2.11.11 Issue #466 info@mckenziemgmt.com 1-877-777-6151 Forward This Newsletter

5 Steps to More Effective Meetings
by Sally McKenzie CEO
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For too many dentists, staff meetings are viewed as a hopeless waste of time in which production is sacrificed. They are intended to be effective, information sharing, problem-solving opportunities. But any number of things can turn a potentially successful meeting into a disaster, including lack of an effective agenda, lack of ground rules, clashing personalities, turf wars and more. 

Take five steps and ensure that your next meeting is the first of many great meetings to come.

Number 1 - Establish Ground Rules
Too often meetings get derailed because there is no code of conduct and they degenerate into a free for all. You have the dominators who absolutely must express their opinion. The silent sulkers cannot get a word in, so they simply shut down until after the meeting when they share their true thoughts. Then there are the “side conversationists” who are whispering away and “multi-taskers” who are checking email or cruising Facebook on their smartphones, and the list goes on. With the team, establish the ground rules for your meetings.

For example:

  • Meetings start and end at the designated time
  • Agenda items are addressed one item at a time
  • Everyone comes to the meeting prepared and arrives on time
  • Opinions and viewpoints are expressed politely and by all
  • One person speaks at a time
  • Everyone listens with respect
  • Cell phones and laptops are turned off
  • Relevant information is shared freely
  • Questions are welcomed to better understand issues and points of view
  • When necessary, reasoning behind opinions is explained
  • Disagreements and differing opinions are welcomed as an opportunity to learn more about an issue and ultimately make a more informed decision
  • Meeting notes are to be sent within one week of the meeting

Post these where everyone can see them at every meeting. In addition, ask a member of the team to read them aloud at the start of every meeting, at least early on. Don’t let people slide - gently remind offenders of the rules from day one.

Number 2 - Keep the Group Focused
Share the agenda a minimum of two days in advance of the meeting to ensure that everyone has an opportunity to adequately prepare. Arrange the agenda so that the most important items are addressed at the top of the meeting. Assign a time limit to discuss each item. If an issue requires additional time, ask the group if they feel the matter deserves more discussion or if it should be tabled until the next meeting.

Number 3 - Control the Meeting
Keep the dominators from taking over the meeting and shutting everyone else down by frequently using round robin exercises. Start with the person to the right or left of the dominator, go around the room and ask each person to share their input.

Number 4 - Facilitate
 Assign a facilitator (not the doctor) for each staff meeting. This person keeps the meeting on track and calls on people in the order in which they raise their hands. The facilitator politely enforces the ground rules. They monitor the clock to ensure that issues are given the time necessary. And as matters come up that are important but outside the scope of the discussion, they track them in the “parking lot.”

Let me explain. During discussion, it’s natural for other important issues and good ideas to emerge that require further exploration. These items are posted on the wall in the “parking lot.” This helps everyone to stay focused on the discussion at hand, not just their pet issue. They know that the matter will be taken up later in the meeting before the group adjourns or it will be included on the agenda for the next meeting.

Number 5 - Identify and State Your Action Items
At the close of every meeting, confirm the list of actions, who is responsible for what tasks and if they need assistance from anyone else to complete that task. Reiterate deadlines that have been established.

With a little planning and preparation, meetings can be highly effective information sharing and problem solving sessions. It’s a matter of practice and commitment.

Want more of me? Click here to visit my blog, The Lighter Side, for more Dental Practice Management info.

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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Tom Limoli
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New Procedure Codes and Updated Fees for 2011-2012
By Tom Limoli

2011 has already brought about some rather unique, as well as potentially troublesome, issues and challenges with redefined and new changes to the Codes on Dental Procedure and Nomenclature. Let’s take a look into the future and briefly see what is in store for the next two years. Current Dental Terminology is available directly from the American Dental Association, as well as through my Dental Insurance and Reimbursement - Coding and Claim Submission Manuel.

 Redefined Terminology

Unless you own or are employed by a pathology laboratory, the redefinition of D0486, once again, is going to have absolutely no impact on your day-to-day life.

What was a sedative filling is still D2940, but it is now called a “protective restoration.” The descriptor is somewhat improved but it now contradicts D9110 while at the same time specifying its previous inappropriate usage for closing an endodontic access hole.

D3351 and D3352 apexification / recalcification codes have been clarified to more specifically address the interrelationship with new code D3354 pulpal regeneration so as to not add confusion concerning appropriate utilization. More on code D3354 will come later.

D4263 and D4264 bone replacement grafts, D4266 and D4267 guided tissue regeneration, D4320 and D4321 provisional splinting all have grammatical as well as technique sensitive corrections to the descriptors.

Implant Services
Existing code D6055 implant connecting bar can now be used for both implant or abutment supported bars while D6950 precision attachment specifies that it is identified separately from the prosthetic.

Oral and Maxillofacial Surgery
Thankfully, D7210 surgical extraction still requires removal of bone and/or sectioning of the tooth, but now the mucoperiosteal flap is no longer required while D7953 bone replacement for ridge preservation and D7960 frenulectomy, frenectomy, and frenotomy have well needed updated descriptors.

Of confusion, is the redefinition of local anesthesia D9215 indicating its potential submission on benefit claims with both operative as well as surgical procedures. The future of the electronic health record notwithstanding, how many operative and surgical procedures are you doing without at least local anesthesia? This has the administrative nightmare of CDT-2005 written all over itself. Have we not learned from the past?

And now to top it all off, analgesia D9230 was redefined by simply reversing the order of the words in order to pacify Sister Mary Mucknfutz, my 4th grade English Composition teacher, while D9420 now includes visits to ambulatory surgical centers as well as hospitals. What a relief…

New Terminology

Preventive resin restorations in a permanent tooth will fall, or fail, under new code D1352.  It does nothing more than simply identify when a sealant is still a sealant, but can now be classified as being a “super sealant.” I will stand my ground and share with you today my personal observation that this ill intended and poorly designed CDT procedure code has the potential for health care fraud and inappropriate utilization abuse written all over it.

In the endodontic section, code D3354 will be used for regenerating the damaged pulp of a necrotic, as opposed to neurotic, immature permanent tooth.

Maxillofacial Prosthetics
Want to see an emotionally challenged and previously hopeless patient’s life change right before your eyes? Go back and give back to both the art and science of dentistry and spend some time with the artisans we all know as the maxillofacial prosthodontist.  New code D5952 will be for adjusting a prosthetic appliance identified in the “D5900” section of the code. Also at their disposal will be D5993, which identifies the cleaning and maintenance of those same appliances found in the “D5900” section of the code. These codes are not intended to identify the simple adjusting and cleaning of traditional full or partial dentures.

Prosthodontics, fixed
In the fixed partial denture section, codes D6254 and D6795 can be used for identifying interim bridges when not entirely part of routine prosthetic services. As with any interim appliance, its intention is strictly to maintain the patient while healing, resolution, and other procedures are completing.

Oral & Maxillofacial Surgery
New to the oral surgery section is D7251 for identifying the intentional removal of only a portion of a tooth so as to not create a neurovascular complication, while D7295 is for identifying only the harvesting of bone when it is going to be used in an autogenous grafting procedure.

Fee Data
In updating your fees for 2011, take care and please do not trap yourself by attempting to establish your office fee schedule based on what some third-party payer reimburses at 65% of the 85th percentile. And don’t establish your fees based on the dentist down the hall or across the street. Your fees should be based on your overhead, expenses, patient base and your individual level of professional expertise.

If you are interested in having a comparative Fee Schedule Review 7 page report detailing 220 of the most often performed dental procedures compared to your existing fee schedule compiled for your zip code, CLICK HERE.

Tom Limoli is the prevailing expert on proper coding and administration of dental insurance benefit claims. He serves as president of Limoli and Associates/Atlanta Dental Consultants, Inc., a company that over the past quarter century has assisted dental offices in streamlining the insurance reimbursement process. www.limoli.com

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Carol Tekavec, RDH
Hygiene Consultant
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The $8,000 Hygiene Day
By Carol Tekavec, RDH

Hygiene production should be three times hygiene salary.  Time management, professional skills, technology, and fees all play a part in making this happen. However, the financial contribution of the hygiene department might also be measured in more than just what is accomplished in the hygiene department today. Treatment needed, identified, and scheduled due to the efforts of the hygienist and dentist working together can be a huge factor in overall office production.

Here’s how: Katherine is the full-time hygienist for a busy general practice. She typically sees eight patients per day, with fewer scheduled to account for scaling and root planing appointments and periodontal maintenance. She and Dr. G have developed a cooperative method of approaching recall appointments that facilitates identification of necessary periodontal treatment as well as restorative needs of patients.

Her first recall patient of the day is a professional man with a tight schedule and a disinclination for small talk. Following the protocol of the office, Katherine takes things step by step. First, she updates his medical history, takes blood pressure, at least one time per year, takes necessary radiographs, performs periodontal probing at least one time per year, performs a preliminary oral cancer screening, and accomplishes a visual assessment of the teeth. During the visual assessment, she notices two teeth with existing amalgam restorations which show cracks. Knowing that broken teeth due to cracks are one of the most common emergencies of the office, she points these teeth out to the patient and takes two photos, which are displayed on the monitor in front of the patient chair. The enlarged photos make the cracks unmistakable, and the patient is engaged. When Dr. G. comes in, Katherine gives her assessment of what she has seen and what she and the patient have talked about, and Dr. G verifies that the two teeth definitely need crowns. Katherine walks the patient to the front desk, the treatment coordinator gives him an estimate, and he sets up an appointment for next week. Projected production for that appointment - $2000

Katherine’s next appointment is also a recall. This retired lady has had a tooth missing in the areas previously occupied by the mandibular left second bicuspid for several years. She has been living with the situation, and Katherine knows that a solution to the “space” has been offered to her several times. Despite knowing that the patient has not sought treatment previously, Katherine follows the same protocol as before, and points out to the patient that an implant and crown could restore her smile in a very effective and long lasting way. Katherine fires up the patient monitor and shows the patient a one-minute video on implants. When Dr. G. comes in, Katherine gives her assessment and Dr. G. verifies that the patient would be a good candidate for an implant and crown.  Due to Katherine’s suggestion, the illustrations in the video, and Dr. G’s explanation, the patient decides this time to go ahead with the treatment. Projected production for the implant and crown - $4,000

Later in the afternoon, Katherine encounters a patient whose teeth are showing extreme incisal wear. Posterior teeth also show wear facets and the patient tells her that most mornings she wakes up with a headache. Katherine explains that an occlusal guard may help reduce or eliminate her headaches, while possibly preventing further damage to her teeth. The patient is interested. When Dr. G. comes in, Katherine gives her assessment, Dr. G. tells the patient more about the way an occlusal guard functions, and the patient decides to schedule an appointment to get started. Projected production for the occlusal guard - $800

Katherine’s direct hygiene production for the day was $95 per prophy x 8 = $760. Bite-wing radiographs at $60 x 4=$240. Fluoride varnish at $40 x 5 =$200, plus the sale of two tubes of prescription fluoride toothpaste at $20 each. Total=$1,240.

While direct hygiene production must be an important consideration when deciding on how the hygiene department is functioning, indirect production in the form of restorative treatment, identified and scheduled, cannot be ignored! The keys to success lie in the way the hygienist approaches the recall appointment, technology to support explanations, the ability of the hygienist to tell the truth to the patient in an empathetic way, and the interaction between the dentist and hygienist when he arrives to complete the recall. The dentist and hygienist have to be on the same page as to how the dentist approaches treatment, and their individual philosophies must “jive.” Nowhere is the need for the dentist and hygienist to work as a team more important to patient care and financial success than during their interaction in front of the patient. When both are functioning well together, with professionalism and mutual respect, the $8000 hygiene day (direct and indirect production) can become a regular feature of the practice.

Carol Tekavec RDH is the director of Hygiene for McKenzie Management.  Carol can improve your hygiene department in just ONE DAY OF TRAINING “in your office”.  Interested in knowing more about how to improve your hygiene department?  Email hygiene@mckenziemgmt.com.

Carol is also a speaker on hygiene efficiency and profitability for McKenzie Management. Interested in having Carol speak to your dental society or study club?  Click here

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