3.31.17 Issue #786 info@mckenziemgmt.com 1-877-777-6151 Forward This Newsletter

Improve Leadership Skills and Grow Your Bottom Line
By Sally McKenzie, CEO

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You likely didn’t focus much on the business side of running a practice while you were in dental school. What you do know, you learned either on the job or from your time observing practice ownership as an associate. It’s no wonder you feel a little overwhelmed in your role as practice CEO.

These days, there’s a lot that dentists need to understand to successfully run their business, including profit and loss, human resources, marketing, hiring and firing. You also need to pay careful attention to the 20 business operational systems especially the ones that directly impact practice revenues. If you’re not, I can pretty much guarantee you’re losing money. But don’t worry. With a little direction, you can turn it around.

To get started, let’s take a look at production. Few dental practices know how to establish production goals or determine the number of hygiene days they need. Here are a few tips to get you on the right track.

Identify realistic financial goals for your practice
Say your goal is to produce $700,000 a year. How exactly are you going to get there? You’ll have to bring in $14,583 per week (minus four weeks of vacation). If you work 40 hours per week, you’ll need to produce about $364 an hour. Want to work fewer hours? Great, but that means your per-hour production number will need to increase.

How can you determine the rate of hourly production? I suggest you follow these steps:

Train your assistant to log the amount of time it takes to perform specific procedures. If a procedure takes the doctor three appointments, the assistant should record the time needed for all three appointments.

• Record the total fee for the procedure.

• Determine the procedure value per hourly goal. Want an example? Let’s say a crown is $1000. Divide that number by the total time it takes to perform the procedure, which is 120 minutes. That gives you a production per minute value of $8.33. Multiply that by 60 minutes and it comes out to $500 per hour.

• Compare that number to the doctor’s hourly production goal. It should equal or exceed the goal you’ve identified.

Train your Scheduling Coordinator to schedule to meet that goal every hour of every day.

Don’t schedule “dream days”
Some dentists have their Scheduling Coordinator block out time for specific procedures. That’s OK, but don’t save slots for procedures just because you enjoy doing them or because they bring in the most money. Base it on the actual number of procedures you’ve performed over the last six months instead. Trust me, this will make your days run much smoother and will keep you on track to meet production goals.

Schedule for the hygiene days you need
You should have an adequate number of hygiene days on the schedule so new and existing patients don’t have to wait weeks or even months to get an appointment. When patients have to wait, you run the risk of them making an appointment with another dentist who can see them sooner. Also remember the hygiene department should account for 33% of your total practice production, and your hygienist should produce 3x her/his daily wage.

Follow this formula to guarantee your supply meets demand:

Count the number of active patients seen in the past year for oral health evaluations.

Keep in mind most patients come in twice a year for these appointments, so multiply that figure by two.

Add the number of new patients receiving a comprehensive diagnosis per year to that figure. For example, let’s say your practice has 1000 active patients + 300 new patients. That equals 1300. When multiplied by two, that gives you 2600 possible hygiene appointments.

Take that number and compare it to the hygienist’s potential patient load.

If the hygienist works four days a week, sees 10 patients per day, and works 48 weeks a year, that means there are 1920 hygiene appointments available.

Subtract that total from 2600. This shows you are losing 680 appointments per year, or 14 patients per week. In this example, the hygiene department should be increased 1.5 days per week.

Another tip? If your practice schedules patients when they are due, examine how far ahead patients are booked for appointments. If there are no openings in the hygiene schedule for three weeks, with some patients getting bumped into the fourth week, I recommend increasing the hygiene department’s availability in half-day increments. If you have several open appointments, it’s probably time to develop a patient retention strategy.

If you’re struggling with the business side of running a practice, it’s likely leading to lost revenues and plenty of frustration. With the right skillset, you can turn this around and finally start achieving true success and profitability. If you’re interested in becoming a more effective CEO, don’t hesitant to contact me at sallymck@mckenziemgmt.com. I’ll help get you there.

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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Jean Gallienne RDH BS
McKenzie Management
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Treatment Plan What You See
By Jean Gallienne, RDH BS

There is a new code available to use when submitting claims to insurance. According to “A Guide to Reporting D4346” written by the American Dental Association, the D4346 code can be used for “scaling in presence of generalized moderate or severe gingival inflammation-full mouth, after oral evaluation. The removal of plaque, calculus and stains from supra- and sub-gingival tooth surfaces when there is generalized moderate or severe gingival inflammation in the absence of periodontitis. It is indicated for patients who have swollen, inflamed gingiva, generalized suprabony pockets, and moderate to severe bleeding on probing. Should not be reported in conjunction with prophylaxis, scaling and root planing, or debridement procedures.”

Based on further reading, I can’t say I am overly excited about using this code. I have been practicing full time as a clinical hygienist for 29 years. This code has the description of what we are missing when it comes to codes, and it is supposed to fill the gap we have needed for years. However, the actual utilization and the way it may be paid might not be what we need.

In the question/answer portion of the D4346 guide, it says the procedure that goes with this code is “based on the diagnosis rather than intensity of treatment required. The procedure is expected to be completed on a single date of service, but patient comfort and acceptance may require delivery over more than one visit. Should more than one day be required, the date of completion is the date of service.”

Who knows if insurance companies are going to pay any more for this code than a D1110. They might only pay for it once in a lifetime, or not at all. They may even count it as one of the patient’s prophylaxis appointments. Even in the question/answer information, it states individual plans may have limitations and it may be best to pre-authorize. As many employers continue to cut employee benefits, it can often seem like we are going backwards regarding insurance. Pre-authorizing is old school in today’s society.

At this time, there is not a set waiting period between performing a D4346 and a D1110. However, this does not mean individual insurance plans will not set their own standards of payment. When you use the code, it is not followed by a periodontal maintenance. The patient will be considered a prophylaxis, unless root planing is later performed due to the patient’s gingival health continuing to deteriorate because of attachment loss.

When you have a patient with clickable calculus that is visible on the x-rays, no attachment loss but a lot of inflammation and bleeding upon probing, this may be a D4346. However, just because you need to get them numb and more time is required for treatment, it does not necessarily mean you will get paid more by insurance. The practice could always charge it out at a higher fee once the procedure is complete, but it still does not mean the insurance companies are going to pay anything more than the allotted amount for a prophylaxis, and count it towards one of the two prophylaxis that they allow.

Treatment planning patients’ gingival care is extremely important at every visit they have. It is also very important that the treatment plans be based on what your diagnosis is, and not what the insurance will or will not pay. When reviewing the treatment plan with patients, if there is no preauthorization you might want to tell them their insurance company may not pay at all, but you are happy to bill insurance and in the meantime they can utilize CareCredit if needed.

For many patients, as long as the probings are complete along with gingival recession, it would benefit them and the practice more to do scaling and root planing on any areas that specifically show loss of attachment. This code may be nothing more than a smoke screen that does not enable us as dental professionals to be paid for the amount of work being done. Time will tell.

Interested in improving your hygiene department? Email hygiene@mckenziemgmt.com and ask us about our 1-Day Hygiene Training Program or call 877-777-6151

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