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Thinking About Becoming an Associate? Here’s What You Should Know
By Sally McKenzie, CEO

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Joining a practice as an associate offers young dentists a lot of opportunity for growth. As an associate, dentists have the chance to learn from an experienced clinician while enhancing their skills and preparing for a long, rewarding career in dentistry.

Yes, it can be exciting to join a practice as an associate, but it’s important to make sure the practice you choose is a good fit.

You’re probably thinking, “That makes sense Sally, but what questions should I be asking?” Not to worry. I’m here to help, and have put together a few questions every associate should ask before joining a practice:

Is the practice saturated or struggling?
Becoming part of a struggling practice won’t do you much good, so look for practices that are saturated. What does that mean? The practice should have a base of between 1,500 and 1,800 active patients who visit the hygienist at least once a year. With that many patients, there’s a good chance many of them have unscheduled treatment, giving you the opportunity to take on a variety of cases. This helps give you the experience you crave while also boosting the practice’s production – and that’s a good scenario for both you and the senior dentist.

In a saturated practice, you’ll also likely find a good number of patients who are overdue for their professional hygiene appointment. I suggest you meet and make an effort to start building relationships with these patients. Get them back in the chair and talk with them about their oral health goals and how you can help them meet those goals. They’ll get the care they need while you gain experience and contribute to practice growth.

How do you approach treatment planning?
This is actually pretty important. If you sign on with a practice that has a philosophy or care that you’re not comfortable with, it could lead to conflict and an overall bad experience for everyone involved.

To avoid this, I suggest you talk with the senior dentist about his or her approach to patient care and treatment planning. Find out if there’s a Treatment Coordinator or if producers are expected to handle their own case presentations. Ask about the case acceptance rate and how patient education is presented in the practice. Once you know the answers to these questions, you’ll have a pretty good idea if the practice is a good fit for you or if it’s better to move on.

What type of guidance and feedback will you offer?
Remember, this is a learning experience for you. You want to find a dentist who is willing to serve as a teacher and a mentor during your time at the practice, not someone who expects you to put out fires all day and fix everything that’s wrong in the office. That just isn’t realistic, or fair to you. For you and the hiring dentist to get the most out of the arrangement, it’s critical that you receive guidance from the very beginning as well as continual feedback.

It’s a good idea to schedule a standing weekly meeting with the senior dentist for the first six months. Use these meetings as an opportunity to learn. Talk about difficult cases and any management concerns you have. Trust me, this is a great way to keep communication open and address any issues that come up before they turn into major problems. You’ll also know exactly how you’re progressing, including where you’re excelling and where you might need to make some improvements.

I also suggest you and the hiring doctor meet once a month to review key practice indicators, including accounts receivables and production reports.

What if this doesn’t work out?
The reality is, these relationships often fail for one reason or another. Doing your research, asking the right questions before you join a practice and committing to open communication with the hiring doc will certainly up your odds of success, but there are still no guarantees. While you might not like to think about the arrangement breaking down, you should have a plan in place in case it does. That means making sure the agreement you sign includes a timeframe for leaving the practice, which is usually 30 to 60 days after you tell the practice owner you plan to move on. This gives you enough time to complete most of the cases you’ve started.

Just remember: No matter what happens or why you decide it’s time to go, it’s important to leave on good terms. This is not the time to burn bridges.

There are many benefits to joining a practice as an associate, and with the right research and preparation, it can be a rewarding experience for both you and the hiring dentist. Keep in mind this is an important stepping stone for you, and not just any opportunity will do. Take the time to find the right fit and you’ll be well on your way to a rewarding career.

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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Nancy Caudill
Senior Consultant
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Production Adjustments Out of Control? Here’s How to Fix It
By Nancy Caudill, Senior Consultant

Dentist Case Study #367

The doctor’s concerns: “Production adjustments in my practice are out of control and hurting my revenues. I need to find a way to reduce the adjustments so I can start bringing in more money.”

This dentist had no idea how he got into this situation or how to fix it, which is why he called McKenzie Management for help.

Let’s take a look at the practice facts:
-Monthly gross production was at $83,000 and monthly net production was at $45,650. Remember production adjustments reduce the dollar amount of gross production. A practice collects money based on net production.

-These numbers equated to production adjustments of $37,350, or 55% of gross production. 

-Collections were at $44,737, or 98%. Seems pretty good, right? Not so fast. The large amount of production adjustments the practice was experiencing served as a tell-tale sign the doctor had a problem that needed to be addressed.

OK, so how did he get here? To start, this doctor was posting more than 7% of his gross production to doctor courtesy – which means he was giving away 7% of his production to family, friends and anyone else he deemed worthy of a discount. That might not seem like a huge number, but it added up to nearly $6,000 a month! 

This doctor’s bad debt and collection adjustments sat at 3% of gross production, or $2,500 a month. They should only be 2%. So while collections reached 98%, the Financial Coordinator was writing off 3%. That works out to more than $800 a month over the acceptable amount. The culprit? Unclear patient financial arrangements and a lack of systems in place to collect unpaid balances.

Now let’s look at PPO adjustments. Those made up 42% of the doc’s gross production, or $34,860 a month. That’s a lot of lost revenue. When we took a closer look, it became clear the Financial Coordinator wasn’t posting insurance adjustments correctly. To make matters worse, the doctor opted not to request the additional payment due from his patients. Why? He was afraid it would upset them enough to start looking for a new dentist. So that money was never collected, hurting the practice’s bottom line.

There is no industry standard for PPO adjustments. Some offices reduce their gross production for each PPO plan, therefore requiring very few adjustments. Others post their fees and require a much higher PPO adjustment when the insurance check is received. Either way, it’s important to train your Financial Coordinator to properly post adjustments and collect the accurate amount from each patient.

The Fix
Dental software programs are set up with basic adjustment codes, such as credit and debit adjustments, miscellaneous adjustments, refunds and insurance adjustments. That’s exactly how our doctor’s system was set up. To improve his use of production and collection adjustments, we suggested he establish more specific adjustment codes. Here are a few examples:

Production (Credit) Adjustments
Employee Courtesy for Dentistry
Family Courtesy for Dentistry
Senior Courtesy
Cash Courtesy
PPO Adjustment
Bad Debt Write-Off (smaller balances that are uncollectible but not turned over to a collection agency)
Collection Write-Off (accounts that are turned over to a collection agency)
Small Balance Write-Off (used when patients don’t return and their balance is less than $10)
Collection Agency Fee
Doctor Courtesy (used when the doctor elects to reduce the patient’s fee)
Transfer Credit to another Account/Family Member
Corrected Post-Credit

Collection (Debit) Adjustments
Refund to Patient
Refund to Insurance
Refund, No Check Issued (used when the credit balance is small or the patient’s mailing address is incorrect and the patient can’t be contacted)
NSF Check Recharge (used when a check is returned from the bank because of insufficient funds)
Recharge Collection Write-Off (used when the collection agency collects on an account that was written off when turned over)
Transfer Debit to Another Account/Family Member (should equal the “transfer credit” totals)
Corrected Post-Debit  

Beyond that, we also created a monthly monitor for the doctor that included all the codes. Our goal? To reduce what I call “red flag adjustments” over the next few months, allowing for increased collections based on higher net production. We also encouraged the doctor to stop giving away dentistry to family and friends. Once he realized how much he was losing each month in free dentistry, it was an easy sell. The good news? Because he provides high-quality dentistry and a top-notch patient experience, family and friends still come to see him, and are happy to pay full price.

The Financial Coordinator received additional training, and spent time speaking with various insurance representatives to learn how to properly adjust patients’ accounts and determine what portion of the payment they’re responsible for. This team member also started working with patients who owed money to the practice, and established protocols to reduce bad debt and collection agency adjustments.

After six months, the doctor reduced total adjustments to 32% of gross production. That led to a new net production of $56,440. With collections increasing to 99%, average collections came to $55,876. This improved cash flow by $11,139 a month or $133,668 a year. Not bad!

If you’d like to see revenue increases like this in your practice, give McKenzie Management a call. We’ll help you get started.

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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