3.30.12 Issue #525 info@mckenziemgmt.com 1-877-777-6151 Forward This Newsletter

Fee Increase? Know Where Yours Stand First.
By Sally McKenzie, CEO

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The price of gas has topped $5 a gallon in some parts of the country. It feels like the latest volley in the seemingly never-ending match between economic recovery and continued uncertainty. The good news - it doesn't appear that the upsurge is having a detrimental impact on overall inflation.

For dental practices that are seeing improvements in new patient numbers, patient retention, and treatment acceptance, there can be a general sense that the time is right for an increase in their own fees. Certainly, many practices have made a concerted effort to keep the cost of treatment in check the last few years. And as a result, some practice owners may feel it's time for an economic adjustment.

However, with such jolts to the wallet as $5 gas prices, dentists must continue to be cautious about fees and think carefully about how they can best compete in today's marketplace. I recently had the opportunity to catch up with Tom Limoli, Jr. He is a noted expert on proper coding and administration of dental insurance benefit claims, and he serves as president of Limoli and Associates, which assists dental offices in establishing fee schedules and managing insurance reimbursement. Like me, Tom has watched the business of dentistry for many years. The common practice in the past for practices was to increase fees 3-5% annually. It was a widely accepted standard in the industry. Today's dentists, however, are encouraged to take a different approach and base fees on true overhead. In other words, what it is costing them to actually deliver the dentistry.

In setting fees, Tom notes that dentists need to be very aware of where fees stand in the area that they are practicing. It would not be advisable for a dentist to set fees that are at or exceed the marketplace. “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, your individual level of professional expertise, and debt,” notes Tom. In addition, dentists should be wary of creating a fee schedule that is too high or too low because it is based on third-party reimbursement rates. “You don’t want to trap yourself by attempting to establish your office fee schedule based on what some third-party payer reimburses at 65% of the 85th percentile,” he explains.

Additionally, dentists need to recognize where they are on the skill continuum. For example, newer dentists do not perform dentistry at the same speed as more experienced doctors. For these doctors, what they don't have in speed they can make up in relationship building. Similarly, for dentists establishing new practices it can be particularly beneficial to hold off on hiring a hygienist right away. It allows the dentist to focus on building one-on-one relationships with patients and will help keep overhead down until production increases and it makes financial sense to add a hygienist to the payroll. As Tom emphasizes, when patients have a relationship with their dentist, they don't question the fee. Building good relationships with patients has never been more important.

Dentists also need to be cautious about setting fees too low for some services and too high for others. In the past, it was not uncommon for dentists to keep hygiene fees unrealistically low, and then make it up with much higher fees for other procedures, such as crowns.

In many areas of the country we are seeing smaller treatment plans, and that is translating into steady production and financial success for some practices. Regardless of practice location, what is imperative for every dentist in today's marketplace is paying close attention to what the patients want and why they are coming into the practice. Addressing the smaller issues and offering more conservative restoration options, provided they are in the patient's best oral health interest, can be absolutely critical in some situations before recommending larger, more extensive alternatives.

One thing is true across the board - the doctors who are successful in today's economy have a relationship with their patients. They are focused on providing the level of dentistry that achieves the greatest return for the patient. After all, patients are no different than the rest of us. They want to know they are getting the most value for every dollar they spend, be it at the gas pump or in the dental practice.

Next week, keep cash flowing.

For more information on this topic and for additional Dental Practice Management info, visit my blog: The Lighter Side.

Interested in speaking to me about your practice concerns? Email me at sallymck@mckenziemgmt.com or call me at 877-777-6151 ext, 511,

Interested in having a Sally McKenzie Seminar speaker at your dental society or study club? Click here.

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Belle DuCharme, CDPMA
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Avoiding Patient Complaints
By Belle DuCharme, CDPMA

In the past, if a patient wanted to complain about an experience they had in a dental practice, they would pick up the phone and ask to speak to the doctor or the office manager. Now there are other ways to complain that are not as confrontational, but more damaging because of the public display to a large number of people. Social media in the form of Facebook, Yelp, Twitter, Google and others offer a forum to exchange information both honestly and sometimes unreasonably dramatized. Many people look to online reviews prior to booking a hotel room, a restaurant reservation and a visit to the doctor or dentist, to name a few.

It is difficult and time consuming to remove a bad review or to challenge the review. The proactive measure would be to create a system to prevent complaints, allowing patients to communicate and resolve their issues without a public rant. The following is a list of ideas to implement in your practice to proactively mitigate the possibility of a bad online review.

1. Build the best customer service, from the first phone call to the post treatment phone call. Often patients will say that they have been treated rudely on the phone. Train the team to treat people on the phone like they are standing in front of them by giving them undivided focus and attention.

2. Let patients know how to contact you for complaint resolve. If you have an office email on the website for this purpose, make sure you monitor it daily and respond immediately. On your website under “contact us” have a section for compliments, comments, concerns and complaints. List phone numbers and email addresses that may be specifically for complaint resolve.

3. Build a positive reputation in your community. Become involved in the community and sponsor events that improve the living quality of those you serve. If there are enough people who know you and are happy with your care, it is less likely they will believe bad reviews.

4. Contact your patients for feedback after their first visit and after every visit when treatment with anesthetic is used. A qualified team member can be just as effective as the doctor when showing a caring practice. The team member might say “Doctor M. asked me to call you to see how you are doing after your visit with us today.”

 5. Develop an online presence that shows you are accessible and listening. Check for reviews online at different sites as part of your quality control program. Immediately respond to negative reviews and work toward the resolve and removal.

6. Don't post fake reviews with fake accounts to falsely improve your ratings. If you are ever exposed it can be very embarrassing and certainly hurts your credibility.

7. Address the concerns with a listening, information-gathering manner and do not act defensive or blaming in any way. 

8. Become part of the conversation by offering to make it right to the parties involved.  Addressing the complaint in the same thread in a manner that shows you care will give credence to the issue.

9. Do not offer to pay anyone to remove their negative posts.

10. Analyze the circumstances that led to the negative review and make corrections to ensure it does not happen again.

11. Make sure that billing of dental insurance is accurate and that the procedures submitted were actually done. Often the procedures are scheduled, but in real time things can change and the appointment details are not changed to reflect that. Patients can be quite vocal when they feel they have been treated unfairly, especially when it concerns money.

The conversation for achieving positive reviews begins with the entire team and their participation in everyday patient care. The above list is excellent subject matter for a team meeting, and until there are changes in how online reviews can be removed it is imperative to be aware of your online presence.

Want to learn superior front office skills? Contact McKenzie Management today for a training course customized to the needs of your 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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10 Years in Practice and Only 1 Hygienist?
By Nancy Caudill

Dr. Jones called the other day with an observation that is not uncommon to McKenzie Management.  “My practice has plateaued. What can I do to get over the hump?” Have you found yourself in this position or possibly see it coming in the near future, based on your past few years of statistics? What are the symptoms?

Symptom #1 - No Additional Hygiene Days Added in the Past 2-3 Years
Let's take a look at this from a statistical standpoint and assume the following. You can plug in your own numbers and make your own assumption about your practice.

•   Number of years in practice: 10
•   Number of new patients that are going into hygiene monthly: 20
•   Total number of potential hygiene patients over the past 10 years: 2,400
•   Number of patients seen/day by your hygienist:  9
•   Number of hygiene appointments needed to support 2,400 active patients:     2,400 x 2 visits/yr = 4,800
•   Number of hygiene days needed to provide 4,800 appointments: 533 days or 11/week based on 48 working weeks

The above scenario indicates that Dr. Jones should have 2 hygienists working 5 days a week IF he were retaining 100% of his hygiene patients. Since we all know that's not possible, let's reduce the worksheet and assume 10% attrition over the past 10 years.

2,400 patients - 10% = 2,160 patients x 2 visits/yr / 9 pts/day = 480 hygiene days or 10/week.

The point is this - Dr. Jones is not retaining his hygiene patients, even with a 10% attrition. One hygienist working 4 days a week and seeing 9 patients/day can only support 864 patients, assuming they come every 6 months. If 33% of her patients are periodontally involved, then they are coming every 3-4 months, so she can support even fewer patients. This is a problem!

Peak PerformanceThe cause behind this “symptom” can be unique to each practice and requires an examination of all the business operational systems to uncover the cause. Patients can leave or not return to a practice for a myriad of reasons.  Having poor customer service in any aspect of the practice will cause the practice not to reach its full potential.

What if your hygiene retention is actually healthy but you just aren’t seeing enough new patients? You need to improve your internal and external marketing. 50% of your production comes from treatment recommended for new patients. If you have done a good job of providing all the necessary treatment for your existing patients, you have nothing more to do until something breaks. You must have a steady flow of new patients coming into the practice, especially if you want to GROW your practice and increase the number of hygiene days.  This goes back to having the best in customer service “internally” FIRST and foremost before you think about “inviting people over for dinner!”

Symptom #2 - Production and Collections Have Not Increased
With the exception of fee increases, production and collection dollars have not increased over the past several years. Before we go there, let’s make sure that you are comparing apples to apples - in other words, did you work the same number of days over the past few years? This will make a huge difference in your production and collection numbers, unless you are collecting and producing more/day and working less days, which is not a bad thing. We call that “working smarter and not harder.”

A doctor's goal should always be to maximize the potential of the practice daily, opposed to simply working more days and hoping to make more money. This scenario only increases employee costs and takes away from your bottom line.

Make sure that you are collecting 98% of your net production and writing off no more than 2% for uncollectible accounts. There is nothing worse than working hard and not getting paid for it. Statistical monitoring of the practice performance is essential for you, as a practice owner, to review monthly and find the areas that need improvement. This means that you need to understand how to read the various reports that are available to you from your management software. How can you make important business decisions about your practice when you don't know how well the practice is performing?

Symptom #3:  You and Your Team are not “Excited” About Coming to Work
No one is motivated, including you, and you set the mood every day when you walk in the door. How often we hear, “He/she is not in a good mood today!”  How many times have you said to your team, “We need to start producing more or you won’t have a job next month!” Seriously, do you think that they have the tools to make this happen? If they did, it would have already happened. They are not passive-aggressive. They just don’t know HOW to help you produce more.

Talk with McKenzie Management today about putting tools in your team's toolbox so coming to work will be fun again for you and for them. Call (877) 777-6151.

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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