9.11.15 Issue #705 info@mckenziemgmt.com 1-877-777-6151 Forward This Newsletter

4 Reasons Patients Don’t Show Up
By Sally McKenzie, CEO

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It’s 11:20 a.m., and the patient who was supposed to be in your chair at 11 still hasn’t shown up. Your Scheduling Coordinator has been working the phones trying to get someone to take the slot, but to no avail. So instead of working toward meeting your daily production goals, you’re sitting around hoping your next patient is more reliable.

It’s frustrating when patients don’t show up for their appointment times or cancel at the last minute, and it’s also costly. If you’ve ever done the math, you know that broken appointments cost you tens of thousands of dollars in lost revenue every year. Let’s say your practice averages two cancellations/no-shows a day, at a value of about $100-$125 each. That means you’re losing more than $40,000 a year, before you factor in the lost production you never had the chance to diagnose.

Broken appointments are chaotic and costly, and most doctors tell themselves they’re just part of running a dental practice. Not true. While you’ll never eliminate broken appointments entirely, there are ways you can significantly reduce them while also boosting your production numbers and your bottom line.

First, you have to understand why patients flake out. Here are four reasons patients don’t show up, and changes you can make to help get them in the chair during their scheduled appointment time.

1. You don’t emphasize the importance of dentistry. When you recommend treatment, you need to educate patients about the value of that treatment. Never leave them with the impression there’s no hurry to go forward. Create a sense of urgency, and you’ll notice more patients showing up for their appointments.

How? Educate them about their condition, and make sure they understand the possible consequences of not going forward with treatment. Talk with them about the benefits of improving and maintaining their oral health, and help them see the value of the services you provide.

Do the same during hygiene visits. Train you hygienists to educate patients about systemic health, oral cancer and periodontal disease. They should talk with patients about the importance of prevention, and what could happen if they start skipping routine dental visits. Once they truly understand the benefits of maintaining their oral health, they’ll be much less likely to flake out when it’s time for their next appointment.

2. You rely on pre-appointing alone. Most practices have pre-appointed their patients for years, and have lost money to cancellations and no-shows because of it. Think about it. Do you know what you’re doing at 10 a.m. six months from now? Neither do your patients, and that means the chances of them actually keeping an appointment with you that far out are pretty slim. Either something more important will come up, causing them to cancel at the last minute, or they’ll simply just forget.

If you’re not ready to give up pre-appointing, consider developing a hybrid system and only pre-appoint reliable patients you’re confident will show up.

3. You don’t confirm appointments. Train your Scheduling Coordinator to confirm appointments with every patient through their preferred method of contact, whether that’s text, email or phone call, two days in advance. And when a patient wants a phone call reminder, make sure your coordinator understands that leaving a message isn’t good enough. To confirm the appointment, the Scheduling Coordinator has to actually talk to the patient. This can be challenging; not every patient can take calls during the work day. Consider scheduling time to confirm appointments after hours to ensure you connect with patients who are difficult to reach during the day.

4. You don’t have a policy. If you don’t have a broken appointment policy, you might want to consider developing one. When you create a policy and communicate that policy to patients, they’ll be less likely to blow off their scheduled time with you. Remind patients of your policy every time they make an appointment, and let them know how it affects the practice if they don’t show up, or call to cancel at the last minute. Ask them to cancel at least 48 hours in advance so another patient can see the doctor during that appointment slot.

Every time a patient cancels at the last minute or doesn’t show up at all, it wreaks havoc on your day. It leads to stress for both you and your team members, and keeps you from meeting daily production goals, which in turn costs you money. Reducing cancellations and no-shows at your practice will reduce stress and frustration, while also growing your bottom line.

Next week: Follow these tips to reduce cancellations and no-shows.

For additional information on this topic and more, 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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The 80-20 Rule and Dental Practice Management
By Belle DuCharme, CDPMA

Dear Belle,
I feel like I am always putting out fires and my practice is stuck in the same old rut. I want to take my practice to the next level of success, but don’t know what to do. Any suggestions? - Dr. Anonymous

Dear Dr. Anonymous,
Focus on activities that produce the best outcomes for you. From Wikipedia the online dictionary:

The Pareto principle (also known as the 80–20 rule, the law of the vital few, and the principle of factor sparsity) states that, for many events, roughly 80% of the effects come from 20% of the causes. Management consultant Joseph M. Juran suggested the principle and named it after Italian economist Vilfredo Pareto, who, while at the University of Lausanne in 1896, published his first paper “Cours d'économie politique.” Essentially, Pareto showed that approximately 80% of the land in Italy was owned by 20% of the population; Pareto developed the principle by observing that 20% of the peapods in his garden contained 80% of the peas.

It is a common rule of thumb in business; e.g., “80% of your sales come from 20% of your clients.” Mathematically, the 80–20 rule is roughly followed by a power law distribution (also known as a Pareto distribution) for a particular set of parameters, and many natural phenomena have been shown empirically to exhibit such a distribution.

The Pareto principle is only tangentially related to Pareto efficiency. Pareto developed both concepts in the context of the distribution of income and wealth among the population. The distribution is claimed to appear in several different aspects relevant to entrepreneurs and business managers. For example:

80% of a company's profits come from 20% of its customers
80% of a company's complaints come from 20% of its customers
80% of a company's profits come from 20% of the time its staff spend
80% of a company's sales come from 20% of its products
80% of a company's sales are made by 20% of its sales staff

Therefore, many businesses have an easy access to dramatic improvements in profitability by focusing on the most effective areas and eliminating, ignoring, automating, delegating or retraining the rest, as appropriate.

Concentrating on systems and people that do not support or produce the best outcomes for you is counterproductive. In a business sense, finding the 80-20 ratio is crucial for maximizing performance. Find the products or services that generate the most income (the 20 percent) and drop the rest (the 80 percent) that only provide marginal benefits. Spend your time working on the parts of the business that you can improve significantly with your core skills and leave the tasks that are outside your best 20 percent to other people. Work hardest on elements that work hardest for you. Reward the best employees well, cull the worst. Drop the bad clients and focus on upselling and improving service to the best clients. Identify what elements of your practice contribute to the worrisome nights. Are they critical to the success of the practice? 

Perhaps employee performance is one. You ask for better customer service because you “feel” patients are leaving your practice because of it, yet you don’t like confrontation. Hire an outside service to conduct Performance Appraisals with each employee if you are not able to. You can design the appraisal to include the five best behaviors and the three that must be improved by a specific date. Put the deadline in the calendar and then keep your word.

Holes in the hygiene schedule plaguing your day? The schedule was full last week but today there are two cancellations that have not been filled. Assign a specific employee to contact by phone all patients who have not responded to email or postcard reminders. Look to see that the calls are placed daily and kept on a spreadsheet. Set a goal of setting five appointments a day. 

Not enough money to pay yourself, yet production is okay? You don’t pay bills from the production, so meet with your accountant and discuss the “net” after costs or overhead are factored into the equation. Learn about the industry standards for measuring overhead and then look at your costs in comparison. What areas can be improved and what can you do to make it happen?

Don’t just work, work smart by focusing your 80 percent on the 20 percent that is really important. Need help managing your practice or figuring out the best course for success? Call McKenzie Management today.

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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New Technology and Old Protocols Don’t Mix
By Nancy Caudill, Senior Consultant

New technology that you incorporate into your office is not only impressive to patients, it also makes coming to work more fun for you and your team. Not having to manually call 50 patients a day to confirm their appointment is a great technological advance – if you doubt it, ask your Business Coordinators! Other advancements that can make life easier for you and your team include the ability to review the computerized appointment book from your telephone or other device, as well as emailing digital radiographs to specialists or other dentists (as well as receive them) instead of having new patients bring in a paper copy of an FMX or Panorex.

These and all the other technological advancements in dentistry all bring along with them a different set of challenges you may not have considered. I would like to review a couple here in this article.

Chartless Offices
Let’s say you have a new patient whose last name is Cenisky. A paper record would have the letters CE on the side for filing purposes, even though it was misspelled in the computer as Senisky. The chart is still easily located. When you are chartless, accuracy is much more important. If this patient’s name was misspelled in your software program and you are trying to find their clinical chart, you are going to have to search around for a bit…quite a bit.

Do you now use kiosks for new patients to complete their patient information, or have a link on your website to the software itself that auto-populates the patient’s demographic information? Be sure that all information in entered correctly from the beginning. 

Digital Radiographs
Using digital technology forces team members to accurately attach x-rays to the correct patient to avoid errors. The “old school” way of taking processed x-rays included preparing the x-ray mount with the patient’s name on it. It could accidentally get filed in the wrong paper record and you would never find it again, but at least there was a name attached to it. So, again, accuracy is so important.

Also, in order to send and receive patient medical information from another medical entity, it must be sent over a secure email address, opposed to the patient bringing you a copy of their x-rays. Is your email secure and HIPAA compliant?

Automated Confirmation Systems 
Back in the day, telephone confirmation calls were made during office hours and most of the time you could actually speak to someone. If they needed to cancel and reschedule their appointment, it was handled at the time the call was placed. Not anymore with automated systems. Now your system sends out an email to the address that is on file and an automated call is placed to the patient or a text message is sent to a cell number. The patient responds at 9:00 p.m. to inform you that they are not going to keep their 8:00 a.m. appointment. You may get this information on your smart phone or another device, but are you going to start “dialing for dollars” to fill the opening? I doubt it.

Again, accuracy is key in keeping the patient’s demographic information updated. Statistics say that 17% of us change our email address every six months, and subscribers change theirs annually. You can’t assume that patients don’t change theirs as well. As a result, it is important to review the demographic information of your patients more often than in the “old days” when there was only a home and work telephone number. And what do you do with patients who don’t respond to email, texts or calls? It used to be that you kept calling until you actually spoke to someone. Do you have the same protocol now?

Just like those who live or die by their smartphones and carry them everywhere, automation can also keep you “connected” to your practice much more than you really want to be. Technology is great and we need it to be more efficient, accurate and productive. Be careful, however. Avoid finding yourself insisting that your Business Coordinator have cancellation notifications go to her personal phone or even an office smart phone so she can respond and/or review at all hours of the day. Review all your protocols that are “old school” and make sure they still apply to your office today. If you don’t have protocols for an efficient and productive office, contact us. We can help.

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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