAL) of 4mm or deeper. The previous stringent review by carriers of D4341 and D4342 has lessened somewhat in recent years. However, any office that submits these codes at a much higher rate than others in their geographic area may still find themselves under scrutiny. Documentation in the patient’s record of an appropriate diagnosis and treatment plan is important to support claims and defend against an “over-utilization review” and possible refund request.

Many carriers will cover D4342 at a rate of 60-70% of what they allow toward a D4341. It is a good idea to decide on one fee for the code, regardless of whether one, two or three teeth in the quadrant need treatment. In other words, if #3 and #4 are in need of root planing, submit D4342 with whatever fee the office uses. Don’t reduce it by 1/3 because only two teeth are involved. Many carriers are paying toward D4341 and D4342 once every two-three years. Patients who have undergone these services may then receive D4910-Periodontal Maintenance for the “life of the dentition or any implant replacements.” Most dentists also consider that they, and their hygienists, have the prerogative to decide when and if a patient has returned to health.

D4910-Periodontal Maintenance
No service seems to cause more trouble for offices than does periodontal maintenance. This appears to be because patients don’t seem to understand the procedure in general, or why they personally have a need for it. Add this to the fact that some patients think the only difference between a “regular cleaning” and a “periodontal maintenance procedure” is the cost, and you have a blueprint for blunders. What to do?

  • Be sure that when patients are receiving information about their need for root planing in the first place, that the necessity of maintaining their periodontal condition from now on is fully explained. Patients need to know that they are now on the “perio track” and that so-called standard cleanings are not appropriate for them anymore. A good analogy might be that of controlling high blood pressure. Once a person has been diagnosed with the problem, he must be vigilant in taking proper medication, controlling diet, reducing salt, or exercising from now on.
  • In advance of treatment, patients need to realize that their insurance will likely provide only partial payment toward what they require. It is not helpful to address insurance limits after a patient has already received an Explanation of Benefits refusing responsibility for much of their care. Discussion of fees is important and should not be avoided.
  • Make sure that you are providing the appropriate services during a periodontal maintenance procedure, and that the patient is aware of it. These services might include irrigation, use of the cavitron or other devices, root planing and scaling of individual teeth as needed and/or any other procedures not always associated with a D1110. For guidance, offices can use the American Academy of Periodontology Parameters of Care description for periodontal maintenance. In addition, the hygienist should explain what she is doing and why throughout the appointment.

Next time: Hygiene Scheduling - Never Enough Time?

Carol Tekavec CDA RDH is a speaker on dental records, insurance coding and billing, and patient communication for McKenzie Management.  Interested in having Carol speak to your dental society or study club?  Click here

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

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