Whatís Your Compensation Culture?
Take a moment and think about each person on your payroll. Consider the individual and ask yourself a few questions: Does this person contribute to the success of the practice? Does s/he consistently deliver an excellent attitude and a quality product? If so, what examples come to mind? Does this person help the practice to be more profitable and successful, or is this person a source of frustration and discontent for you and your team? Be honest.
Next, ask yourself this important question: Do employees feel “entitled” to an annual pay increase, or do they understand that it’s performance that drives the dollars? Now it’s time to turn the mirror on yourself: What have you done to help each person become a fully contributing member of your team? Examples that should come to mind include, training, ongoing feedback, clear job descriptions, performance reviews, assistance with goal setting, etc.
Your responses are an indicator of your “compensation culture.” Let me explain. In many small businesses, including dental practices, there are those employees who are star performers and those who are merely doing their time and investing the minimum effort. And then there are those who are somewhere in between.
They see the star performers working hard and the poor performers hardly working, yet both get the same annual raise each year. The star performers are “rewarded” with more work piled upon them because they will get it done, until they burnout and move on to another job. Meanwhile, the poor performers do just enough to get by. Where’s the incentive to make the effort? Almost without exception, doctors who scan their employee lists and see “troublemakers” and/or “chair warmers” on their teams have an entitlement culture, which drives their compensation culture. Worse yet, it fuels high overhead and torpedoes production.
It’s time to tackle your compensation culture, starting with a clear compensation policy. The policy explains when raises can be discussed, under what circumstances they will be given, and spells out in no uncertain terms that they will be based upon employee performance. The policy must be clearly explained to current staff, detailed in the employee handbook, and discussed with new hires. Next, take steps to measure employee performance. If you don’t have performance standards, now is the time to establish them. These determine raises. Best of all, when you have clearly articulated performance measurements, performance reviews become something that you actually look forward to, rather than dread.
Performance reviews are one of the most effective tools in creating a total climate of success in your practice. They provide an objective and neutral means of leveling the playing field for the entire staff. While resistance is common initially, employees rated against objective measures will place more trust and confidence in the process. They also see the direct relationship between their performance, the success of the practice, and ultimately their potential for individual achievement – a pay raise. Moreover, systems based on individual jobs that are focused on specific job-related goals and how those relate to improving the total practice are the most effective.
With input from the employee, develop results oriented job descriptions and expectations. For example, your dental assistant’s job description should include points such as attending beginning of the day meetings, completing case presentations, reinforcing to patients the quality of care delivered in the practice, directing the doctor to check hygiene patients, completing post treatment care calls, converting emergency patients to new patients, turning the treatment room around promptly, etc. Avoid the common yet dangerous pitfall of overlapping job duties. Instead, cross-train so that each area has coverage when the point person is out ill or is unavailable. If you overlap duties, employees are given tasks but not responsibility.
Next, establish individual performance goals that complement practice goals, such as increasing collection ratio, improving accounts receivables, expanding production, reducing time to prepare treatment rooms, increasing clinical skills, etc. Present job expectations and performance goals in writing, and rate the employees on those. Help employees develop a strategy to achieve their goals, and if necessary provide professional training. Remember, your employees’ ability to meet their goals goes hand- in-glove with the practice’s ability to meet its goals. Review job expectations and performance goals twice a year. Doing so helps doctor and staff to stay on top of issues that might arise. And provide constructive feedback regularly.
For more information on this topic, visit my blog: The Lighter Side
Interested in speaking to me about your practice concerns? Email firstname.lastname@example.org
The Affordable Care Act: What about Dental?
A roll-out of the possible avenues for general healthcare under the ACA begins in October, 2013 to be implemented beginning in 2014. Insurance coverage changes already in effect for several years have been the ability of young adults under the age of 26 to be covered under a parent’s policy, as well as a prohibition for denial of coverage for a child with pre-existing health problems. Adult coverage for pre-existing conditions will be a part of the “rules” starting in 2014. Prior to this change, individuals who have insurance at their place of employment, but change jobs, might find themselves unable to obtain coverage at their new workplace. Insurers have used the pre-existing condition clause for decades to successfully avoid taking on persons who might need medical treatment.
Of course, possible dental coverage is of prime interest to our profession and our patients. As of January 1, 2014 dental coverage will be a required inclusion in individual and small group market plans, both within private markets and also “exchanges” being set up under federal guidelines, but only for children under age 19. According to the ADA, all states except for Utah (which is offering only a preventive plan) have selected existing state Children’s Health Insurance Program (CHIP) plans or the MetLife High Option plan from the Federal Employee Dental and Vision Insurance Program as their benchmark plans for exchanges.
Of concern to dental insurers is the fact that within the exchanges run by the federal government, a dental “essential health benefit” must only be offered, however in the individual and small group markets outside the exchange, the dental EHB must be purchased. State exchanges do not face this requirement, and according to the ADA, few states have chosen to mandate dental benefits. Even without a mandate, increases in dental coverage for previously uncovered persons is expected.
- Actual dental visits through 2018 could add 11 million pediatric and around 2 million adult private dental visits through the exchanges and regular employer sponsored insurance.
- Dental spending through 2018 will likely increase by $4 billion nationwide, with the largest effect seen in the Medicaid population. An additional $2 billion by adults and children gaining private dental benefits through exchanges and employer plans is also expected.
Expansion of Medicare coverage for older adults needing dental treatment is not expected. Currently Medicare practically has a blanket exclusion to dentistry with the exception of services provided in a hospital in connection with an underlying medical condition, such as extraction of teeth to prepare jaw for radiation treatment, or an oral examination as part of a comprehensive workup prior to renal transplant surgery or heart valve replacement. Beginning in 2014, older adults may purchase coverage through an exchange or under a private plan. Private plans for over 65 seniors have been available for many years, as have Medicare supplement plans with dental provisions.
Additional information concerning state-by-state ACA policies and projections are available from the ADA.org website. States already known to have more extensive dental coverage under existing Medicaid plans are AK, CT, IA, NM, NY, NC, ND, OH, RI, and WI, and these plans are likely to continue or increase. Other states may or may not develop or increase adult coverage.
For example, in Colorado where I work in a private general practice, a new adult Medicaid dental benefit is set to begin in April of 2014. The benefit will amount to up to $1,000 in everyday dental benefits such as exams, cleanings, and scheduled work. This is a huge improvement over the limited emergency type coverage previously available. However, there are still many questions, such as what amount will be covered per service, if previously non-Medicaid providers might be required to accept all Medicaid patients, and what, if any, increases to general Medicaid fees might apply.
In additional news, the ADA is already making the 2014 CDT coding manual available. Treatment codes are going to be updated on an annual basis from now on and input from the profession for 2015 codes are now appropriate (up until Nov. 1, 2013). The 2014 manual has included codes for Caries Management by Risk Assessment (CAMBRA) for the first time and is expected to further address diagnostic concerns in this and future revisions.
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 email@example.com.
Communication: When Commitments Arenít Kept
The topic of my last article was the importance of clear expectations for employee accountability. Try as you may, however, there are times when staff members don’t keep their commitments. They are human and mistakes happen. The reality is that people on your team are bound to slip-up at one time or another. At that point you have two choices: you can tolerate mediocre performance or you can insist on a team that follows your standards and executes on your goals. If you choose the latter, you must start holding your employees accountable.
One of the best strategies for effective people-management is to address troublesome issues early. It’s much easier to correct a problem when it’s small in scope. By extinguishing sparks before they become raging fires you will save yourself the aggravation of having to deal with an inferno later.
The key to creating a successful performance conversation is to emphasize what the employee needs to do to succeed in the future, rather than focusing on what has caused them to miss the mark in the past. Here’s an example to illustrate how to improve your communication and coach an employee.
Mary is your Front Desk Manager. She has a challenging job that entails scheduling, billing, and general reception duties. You have a busy practice that requires her to juggle “customer service” with detailed tasks. Overall she does her job effectively. During the past two weeks, a few patients have complained that Mary was rude to them. You are concerned about this and schedule a private meeting with her.
You: “Thank you for meeting with me today, Mary. I wanted to discuss your performance. There are many things you are doing well.” (Give Mary 2 or 3 specific examples such as accurate billing/collection, keeping the schedule full, etc). PAUSE. “I also want to talk with you about your interactions with patients because I’ve heard some complaints.” PAUSE and let Mary respond.
Mary: “I don’t know what you’re talking about. I’m friendly with the patients.”
You: “I think it would be helpful to review a couple of specific examples so let me give you those” (provide 2 or 3 behavioral descriptions such as ‘Mr. Smith said that you were rude, that you told him he didn’t know what he was talking about’). “Tell me your side of the story.”
Mary: “Some patients ask such stupid questions. It just annoys me. I’m too busy.”
You: “I know you have a difficult job and a lot of responsibilities here in the office. The fact remains that you are the first and last point of contact. You set the tone for how patients view me and the entire team. I need you to put patient service first…no matter what other work you have to do. Without patients none of us has a job.”
Mary: (in an angry voice) “Why are you making such a big deal out of such a little thing? I was just having a bad day.”
You: (in a calm, kind, firm voice) “I agree that you might have had a bad day. You juggle a lot at the Front Desk and I appreciate everything you do for the practice. I also know that patients need to feel valued and appreciated. We can’t go backwards. Starting from today I’d like to give you the opportunity to work on developing a friendlier and more patient approach with everyone who comes into our office. Patients are our customers and service is #1 in our office.”
Mary: “Well, maybe…I’ll see what I can do” (or, “I can’t make any promises but I’ll try”; or “Alright…whatever you say.”)
You: (in a calm, kind, firm voice) “Your tone tells me that you’re not fully committed. I'd like you to think about what we discussed and whether or not it's something you can put the required effort towards developing. In the meantime I'll put together a written summary of our discussion so that you are clear on the expectations I've outlined. Let's get back together tomorrow and you can let me know what I can do to help you.”
No one likes to hear that they're doing something wrong. It’s natural that people will react differently. Create messages that avoid inflammatory wording. Anticipate how the employee is likely to react to feedback and prepare for how you will respond. By concentrating on the desired results rather than the employee's perceived shortcomings, you improve the likelihood of a positive outcome. Demonstrate leadership courage. Give effective feedback and get a more committed team of employees.
To assist you in building skills in feedback, read the “Communication Series”
Dr. Haller provides training for leadership effectiveness, interpersonal communication, conflict management, and team building. If you would like to learn more contact her at firstname.lastname@example.org
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