Cliff's Notes

The Business of Dentistry

Vacation Notice & Contact List

Please be advised that I will not be available the week of July 22nd and will be returning to the field on July 29th. I will not have the ability to return calls but will do the best I can to respond to emergencies. For immediate attention, please contact my team and refer to the below contact information. I will follow up on all situations that arise.

Merchandise orders:

In-bound customer service …… 800-372-4346

Andrea Silberberg ……………. 800-707-5678 ext. 2228878

Robin Reeman ………………… 631-454-3168

Metro Branch, Moonachie, NJ ………… 201-440-7004

Equipment Field Service ……………… 800-645-6594 prompt #3

Equipment Replacement (New)

Eric Green ……………………. 862-812-0426

Cliff Brenner …………………. 516-655-4322

High Tech Equipment & Computers

Matt Chernego (New) …………551-697-1596

Tech Central (Service) …………887-483-0382

July 17, 2019 Posted by | Uncategorized | Leave a comment

The Dental Business Institute – Prepare for the Future

The best way to be successful is to listen and observe the success that others have had or are having. There is no cookie-cutter solution because every business is different and serves a different demographic (that’s why I like local consultants) but best practices can be modified to fit any environment. A dental practice is a small business and it has to run efficiently while investing in growth. Years back I attended the Disney Institute, the seminars and training changed the way I approached customer service and employee management. Employee management (Team Engagement) is the foundation for success. The Dental Business Institute ((https://henryscheindbi.com/) is a similar program that was specifically designed for the dental industry by Henry Schein.

Many dentists who operate independent practices find it difficult to compete in the ever-changing marketplace. Many small group practices encounter the same challenges. Reduced reimbursements and emergence of group and corporate practices force practitioners to think about the future differently. The Dental Business  Institute at Henry Schein was created to support and guide dentists through a successful entrepreneurial exploration of their business and its potential.

The Dental Business Institute … is a year-long educational program that guides practitioners through the process of applying different business models to their practice vision. Attendees first identify their desired outcome, then design a business model that helps achieve that outcome. The model is tested through simulation to see how different decisions impact financial statements and attainment of business goals.

Program attendees can experience the impact of business decisions prior to investing time and resources. As plans are made, each action is tested to determine the impact on cash flow, profitability, and valuation. Based on the simulation results, participants learn where to adjust prior to implementation in the real world.

Question … What is the most important asset you have? It’s probably the one you abuse the most.

Answer … Your Team! Most dentists (small business owners) don’t understand how to develop strong clinical and management teams that will work together “peacefully”.

Success Costs Money … It is true that you need to spend money to make money. Where you spend (invest) your money will effect the success of your business. A competitive compensation package will attract competent team members and retain them for a long time. Today’s labor shortage puts quality at a premium and if you pay peanuts you’ll get monkeys. You can’t build a dental practice that will rise smoothly through the next decade without a solid foundation. Listen and learn from experts. Please feel free to contact me at any time with any questions or concerns.

May 22, 2019 Posted by | Uncategorized | Leave a comment

Walking Over Dollar$ -To Pick Up Dimes!

“In the business world, the rearview mirror is always clearer than the windshield”

Warren Buffet

Price, Price, Price is a consumer mentality. Sure, at home I cut coupons and my wife looks at all the specials but we are doing it in our free time not in time spent generating positive revenue. I owned and managed a dental distribution company for a lot of years and our goal was to buy low, sell high and generate profit. However, with the materials we used to operate our business we cut a deal, reviewed it annually and never looked back. It was all about production, moving product and turn-ing inventory. We utilized analytics to know what was selling, where we were making money and where we were spending it. Today, the analytics available is so much more detailed but the data has to be there to analyze.

Analytics … Every industry utilizes analytics to refine their production and gain a competitive edge, dentistry is not different. We hear about it most in sports and Amazon & Google have been front page news with everything they know about us. Isn’t time to use this technology in analyzing production, purchasing, team engagement, patient treatment plan acceptance and re-care? This can be game changing for the dental practice looking to grow. By utilizing today’s technology we can capture data and use it to positively effect the bottom line

The Bottom Line … Making money is the bottom line of every business. Clinical perfection is always at the top of the list, but face it, making money is what we get up for in the morning. Fortune & Glory, but fortune always comes first. Unfortunately most dental practices are also small businesses and often general consumer concepts override good business practices. We tend to focus on the individual line items more often than the whole picture. Time is the most valuable thing you have and getting more production out of a fixed component is “Best Practices”

Best Practices … What exactly does that mean? It’s a standard of universal business operations in a perfect world. We all know that nothing is perfect but we do need standards to use as a goal. One of the parts of best practices that is often overlooked is time spent.

Time Spent … Chair time is always a concern for dental practices. Manufacturers design products to speed-up clinical procedures to allow more time to see more patients. If done correctly and systematically 1 to 2 more patients can be fit into the schedule and that is added revenue. Time spent may be the most valuable variable investment any business has. Time spent should be focused on revenue generating projects and procedures weather it be chair side or patient contact. Time spent on non revenue generating business necessities such as cleaning & product procurement has to be minimized by product selection and automation.

Automation … Yes, it may cost a few dollars but way it against the cost of time spent and increased revenue. It’s all about the bottom line. If $10.00 spent over there allows time to generate $25.00 over here, it’s a win! Those of us in business that worry more about spending the $10.00, are Walking over Dollars to Pick up Dimes. Please feel free to contact me with any questions or concerns.

May 4, 2019 Posted by | Uncategorized | Leave a comment

How to Buy a Dental Impression Scanner

The truth is that dental impression scanners will become standard office equipment just like curing lights and digital radiography. They are a game changing addition to any dental practice. Not just because they are incredibly accurate and fast but also because they WOW the patient. Scanners won’t save you money but they will improve you clinically and increase your production. Unfortunately, not all scanners are the same and what works for your friend may not work for you. Due diligence and team involvement will give you the greatest ROI. Now let’s think about who your current and future patient base really is?

Who? … The millennial generation is you patient base for the next 30 years and generation Z (born after 1996) is coming up fast. These new patients will have dental insurance and expect everything now. Their society wants immediate results, they do not want to wait and they respect technology. A scanner is a WOW factor that can reduce chair time by 15-20 minutes for both C&B appointments (prep & seating) and with a mill 70-90 minutes and you are done (bill upon insertion). So if you haven’t started thinking about digital scanning you better or you will fall to far behind the healthcare curve and playing catch-up is more expensive. Where will you & dentistry be in 10 years when x-rays will be a thing of the past?

How? … The very first thing you have to decide is how far do you want to go with digital scanning. Do you plan on doing in-office milling anytime in the next five years? If you will be practicing for more than another 10 years you should anticipate it. There are several very good scanners on the market today and they are all in the same price range. Price is the most attractive part to most dentists but the least important. Service and support is the major concern when incorporating advanced technology along with training and the expected learning curve. There is an old saying “price, quality or service, pick two because you can’t have all three. When it comes to technology integration, always pick quality & service. Sales people are very good at what they do and will tell you that their technology works with yours. Consider speaking with experts that are authorized resellers for more than three different brands so you can get a non-biased comparison. The reseller should also have service technician on staff that can work directly with the manufactures technician. Don’t get caught in the technology sandwich when both sides of a problem blame each other.  So, what is the next step in due diligence?

What? … After you decide to start looking into digital scanning you need to have an IT group that is certified in dental technology evaluate your network to see if it needs to be upgraded. Often practices purchase technology and realize after the fact that they need to invest in additional hardware or software. Have all demonstration done in your office with your team present, make them part of the experience. Getting the team excited will help with the introduction to patients and minimize the learning curve. Again, make sure that your IT group is fully trained on all the technology that is running through your network. We tend to trust our mechanics and often they don’t have access to manufacturer support, that’s when everyone is blaming the other one and your stuck in the middle (the sandwich). Seek out organizations that represent several brands, have their own IT and support systems and can own your  down time.

Conclusion … Don’t buy something because your friend did, few admit to a $25k mistake. Please feel free to contact me at any time with any questions or concerns.

January 27, 2019 Posted by | Uncategorized | Leave a comment

Dental Operatory Equipment “In The Long Run”

Dental operatory equipment is very expensive and understanding what causes breakdowns is an important part of maintenance and work flow. The task of maintaining working assets in a dental office is usually entrusted to a team member (Dental Assistant) and never thought of again until something breaks. But, what caused the down time and can it be avoided in the future? Proper maintenance will cost a few dollars but will dramatically increase the life span. It starts with quality.

Quality Lasts … I have been in the dental industry all of my life and I have seen so much come and go but quality lasts. Today I still see 30 year old Midwest Quiet Air handpieces still in operation. 25 year old Adec Mini-Troll delivery systems & Belmont 071-A X-rays are still working everyday. Why is a $5000.00 chair better than a $3500.00 chair? It’s quality and life expectancy. So, what can be done to maximize your investment? Disinfectants can be a big part of the problem.

Disinfectants … Infection control protocol requires all operatory equipment be cleaned and disinfected after each patient. The chemicals used in the sprays and wipes are made to kill things and are not kind to plastic, metal, circuitry and upholstery. Did you ever notice a yellowing effect on your equipment? Disinfectants need to dry on a surface to be effective and the vapor in the air settles on everything. After repeated use these chemicals will reduce the life expectancy of all equipment especially lower quality items. You can’t prevent it but you can maximize the time line.

Chairs & Stools … Every dental chair manufacture recommends that nothing but soap and water be used to clean patient chairs and stools immediately after use.. That’s not practical because of the time it would take to turn over a room. Sprays and wipes are used to for faster turn around, but the chemicals involved will deteriorate the equipment over time. There are several products on the market that now address the issue of upholstery and plastics yellowing such as Optimum 33TB by Sican or CaviWipes1 by Kavo Kerr. However, barriers are the best. There are barriers for everything but Cover Film should be used every where. Use cover film on the chair switches to protect liquids and vapers to settle on circuitry. Use a full chair cover (my favorite is Slip-N-Grip by Kavo Kerr) to prevent excessive ware, especially when the weather is bad. And at the end of the day clean the upholstery with soap & water or even better, Chair-Guard by Palmero Sales. Chair-Guard will protect the upholstery against disinfectants but it has to be used everyday and it does have an odder so end of the day use is recommended.

Delivery Systems … Internal and external maintenance is required if you want to protect the tubes, valves and blocks from corrosive agents. If you choose to use wipes, the same ones used on chairs and counters will work but lower quality plastics may yellow. Internally you should be using inline biofilm filters and utilizing a handpiece purge. Handpieces have drive air & exhaust lines. Excess lubricant will expel through the exhaust and build up on the inside of the tubing that will lead to replacement. An external system will reduce the vapor and also increase the life of the handpiece. All handpieces should be removed from the room before clean-up. Please feel free to contact me with any questions or concerns.

 

 

January 17, 2019 Posted by | Uncategorized | Leave a comment

Infection Control, Not Good …

Over the last several months the local news has been covering the lack of infection control at several large health care facilities. One resulting in numerous deaths and the others just now getting investigated. Being as infection control is one of my strong points let’s do a quick review.

History … Boring to most but we learn from it. The first infection control seminar I produced featured Dr. Robert Runnels from the University of Utah. Dr. Runnels was the developer of the Chemclave, a chemical vapor sterilizer. Without a doubt it was the best form of sterilization available to dentistry but not practical. Dr. Runnels spoke about the need to continually improve your infection control protocol because bacteria and viruses continue to evolve. Today we are fighting things that didn’t exist when Dr. Runnels spoke 30 years ago..

They Didn’t Exist … Politics aside, people, animals and plants can move globally with more ease than in anytime in history. The recent outbreak of measles in New Jersey was spawned by a visit to Israel. A flu outbreak in New York City can easily start a pandemic after a jumbo jet plane ride to London or Paris. Medical science is at constant war but now we have super bugs. Up graded protocol is needed. Lets look at what most offices do and what they should. You don’t know what you don’t know.

Face Masks … Did you ever wonder why some face masks sell for $15.00/box and others for $3.95? There is a difference in the filtration and how long the mask is effective. A top quality face mask loses most of its filtration ability after 45 minutes. After 60 minutes it is just keeping out dust. The lesser quality brands are good for about 20 minutes but unfortunately most people don’t know that, it’s all about price. The CDC recommends Level 3 face masks.

Gloves … Nitrile is a CDC suggestion due to the fact that 10% of the population has some form of latex allergy, that’s one out of every 10 patients that walk into your office. Just like masks, a $2.95 box of gloves can not be compared to a $9.99 box. Where are gloves made? Economy gloves have microscopic pin holes. Microbes can enter through those pin holes plus the glove may tear easily.

Autoclave Pouches … If a pouch with a color strip turns color it does NOT indicate sterile.  Lower quality pouches will not maintain a sterile environment as long as a quality pouch. Think about it, during the dry cycle moisture escapes so if vapor can exit it can also enter. The pouch is just a barrier that will wear-out sitting in a draw.

Disinfectants … There are a lot of them to choose from. The key to surface disinfectants is how they are used. Wipes are the most popular but maybe not the best. For proper disinfecting the liquid should be allowed to dry on the surface, spray bottles and paper towels do a better job. However, wipes are faster and speed up turn-around time. Also, using wipes will not expel as much vapor in the air which is not only a health concern but can also damage dental equipment. I guess it’s a trade-off.

Summery … The average dental office cannot maintain a sterile environment like an operating room, it can only attempt to control the transfer of bacteria and viruses with procedure and protocol. Masks, gloves, and barriers should be changed every time you leave the operatory. An annual infection control review is as important as OSHA & HIPAA training. For my clients I provide a free one our lunch & learn review with CE’s. Please free to contact me at any time with any questions or concerns.

January 6, 2019 Posted by | Uncategorized | Leave a comment

Reflections of Dentistry 2018

Closing out a year of business is like approaching the finish line in a race or scoring a goal. Most of the NJ/NY dental healthcare community has finished up. Now take a deep breath because January 1st it starts all over again.

This is the time when we look back on the past year and reevaluate procedure and protocol. It’s time to take ownership of all the successes and failures as an organization and fix the things that don’t work while enhancing the ones that do. Let’s start with the single most important asset, the team.

The Team … In this ever evolving healthcare market an investment in personnel and infrastructure is absolutely necessary. When I walk into a dental practice and hear an owner or manager say “we just can’t find good help” or “I can’t find a good assistant”  I know they don’t understand team management. Team members are not there to “help” or “assist” you, they are there to support their own lives. A team leader’s job is to get everyone to do what they don’t want to do and enjoy doing it, that is not easy. The best way to accomplish this is to “Show them the Money”.

Show Them the Money … Let’s face it, pay peanuts & get monkeys. But, you can’t keep giving raises for two main reasons. First, you can’t afford it and second, it is not healthy for the team. If you continue to give raises you will eventually price your team out of the market and when the day comes that you can’t give anymore dysfunction begins. If you want people to help you make money, you have to let them make money. So, why not give them the opportunity to put some skin in the game.

Put Some Skin in the Game … Every growing business needs quality team members and programs to keep them happy and loyal. Bonus based on production is the most popular because it is a transparent and can be set-up on a quarterly basis. These programs almost always have a positive effect on the bottom line. There may be several revenue generating projects you have such as Sleep Medicine, Clear Aligners, Internal Marketing, etc. Have one separate team members focus on each and production will grow. Project leaders will also feel good about their successes. The real golden handcuffs that retain quality personnel are added benefits.

Golden Handcuffs … The unseen value that the millennial workforce is looking for. Healthcare and 401k plans are important for a smooth functioning team. I see practices everyday that offer benefits and others that don’t and there is a difference. Top line talent want a career with opportunities. Years ago I was offered a great position with a well respected company and I turned it down. The reason was that I didn’t see any younger management being offered long term opportunity and that limited company growth. Trained talent moved on to competitors for a better package.

The Package … The package is everything. When you combine a competitive wage with benefits and bonus on production that is tied to a 401k you are not only showing your team you are investing in them, but you are asking them to be part of the future. Now you have a team that has a reason to preform and be accountable for their failures and successes. Now it is time to lead.

Team Leader … You must be involved with every phases of your practice. You don’t have to know how to do everything but you do know what to expect from a good team.

December 31, 2018 Posted by | Uncategorized | Leave a comment

What Is MBWA? Maybe a New Year’s Resolution …

 

You would not believe the complaints I hear from dental team members in 90% of the offices I walk into. Then I hear the concerns of the practice owner (s). Most organization have the same problems but only a few address the issues. Your team is your most important investment. Their success is yours. MBWA!

What is MBWA? … Back in the 1980’s the acronym was coined by IBM, it stood for “Management by Walking Around”. The concept was to get management to interact with their team by getting up from their desk and walking around and asking if anyone needed any help with anything or if they had any ideas or suggestions. Several years later Disney picked it up and renamed it “Management by Wondering Around”, I like that one better.

Management by Wandering Around … Disney’s reasoning for changing the word was simple and effective. Team members (especially lower level) will be reluctant to voice any problems to superiors, it’s human nature. But when you “Wander” you are walking slow with your hands in your pockets, you are now “Approachable”. I did it, it works!! How do you approach your team?

Approach Your Team … The key to beginning any negotiation is to understand what the other side of the table wants. You may not agree with it but you have to understand their reasons. Most practicing dentists do not understand the day by day issues and frustrations that team members deal with. Sit in the chair and see what the job is all about. In American Football your team would be playing on both sides of the ball, often at the same time. Try the front desk for one week!

The Front Desk … Dealing with patients wouldn’t be that hard if it wasn’t piled on top of scheduling, collections, re-care, insurance companies, email requests, and the clinical team. In smaller offices that person may also be involved with treatment planning. With a daily plate full of problem solving issues it is reasonable to assume that some things will slip between the cracks. And then you want to know why they couldn’t fill the schedule. Try asking your front desk what is the one thing that would make their job easier and explore the suggestion, you may be surprised at the end results. You just wondered into their world and the moral will instantly rise and productivity will improve as long as you follow through. Now what about your assistant?

The Dental Assistant … Did you know that your patients ask your assistant for their opinion when you walk out of the room? Patients even ask if you are good at what you do. You are a dentist and that means you are creative and artistic, you enjoy reconstructing the oral cavity. Your assistant gets to listen to the patients complain, the doc complain, the Hygienist complain, and then clean up the mess. Look at what they have to do between patients while following all regulations. Anything that would help speed up the room turn around time is worth looking at. What is your turn-around work flow? What would make the job faster and easier? Wonder into their world and grow your practice by wondering outside your comfort zone.

The Comfort Zone … If it works don’t fix it. That is so true when it comes to your equipment, but your practice flow and team harmony are what the patient sees and feels when they are in the office. Team harmony and moral must be an everyday concern. Team discovery meetings are always available free of charge and please feel free to contact me at any time with any questions or concerns.

December 9, 2018 Posted by | Uncategorized | Leave a comment

Dental Impression Scanners “An overview of What’s What”

Dental impression scanners are soon to be thought of as standard office equipment. Digital imaging can save money by speeding up process time in every facet of healthcare from chair time to insurance processing. The more you engage in digital technology the more access you will have to increased cash flow. Shopping for a dental impression  scanner is like shopping for a new car, and they cost about the same. But, when was the last time your car saved you chair time or helped you increase production and cash flow? So, let’s talk scanners.

Talking impression scanners … There are so many coming to the market it is confusing which system is best for your practice. Because there are so many I am only using 4 brands as a sample review. First you have to have an idea of where you want to go with impression scanning. Do you plan on utilizing in office milling now or in the future or do you want to transmit data to your lab. Another consideration is how the Scanner software integrates with your practice management system as well as your diagnostic network.

True Definition Scanner (3M) Exhibit Booth #4019 … This is the perfect entry level scanner. It is simple & very portable but only displays in black & white. The video image capture technology is standard video with no bells and whistles and that keeps the price in the lower range. The system is an open platform and will communicate with most labs and in office mills. Images are accepted for Invisalign.

Emerald Scanner (Planmeca) Exhibit Booth #5425 … Originally developed by D4D Technologies this scanner is the enhanced version on the E4D system. It is an excellent choice for a full use scanner & mill. The design programs are comprehensive and accurate with constant up-dates to performance and features. The camera is small and ergonomically designed for easy access to the oral cavity. Planmeca has been offering impression scanning and milling for over a decade and incorporates an open platform.

Trios Scanner (3Shape) Exhibit Booth #2626 … The Trios System is the most popular dental impression scanner on the market. The capture speed is super fast allowing the user to scan a full arch in less than 30 seconds in HD and true color. The Trios is actually 3 cameras in one. Aside from the superior scanning ability it incorporates an intraoral camera and a shade matching camera that links to the design program. The system will capture multiple shades within a tooth and all the data can be transmitted to any lab with an open platform. Although the Trios will work with most Mills it is more suited to interaction with your lab as the milling prosses is more complicated.

Cerec Omnicam (Dentsply Sirona) Exhibit Booth #3409 … Young dentist graduating dental school this year were not born when Sirona developed the Cerec System. This is the Granddaddy of them all, the one that started the revolution. The small camera and the super fast scan is complimented by a comprehensive design program. If in-office milling and same day dentistry is in your future, this is the system to look at. Although Cerec is a closed platform, design images can be converted to an STL file and sent to any digital lab. Cerec images are accepted by Invisalign and.

Please feel free to contact me at any time with any questions or concerns. See you in New York!

 

November 6, 2018 Posted by | Uncategorized | Leave a comment

Do’s & Don’ts of “Convention Season”

 

The Year is coming to an end and for most business 2019 investment plans are underway. Q4 usually brings along some great deals and a good amount of “Convention Specials” are available now. That’s why you have to sit back, do your due diligence, and plan your investments carefully. Through my 40 years in dentistry, here are some do’s and don’ts that I suggest.

Dental Technology Do listen to your friends and get “IN-Office” demonstrations … Don’t buy something because they did. This especially holds true for dental scanners and cameras. A dental office is a unique business. No two operate the same way and here in the northeast the patient demographic changes every 5 miles. When planning the purchase of a dental impression scanner there is a lot of behind the scene support that will determine what system will work best for your work flow. Also, how far do you want to take a scanner? Some work better with mills and integrate seamlessly with other technologies such as CBT, 3D Pinters, Management Software, etc. and all of that should be evaluated before any decisions are made. Do go to the shows and look at everything … Don’t buy it at the show and make sure to get you team involved. Do look at the financial end … Don’t buy from a seller that offers less than 3 options, remember your looking for what works best and integrates with your existing network and future plans … Do Support is a key factor.

Dental Operatory Equipment … Like going to the car show, you want to slam the doors & kick the tires to see what lights you up. Do listen to your friends about the pro’s and con’s of what they have … Don’t decide on just their experience … Do ask a manufacturer representative about their ergonomics. Quality equipment is ergonomically designed for the professional to sit in a stool while treating a patient. The ergonomic design of dental equipment is important to your health. Also, speak with dental equipment specialists that offer more than 5 different brands and multiple options.

Small Equipment … IRS Sec. 179 works great when it comes time to replace Curing Lights, Handpieces, Intraoral Cameras, lasers, etc. But how do you choose what to buy? Don’t buy a year’s supply of composite just to get a free Light, it’s not free! Do look at the Light that is made by the manufacture of the composite you like. Don’t buy a Handpiece because of price, it is your #1 tool. Do demo quality Handpieces to see how they feel in your hand. Don’t buy an Intraoral Camera for the bells and whistles. Do think carefully if you will utilizes the options or just pay for them. Do make sure that all digital data will move smoothly throughout your network. Utilizing the resources of an equipment and IT team that has direct connections to multiple equipment and technology manufacturers is essential.

Consumable Merchandise … Convention & Special are the 2 buzz words. Don’t buy a years supply of anything! Why keep the money on the shelf and not in the bank? When something sits on your shelf for more than 30 days it starts to lose value. Do think about how long it will take to use up an item and free is not free. If it will sit for more than 90 days it better be a real good deal. Do have your team gather up all the expired items in your cabinets so you can estimate how much money you lost and gauge what to buy.

Step #1 … Talk to your tax adviser about all year end investments. Step #2 … The Plan!

 

October 18, 2018 Posted by | Uncategorized | Leave a comment