6.25.10 Issue #433 Forward This Newsletter To A Colleague

3 Steps to Get You and Your Team Exactly Where You Should Be
by Sally McKenzie CEO
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There are few things as satisfying as setting a goal and achieving it, whether it’s simply completing a mile on the treadmill or qualifying to run the Boston marathon, whether it’s learning to boil water or fixing a fabulous gourmet meal for friends. There is great satisfaction in identifying your own personal summit and setting a course to reach it.

That couldn’t be truer than in the workplace. Yet too many people don’t enjoy their jobs in the dental practice; they are bored or unchallenged. It’s a symptom that I believe is a direct result of an inability to establish achievable practice goals and set out on a course to reach those goals. My advice: examine each position in your practice and together with your team establish specific job-related goals that will enable your practice to move forward and your team members to grow both personally and professionally. Take these steps:

Step #1
Create specific job descriptions for each employee. Define the job that each staff member is responsible for performing. Specify the skills the person in the position should have. Outline the specific duties and responsibilities of the job. Include the job title, a summary of the position, and a list of job duties. This can be the ideal tool to explain to employees exactly what is expected of them. You’d be amazed how many employees have little more than a vague idea of what the dentist expects.

For example, your dental assistant’s job description should include points such as attending beginning of the day meetings, completing case presentations, reinforcing to patients the quality of care delivered in the practice, directing the doctor to check hygiene patients, completing post treatment care calls, converting emergency patients to new patients, turning the treatment room around promptly, etc.

Avoid the common yet dangerous pitfall of overlapping job duties. Instead, cross-train so that each area has coverage when the point person is out ill or is unavailable. If you overlap duties, employees are given tasks but not responsibility. Consequently, the team member trying to fulfill her/his job duties effectively quickly becomes frustrated. S/he wants to take ownership for a particular system, but can’t because it’s not her or his “system” to oversee. It’s simply not in the practice’s best interest to have multiple people responsible for areas such as collections or scheduling.

Step #2
Lay the groundwork for success!

  • Provide the necessary equipment and tools to perform the job
  • Provide training to help team members carry out the job duties most effectively
  • Evaluate the number of staff to ensure the number is adequate
  • Explain what is expected of the employee and how their performance will be measured

For example, if you are measuring the performance of your dental assistant, you should be able to see the distal of the cuspid on every bitewing X-ray, you should never have to reach for an instrument on any setup, and the molds the assistant pours should be free of defects. In addition, if you expect your assistant to achieve an 85% case acceptance, that person needs to know this. If it’s your expectation that the assistant give a daily report on post-treatment calls, this needs to be said. If you expect her or him to convert 75% of emergency patients to comprehensive exam patients and keep the cost of dental supplies at no more than 5% of practice collections, make sure that direction is abundantly clear to the employee.

Step #3
What gets measured gets done. Appraise employee performance using an effective performance appraisal instrument that evaluates key areas such as:

  • The employee’s ability to follow instructions
  • Their willingness to help others and cooperate with others
  • The incidents of errors in their work
  • Their initiative, commitment, and innovation in carrying out their responsibilities and improving work flow
  • Their work ethics, attitude, and individual productivity

When you provide your team with clear direction and guidance, they have the opportunity to do more than just perform a task. They can excel at what they are doing. Remember, the vast majority of employees want to deliver a quality work product, and they want to know that they are heading down the right path to achieve individual and overall practice success.

Give the team a little direction and you’ll find the road to success doesn’t have to be a circuitous journey after all.

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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Reactivating Patients and When a Patient Declines Treatment
By Belle DuCharme, CDPMA

It has been said that it is five times the cost to attract a new patient versus keeping a current one satisfied. If a patient has not returned to your practice during a twelve month period, that patient is now considered inactive. These patients are often the easiest to appoint because most have just forgotten to call or were too busy to notice that it was time to come back for the professional teeth cleaning and exam. Many offices wait too long to call these patients or some offices don’t call at all. This is a missed opportunity to show that you care and that you believe the services that you provide are important to maintaining optimum health. 

If the new-patient experience left the patient feeling unimpressed and the only thing worth remembering, and not in a positive way, is the $7,300 treatment plan presented haphazardly at the front desk, then failing to follow up will probably cost you the patient. Think for a moment what brought that patient to your practice in the first place. Was their chief concern addressed, was time taken with the patient to build rapport and trust? What kind of marketing motivated the patient to call - direct mail, signage, drive by, personal or professional referral? Whatever motivated the patient to contact you could get chalked up as a big mistake if the patient is less than satisfied with your services.

What will motivate practices to follow-up on unscheduled patients are unfilled appointment blocks in the schedule or what we often refer to as “holes in the schedule.” The calls made are outbound calls similar to cold calling or telemarketing and are not pleasant to make unless there are some good notes in the chart about the patient that can be used to build phone rapport. If it has been a long time since you tried to contact the patient, the patient may think that you are not interested in them so much as getting business in the door.

If you contact a former patient who tells you that they have decided to go to another dentist or that they are not interested in coming back to your practice, make sure to carefully note the call in the patient record along with a summary of the conversation. If the patient sounds receptive you may ask this question: “Mrs. Patient, may I ask why you have decided to leave our practice?” If you do not ask, most patients will not tell you the real reason for fear of hurting someone’s feelings or they don’t want to make trouble for anyone. Often patients feel that it doesn’t do any good because nothing will change. 

If the patient is in the middle of treatment such as endodontic therapy and chooses not to return for treatment, send a certified letter with a return-receipt request stating the risks for not completing treatment and an offer to send them a copy of their records or to a dentist of their choice. Make notes in the chart and make sure to save or scan in any correspondence to the patient. Offer to refer the patient to another dentist or to the local dental society for a referral.  Also note this in the patients’ record to reduce the likelihood of the patient claiming abandonment

Have a system of making 5 outbound calls a day to unscheduled patients. Even if you have to leave a message, it will plant a seed in the mind of the patient that you do care and you have not forgotten them. Make this call monthly until you hear from the patient.  At some point the patient will call to appoint or will call to let you know what is keeping them from appointing.

If the patient does tell you why they are not returning to your practice and it has something to do with a communication or issue with a staff member or the dentist, don’t cast it off as an isolated incident, it could be indicative of a chronic condition that can cause the practice to suffer with loss of many patients. Take action to address the concern so that changes can be made for better communication and stop the loss of your valuable patients.

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

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Nancy Caudill
Senior Consultant
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Why Are ‘Net’ $ So Important?
By Nancy Caudill, Senior Consultant McKenzie Management

Case Study #443
Dr. Brian George

Dr. George contacted McKenzie Management for the same reasons that so many of our wonderful clients do – he needs more income! It is as simple as that. Obviously, the solution is not as simple and involves every aspect of the practice. This article is written to shed light on the word “net” - as in production and collections.

Dr. George’s practice statistics:

  • Gross Production for the month = $76,000   
  • Gross Collections for the month =  $65,500
  • Gross Production to Gross Collections % = 86%

At first glance, you would say that he made his daily production goal for the month on average. However, statistics can be deceiving if you are not comparing apples to apples. How many of your dentist friends comment to you about how much they are producing a month? It is always a topic of discussion. What is more important is how much are they collecting?  And to take it a step further, how much are they collecting after adjustments?

Gross Production
Gross production can be different between offices because some offices post the already-adjusted PPO fees as their gross production. Other practices post their “office” fees for patients where PPO contracted fees are not applicable. An example of this would be a D1110 ADA Code where the “office” fee is $80 and a contracted PPO fee is only $68.

  • Office X is a PPO participant with this patient’s insurance and posts $80
  • Office Y is a PPO participant with a similar patient’s insurance and posts $68
  • Office Z does not participate with a patient’s insurance and posts $80

These figures are all considered “gross” production because an adjustment has not been applied to it by the Financial Coordinator.

Net Production
Office X receives the insurance payment and the EOB (Explanation of Benefits) and now must post the adjustment of $12 because the EOB reveals that the submitted amount of the claim was $80 but the “allowed” amount is only $68, so the difference must be adjusted in this case. Therefore, the NET production for this office is $68.

Office Y also receives payment from the insurance company and the EOB indicates that the submitted amount was $68 and the allowed amount was $68.  Therefore, no adjustment is posted.  In this case, the NET production for this office is still $68.

Office Z’s EOB with the insurance payment indicates that the submitted amount of $80 and allowed amount is the same so there is no adjustment made.  The NET production is $80.

Now let’s look at the gross collections for this same scenario. We are going to assume that the insurance paid 100% for this procedure in their plan.

Net Collections

  • Office X collected $68
  • Office Y collected $68
  • Office Z collected $80

The above collection dollars are ALL gross collections. No adjustments have been posted to them. However, let’s say that office Z’s family balance was only $68 before the insurance paid. Now the insurance is paying $80 and there is a credit balance of $12 that needs to be returned to the account. A check is written for $12 at the end of the month, bringing Office Z’s net collections to $68.

What does all this mean? Gross production means nothing!  Even net production means nothing other than this is the amount that the collections are based on. Gross collections mean nothing because the refunds and NSF checks have not been factored in yet. It is all about NET COLLECTIONS!

Credit Balances
During my visit with Dr. George, I reviewed his credit balances. This is the amount of money that he owes his patients due to the differences between what the patient paid versus what the insurance paid. It does not indicate that the insurance paid too much!  It just indicates that when the patient’s portion was “guestimated,” the insurance company paid more than anticipated, leaving the patient with a credit balance.

In many states, it is required by law that this credit be returned to the patient within 30 days. Unfortunately for Dr. George, he had over $14,000 in credit balances that had accrued over the 18 years in practice and had not returned these overpayments unless the patient requested it.

As a side note – it is VERY important that credit balances be excluded from the Accounts Receivable Report. In Dr. George’s case, this $14,000 reduced his A/R to $53,800 when it really was $67,800 or 1.01x his net production instead of .80x, which he was misled to believe.

Bottom Line for Dr. George
His practice incurred production adjustments equivalent to 12% of his Gross Production.  Therefore, his NET production = $66,880. Production adjustments are any adjustments that reduce the original fee. Examples would be senior citizens courtesy, professional courtesy, PPO adjustments, bad debt write-offs, small balance write-offs, employee courtesy, family courtesy, incomplete treatment, etc. All of these adjustments reduce the patient’s original fee that was posted. None of these are collection adjustments, which only include refunds and a recharge of an NSF check.

He also incurred $356 in refunds for the month because a patient elected not to complete treatment that was already paid for. Therefore, his NET collections for the month were $65,144. 

$66,880 net produced
$65,144 net collected =
97.4% net collection to net production % compared to 86% when comparing gross production and collection dollars.

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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