Yes you have one, maybe several. Any outbound asset that is not directly monitored by daily operations and not subject to checks and balances (digitally) can be a “leak in the ship” and a silent partner.
When a small business like a dental office hears the term “silent partner” they think about embezzlement. Embezzlement does becomes possible without checks and balances but we will leave that discussion for another time. It’s time to look at inventory, work flow, and the all to elusive cash flow.
The Inventory: Inventory time management is one of the most difficult tasks a business has. It is not revenue generating but is an absolute necessity for any on going business. However, you need to take this necessary chore and make it have a positive impact on the overall operation. When you get right down to basics all businesses do the same thing, they buy and sell goods and services.
A very wise man once told me “don’t fall in love with your inventory”. I see clients attend year end trade shows to get great deals on a full year supply of certain products. How wrong is that? By putting large quantities on the shelf you are tying up cash, and cash is why you go to work. If you work with a quality vendor (there’s that word “quality” again) you would already have the price and get next day delivery so buy what you need when you need it. If you buy a quantity of product that last more than 90 days the additional savings need to be a minimum of 10%. Ask your accountant about inventory carrying costs. Automated inventory control is simple and is provided at no cost by quality vendors. Many of my clients use the Aruba Inventory Management System. Good software simplifies the process and the “usage” reports will help you make an informed decision when a “bulk buy” opportunity arises.
The Work Flow: How smooth does production move through your organization? Are you constantly looking over peoples shoulders to make sure they are doing things correctly? As the healthcare world continues to evolve the work flow of any business needs to streamline and automate. This requires change and investment. Utilizing technology and automating systems turns operational time into productive time. As an example, how long does it take your office manager to prepare the morning huddle? Some practice management software (i.e. Dentrex G6) do it automatically saving 15 minutes of business office time. Do that in 4 areas and that is 1 hour. What is the true cost of an employee? Investing a little money in work flow technology can have a huge ROI. Dental offices can now have their large equipment (i.e. compressor, vacuum, X-ray) monitored by software with notification of required maintenance. Hey, your car does it…
The Cash Flow: This is what it is all about. Another term I like to use is “disposable income” because that is what will result with a well organized operation. Cash Flow is the blood of any business. The better the cash flow the healthier the practice. Properly implemented procedure and protocol is essential for the survival of any modern healthcare facility. Please feel free to contact me with any questions or concerns.
Like many Americans I find myself ordering things on-line and looking for good deals. Amazon continues to amaze me with the quality of there distribution and how they handle returns and complaints. However, they are not always the lowest price. Amazon chose a business model of quality and service and is constantly attempting to improve on their “customer experience”. On the other side of the equation are the big box stores such as Costco, BJ”s, Sam’s Club, etc. that chose quality and price. The low “PRICE” is what determines the level of service.
Ask yourself what your dental practice focuses on. Quality is not the question, its all about the service and the price. The lower your price the less service you can afford to offer or the harder and longer you work. Also, a low price decreases the value of your service. However, on the other hand , if you price your services according to your quality standard of care, your patient base will recognize your value. Most people look for value in the services they buy.
Your clinical skill is your quality and the “patient experience” is your service. I have several clients that are afraid of raising their fees for the fear of loosing patients. Well that may be true of a small percentage but are they the type of patients you want? They are looking at price. By increasing your services and enhancing the patient’s experience, you can increase your fees at a slow rate. Quality patients will recognize your value.
Now for the “making money”…. Quality & Service, when working together, overcome price. However, to make it work you need to share in the cash flow. What that means is providing a reason for team members, vendors, consultants, etc. to provide you with the highest quality of service so that you can maintain the quality of your management and clinical production.
The Team … One of the hardest situations for a manager is how to evaluate a long time employee for a raise. Employees can price themselves out of the market so how do you maintain quality and service when that time arrives? Simple, stop giving raises! Start establishing goals and reward with a % of the increase as a bonus for production. The team is now incentivized to help you make money. That’s how you get people to help you make money.
The Vendors … A well organized business of any size can be a little powerhouse, focus the power. Chose vendors by what they can offer to help you be successful. The quality and service they can provide allows you the opportunity to streamline your organization to maximize production. You need to go into these relationships with your eyes wide open. Its not about the price, that can always be negotiated with an agreement of an on-going relationship, its about the quality of the services being provided. Choosing a vendor is an investment, what’s the ROI?
The Value … I can’t tell you how many clients tell me that they changed accountants because the accountant was too expensive. That may be one of the most foolish statements a business owner can make. What type of services were they getting? Those clients chose price over quality and service. If price takes over the conversation, quality and service will be reduced as will overall revenues. You have no expenses, only investments in quality. What’s the ROI?
Price– Quality– Service … Pick 2 because you can’t have all 3… Quality organizations associate with other quality organizations. I prefer quality. If I can help a client be more successful and do more dentistry, then they will welcome more of my services, everyone wins with quality & service, especially the patient.
As a business owner or manager, there are some very difficult decisions that you will have to make through-out your career. Some of the hardest involve your team and their compensation vs production (value).
In a different time an annual wage increase was standard business practice, but in todays economy when operational cost are continually rising, there is not much left over to give to the team, and, you will be expected to give again next year. How can you do it? You can’t keep giving. As an example, a good dental assistant (in northern NJ) will command an hourly wage of $18-$25 per hour. If that quality employee stays with you for 10 years that wage may run as high as $35 per hour and be far above market rates. How do you deal with a team member that has been with you since you bought the practice, is over paid, under produces, but the patient love them? Here comes that difficult decision.
Quality is the key to success and a quality team is one of the most important investments your practice can make. The question is how to compensate them, keep them, and help them “grow” with you and the practice?
There are many creative ways to compensate and retain quality team members. But first you need to up-date and complete your employee management program. Team management is part of both your defensive (risk management) and offensive (production) strategies. We all know the risk management issues, they are the ones that cost you money and everyone is try to sell you. The offensive side relates to production and we don’t talk enough about it.
Some of the most successful practices I deal with offer “employee extra’s”. Everything from bonuses tied to production, medical benefits and 401K programs attract and retain quality team members. If you establish realistic incentives as part of your compensation program you will see production increase. As leader you need to motivate your team and compliments only go so far. People go to work for mostly one reason, to make money. And if you want people to help you make money, you have to let them make money. Let them make extra money by incentive programs.
Talk to your financial advisor about establishing a 401k program, one that requires several years for vesting. Matching funds can be tied to production goals. You may be surprised how this small investment will pay off. Now, every team member has something to lose if production is flat.
There is a great employee management program that was just released. Check out the link and please contact me with any questions or concerns.
I remember the first 5 minutes of my first marketing course. The professor started off by saying “marketing 101, packaging is 95% of the sale”. This is a very important concept to consider when addressing declining patient flow and new patient scheduling. The culture of your dental practice is your package and it needs to fit in with the patient base you want to attract.
Dr. Omar Reed believed that your reception room should be as nice as your patient’s living room. That was 35 years ago and the only thing that changed since then are the decorative styles. Think about it, if your office looks old, no matter how great your dentistry is, the perception is old. If your office is clean, modern and bright the perception is that your clinical skills are also modern and bright. The average patient doesn’t know how good you are, they just know if they like you and feel comfortable. The passion for the patient’s overall health that you and your team exhibit is the bow on your package. When was the last time you repainted the office? What do your floors look like? What does your patient look like? Think about what you want people to think when they walk into your house?
Marketing your practice should be a coordinated effort across all medias. And what the patient sees on your website is what they expect when they walk through the door. I can’t count the number of offices that have great websites or Facebook pages and the physical location is a downgrade.
The patient market that your practice in is also a major factor. When was the last time you did a demographic study of the area you draw your patient base from?
If you opened your practice 20 years ago and the area had a heavy Italian population, that may be shifting to other cultures. Addressing those cultures may require a different package. Bank of America Practice Solutions and Henry Schein offer real time demographic reports that include age, income, ethnicity, family size, etc. These reports should be considered so that you can realize the maximum ROI for your 2 year marketing program. That’s right, a 2 year plan.. The world is changing too fast to plan anything further out.
What does your reception room look like? Remember, it is NOT a waiting room because your patients don’t wait, or do they? When your patients are on line at the super market, they are seeing a flat screen with advertisements and current magazines. What do they see in your office? Sports Illustrated with last year’s Super Bowl round up? All the magazines and wall décor actually compete with your treatment plan acceptance so keep it current and dental health orientated. I see some beautifully decorated offices that keep well within the healthcare theme.
Marketing programs are not an expense, they are an investment, however, for the investment to produce a healthy ROI, you need an organized plan. Maybe it’s time to Brand Yourself and stand out from the crowd?
Please feel free to contact me with any questions or concerns.
It takes a special kind of person to be a business owner, especially a successful one. If you never had to make a payroll or cover a business loan payment then you can’t understand. It’s that low rumble deep inside that keeps you up at night. The rumble you get when not knowing if you will be able to cash your own pay check. It’s the rumble you keep to yourself and hide with a smile and a positive attitude.
Running a successful dental practice is no different than any other business. When you break it down to basics, you are buying and selling goods and services. You are an employer and employee, marketing director, compliance officer, human resources, purchasing agent, CEO, COO & CFO. You are sitting on top of a mountain taking dirt from one side and packing it on the other to keep the mountain standing. It can become an endless cycle that you can’t seem to get out of. Did you ever hear the saying “your too close to the forest to see the path through the trees”? Maybe its time to step back and look at your situation through another pair of eyes.
When was the last time you had a discussion about the cost of operations? Who did you have that discussion with? If you have a progressive accountant, they may be able to help but they are money and contract people and can only advise you on standards. Every business is different and for any advisor to suggest sound and constructive changes they need to understand the intimacies of the work day. An owner/manager’s dreams, plans and personality as well as that of the entire team, deeply effect day by day operations.
I have a client that called me last week all excited that after 5 years of struggling they realized a 15% increase in production in 2015 and scheduled over 200 new patients. They spent $35k over a 12 month period on a personal dental management consultant, followed a “customized” plan that was unique to the office personality, and increased revenue by almost $100k. The investment and the educational experience were a huge success. There is an old saying “give a man a fish and you will feed him for one day, teach a man to fish and you will feed him for a lifetime”.
Business operations are more than crossing the I’s and dotting the T’s. Procedures and protocol are essential, but so is leadership. You have a large investment in your team and when they fail it is your fault. As a leader, you did not follow-up your investment with training and reward. I am a firm believer in the 80/20 rule and 80% of my client base have complaints about team members. The conversation is always the same “I wish they would” or “I wish they wouldn’t”. Well, here is a foolproof solution, train them and if they can’t provide a positive effect on the operation, replace them.
The Problem is that you don’t know how to train them, that is not what you do. As soon as you realize that you are on the road to a productive future. Interview consulting groups, different groups offer different programs. Talk to your financial advisors about a detailed evaluation of you dental practice and team. Find a Practice Management Group to work with your advisor to conduct the evaluation. Being a great leader requires surrounding yourself with quality people. Below are some groups that I have experience with and trust.
Straine Dental Consulting http://www.straine.com
Million Dollar PPO http://www.milliondollarppo.com
Jameson Dental Management http://www.jamesonmanagement.com
Did you ever figure out what your time is worth? I don’t mean what you get paid, I mean what is it worth. If you sit chairside for 32 hours there has to be another 15 to 20 spent working on treatment plans and managing the business end of the practice. What is 15 hours worth in dollars? At $50.00/hour it amounts to $39k/year. If you earn $150k/year, do the math. Now think about the non-revenue generating tasks that you and your team need to preform to fuel revenue production and cash flow. What is the investment value of that time? If you could transfer some of that time to production, how do you think it will effect your bottom line?
Outsourcing is an effective way to reduce time and capture lost value. Remember that word “VALUE” because that will dramatically effect your ROI. Let’s start with the simple stuff like printing and mailing statements. If you need to mail 500 statement, how long does it take your team to print, stuff and stamp? For 55 cents per statement why wouldn’t you use one of the HIPAA compliant services? If it takes 2 hours to print fold and mail, what else could the team be doing for 2 hours? How much does it really cost to do it yourself?
Then there is the most expensive statement you can make to your team “just get me the best price”, When you should be saying is “just get me the best deal”. The best deal is the best value as it relates to the global scope of your business. Here is an example, some of you may know this story: When I ran my own company we used to sell a lot of Crosstex products. They were a great company and we were very friendly with the upper management. They would send their truck to our warehouse once a month with a couple of thousand cases of bibs, cups, saliva ejectors, etc. One day another manufacturer approached us and offered the same deal at $1.00 per case less. Its hard to turn down several thousand $$ per month. However, we were loyal to Crosstex so we contacted them to see what they could do. One week after a friendly meeting at our office, they got back to us with their proposal. They couldn’t give the $1.00 per case but they did offer something else., they would deliver to us once per week. Now we could carry 75% less inventory, turn it over 6-7 times per year, free up a large amount of warehouse space (think about the cost of a sq. ft. of floor space in NJ) and spend less time unloading trucks. That “value” was far more than the money we would have saved.
The reason you automate is to save time and increase efficiency. The most successful organization look for fair market price and discounts but way-in delivery time, fulfilment rates and operational solutions. Many of the dental offices I walk into do not have an inventory management solution. The practices that utilize technology in their purchasing department don’t have items expiring or sitting on a shelf for several months. Inventory carrying cost can be the hidden expense that you need to translate into dollars. Do you know the value of your inventory investment? Do you know how fast it turns over? Have you ever taken a physical inventory?
You run a business and time is money. The more time you spend shopping for the best price, tracking multiple shipments and guessing usage rates, will eat up any savings you think you are getting. Focus your buying power with organizations that can provide “Just-In-Time” inventory solutions and the time saved can be turned towards production. Try Aruba EZ, it’s Free.
Please feel free to contact me at any time with any questions or concerns.
Yogi Berra once said “when you come to the fork in the road, take it”. Think about your dental practice and the culture it projects. Is your clinical culture similar to your dentist friends? Do you collaborate and involve yourself in dental chat rooms? Do you read and discuss product reviews? Do you react to the crowd or do you learn and lead? On & off line discussion is very valuable but what works for one may not work for another. Your business is unique to you, your personality and your clinical comfort level.
I read a great article in the North Jersey Record’s Sunday, February 14th addition. It was about the Veterinarian industry and it is another look at what is coming to dentistry.
The article questioned if young graduating Vets would ever own there own practice. With enormous educational debt and mounting living expenses, the average graduate can not afford to buy a practice and be able to compete. So, they go to work for a group practice, or shared groups just like what is happing with your medical counterparts. So, now you, the dentist, is at a fork in the road. You can invest in your practice and grow it to a level that you need an associate and specialists on-site or you can keep going the way you are going and sacrifice your ownership equity that may be built into your exit plan. Maybe it is time to re-examine your retirement strategy. The changing landscape in all forms of healthcare will dramatically effect your “life after dentistry”.
The direction you chose to go should depend on where you are in your career, your desired life style and what part of dentistry you enjoy the most. If your plan is to practice dentistry for another 5 years or more, I would suggest an investment in technology to keep your business up to date and attractive to both patients and potential associates. Without an investment, your practice will begin to lose value despite your gross production. The age of your patient base is also a factor in value (equity). Typically, a dentist’s patient base is within 10 years in age (+/-) of the dentist. Technology brings in a younger crowd as will a young associate and you don’t need to mortgage the farm to be on the cutting edge as long as you are in the game.
If your exit plan is less than 5 years and you are not inclined to make a further financial commitment in your practice, you need to create a transition strategy and put it in place as soon as possible. A transition strategy can be as simple adjusting your bookkeeping methods to as complex as a practice merger. A practice merger at the end of a career can be very financially satisfying if structured correctly but it will require the help of a transition specialist, so plan on paying a small percentage of the deal to retain their services. Please don’t try to do this yourself, you know how to fix teeth, not create contracts and don’t think that your accountant or attorney can do it. They are there to protect you and crunch numbers, not to negotiate a relationship.
So, where do you go from here? For the next 3, 5, 10, 15 or 20 years will you follow the crowd and do as they do? Or, do you go left and forge your own trail? Listen to the experts, don’t try to reinvent the wheel, but make sure that you are driving the bus to where you want it to go.
Please feel free to contact me at any time with any questions or concerns.
Carivu by Dexis … No Radiation!
A small business is defined as a company that does less than $50M per year. A very large part of the dental industry fits into that category and employee management is a necessary expense, or could it be a positive investment?
When discussing procedure and policy with my clients I like to categorize topics as defensive or offensive. Employees fit into both so it is imperative that your defensive strategy incorporates an updated employee manual and you fully understand your legal responsibilities as an employer, Defense Wins Games. We live in a very litigious society and workers rights take precedence in a court of law.
The following story is true, unfortunately it is a common scenario: Dr. Charlie has a 4 chair practice located in the center of town. One afternoon while the hygienist was working on a patient he went next door to pick up lunch and bring it back to the office. When he returned his office manager said that after the patient left the hygienist walked up front said she is quitting and walked out. Dr. Charlie panicked a little and then proceeded to handle the rest of the day on his own. That evening he called the hygienist and left a message that was not returned. The next couple of days he used a temp agency to manage the schedule at the end of the week hired a new hygienist. At the end of the following week the original hygienist called and apologized and asked to return. Dr. Charlie explained that she didn’t return his calls so he hired a new hygienist.
Everything was fine for 2 weeks until Dr. Charlie got a registered letter in the mail from a law firm accusing him of “wrongful termination” and was looking for $175,000.00 in compensation. How could that be possible when the employee walked out? Well, the employee was well within her rights plus, she was 3 months pregnant. Now what?
Dr. Charlie made one big mistake, he didn’t document the incident. What he should have done was to send the Hygienist a registered letter with a return receipt stating that she is be terminated and the reason. It’s a real good idea to consult you legal advisors or the local State Dental Society for the proper wording for individual situations. However, the official and documented letter needs to be sent.
When Dr. Charlie asked me for advise I referred him to an attorney that specialized in employment law. The case was settled for $95,000.00 plus legal fees. Dr. Charlie paid out $125,000.00 in settlement, court and legal fees because he went next door to pick up lunch. This is a true story.
Employee management defense is proper documentation and an understanding of employment law. Federal, state and local regulation directly effect your rights as an employer. It is imperative that you have an up-dated employee manual, employee files with a filled out and signed employment application. Every incident requiring a private “sit down” requires a written document that the employee signs as an acknowledgement. You need to have all employment posters required and you absolutely need your O.S.H.A. annual updates current and signed off on.
Employee management is more than incentives and praise. It is a relationship that is heavily regulated at every level. Please feel free to contact me at any time with any questions or concerns.
About 15 years ago I heard of a new camera that was an intraoral trans-illuminator that converted it’s images into a digital format, the system was called Difoti. At the time digital dentistry was just being introduced. Less than 10% of the industry had digital radiography. By the time my company (big companies move slow) made the decision to contact Difoti the company had closed and the product taken off the market. The company and patents were acquired by the Kavo/Gendex organization, and never heard from again. Until 2009 when Difoti re-appeared under the Kavo brand in Europe, but it was still un-known in the United States & Canada. Then, in 2012, Dexis Corp. introduced the new enhanced Difoti System under the Dexis brand and called it Carivu.
First you need to understand that Dexis, Kavo/Gendexx, and about 15 other major manufacturers are owned by the same people, The Danaher Group (http://www.danaher.com/our-businesses/business-directory). This is another thing to consider when integrating new technology, seamless integration between brands. Anyway, Carivu by Dexis hit the U.S. market in the exact same way that digital radiography did 20 years ago. Every practice that installed digital radiography in the last 10 years will say “if I knew then what I know now” and in my opinion Carivu will be the same. However, unlike digital radiography, Carivu’s ROI can be less than 90 days not 12 months.
Carivu utilizes autoclavable tips that transmit high intensity light from both the distal and lingual sides and has a high resolution mirror that reflects the occlusal surface to a UHD video camera in the handpiece. This allows the clinician and patient to actually see inside the tooth without radiation (http://www.dexis.com/dexis-carivu-training-video). Trans illumination will also detect interproximal decay that cannot be seen with conventional x-rays.
The clinical advantages when used along with traditional radiograph images is a proven fact and for those patients that refuse x-rays it can be a diagnostic tool. The procedure code is D0425 and is now covered by some insurances (15%) but if not, the recommended fee is $45.00-$65.00. However, there is a downside you need to be prepared for. If a patient knows that you can see inside teeth without radiation, they may be inclined to refuse x-rays. Now you, or a team member, needs to explain that this wonderful technology cannot see below the gum line and that is where some real bad stuff can happen. That conversation should be scripted & practiced.
For pediatrics, this is a no-brainer! Small children have difficulty with sensors, don’t sit still with phosphorous plates and parents don’t like seeing their kids un-comfortable. But, Parents LOVE the Carivu and can see exactly what you see in real time.
The bottom line is that the Carivu technology needs to be on your wish list and added to your diagnostic arsenal. Your hygiene department will go wild with this and you will recap your investment in a very short amount of time. Live patient demo’s are always available.
Please feel free to contact me at any time with any questions or concerns.
In the movie there was a seen where E.T. follows and eats a trail of candy. Originally the movie producers approached Hershey Chocolate to make a deal to use M&M’s but the executives at Hershey didn’t like the story line and didn’t feel they wanted the M&M’s product associated with a space alien. However, a new product was just launched and it was struggling in the market. Common sense was to use the movie script to promote Reese’s Pieces and let it sink or fly. History shows the success of that decision. They found a positive in a business relationship that had a big NO on the surface.
Running a dental practice (business) will always have risks you have to take. The risk maybe prescribing a difficult treatment plan or the investments you make during your career. The biggest risk you will need to take is in your own confidence.
Just recently I sat just on the outside of two practices merging together. Practice mergers are difficult but very doable. Partnerships and group practices are the future of dentistry so a workable business relationship, if structured correctly, can be very favorable. Think about it, if the practice was open more hours and never had to shut down for vacation, what additional revenue can be generated?
Practice mergers usually start by chance. Someone brings up a subject and the conversation takes all different directions. The Disney Co. & MGM Studios’ deal started by a chance meeting on a NYC sidewalk and a cup of coffee. The conversation just needs to start., an idea should be expressed.
After there is a desire to explore options you will need to spend some money. You need to engage a “Dental Practice” Transition Specialist. Do not go to an attorney or accountant, they cannot create a customized contract and they may favor one side. A Transition Specialist is NOT a dental practice broker, although they do fill that role, they are mediators that understand personality, abilities, work load distribution and all other aspects of a planned long term business model.
Being part of a partnership or group also requires an exit plan with several doors. Let’s say that there is a group of 4 professionals and one seriously violates the code of ethics, how can the other 3 deal with it. Maybe there is a buy-out offer, how can it be approached or god forbid a partner dies, how do you deal with the estate. Now there are professionals that customize these legal arrangements but the Transition Specialist job is to bring all of these points to the table and organize the final contracts for your attorney and accountant review.
A top level Transition Specialist will cost about 5%-8% of the value of the merger. They can also provide direction in funding if necessary. This is money well spent, you should not be negotiating with your future partner/s the Transition Specialist will be the bad guy so that the good guys can work together for a very long time.
Please free to contact me at any time with any questions or concerns.
- Do You Know Your Silent Partner?
- If You Want People to Help You Make Money, You Have to Let Them Make Money!
- Everyone Wants a Raise! What happens when a long time employee exceeds their market value?
- Taxes Are UP & Patient Flow Is Down
- What keeps you up at Night?
- It’s All About the Bottom Line!
- When it doesn’t feel right, go left…
- Defense Wins Games, Offense Sells Tickets! Employee Management
- Dental Practice Enhancements Digital Imaging Without Radiation, Good or Bad?
- When someone tells me ‘no’. It doesn’t mean I can’t do it.
- Maybe it’s Time? Come Down From the Cloud!
- Embezzlement? Who, Me?
- Henry Schein
- Henry Schein Outlet Store
- GURU Dental Patient Education
- Health Compliance Team
- Asteto Dent Labs
- Camlog Implants
- Dexis Digital Imaging
- Dentix Practice Management Software
- E4D Dental CadCam
- I-Cat Cone Beam System
- American Dental Association
- Give Kids A Smile
- Webinars & Continuing Education
- ADA Video Give Kids A Smile
- Bette Midler Sings Long John Blues
- Cliff\’s Notes
- (DRC) Dental Resource Center
- Dental Equipment Parts
- Dental Student Portal
- American Academy of Dental Sleep Medicine