Navigating the world of dental plan contracts and reimbursements can be like reading legal documents written in Sanskrit through a tinted glass window. And yet the results can make a big difference in your write-offs and subsequent take home pay.
This is particularly true with companies that act as administrators/lessors and/or “networks” of dental plans. In essence these administrator networks sell and sometimes administer other dental plans.
The big question is which fee schedule the dentist will be paid from. This question arises because administrator networks and the dental plans which they sell have their own distinct fee schedules and often reimburse at vastly different rates. The difference in reimbursement for crowns alone can be in the hundreds of dollars. The point at which we attempt to determine the fee schedule used for payment is the point at which we jump into the rabbit’s hole.
When a dentist contracts directly with the administrator network she might be automatically enrolled with all dental plans within its network. Surprise!
To complicate matters, the administrator network may pay from its own fee schedule if the fee in question is lower than that of one of the dental plans within its network. However, what happens if the dentist is not directly contracted with the administrator network itself, but is contracted with one of the dental plans within its network? In that case he would most likely be paid from the fee schedule of the latter. To make things even more convoluted, at times a dentist is directly contracted with multiple dental plans sold within an administrator network, while not being directly contracted with that administered network. In that case, the fee schedule used for reimbursement is usually that of the dental plan which was directly contracted with first.
Most administrator network contracts state they administer and/or sell multiple dental plans (although they don’t always publish the full list.) Be careful, because they do not always spell this out. As a result, dentists could be paid from different fee schedules without even being aware that it’s happening, resulting in less take home pay.
You can opt out of unwanted dental plans associated with the administrator network after directly contracting with them, but it can take months for this to be finalized. In the meantime, most require the dentist to continue seeing their patients at the contracted reimbursement rates. To avoid this, you can opt-out of unwanted dental plans before directly contracting.
A key phrase here is “directly contracted.” Some administrator networks may attempt to auto- enroll (or contract) practices with the dental plans in their network without formal notification. Therefore, it is highly recommended to contact the administrator networks to find out if you are directly contracted with them, as well as with any dental plans they sell or administer. It is not uncommon to be told by the administrator network that you must reach out to a dental plan directly. If this occurs, tell the administrator network you first need to know if you are “directly contracted” with them. If they say yes, have them send you the fee schedule they are reimbursing you from (you could use this opportunity to opt-out of any of their associated dental plans.)
The next step is to reach out to any dental plans the administrator network may have mentioned to determine if you are “directly contracted” with them. This dental plan, in turn, may try to direct you to yet another dental plan, or back to the administrator. Keep in mind; however, that each one is responsible (and only able) to answer for themselves.
Most importantly, before contracting with administrator networks it would be immensely helpful to determine which dental plans are the most profitable for your practice. Having this information gives you control (and protects your take home pay) by allowing you to make informed business decisions about the administrator networks and dental plans you wish to work with.
At first glance, that question may sound like a threat. If I’m replaceable, then what is my real value? If I’m replaceable, where’s my leverage? Who needs me?
I can hear your answer. “Me, replaceable? Heck no! I’m the owner! I do the work. I’m highly trained and have years of experience doing x, y, z. I have specific relationships with our clients or patients – it wouldn’t be possible to replace me without severe damage to the business.”
“I’ve worked hard all my life to get where I am.”
And exactly where are you?
“At the top of my game. I have a practice (job – ed.) to go to every day of the week. I can’t take time off because I am so busy doing the thing I spent so many years learning. I still have a ton of debt to pay off, and I don’t see any way off this hamster wheel. But life is good. Someday I’ll be able to enjoy it.”
Hmmm…sort of a Catch 22. The better one becomes at “doing the thing,” providing the technical labor, the less freedom there is. Trading time for dollars, no matter what the hourly pay rate, is not a path to freedom.
Being ‘replaceable’ seems contrary to everything we’ve been taught over our lifespan – that being replaceable is a bad thing. We’re told to shoot for the stars, create goals to exceed, accomplish great things, make a mark, develop a skill-set that creates high value.
But as a business owner or entrepreneur, not being replaceable is actually a problem…a huge problem!
When we focus on how well we “do” something…when we go to school many years to obtain degrees and professional licenses, when we earn accolades because of a specific skill or expertise, we are applauded. We are held as important, valuable, worthy of acknowledgement.
With such achievement, society also promises a better than average income, a lifestyle without needs, security and peace of mind…or does it?
The problem with irreplaceability becomes a trap. If you’ve built a business or professional practice that is dependent to a large degree on your physical labor and activity on a daily basis, you’ve created a job. Very possibly a well-paying job…but nonetheless, it’s a job.
Let me take this one step further – EVERYONE in your organization needs to be replaceable! A tough conversation to have, but you need to be the leader and show your vulnerability first.
Sure, you’re the boss, so you have assumed security, but, you’re no different than your employees. Your customers, clients or patients are ultimately your boss and if your team and business don’t serve, in a capitalistic society where people have choices, you and the business will suffer – you may become obsolete.
So, are you ever really secure? I say, “no.”
In 2004, my daughter Jenna underwent a life-saving liver transplant at age 12. The year-long recovery was physically and emotionally draining. I was absent from my practice about 50% of the time that year.
Was I worried that my patients might see and even prefer my associate dentist?
Was I concerned that I might not be the needed “top dog” in the practice?
No – not at all. I was grateful that in my absence my associate, staff and even our patients continued to do business…without me. No longer did everything revolve around me.
This was the most freeing moment of my life. It was no longer believed the myth that I had to “do it all.” I now had the option to change my life. So, I did.
I vowed to continue to be an absentee owner (a real business owner) and eventually sold the practice in 2010 (not without one failed sale attempt in 2007 – but that’s a conversation for another time).
Fast forward and peek inside today’s Freedom Founders Mastermind Community. At our February meeting, one of the questions or concerns from our members was, “What happens if something happens to David?” That is, what if I become in some way incapacitated?
If I am “the business” and no sustainability plans have been created, then the business might fail in my absence. I don’t want a business that is solely dependent on me – I’m all about building a legacy that will survive me.
After our mastermind meeting, our leadership team also finished our first quarter Level 10 meeting (see the book “Traction” and Entrepreneur Operating System). One of our next quarter Rocks is to deal straight up with the issue of “anti-fragility” (see the book, “Anti Fragile” by Taleb).
Our mission is to identify our company’s weaknesses, vulnerabilities and to create off-setting plan B’s or redundancies against future unknowns, uncertainties and volatility. It’s about handling to the best of our ability as many of the “what-if’s” that we can.
One of the first places we began was with our leadership team – today, there are four of us, including me. The question we put forth was, how can each one of us be replaced? If something occurred which took any one of us out of the business, either temporarily or permanently, what back-up plan is in place and how viable is it? How fragile is the company if a key team member is lost?
Most business owner/entrepreneurs are visionary…or want to be visionary.
You’ve got to be always re-inventing yourself and your business. But you can’t do that when you’re down in the trenches doing the work, providing the fulfillment each and every day.
What are the benefits of becoming “replaceable?” So far, we have only addressed the importance of being replaceable to negate the downside of one’s incapacity or loss. Are there any positives to being replaceable? Absolutely YES!
As soon as you can put away the ego and pride, this is what you will discover in becoming replaceable in your business or practice:
Security and Peace of Mind = less stress.
Real Freedom – being able to do what you want, when you want and with whom you want to do it.
A more valuable company – any business with a high degree of dependency on key person is not a highly valued company. For instance, dental practices sell at no more than a 1-2 times multiple of net income. Most real businesses sell for many times that multiple. Why? It goes back to a real business vs. a self-employed job. The more irreplaceable you are because “nobody else can do what you do” provides for a great deal of self-esteem, but is a ball and chain against the path to freedom.
Vision and Significance – the opportunity for you as the owner to work more “on” the business which will allow you to better lead your business, innovate and create legacy and significance.
So, what’s the plan for my replacement? I know a lot of people…I’m well-connected. We already have a Board of Advisors (Trusted Advisors) within Freedom Founders who play a large role. My leadership team handles all the company operations. I am already at a distance from the daily operations of the company. To replace me would require another visionary with connections to the entrepreneurial business world, professional practice and real estate.
I know and have already identified a small number of first choice people who would be willing and very capable to step in at my absence – either temporarily or in some cases, indefinitely. The right person could step in and replace me with little upset to the company and its member clients.
Each person on our leadership team has also created a replacement or succession plan for themselves, with full documentation and training – plug and play.
Instead of feeling vulnerable about replacing yourself, embrace the process! It won’t happen immediately, but if you have expressed this need to your team and they have bought in that everyone needs to be replaceable, you will find that the business will take on a new level of performance (and reduced stress).
For you as the owner? You will be able to step away from the day to day operations and experience real freedom as a true business owner – not a slave to a business as a self-employed worker.
We’ve all heard this bedtime story. The one about the dentist who after years of dental school and associating, decided to start their own practice.
Eager to get their practice underway, they go through the necessary steps to select a location, secure financing, and happily sign off on a ten year dental office lease provided by their landlord. But, they miss the critical and most important stage that ensures the protection of a healthy and successful dental practice — reviewing the details of the dental office lease.
The fairytale starts to go south when the doctor realizes that the office lease they were so eager to sign initially is now impeding the growth and security of their business. They find themselves buried in clauses and legally binding obligations that hinder their ability to practice alternative forms of dentistry, bring in associates, expand the practice, or eventually sell it.
Having incurred significant financial loss due to unreasonable rent escalations, a forced and unplanned office relocation (at the doctor’s expense), and a decline in business, our dentist is forced to try and sell the practice and return to associating.
The moral of the story? Because the dental office lease is the longest lasting contract you ever sign for your practice, starting a practice requires planning, long-term thinking, and a thorough understanding and review of the dental office lease.
The Storyboard: Outlining the Plot
Before starting a dental practice, it’s important to understand your current situation and what your career goals are as a business owner. A young dentist fresh out of school will have different needs and goals than an established, end-of-career dentist. Identifying your needs and career goals will clarify what your dental office lease should do for you.
Consider what type of dentistry you will practice down the line. Many leases contain limitations in their “use” provisions that disallow you to grow and expand your service offering (ex. a General dentist expanding their services to include a Dental Spa).
If you’re planning to start a practice in a dense urban area, a detailed exclusivity clause will be an asset as it will prevent your landlord from moving competing dentists into the building or center.
What does your career trajectory and timeline look like? If you’re close to, or are planning to retire or sell your practice in the next 5 years, the last thing you want is any legal obligation or financial penalty as you transition into retirement. Assignment provisions in your lease should be written in detail to support your future transition plans, protecting you from continued personal and financial risk.
Create a plan that will clearly define your budget, timeline and long-term business and professional goals. The office lease should support your objectives, not hinder your ability to achieve them.
The Plot Thickens…
The dental office lease is a legal agreement, often 30 to 60 pages or more, containing technical jargon and harmful clauses that can pose significant and expensive risks to a dentist. While it may seem like an onerous process, the review and negotiation of your lease can either set you up for success or drive your practice to the ground.
What to Look for in the Lease
Liability: Who is guaranteeing the lease, you or your incorporated business? If you are personally named as the tenant, your landlord can hold you financially liable for defaults of the lease, even after you transition and sell.
Practice Expansion: Every dentist wants their practice to grow, and sometimes that means expanding into a larger space. Ensure you have the “right of first refusal” to expand into the space adjacent to you should it ever become available.
Growing Your Business: You’ll want to ensure that the lease allows you to bring in associates and expand your service offering.
Practice Relocation: A surprise practice relocation is a very real occurrence that can be financially devastating to a business. Ideally, the “relocation clause” will be structured to prevent a move by your landlord. In the event that a relocation does occur, set up this clause to ensure your landlord is required to pay for all moving and build-out expenses, and that the new premises is comparable in size, location, etc., to your current space.
Selling the Practice: Does your lease permit you to sell the practice and retire? Many leases can prevent a dentist from selling their practice, or entitle the landlord to proceeds of the practice sale, as a form of “consideration”. Ensure you have the flexibility to transition and retire seamlessly and profitably out of dentistry with a properly set up “assignment clause”.
Happily Ever After
Before you commit to a new practice location, ensure that the details in the dental office lease are right for you. Landlords write the terms in the lease in their favor, giving them a villainous advantage over you, the tenant. By reviewing the terms of the lease in the early chapters, a dentist can write their own happy ending and set themselves up for long term practice success.
Since founding Cirrus Consulting Group in 1994, President and CEO Jeremy Behar has expanded the company from its sole focus on office lease negotiation services for healthcare professionals, to a broad line world-class healthcare consulting organization. He assembles and manages all aspects of the operational infrastructure in order to optimize the efficiency and effectiveness of the company. As a prominent leader, speaker and author, Jeremy has extensive experience in commercial real estate consulting, and has taught thousands of dentists how to best leverage their office leases to maximize the value of their practices. Jeremy can be reached at 1.800.459.3413 x 3226 or by emailing email@example.com.
Firing and hiring are probably the least favorite parts of the job for most dentists and office managers. In fact, some dentists dread this process so much that they hold onto employees way too long in order to avoid firing someone. There are many reasons for this. Not only is it unpleasant to have to fire an employee, it also requires another equally dreaded process: trying to find someone new to replace them. I am here to tell you that as hard as hiring might seem, it is much better to replace an employee who is not working out with a new (and hopefully better) employee than to continue struggling with that employee who is holding back your office and your potential.
Hiring does not have to be hard or scary, if you know what you are doing. The best thing to do is to prepare yourself for the process and start it the right way to make it as successful as possible. Here are five things you should do to set yourself up for success in finding your next “rock star.”
1) Get yourself in the right mindset. I know that this might sound cliché, but if you decide that the hiring process will suck, then guess what—it will suck. If you tell yourself that there are no good candidates available, then I bet you that you won’t find a good candidate. Many times our attitude causes the outcome we are expecting, so my suggestion is to take on a positive attitude. Decide that you are going to find a great candidate and you will have a lot more success. Think about one of your best employees on your team right now—aren’t you glad you found and hired them? If the process worked well for hiring that employee, then it can work well again for the person you need to hire now. Start thinking that your next amazing employee is out there and you just have to find them!
2) Determine specifically what you need and want on your team. Take a step back and look at the team you have currently. What skills do they have that are great? What skills or personality traits are you lacking? What things would you benefit from adding to your team? Maybe you have great staff overall, but not one person who is really good at talking about money. Or maybe you have a lot of introverts, and you could use someone that is outgoing and bubbly. Take some time to see what you would like to add to your team that would help your office and team be well-rounded. Many dentists hire based on a number of years of experience of dental, but specific dental experience really does not matter as much as other qualities. With the right personality and work ethic, you can teach them the rest.
3) Create a hiring checklist. Once you have determined the traits, skills, personality type, and anything else that you would like to have join your team, write it down. Keep that list for when you are interviewing candidates, and refer to it regularly. Many times, we tend to forget what we initially were looking for so that when we meet a candidate, we start to think “she or he is good enough” or “they are close to what I was thinking I wanted.” By having a list you can refer to, you can remind yourself what you initially wanted and really determine how well this candidate meets the requirements on that list.
4) Don’t wait until you are in pain. You might have the intention of hiring someone soon, but things happen, you get busy, your office starts to cope without a new hire. Next thing you know, you are in desperate need of help and time is of the essence. Suddenly you are hiring in urgency mode, and you can’t afford to be picky and wait for the right candidate. If you do this, then you end up hiring a round peg to go into a square hole, which results in turnover. Ultimately, planning ahead about hiring before you get desperate will not only let you take the time to find the right candidate, it will also lower the turnover rate in your office.
5) Write an interesting and intriguing advertisement. When you are ready to put your advertisement out, make sure it is something that people want to respond to and submit their resume. If you write an ad that is boring and has too many requirements, guess what you will get? First of all, you will be limiting the number of candidates by making the requirements too strict. You will also attract boring candidates that aren’t actually excited about working in YOUR office– they are just submitting a resume because they are looking for any opening and don’t have a better opportunity at the time. You want to write an ad that is going to attract great people who are excited when they read the opportunity. You want to have an ad that attracts people who are currently employed because your job sounds way better than the job that they are in now—instead of attracting unemployed people who will take anything that comes along.
To sum up my advice: don’t be afraid of hiring. You will find your next great employee, but you have to understand that it might take a little work and some patience. Like some of the best things in life, hiring good employees requires work, but it is so worth it.
Not sure what needs to happen when hiring? Visit Front Office Rocks to learn for more information or call us at 1-800-914-3595.
Editor’s note — for most small businesses, including dentists, accepting credit cards is an expensive business necessity. And if you have ever tried to compare the total cost of two different credit card plans, you know how confusing it can be. So when knowledgeable experts can attack this problem for you, and get paid based on a percentage of the saving they produce, we are intrigued. Read on…
By Eric Cohen
Expert tips can help protect your practice from needlessly losing money on credit card payments.
The system that allows you to collect money from your patients can cost you a lot more money than it should. There are hidden costs that reduce your bottom line without you realizing it! You know that running a practice costs money. You have all the typical expenses: rent, employee salaries and benefits, insurance, marketing, equipment, etc. When you accept credit cards, that costs you money also. Chances are, this revenue collection system costs you significantly more money than it needs to, acting as a “silent siphon” that slowly takes money out of your practice.
There are ways to reduce this cost and optimize the fees that you pay WITHOUT switching providers. Unfortunately, the credit card industry has made it impossible to understand exactly what it is you are paying for. There are hundreds of different cards (over 700 different VISA®, MasterCard®, and Discover Card® categories at last count), most have different costs spanning a wide range: from 0.05 percent to over three percent of the transaction total. Additionally, there are dues and assessments imposed by the card associations, monthly fees, equipment costs, transactions fees, PCI compliance and non-compliance fees; the list goes on and on! Most practices run their patients’ credit cards through their practice management software, so the cost of accepting credit cards increases because there is a middle man potentially taking a piece of your hard-earned money.
YOUR RATE VS. ACTUAL COST
Choosing a credit card processor is not all about your rate. Many times I’ve heard, “I have the lowest rate. We have looked at this many times.” It’s not always that simple to see what your true rate is. Many factors make up the total cost of accepting credit cards besides the markup your processor is charging you, and a busy doctor or office manager cannot interpret all the intricacies of this industry. What can you do? You can have a third-party expert that understands all aspects of the industry, knows all the costs of accepting cards, and can help your office analyze the information to ensure you are processing optimally and at the lowest cost.
WHAT ELSE IS THERE BESIDES PRICE?
Your office must use proper procedures when accepting a card. The same card taken by your office will cost you different amounts depending on how it is accepted. Most practices know when the patient presents their card in the office and it is swiped into the terminal, it costs less than taking the payment at a later date and the card number is keyed in. Did you know that the data entered into your system when the card is keyed will determine the cost of the transaction? There can be several reasons why your practice is not getting the lowest rate possible on every credit card keyed in, such as:
The team member keying the credit card was not educated on proper procedure or is too busy.
Your processor set you up incorrectly-the processors make more money this way!
Depending on your rate structure, your processor may make more profit when you don’t enter in all the required information for each transaction. Sometimes, processors will intentionally set up your equipment improperly to increases profits. These reasons can siphon off anywhere between 0.5 to three percent of your gross profit, which can translate to over five percent of your net income. Having an expert to identify this can increase your income five percent!
Another factor affecting your rate is coding. There are simple coding errors that can cost you thousands of dollars a year. When you initially sign up for processing services, a human being data enters the information and sets up the account in the processor’s system. If the person entering this information is not paying attention, had a bad morning, etc., they can make mistakes, such as:
Incorrectly entering your SIC (standard industry code).
This can increase your cost to accept certain credit cards. We have seen this happen many times. One example we discovered was a not-for-profit organization charged thousands of dollars a year additional because someone entered the wrong code.
These are just a few examples of errors that go undetected because no one monitors your account to ensure that you are processing optimally. The processors have no incentive to save you money! What all merchants need is an advocate who works for them, who is on their side, and whose incentive is to keep processing costs as low as possible.
The first time our CEO heard Chuck Blakeman speak, David’s thought was that “this guy truly understands the essential challenge of owning a small business.” His book Making Money Is Killing Your Business (available on Amazon)is something that every dentist should read.
We are thrilled to have Chuck as a guest columnist!
Build a Practice You’ll Love, and Get a Life, Too.
Build a Practice You’ll Love, and Get a Life, Too.
“You get what you intend, not what you hope for.”
Too many practice owners and managers think their purpose in business is to make money. Surprisingly, it’s not. The practice owner’s purpose is to build a business that makes money. Making money, and building a practice that makes money are worlds apart. Almost every practice owner or manager I know is absolutely buried in trying to make money, which keeps them from ever making a lot of it.
From the beginning, Diane and I thought of all three of our kids as adults in the making. We looked forward to being adults together, where we could all invest in each other, help each other find significance with our lives, and simply enjoy each other for decades.
Dental Practices Should Grow Up, Too
I think dental practices should grow up, too. I don’t mean “it would be nice if it happened.” I mean we should all, every one of us, expect our businesses to grow up and start giving back to us and to the world around us.
Nobody would argue with me that we should intend for our children to grow up and become adults we could enjoy for decades. It’s normal for children to grow up, so why isn’t it normal for dental practices to do the same?
Most practices never grow up. We spend decades changing the diapers in our business. Twenty years later we’re still spending as much time, emotion, and money on our business as we did the day it was born. Why would we so eagerly anticipate the maturity of our children and never expect the same for our business?
I believe the root of the problem is a conventional view of business. The very thing you think will make your business successful, a focus on trying to make money, is the very thing keeping it from happening: You’re too busy making money. No business can survive that. It’s not a play on words—it’s a serious problem. You’re simply too busy making money, and most likely it is stopping you from building a practice that will ever grow up.
Two Opposing Realities
There is a good explanation for why we get stuck trying to make money. Dentists, like all business owners, are constantly fighting to balance two opposing daily realities:
The Tyranny of the Urgent vs. The Priority of the Important.
It’s a daily battle. Almost universally we let the Tyranny of the Urgent keep us from paying attention to the Priority of the Important. I haven’t met anyone who doesn’t struggle to properly balance these two realities.
The Tyranny of the Urgent
The Urgent things fly at us all day, every day, causing us to be reactive and defensive as we hold the practice together as best we can. The Urgent things are tyrannical—they want to rule over us. Like small unruly kids, they scream and yell, poke and prod, and are relentlessly in front of us.
One of the most Urgent things pulling at us daily is the need to make money to cover today’s bills. Think about it. That great-looking clinical space, those shiny instruments, and that great location very quickly turned into a relentless liability screaming, “I need money!”
We don’t have to find the Urgent things—they come and find us. Over time we resign ourselves to the notion that this is normal. And besides, all the dental practices around us seem to be doing the same thing. Welcome to the Dental Practice Treadmill.
The Priority of the Important
In stark contrast is the Priority of the Important, which sits patiently in the corner, whispering, “I can help you solve the Urgent stuff. But you’re right; taking care of me today won’t make you more money right now. I’ll try to nudge you again next week as you go flying by.”
The Important things require us to be proactive because they almost never seem Urgent—planning, processes, training, patient experience, and leading. We don’t make money right away doing those kinds of things, and they’re definitely not as Urgent as paying the bills.
I know plenty of people making millions who are totally focused on the Tyranny of the Urgent. But they’re on a treadmill. Attending to the Urgent can only bring us Riches, which I define as money. But attending to the important things will bring us true Wealth, the freedom and the ability to choose what to do with my time and my money.
Which do you want? Riches you don’t have time to use, or Wealth, the freedom that allows you to go on vacation while your practice makes money for you? Freedom is the best evidence I can come up with that you have paid attention to the important things and now have a mature practice.
You Get What You Intend, Not What You Hope For
Shelley ran her husband’s very successful dental practice in upstate New York full time as the practice manager. For years she had always hoped to figure out how to gain the freedom to start her own consulting business, but the Urgent things kept her on the treadmill. As we worked with her, Shelley developed real clarity on what the practice should look like at maturity, just like we had done with our kids.
With Utter Clarity on where she and her husband wanted the practice to end up, they were no longer relying on the Random Hope strategy of business—working really hard and hoping something good happens. Instead, they were now focusing on a few Important things that would solve a lot of the Urgent things, like planning ahead, developing and writing down simple processes, training people, delegating decision-making, and building a great culture.
In well less than a year Shelley had gone from manager to leader, and was down to investing two hours a week in the practice, not managing, but leading – creating vision and guidance, supporting, training, and asking clarifying questions to keep everyone on track. All the things she thought she could never delegate were now in the hands of the front and back office teams.
She gained freedom without hiring an office manager to replace herself, simply by moving all those management functions to the teams. And the teams were thrilled to take on the responsibilities because it allowed them to begin to make decisions that had always been made for them. Shelley’s consulting business is now booming. Everybody wins.
Failing or Getting Tired
Statistics say fifty percent of businesses fail in the first five years and eighty percent within ten years. But what actually happens is the business owner gets tired because they are focused on the Tyranny of the Urgent, reacting to their business and living on a treadmill. When you’re tired, you stop paying attention to important things, and that will result in failure.
A treadmill is very exhausting and demoralizing if you don’t know how to get off of it. The way off that treadmill is not easy, but it is simple. The profound things are always simple.
Time and Money
The key to getting off the treadmill is time, not just money. A law practice in Denver was stuck at $9 million a year, and the two founders had only taken one week’s vacation in eighteen years. One day they changed their intention. They started requiring that the practice give them back time, not just money.
Four years later the practice is thriving, with $25 million in revenue, exponentially higher income for the partners, and no end in sight for the growth. More importantly, the two founders now take almost two weeks a month off, and a month in the summers. After his first month off teaching his daughter to surf, one of the founders said, “My first thought was that I could have gone my entire life and never had this kind of time, and then secondly, I realized I’m only in my forties and now I get to do this the rest of my life.” You get what you intend, not what you hope for.
Dental practices should be built like this, so they produce both time and money. We focus a lot on how the practice could provide us money but rarely think of how it could produce time. And it is this separation of these two that keeps us from having enough of either.
Thinking Differently About the Result
I regularly get the following response: “This makes such great sense, why haven’t we heard this before?” The Industrial Age taught us that if you make enough money, you would somehow magically be happy. But money is only a resource, a means to an end, not the end itself. By pursuing money alone, all we’ve done is bought ourselves a job and an immature business requiring constant supervision. Why not build a practice someone would love to buy, but then keep it and enjoy it? If you built a practice that got you off the treadmill, that gives you both time and money, you wouldn’t want to sell it.
A successful Washington state practice is now doing just that. After years of micro-management, they decided to build what we call a Participation Age practice around self-managed teams, and it’s working. One of the doctors wrote this note recently:
“Today was a great day even though we were down one doctor, two treatment coordinators and three assistants. Now that the teams are self-managed, they are taking the initiative to cross-train their respective Stakeholders. To make ten columns work there was a collective playing of musical chairs today and it worked almost flawlessly. It was truly amazing. Tanya (the office leader, not manager) and I spoke after work and we think what happened today was a direct reflection of our people taking the initiative and working as a team from hiring to training to implementing.”
Be Intentional About What You Want
Your expectations for your practice should be no less than those we have for children. Expect your business to grow up, or you’ll still be changing its diapers decades later. It’s not rocket science, and it’s not a matter of talent or luck, but simply focused intentionality.
Are you in? You get what you intend, not what you hope for. Let’s figure out what it takes to get off the moneymaking treadmill and build a mature dental practice you can enjoy for decades, that produces both time and money, and gets you off the treadmill.
Kevin Tighe is the managing partner of Cambridge Dental Consultants. We think of him as being a combination of brilliant insight and applied common sense. Let’s see some of his wisdom:
Ten Point Checklist to Reduce Cancellations and No-Shows
Reducing cancellations and no-shows have similar but different protocols for:
Patients due for re-care
Patients past due for re-care
Patients scheduled for operative
Ten Point Checklist
Patient communication: Despite amazing technology available to dental offices, the most important step to keep no-shows and cancellations low is talking to patients while they are in the practice to ensure they’re educated on the negative effects on their oral and overall health that can occur if they do not receive the needed treatment and on-going re-care.
Confirming appointments: It is key that you assign confirmation to one team member otherwise there is no real accountability. That team member should have outstanding communication skills and have their ear “tuned” to lack of commitment phrases from patients and handle accordingly.
Communication preference: Find out how patients prefer to be contacted i.e., postcard, text, email, or phone. Texting is now, in general, the preferred method. I do not recommend offering a postcard. Only use a postcard if a patient requests it.
Confirmation schedule: 3-3-1— three weeks, three days, and one day, unless a patient tells you differently.
Confirm directly: Certain types of patients need to be confirmed directly no matter what. Examples:
a) Previously broke an appointment.
b) Those in their 20s.
c) Medicaid patients or any other government plan (those who pay cash or have private insurance are more reliable).
d) Patients who have not been in the practice for a long time.
e) International patients due to language barriers or different moral codes.
f) A parent or spouse who made appointment for a grown child or their spouse.
Note: For chronic broken appointment patients (three broken appointments or not sorry after the second broken appointment) dismiss or only allow on your short call list.
Short call list: Helps plug holes in your appointment book.
Operative: One day before unless the appointment was booked well in advance, in which case it’s 3-3-1.
New patients: A call from the dentist welcoming the new patient to the practice will cut down on new patient no-shows.
No shows: Call the patient right away. If you do not reach the patient, let them know you’ll try back in a week. Repeat a week later if necessary. If there is still no response, put them on automatic reminders using their preferred form of communication.
Continue to follow up: After a month or so of no response, continue to make calls based on your knowledge of a patient without becoming obnoxious or seeming desperate. How many calls you make should be based on what you know about a patient. You should not be rote about how often you call, i.e., if you know the patient is out of town for a few weeks, is ill, or whatever the case may be, schedule your calls accordingly.
For better or worse, technology has become a ubiquitous aspect of modern life. We work on computers for our jobs and continue using them when we get home. Our cellphones have more computing power individually than all of NASA had for the lunar landings. We are a tech-savvy society, and your practice needs to keep pace.
According to the Pew Research Center, 72 percent of Americans looked online for health information, and 77 percent used a search engine to locate a healthcare provider in 2013. Not surprisingly, this number is expected to continue growing as more and more Americans integrate laptops and smartphones into their daily lives.
One of the most interesting and important developments in this area is the desire for people to be able to schedule appointments online from their computers and smartphones. Many industries such as restaurants, salons, and even auto body shops, have been offering this service for a number of years. The technology already exists and has shown to be reliable. Yet despite the software being available, only about 20 percent of healthcare providers offer an online scheduling service to patients.
Some of the reluctance is based on fear of privacy issues, and some is a general reluctance to add yet another automated component to the practice. Still other providers fear their costs will increase with more technology to pay for. However, these fears prove to be unfounded when held up for examination against the facts. For example, as with any technology in the dental field, privacy and security are paramount concerns. Software offered for scheduling has to be HIPAA-compliant and include encryption. It also needs to be user friendly and compatible with mobile devices. Several platforms providing technological services to the healthcare industries have already implemented these programs and have demonstrated both their convenience and ease of use.
The expectation that another automated element in the practice will create problems or be cumbersome has also shown to be unwarranted. Automated scheduling actually frees up resources in your practice and allows you to be more efficient. When staff members are freed from handling the majority of scheduling calls, they are better able to work one-on-one with patients who are present in the office. This builds better patient-practice relationships which also improves patient loyalty and reduces attrition rates.
Providers who are worried that a digital scheduling system will cost more money are surprised to find this isn’t the case. Monthly maintenance fees are usually reasonable, especially when compared to the costs associated with staff members handling the same calls. The average call to schedule an appointment takes just over 8 minutes. If your practice is receiving 20 calls a day to schedule appointments, that’s 160 minutes, or more than 2 ½ hours out of each day for your employees. That time could be better spent on important tasks like helping in-office patients, attending to paperwork or billing, or preparing exam rooms. In addition to improving office efficiency, online scheduling works 24/7, something your staff can’t do. Patients select the type of appointment they need from a drop down menu, and only the available slots that fit the appointment type are offered for them to choose. Once the appointment is booked, your digital schedule is updated instantly, and your staff is notified to confirm the appointment so there is no risk of over-booking.
The efficiency and convenience are obvious, but an additional benefit to online scheduling is the ability to recruit new patients with limited effort. If a prospective patient uses a search engine and finds your page, the likelihood of that prospect becoming a patient increases if they have the opportunity to schedule an appointment right then. Your staff can confirm the appointment when they return to the office, minimizing the amount of time your prospective patient has to wait for the appointment..
It’s also important to consider who your future patients are. Millennials, those Americans between 18-34 years old, are the largest segment of the American population, outnumbering even the Baby Boomers. This generation was raised on technology. They had computers in their pre-school classes and they played games on their parents’ cell phones from the time they were toddlers. This group expects to have digital access through their phones or laptops to both information and appointments. Not providing online scheduling to this group of potential patients is the same as telling them you don’t want their business.
Technology is the future, and the future is now. Those practices that have adopted this automation are already reaping the rewards. When you look at all the facts, it’s clear: online scheduling is not science fiction, it’s healthcare fact.
Solutionreach is a provider-led, cloud-based company that revolutionizes patient relationships and optimizes the patient experience. Its web site is https://www.solutionreach.com/, and the toll-free phone number is (866) 605.6867.
If you don’t know who Laura Hatch is, you probably should. Laura runs a consulting company called Front Office Rocks, and is quickly making a name for herself as one of practice management’s bright lights. We have featured her twice as a guest columnist, and her articles have been wildly popular with our readers. So we are all looking forward to Laura’s next installment.
How to Prepare the Morning Huddle
A morning huddle isn’t just about reviewing what procedures are being done that day. It should include every piece of information about the patients on that day’s schedule so that the whole team can fully take care of the patient’s needs. I can’t emphasize enough how important it is for your office to be having a morning huddle each and every day before you start seeing patients. The morning huddle is essential to get everyone on the same page and plan out the day. Everyone on your staff should be responsible for getting ready for the morning huddle and being prepared to share information regarding the patients scheduled.
An accurately prepared morning huddle, at a minimum, starts the day before.
Have one person responsible for reviewing the following day’s upcoming patient appointments and double check the schedule.
Have your Financial Coordinator reviewing the next day’s appointments for outstanding balances. and call on any outstanding insurance claims.
Update the patient’s file with any notes relevant to the upcoming appointment or balance.
Print the schedule out to review in the morning huddle
Completing the “next day review process” primes the day to go as smoothly as possible for the staff and patients. Being prepared prior to patients arriving in your office is not only exceptional customer service, but it also lowers the stress of your front office team. Preparation in the huddle means knowing details about the patient—their balances, their appointment, or any pertinent information. By reviewing the schedule ahead of time, you are able to determine if there are any incomplete tasks or outstanding issues that need to be resolved prior to the patient’s appointment or upon their arrival at the office.
Not sure what needs to happen within the morning huddle? Visit Front Office Rocks to learn for more information or call us at 1-800-914-3595.
When Laura Hatch, who was one of our most downloaded guest columnists ever, offered to give us another guest post, we didn’t hesitate for a minute. Her last guest spot in Prosperident’s newsletter was the most-clicked-on guest article ever. (If you want to check out that article you can find it here – https://www.prosperident.com/2016/06/23/guest-post-laura-hatch/).
Here is Laura’s newest article, which we are sure will be at least as popular:
Speed vs. Quality: 3 Reasons Why Being Productive is Not Your Only Concern
Dentists focus a lot on production. I hear these questions all the time: “How can I produce more in a certain period of time? How can I make my hygienists more productive?” Dentists are constantly asking, “What was our production today versus goal?” As owners or managers of a dental office, we are always looking for ways to become more efficient with the schedule, simply because more production typically equates to more collections.
It’s true that production (along with collections and new patients) needs to be monitored and achieved on a daily, weekly, and monthly basis. It’s important to keep those numbers up. But I do think that sometimes there is a significant downside to focusing too much on increasing production.
Here are 3 ways that too much focus on production can actually hurt your office.
Choosing Production Over Quality
Many times when we are trying to produce more, quality can be jeopardized. If your staff is feeling pressured to hurry up and meet production goals, they will be tempted to cut corners in order to save time. When quality is jeopardized, mistakes happen. This leads to things like having to re-do dentistry that should have been done the right way, or patients that are unhappy because they have to come back to have dentistry fixed. We should always be looking to be more efficient—but not at the expense of quality. Your patients’ satisfaction, and your staff’s sense of integrity, are at stake.
More Production = Faster Pace = Less Time Per Patient
The idea of producing more and producing faster is to get more things done in a certain period of time. What is missed, though, is making sure we are spending enough time with the patients in the chair. Patients don’t want to feel that they are just a number—they want to feel recognized and appreciated.
Chances are, there are plenty of dentists in your city for your patients to choose from. When you build a real relationship with patients, they will keep coming back and they will refer their friends and family. On the other hand, if patients feel that you are trying to rush them through the process and move them along to billing, then they are going to think twice about spending their hard-earned money at your dental office.
And since most people feel some level of anxiety about going to the dentist, it’s going to take great customer service to get them to keep scheduling. When your office is focused only on meeting productivity goals and not on relationships with patients, you are creating a tense environment that will only add to patient anxiety—and they won’t come back.
Too Much Focus on Production Leads to Frustration
There is a real difference between a productive schedule, which realistically allows for time to complete the scheduled work, and a schedule that is packed so tightly that it’s impossible to complete work in the time allotted. When this happens, both patients and staff get frustrated. The worst thing an office manager can do is to create an impossibly tight schedule that guarantees the day will run behind.
We all know that every day in the dental office brings changes and interruptions. It’s not possible to have the schedule run perfectly on time every day. The way to accommodate this reality is to build in scheduling cushions that allow for the unexpected to happen while still making it possible to meeting production goals.
Running a dental office requires a balance. Too little attention to production means that collections goals won’t be met. But putting all of your attention on production will hurt the office in other ways that will be felt deeply by staff and patients. A happy medium, with an eye on production but plenty of attention to quality and relationships, is the best long-term strategy for any dental office.