9.3.10 Issue #443 info@mckenziemgmt.com 1-877-777-6151 Forward This Newsletter

Rid Your Practice of the Top Two “Misery Makers”
by Sally McKenzie CEO
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One little procedure here, another little procedure there, and a different little procedure after that… We’re seeing it again – dentists cobbling production together from a series of “little” procedures. This brings me to #2 on the list of Misery Makers in the dental office (I talked about #3 last week) – Production/Scheduling Inconsistencies.

Some figures indicate that more than 80% of all patients come to the dental office to receive care because of a single issue or problem. What does that tell us? I think we can draw a couple of conclusions. For starters, generally speaking, patients have not been educated to expect to come in for more than one procedure at a time. And doctors are most likely recommending treatment that they believe patients will schedule – a single procedure here, another single procedure there. I’ve said this before and I will say it again: You have a professional obligation to recommend the treatment each and every patient needs, not the treatment that you think they will either accept or can afford.

Certainly, you should expect that patients will want to pursue larger treatment plans in phases. And it’s not likely that most will immediately accept a $10,000, $5,000 or even $2,000 treatment plan the first time that they hear it. But my bigger concern is that too many dentists, particularly in the current economy, are shying away from recommending ideal treatment, i.e. more comprehensive treatment plans. And if such plans are recommended, they are typically discussed once and then relegated to the patient files where they will remain indefinitely.

Your ability to produce is tied directly to the patient’s desire and understanding of the need for treatment. Patients must be continually educated on the value and importance of pursuing recommended treatment. If production is not where you want it to be or not where it needs to be, it’s time to closely examine your treatment presentation protocols and techniques.

From there, specific production goals can be identified and communicated to the scheduling coordinator. This person is critical in your ability to meet your production goals. However, in too many practices the scheduling coordinator believes her/his job is merely to fill open time slots. Wrong. S/he needs a clear and specific job description, well articulated goals and objectives, and training to learn specific scheduling strategies to meet established production goals. Scheduling and production should be the strongest systems in your practice. If they’re not, seek help and eliminate the suffering.

And the #1 Misery Maker for most dentists – Staff Conflict. Conflict often begins with a minor disagreement, an annoyance, or misunderstanding. Rick isn’t providing the production reports as promised. Anna is routinely walking in late. Caroline is scheduling 60 minute patients in 40 minute slots or worse yet… in 80 minute slots because she “knows” her doctor talks too much!

Issues such as those come up in virtually all dental practices. But because the employees are afraid to deal with the matters head on, they opt for the passive aggressive approach, engaging in gossip and whisper campaigns instead. Nasty comments and accusations quietly abound. Eventually, the lid blows and the damage caused can, in some cases, be irreparable.

Conflict may be a reality of living and working, but if managed correctly, it can become a constructive rather than destructive tool in the practice. Follow these strategies for dealing with conflict effectively:

  1. Set aside time to directly address matters that are causing conflict. Focus on the issue, not the people. Do not allow gossip or personal attacks. These are a profoundly destructive force in any workplace, especially small offices. 
  2. Establish clear standards for professional office behavior and specific office policies. If the scheduling coordinator is routinely slotting emergency patients incorrectly, assume she/he doesn’t know what you expect. Educate and help her/him to become more effective.
  3. Deal with the issues that cause conflict. Do not make excuses so that you can continue to look the other way. She’s too nice. He’s too argumentative. They’ve been doing it that way forever. They’ll never change.
  4. Choose to be positive. Anyone can criticize others and be negative in difficult situations. It’s the leaders and problem solvers who choose to remain positive and constructive.

Address the issues that are impeding your personal and professional satisfaction. Whatever the “Misery Makers” are in your office, you do have the power to fix them. It’s a matter of choosing to do so.

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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To Pre-Appoint Hygiene or Not?
By Belle DuCharme, CDPMA

To pre-appoint hygiene or not? Ahh, if only it was that simple to have a black and white answer to a question that carries so much gray matter. Assuming that you have laid the ground work with great verbal skills and value-building of practice services, and assuming you have a philosophy of patient care that includes not having patients wait more than ten minutes for their appointment, and assuming that you and your staff promote total health and “walk the walk” not just “talk the talk” - then pre-appointing every patient is a good idea. Did I say that?

What about new patients that call in for an appointment? They want to be seen usually within a week or two on the outside. Since practices spend thousands to attract new patients, giving them what they want when they call is paramount to building a thriving practice. “We are booked out six weeks for a new patient hygiene appointment,” the business coordinator whispers apologetically as she scans the tightly filled hygiene schedules. “We can put you on our wait list. All of our patients pre-appoint but sometimes they call in to change their appointments because things come up. When that happens I will call you to get you in. Is that okay?”

Or, how about scaling and root planing appointments, can they be scheduled in a timely manner? Your diligent hygienist is diagnosing periodontal conditions that have an urgency to appoint attached to them and to the dismay of the hygienist, the business coordinator says, “Oh, we can get you in six weeks from now”, or “I don’t have a two hour block of time for several weeks, let me see what I can do to get you in. Lets put you in here and if anything opens before this, I will give you a call.” Does this convey value or importance? 

Okay, you say you need to add more hygiene days, but what about the average one or two daily cancelled or broken hygiene appointments? These were pre-appointed hygiene appointments that now are open to fill. If we get on the phone and frantically call everyone that has agreed to be moved up, then we should be able to fill those spots, right? Having to pay a hygienist to call unscheduled recall is counter-productive, so the business staff drops what they are doing to make these important outbound calls.

All practices are unique to their demographics, psychographics, philosophy, training and skills. Insurance driven practices that pre-appoint will hear this with a cancellation: “My insurance changed at the first of the year and you are no longer a provider on my list, sorry, I forgot to call to cancel my appointment.”  Or, “Sorry, I still owe you money from last year so I am canceling my appointment.” Or, “I don’t recall making that appointment; my work schedule has changed so I cannot come in.” You are going to get cancellations and no-shows with pre-appointing, but it is far more successful to pre-appoint most than to pre-appoint none.

I would not pre-appoint those that have a track record of last minute cancellations or failures, those that are having difficulty paying their bill (unless they have agreed to pay for the hygiene appointment and continue to make payments on their existing bill), those that balk at making a future appointment, and those that are patients only because of the insurance. You will have far fewer broken or cancelled appointments from patients who value their appointment and understand the connection between good health and regular professional dental care. 

When pre-appointing, take into consideration the new patients that want to come in and the patients diagnosed with scaling and root planing.  My advice would be to not schedule all openings several weeks out, as that will eliminate your opportunity to see new patients and patients needing scaling and root planing. Hold or block times strategically throughout the schedule for new patients and scaling and root planing, and if these appointments are not booked two days before the time, then call patients that are open to being moved and unscheduled patients to fill the times. This will prevent new patients from canceling and going to another practice that can see them sooner.

So, the question was - do we pre-appoint hygiene or not? The answer is a qualified yes and a qualified no, depending on your practice and its uniqueness. Want to build your practice and establish a successful recall system? Call McKenzie Management today and get the advantage with trained consultants.

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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5 Time Wasters at the Front Desk
By Nancy Caudill, Senior Consultant McKenzie Management

Dr. Jeremy Jackson – Case Study #322

Dr. Jackson had been a client of McKenzie Management in the past and continues to read the weekly e-newsletters to “stay on course” and continue to incorporate new game plans into his already productive practice.


Today he called to inquire on how to save time in the business area. Like so many other dentists across the nation, he was pinched by the economic times and followed McKenzie Management’s recommendation to keep his practice “lean and mean.” When one of his front desk employees’ spouses was relocated and she turned in her notice, he, along with the two remaining business team members, elected not to replace her.  Instead, he was willing to increase their salaries incrementally for their increased job responsibilities and help them to be more efficient at the same time.

Five Time Wasters We Eliminated

1. Filing Paper Records
Over the next six months, the practice took serious steps to eliminate the need for paper records. The practice was already digital in all the operatories so this step was actually quite easy once a plan was implemented. A software trainer was obtained to teach the clinical team how to enter clinical notes, treatment plans, etc. Auto-notes were written to save time. As the patients were seen over the course of the next six months, only the most recent written clinical page was scanned into the document center of the software. The medical history was updated in the computer, as well as insurance information. Because the paper records were still available for reviewing information, such as letters from referring dentists, old lab slips, etc. these items were NOT scanned.

How was this a time-saver? Beth and Janie were retrieving and filing a minimum of 30 paper records per day. At best, an average of two minutes per records = 2 min x 60 records = 120 minutes, that’s 2 hours per day being used to manage these paper records. This does not include miscellaneous records that were retrieved for other reference needs.

2. Filing EOBs
Explanation of Benefits from the insurance company - currently, Linda was posting insurance payments and then filing a copy of the EOB into each patient’s record. For the bulk checks (sometimes as many as 15-20 patients), she was making a copy of the EOB so a copy could be placed in the applicable record. This was taking approximately 3 minutes (not including the copy time) to file each EOB. 20 x 3 = 60 minutes or 1 hour per day to manage the EOBs.

The solution - until the practice is chartless, the EOBs should be filed according to the date that the payment was posted to the patients’ accounts. For example, today there were 18 payments posted. All the EOBs were stapled together and today’s date was clearly written on the top EOB. This stapled stack of EOBs are filed chronologically in the August file. If one of the EOBs is needed, simply review the patient’s ledger, obtain the date the claim was posted, and then retrieve the EOB’s with that date. The goal is to manage the EOBs as quickly as possible. After the practice is chartless, it is recommended that Beth and Janie continue to do the same time - there is no need to take the time to scan each EOB into the computer.

3. Manually Confirming Patient Appointments
Let’s face it. For the most part, we are a ‘techie” society. I acknowledge that not everyone has a cell phone or computer, and that is why there is the US Postal Service.  But 75% of Dr. Jackson’s patients use text messages and emails on a daily basis.

A campaign was created to obtain cell phone and email addresses from all the patients as they were seen. The patients were advised of the new advances in “customer service” that were being provided, by contacting them via text message or email about their upcoming appointments. The patients were given a printed one page instruction sheet that illustrated how to “acknowledge” the receipt of their email or text message.

The practice obtained cost-effective software that contacted all of their patients regarding their upcoming appointments. This saved the practice approximately 80% fewer phone calls and a time-savings of about 1-1.5 hours per day.

4. Manually Verifying Insurance Eligibility
Previously, Linda was making phone calls, reviewing websites or receiving faxes to verify patients’ eligibility for their annual benefits. A program was implemented through their practice management software that reviewed eligibility automatically for all their patients. If there was a specific benefit that needed to be verified that was not available through the automated system, the manual protocol was implemented.

Verifying insurance eligibility is a very time-consuming process. It was estimated that a minimum of one hour per day was saved using the new automated system.

5. Sending Monthly Statements and Insurance Claims by Hand
Most all practice management software has the capability of electronic statements and insurance claims. If your practice is not taking advantage of this opportunity, your business team is wasting a lot of valuable time. Yes - there is a minimal investment but compared to the time it takes to print, stuff and mail claims and statements, the time-savings is worth the trade-off, not considering the savings of paper, printer ink, envelopes and postage.

Electronic claims should be processed daily, and yes, the insurance company processes these claims first so your cash flow is improved. Electronic statements should be processed weekly. The time to review 25% of your A/R compared to 100% is reduced and, again, your cash flow is improved.

Dr. Jackson feels that his business team is much more efficient now and they are happier because their “bottom line” has improved! Invite a MM consultant into your practice today and see how you can help your team save time, save money, and take you into the 21st century with the use of technology.

If you would like more information on how McKenzie's Consulting Coaching Programs can help you IMPLEMENT proven strategies, email info@mckenziemgmt.com.

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