8.16.13 Issue #597 info@mckenziemgmt.com 1-877-777-6151 Forward This Newsletter

Family - For Better or For Worse?
By Sally McKenzie, CEO

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Certainly, when it comes to the Family, the ties that bind can also fray. What is supposed to be a source of strength is often the cause of stress and anxiety. And maintaining family harmony in the face of workplace challenges can be no small undertaking for any business, particularly dental practices.

Consider the situation that “Dr. Mike” faces. His wife “Mary” works in the practice as the business manager. She is also in charge of collections. The couple lives and works in a large metropolitan area and has extended family nearby. Mary’s sister, husband, and two children are patients in Dr. Mike’s practice. It’s a classic situation; Sis and the husband walk all over Dr. Mike and Mary.

Happy Labor Day Mary’s sister thinks nothing of cancelling scheduled appointments for her family at the last minute. When Mary tries to explain the hardship that those cancellations cause the practice, Sis promptly shuts Mary down. “Cancellations happen all the time in dental practices. You should expect it.” Pouring salt on this wound, Sis’s husband never pays the bills for the dental care the family receives.

You could say it’s causing a bit of a strain on the familial relationship. But these types of situations aren’t limited to just family. The truth is Mary is an easy target, not only for her manipulating sister and freeloading brother-in-law, but for anyone else who claims they “forgot their wallet,” “will send a check as soon as they get home,” or “is a little tight on cash right now.” Just because Mary is Dr. Mike’s wife and the anointed “business manager” does not make her capable of performing the job duties effectively.

Family businesses can be very complex – to say the least. And navigating through the potential minefields is no small challenge for many. After all, when it comes to working with family there is a lot to gain…and a lot to lose. In dentistry, family-run practices are common with fathers and sons, husbands and wives, mothers and daughters, siblings, in-laws, aunts, uncles, etc. working under the same roof. Some function very effectively together, and typically those that are the most successful are able to deal with business issues as partners, not as husband-wife, father-son, mother-daughter, etc. However, without clearly defined roles and detailed practice systems, emotions and family “dynamics” can quickly take over.

Communication and trust are essential, but clearly defined management systems and accountability are absolutely critical. Maybe the doctor’s spouse has been handling new patient calls “that way” since 1999, but asking callers whether they have insurance immediately after they indicate that they would like to schedule a new patient appointment simply isn’t good for the office – no matter how long she’s been doing it “that way.” Perhaps Brother Joe, the financial coordinator, is allowing his friends and neighbors to carry balances indefinitely, sending accounts receivables over the top. And Aunt Carol is habitually late. Joe, Carol, and yes, even the doctor’s spouse, must be professionally trained and held accountable for their systems, their actions, and their results.

Bottom line, just because you are the spouse, the sister, the brother, or dear old dad doesn’t mean you can do as you please. The practice is a business first and a family operation second. What’s in the best interest of the business comes before anything else. And that is where things can get complicated.

While conflict may seem to be an obvious area for family strain, trying to avoid it can be far worse. Too often family members won’t question one another’s decisions or actions. They won’t address problems. They refuse to buck the status quo and push for necessary change because they are afraid to start an argument within the family. Families that attempt to dodge conflict open the door for much bigger problems because the issues only grow and fester. And if family members won’t confront family members, where does that leave the rest of the staff? Most likely searching for employment elsewhere.

Next week, navigating the financial minefield of the family practice.

For more information on this topic, visit my blog: The Lighter Side

Interested in speaking to me about your practice concerns? Email sallymck@mckenziemgmt.com
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Belle DuCharme, CDPMA
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Dental Diagnostic Codes in the Future
By Belle DuCharme, CDPMA

Dear Belle,
In conversation with a colleague, the question arose as to whether diagnostic codes are going to be required by 2015 on dental claims and in clinical records. Do you know the answer to this question?
Dr. Needtoknow

Dear Dr. Needtoknow,
Research is not giving me an exact date for this event to occur, but the following is a summary of my findings: In the 1990s the ADA started working on the first draft of SNODENT, its version of dental diagnostic vocabulary. It was supposed to be released in January 2000 but never came to complete fruition. The Harvard University School of Dental Medicine’s product EZCodes emerged to compete. One of them, unless others emerge, will be chosen as the standard for usage by the Department of Health and Human Services. Neither is ready for prime time according to Titus Schleyer, DMD, Ph.D., Associate Professor and Director, Center for Dental Informatics. Should you be prepared for future compliance? Yes - the day is coming that medicine is formally attaching the teeth to the rest of the body.

Dental condition diagnostic codes have been in the International Classification of Disease (ICD) but are now being updated and scheduled for completion by 2015 with the ICD-11 version. Diagnostic codes cover diseases, signs and symptoms, abnormal findings, complaints, social circumstances and external causes such as injury or disease. Dentistry has only been concerned with supplying treatment codes from the ADA’s Current Dental Terminology (CDT) on insurance claims.

To prepare for having to provide diagnostic codes to dental claims, start recording more detailed periodontal findings. At present the patient has health signified by a prophy, or periodontal disease signified by need of scaling and root planing or other treatment. The patient that is somewhere in between has been treated with a prophy. With the advent of diagnostic codes, many prophy patients will most likely be diagnosed with disease or at risk for disease. As with medical diagnostic codes, there will most likely be more dental diagnostic codes than treatment codes. There will be more treatment codes on the horizon because of the shades of gray in the standard of care in dentistry. A closer scrutiny of the patient’s health history and a higher due diligence in updating health history records will be in order. I have observed that many practices are lax in this area or allow the patient to dictate whether the health history is updated or not. Educating the patient on the importance of updated health history is the dentist’s prime responsibility to insure proper care and accurate record keeping.

There is no doubt that how the dental practice manages dental records will change very quickly in the future. The current initiative to create electronic health records that can be accessed by all health care providers anywhere in the country through an interoperable system is making headway. According to the ADA: Scheduled for completion in 2015, the National Health Information Infrastructure (NHII) will be a communications system comparable to a network of highways, roads and pathways on which all health information will travel. Its purpose is to enable patients' electronic health records to be accessed and added to by all health care providers electronically (with patient authorization), virtually anywhere in the country, via the network. The electronic health record will include health information entered for a specific patient at a specific point of service. It will travel and be accessible on the NHII, the National Health Information Infrastructure. For updates on this evolving concern, go to the American Dental Association Website, www.ada.org.

This initiative is fueling the need for diagnostic codes in dentistry to be completed and used on future claims. Falling under the purview of the Department of Health and Human Services, HHS envisions regional collaborations among health care entities, including dentists and other health care practitioners, so that a patient's information can be securely stored in the local community and made electronically accessible to all health care providers involved in treatment of a particular patient.

Undoubtedly there will be more information coming out in the next year, including protocols for compliance. The digital age is here to stay, and being prepared is certainly better than sticking your head in the sand and hoping it will go away. If you are currently using a dental software practice management system, call support and ask if there is any news about how their system is being modified to meet the upcoming requirements.

For professional business training, call McKenzie Management today and schedule a training session.

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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Part Timers vs. Full Timers
By Nancy Caudill

Obamacare indicates that if you are an employer with 50 or more full time employees, it is necessary for you to offer health insurance to your employees and cover a portion of the premium or suffer a penalty. If you have less than 25 full time employees and would like a tax credit, you can also offer health care to your employees to receive the credit.  This is it in a nutshell, and I am not an expert. The reason for bringing this subject up is that the question regarding full time vs. part time is more relevant now.

Why do we employ part time employees anyway?
My experience over 30 years has been that part time employees are hired not to avoid benefits, but rather because there simply is not enough work in the office for a full time employee. This seems reasonable to me. Hygienists come to mind first, and you may have a part time hygienist in your office because you don’t have enough active patients to keep a full time hygienist busy yet. Is it possible, however, that you do employ part time employees in your office to avoid offering benefits? Is it a good business strategy?

Challenges of Working with Part Time Employees
1. The length of employment for a part time employee tends to be shorter than a full time employee. In many cases they prefer full time employment, but took your part time position because it was better than nothing at the time. How long will they stick around? Only long enough to keep searching until they find a full time position.

2. A part time employee’s loyalty to the practice is not as strong as a full time employee who is receiving benefits and feels empowered to make a difference in the practice. There are exceptions, and I understand that some employees choose to only work a couple days a week opposed to full time. I am referring to those part timers that work a few days in your office and a few days in another office, just waiting like a vulture for an opening to come available in one of the two offices.

3. Communication and continuity is difficult without very specific guidelines on how to keep the part timers “in the loop” regarding changes in office policy, the office dynamics, and most importantly the sharing of work-related responsibilities with their co-workers. How many times do you hear, “I don’t know, Dr. Jones…Susie Parttime must have done it!”? If you have two employees that are job sharing, their ability to communicate and work as a single unit is vital for them to be successful. Otherwise, as the saying goes, “the right hand doesn’t know what the left hand is doing.”

4. Fitting into the circle of employees is difficult since they are not always considered a part of the team. Although not intentional, they may feel left out. “Out of sight - out of mind”.

When Does it Make Sense to Hire a Part Time Employee?
Can you afford to hire another employee, even if they are part time? Industry standards indicate that no more than 19-22% of your net collections should be earmarked for gross wages for your team, not including benefits such as vacation, holidays, sick leave, retirement, health insurance, etc. So take a look at the numbers before you make a decision.

Be careful when your team says that they are just too busy to get the day-to-day tasks completed in a timely manner and they need more help. I can promise you that they are not considering what it’s going to cost to hire another employee, especially when that employee is not revenue-producing. Reviewing their time management skills and job descriptions would be helpful before you make a decision based on their request.

Let’s say that you determine your practice can afford to employ a part time person to manage the insurance claims, eligibilities, submissions and follow-up for claims. Your outstanding claims over 60 days are out of control and your only front desk person just can’t seem to find the time away from the “hot seat” to make these calls. It would make sense to hire someone part time for this position, AND this position will improve the cash flow for the practice.

How to Hire a Good Part Time Employee?
Of course you conduct the normal steps that you would for hiring a full time employee. The difference is understanding the applicant’s employment goals for themselves. Are they the primary breadwinner in the home? If so, how can they afford to work only part time? Are they looking for anything at this point? Do they plan to work in more than one office so it equates to a full time position? Do they need benefits? Do they want to work a few hours each day or do they prefer more hours per day and less days? What do you need in terms of how many hours per day?

If you have a choice, I would recommend one full time employee over two part time employees every time because of loyalty, continuity and longevity. However, it makes sense to hire a part time employee when the work load requires less hours. If you need assistance in making a good decision for your practice regarding employment, don’t hesitate to contact McKenzie Management at (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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