7.9.10 Issue #435 Forward This Newsletter To A Colleague

Help! Things Have Got to Change!
by Sally McKenzie CEO
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You want to change your practice. You know that you need to change the culture, the systems, perhaps even the staff. You have the desire, but desire alone doesn’t prepare you for the climb when you are standing at the base of what seems like Mt. Everest. Singlehandedly achieving real change in the dental practice can be a truly Herculean effort. Team dynamics, history, patients, practice culture and technology all play significant roles in the transformation efforts, and each can erect seemingly insurmountable barriers to achieving the goals unless outside help is brought in to effectively and constructively remove those barriers.

Some dentists can successfully direct true system and cultural change in the practice on their own. However, most don’t have the time, the energy, or the mental fortitude to push through when seemingly everyone else is pushing back. When the desire for change and the painful realities of achieving it are worlds apart, it’s time to call in the professionals. But how do you distinguish between those that can deliver results and those that can’t? 

Like dentists, there are excellent consultants, good consultants, and, unfortunately, bad consultants. Rather than lumping all practice management consultants in the same category, I suggest you conduct a simple evaluation.

Does the company or consultant you are considering come to you or must you and your team go to them? Certainly, it’s valuable for your team to go off-site for a team retreat and continuing education, but there is no substitute for what happens on-site, day-after-day in your practice. If you are trying to make major changes to critical systems, a consultant cannot make effective recommendations until s/he stands in your office, witnesses the challenges you face, understands your goals and vision, studies your practice data on-site, evaluates the demographics and psychographics of your community, and stands side-by-side with the team that makes or breaks your success.

Does the company have a track record of success? You want numbers, you want data, and you want references. The credible companies and consultants will not hesitate to share this information with you.

Can this company tailor its recommendations to address the specific needs and uniqueness of your practice? Perhaps yours is a specialty practice, or maybe you have certain economic challenges in your community. Possibly yours is an HMO office, or maybe your practice is in a rural setting. Certainly, there are management systems that every practice must implement - such as scheduling, collections, production, etc. But no two practices are exactly alike. You want a consulting company that has the experience and breadth of knowledge to address the uniqueness of your practice.

What type of follow-up will this company or consultant provide? Is this a once-and-done operation? They spend a day or a few hours with you, hand you a manual to follow, and send you off to implement the recommendations on your own? In most cases, that’s a strategy for failure. The doctor cannot make major changes in her/his practice singlehandedly.

Or, are the consultants on-site for as many days as the dentist would like. In some cases, we find it is as few as two, in many it is four, and oftentimes doctors request that the consultant be on site on a more continuous basis. But regardless of the number of onsite days, you have a partner walking through the change process with you and your team for a longer period of time. Ultimately, you want to work with a consulting firm that is prepared to provide individual attention and specific assistance to your practice over the long haul.

Give me a call today and learn how McKenzie Management can help you achieve real change before the end of the year.  877-777- 6151 Ext. 511.

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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The Best Month of My Dental Practice!
By Belle DuCharme, CDPMA

Case File #248
Dr. Bob Smithston*

 “I cannot believe what just happened. Six months ago, I had holes in my schedule with low production and hygiene fall out. This month we finished with the highest production and collection month I have experienced in my career.” 

Dr. Bob decided he needed to make some changes in his practice six months ago. He said “what have I got to lose, I am not happy the way things are.” Wanting to pursue another focus for his practice, he was met with resistance and disregard from his staff.  In frustration, Dr. Bob decided to enlist the help of a professional and reputable dental consulting firm. Concern for how his patients may view new team members kept the doctor from making decisions to find new people, along with the fact that he just didn’t trust that he had the skills to make the right decisions in the hiring arena.

Of his small team of four people, only one team member - the dental assistant - supported the direction he wanted to go. Because of this, Dr. Bob enlisted the consulting team to direct him in finding the right people for his practice. He replaced his two part-time dental hygienists with a full time, extroverted, highly motivated and skilled dental hygienist who took the extra time to help guide patients toward accepting the treatment that had been diagnosed and yet not treated. She began using the intra-oral camera on a regular basis to demonstrate not only the need to replace worn, defective, unsightly and failing restorations but also focused on the benefits of new and better restorative options. Of course this took extra time, but the dental assistant then stepped forward to do the hygienists’ instruments, thus freeing her a couple of minutes for each patient to get oral pictures.

Finding a front office administrator who was not overly concerned about what the insurance was going to pay or whether the patient could afford the dentistry was a challenge. After much interviewing and testing, he finally found an applicant who shared his philosophy about health-centered dental care. The total interview process took almost three hours but at the end of that time, the doctor felt confident that this person shared his goals and could deliver the right attitude.

With the new team on board, regular meetings including a daily morning huddle took place at a scheduled time. Constant supportive or directive feedback came on a daily basis. More education and training helped everyone stay focused on their work and goals. Setting goals like going “chartless” and training everyone to scan documents when they had open time was achievable when everyone shared the same goals.

Making the practice a pleasant place to be included storing unsightly charts out of site and making sure the areas that patients could see were spotless and beautifully decorated. Internal marketing was improved to make sure that patients did not wait more than five minutes to be seated. Financial arrangements were presented for everyone that was given a treatment plan so that there weren’t any miscommunications about payment and when it was due. 

The biggest key to this practice’s success was the thoughtful and careful dentistry that Dr. Smithston delivered to his patients. His goal to provide the best dental care was demonstrated in all that he did for his patients. He had been doing this type of dentistry for years, but there was an important element missing - and that was the support and focus of his team. His leadership skills improved with coaching from the consulting team and he realized that he needed to be accountable for the success of his dental team. 

The positive energy created by this shared vision attracted the patients, and they began accepting the benefits of improved health offered by Dr. Smithstons’ dental care team.  Compliments began coming in about the team and patients voiced their pleasure over the positive changes made to the practice. It was a wining situation for all concerned and manifested in more than doubling his production and exceeding production and collection goals by thousands of dollars.

*names changed to ensure privacy - case study is based on an actual practice.

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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Job Descriptions - Why Does It Really Matter?
By Nancy Caudill, Senior Consultant McKenzie Management

Dr. Jamey Gleason – Case Study #211

One of the twenty-plus business operational systems of a dental practice is “Accounts Receivables” - the money that all your patients owe you, including their outstanding insurance claims.

Dr. Gleason was under the impression that his A/R was okay, understanding that “industry standards” indicate that if your A/R is no more than 1x your “NET” production, you are good to go.

Upon closer study of his report, this is what he learned:

Lesson #1 – Do Not Include “Credit” Balances
Most all practice management software systems have the capability of “filtering” out the credit balances.  Credit balances are those accounts where the account’s balance is a negative amount.  Reasons for credit balances can be:

  • Patient’s insurance paid more than was estimated after the patient’s portion was paid, therefore leaving a credit balance on the account
  • Patient is pre-paying for treatment that has not been performed yet
  • Patient is an orthodontic patient and paid for all or part of their treatment and the entire amount has not been charged out yet because of insurance billing
  • A fee was adjusted due to uncompleted treatment, leaving a credit balance since the treatment was paid in full

Be careful when reviewing an individual patient’s account within an account.  The patient could have a credit balance and another family member could have a debit balance that offsets the credit. Most software programs will make the transfers between family members automatically and some must be performed manually. This transfer should be conducted as soon as the credit balance is noted.

Why is it important to eliminate the credit balances? Because the credit balances REDUCE your true A/R!  See example below for Dr. Gleason:

A/R balance including credit balances: $151,500
Credit balance total: $30,000
True A/R: $181,500

Dr. Gleason’s monthly net production was $149,000 so he assumed that his A/R to net production ratio was $151,500 / $149,000 = 1.02. In actuality, his true A/R to net production was $181,500 / $149,000 = 1.22 or $32,500 higher than it should be!

Lesson #2 - Balances Over 90 Days
A healthy A/R should not have more than 10% of the total monies 90 days and over. In Dr. Gleason’s case, there was 15% that was over 90 days. Upon further evaluation, we determined that several of the accounts had not made payments in over 6 months and no action had been taken!

First – clear payment arrangements should be made with the patient to manage their treatment investment. If the patient has the assistance of an insurance “supplement,” his Financial Coordinator should “guestimate” the patient’s portion, inform the patient when the appointment is scheduled and ask for this payment when the treatment is completed.  Yes - patients will fail to pay even when they promised! Now they have a balance and the treatment has been completed. 

Next - this is when your verbal skills are tested! A commitment date should be established with the patient for receipt of the promised payment. A task or reminder should be created in the software to remind you to contact the patient if the payment has not been received.  A call is placed to the patient with a statement such as, “Mrs. Jones, this is Nancy at Dr. Gleason’s office. I didn’t receive your promised payment on June 20. Is it possible that I overlooked it?” Ask the patient to commit to another date or better, offer to take their payment over the phone with a credit card.

Lastly – if attempts have been made to collect the past due debt, you should have a relationship with a collection agency to assist in collecting delinquent accounts. Prior to sending the patient to collections, I would recommend that you send the patient a letter indicating that you will offer a 5-20% bookkeeping adjustment if the patient will pay their account in full within 15 days. Be sure to flag the account for payment in advance for future treatment.

How to Avoid Falling into the A/R Trap
When working with patients with insurance benefits, attempt to “guestimate” as closely as possible the patient’s portion and collect this at the time of service. This may require calling the insurance carrier and verifying their benefits, visiting the carrier’s website or using other eligibility tools.

  • Inform before you perform! Avoid prepping that tooth for a crown without your Financial Coordinator discussing with the patient their financial responsibility.  There is nothing worse than checking out an emergency patient and informing them that their investment for the crown that was just prepared is $500 and they are shocked because they thought that their insurance would pay for it.
  • Utilize CareCredit for patients that need additional time to pay for their treatment.  You can offer them interest-free payments for up to 24 months in some cases.
  • If statements must be sent due to the failure of the insurance carrier to pay the estimated portion, send the statement as soon as the insurance payment is posted.  Do not wait until the end of the month when statements are generated.
  • Remit statements electronically daily or weekly.  Do not send statements on the first of the month. It is too late! Sending statements on a regular basis improves cash flow and avoids all those blue envelopes hitting the Financial Coordinator all at one time.

Take your Accounts Receivable’s temperature and see if yours is healthy.  After 6 months, Dr. Gleason’s is!

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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