2.7.14 Issue #622 info@mckenziemgmt.com 1-877-777-6151 Forward This Newsletter

10 Steps to Solid Fees
By Sally McKenzie, CEO

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Fee adjustments are simply a necessary part of running a high quality dental practice. If you are reticent to increase them, it’s important to ask yourself if you are compromising quality for low fees. Do you continue to forego necessary investments in staff training? Do you bypass updated equipment and more efficient systems because you fear you can’t afford any more than the status quo? Are you compromising your own continuing education opportunities because of the impact on the budget? If so, this commitment to being cheap is costing you a fortune in lost opportunity, higher production quality, staff efficiency, and probably your reputation.

I don’t need to tell you that the cost of running a dental practice increases every year. Establishing a sound fee schedule allows you to be fair to your practice and improve care to your patients. Lean years may still be lean, but their impact will be lessened because you will have kept pace with the cost of doing business. Consider these 10 steps when establishing a fee schedule.

1. Know where you stand. Make sure you are well aware of where fees stand in your area. Your fees should not be far below or well above the local marketplace. But that’s not the only consideration. Your fees need to reflect your business.  

2. Establish a standard fee for each service. You need to consider what it’s costing you to actually deliver the dentistry. Base fees on your overhead, expenses, patient base, your individual level of professional expertise, and debt.

3. Track your overhead expenses. They should line up according to the following benchmarks. Laboratory: 10%, Dental and office supplies: 7%, Rent: 5%, Employee salaries: 19-22%, Payroll taxes and benefits: 3-5% of collections.

4. Recognize where you 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. This allows the dentist to focus on building one-on-one relationships with patients. It will also help keep overhead down until production increases and the practice can handle adding a hygienist to the payroll.

5. Build relationships. Remember, when patients have a relationship with their dentist, they don’t question the fee. And building good relationships with patients has never been more important.

6. Avoid the “seesaw” fee structure. Don’t set 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.

7. Pay attention. Listen to what patients want and why they are coming into the practice. Addressing the smaller issues and offering more conservative restoration options, provided that it’s in the patient’s best interest, can be absolutely critical before recommending larger more extensive alternatives.

8. Avoid the fee ceiling. Don’t trap yourself by attempting to establish your office fee schedule based on what some third-party payer reimburses at 65% of the 85th percentile.

9. Establish goals. Identify specific production goals based on the number of days per week you will see patients and the number of hours you will spend on treatment.

10. Plan for increases. Establish a solid fee for each service and plan to adjust your fees twice a year, 2% then 3% for an annual increase of 5%. Even if you increase your fees only slightly, $4-$5 per procedure, that will make a huge difference in your bottom line. 

Lastly, never lose sight of your vision and goals. Step back and take a look at what you want to get out of your career, now and in the future. No matter what your personal/professional desires, they all have a price tag attached. The key is to determine how much your practice needs to produce and collect to achieve them. And remember that the most successful doctors 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.

To speak with someone about receiving a complimentary Fee Analysis for your practice, call 877-777-6151 or email info@mckenziemgmt.com and mention this article.

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
Interested in having Sally McKenzie Seminars speak to your dental society or study club? Click here.
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Nancy Haller, Ph.D.
Leadership Coach
McKenzie Management
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Lead from Your Heart (As Well As Your Brain)
By Nancy Haller, Ph.D.

We’ll be celebrating Valentine’s Day next week. No, this is not an article about red roses, boxes of chocolates, or candlelight dinners. But if you are going to be a successful leader, you’ve got to put heart into the workplace. What matters most to people is how they are made to feel by the organizations that employ them, and by the bosses who manage them.

The American Psychological Association has been an advocate of the importance of psychological health in the workplace. In 1999 the APA established ‘The Psychologically Healthy Workplace’ Award to recognize organizations for their efforts to foster employee health and well-being - not just to help workers feel good, but to understand the impact of psychological health on organizational performance. Consider this: The four award winners in 2013 had a turnover rate of just 6%, compared with the national average of 38%. Surveys completed by the winning organizations revealed that an average of just 19% of employees reported experiencing chronic work stress, compared with 35% of workers nationally.

One of the most interesting ‘Best Practice’ Honorees was in the Government/Military/Educational Institution Category, Hawaii’s Tripler Army Medical Center (TAMC). It supports 264,000 local active-duty and retired military personnel, their families and veteran beneficiaries. In response to the dangers of compassion fatigue and burnout, Tripler developed resiliency training for all staff members. Ultimately, the program has shown that what’s good for the staff turns out to be even better for patients.

Compassion, satisfaction and resiliency in the face of a challenging patient base is easier said than done. The trainings at Tripler range from two-hour workshops to half-day programs to five-day retreats for every staff member on an annual basis. Anyone who comes in contact with patients is mandated to attend their particular level of training. Some take place in the hospital and others on the beach.

Every training session includes some lecture with some experiential modules. The curriculum consists of information on health, fitness, and stress management. Training incorporates humor, yoga and even meditation. Facilitated group discussions and written exercises emphasize the importance of self-care and personal health. The impact is impressive, especially given the fact that this is happening in the military, traditionally known for a control-and-command type of leadership.

Since the program’s inception, employees have shown significantly lower rates of burnout and secondary trauma and broadened their knowledge of key resiliency concepts. Additionally, patient satisfaction, communication and morale have improved because employees are better equipped to handle the stressors they face every day. The training has made Tripler the top-rated Army Medical Center in Army Medical Command for performance measures focused on cost, access and quality of care. They even increased their workload 10% over the previous year, and this enabled them to schedule more appointments. If the Army can do this, think about your office!

It is important to remember that there is no “one-size-fits-all” approach to creating a psychologically healthy workplace. Success is based, in part, on addressing the challenges unique to your particular organization and tailoring programs and policies to meet your needs. Nonetheless, here are some common criteria.

1. Employee involvement in decision making and increased job autonomy.
2. Acknowledgement that employees have responsibilities and lives outside of work and helping them to better manage these multiple demands.
3. Employee development so that they expand their knowledge, skills and abilities.
4. Health and safety initiatives that maximize the physical and mental health of employees.
5. Employee recognition that rewards both individually and collectively for contributions to the organization.

Positive emotions create harmony in our nervous system and maximize the ability to use our brains. That means higher productivity and better patient care. So pay attention to the emotional tone of your office. Bring your heart to work, on Valentine’s Day and every day!

If you would like information on bringing happiness and resiliency training to your practice, contact Dr. Haller at nhaller@mckenziemgmt.com.

Dr. Haller provides training for leadership effectiveness, interpersonal communication, conflict management, and team building. If you would like to learn more contact her at nhaller@mckenziemgmt.com

Interested in having Dr. Haller speak to your dental society or study club? Click here

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Carol Tekavec, RDH
Hygiene Consultant
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Serious Conflicts
By Carol Tekavec RDH

Most dentists keep their patient’s well-being foremost in their minds. In my experience, they are some of the most competent, compassionate and caring individuals in the health care field. Dentists who work with McKenzie Management are focused on high quality care in a happy, productive atmosphere. They number in the thousands.

We know, however, that every workplace provides opportunities for success and failure. We create some of these opportunities by the way we approach the work that we do. Office circumstances can also dictate how many successes or failures come our way. As hygienists, we work in an environment where we function somewhere in the middle of an office hierarchy. We work primarily alone, but many times we rely on others in the practice for our daily schedule of patients. We provide treatment and screening, but we rely on the dentist for the “last word” on patient recommendations. We have control over how we approach our patients and the amount of time we devote to each segment of their appointments, but we lack the ability to stay on time if the dentist is busy and exams are delayed. We watch the clock constantly, but are keenly aware that each patient deserves our full attention and care.

The good news is that most of the time we are able to juggle all of these factors successfully. We work in offices where others on the dental team are working with us to make the practice run smoothly. We respect our dentists and co-workers and value everything they do to take care of patients and make sure they get the treatment they need and deserve. We also try to do our share in being “part of the solution and not part of the problem.” We accept that some conflicts may arise, but understand that many of these conflicts are within the realm of being handled with good faith adjustments and a focus on providing proper patient treatment.

The bad news is that in some offices, serious conflicts can make providing proper dental care extremely difficult. An experienced dental hygienist contacted me recently with a story of such conflicts. She was wondering what, if anything, she could do about her situation or if she should simply leave the practice. 

Conflict #1: Pre-Medication
All of us know that antibiotics have been overused in the past, and are not being recommended in the same way they were previously. Guidelines for pre-medication have also changed dramatically. Be that as it may, some patients still require pre-medication, and can suffer serious problems if this is ignored. The hygienist who contacted me told of a patient with a recent joint replacement. His physician recommended that he be pre-medicated with a certain antibiotic prior to dental treatment. He had not taken this antibiotic prior to his appointment with her today. Her dentist did not believe in keeping antibiotics in the office to cover patients who appeared without taking a pre-med. The rationale was that patients should know if they needed a pre-med and contact the office in advance to receive a prescription. “Why should the office pay for the antibiotics? It is the patient’s responsibility.” 

The hygienist talked with the dentist and told him about this patient. She wanted to reschedule him. The dentist told her to treat him today. Because she felt she could not do this in good conscience, she left the office, went across the street to another dentist’s practice, and “borrowed” the proper pre-medication to give to the patient. She then had the patient wait in the reception room for an hour, and completed his appointment during her lunch break. The dentist was very upset that she had ignored his direction and an unpleasant argument ensued. She felt that since she knew from her training that a prophy might cause a bacterial shower that could affect the patient’s joint replacement, and also that the patient’s physician had recommended pre-medication, she had to either reschedule or arrange for a pre-med today. She also knew that she had overstepped the bounds of her legal duties by providing an antibiotic without the dentist knowing.

Conflict #2: Full Mouth Probing
A new patient presented with serious periodontal disease and bleeding tissues. His mouth was extremely sore and the slightest contact with the periodontal probe caused him pain. A preliminary “screening” revealed 5 and 6 millimeter pockets around all molars. The normal routine for a new patient visit was a full mouth periodontal probing and recording. Investigation of this patient’s situation revealed that he did not have dental insurance. However, he readily accepted this hygienist’s recommendation of full mouth scaling and root planing with a subsequent evaluation to see if referral to a periodontist was appropriate. The hygienist decided that she could record all probing depths on one half of the mouth after the patient received local anesthetic at his first SRP appointment, and the other half of the mouth at his second SRP. Since dental insurance approval necessitating full mouth depths prior to treatment was not a consideration, she felt that this would be the best way to approach his care. When the dentist came to perform his exam he was upset that probing depths had not been recorded. He berated the hygienist in front of the patient and insisted that she complete the probings now. The hygienist did as instructed but was very upset, as was the patient.

Luckily, serious conflicts such as the ones described are not common. This dentist is an outlier. The hygienist risked her license by providing an antibiotic and should not be placed in this position again. Being berated for showing concern for patient comfort is also wrong. My advice to her was to begin looking for new employment right away. When conflicts arise that go against a person’s knowledge of proper dental practice or concerned dental care, it means a change in employment should be considered.

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.

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