Cliff's Notes

The Business of Dentistry

“A Picture is Worth a Thousand Words” … Napoleon Bonaparte

A treatment plan presentation begins when the patient calls for an appointment and walks through the front door into your reception room. Your office doesn’t have a waiting room because your patients don’t wait.

A treatment plan presentation is all about communication and that begins with the patient’s perception of you, your team and the physical environment. If the office looks old how does that effect the patients perception of care?

Napoleon Bonaparte was known as the Little General. He really wasn’t that short but he surrounded himself with tall bodyguards. That image also helped hide his military genius from his enemies and retain the loyalty of armies. What professional image does your practice portray?

The Professional Image … When you get to the office do you walk in the front door or the back? When I visit my clients I always use the front door and sometimes I am shocked at what I see. My business background is marketing and operations and Stu Leonard was one of my marketing heroes, he once said “Retail is Detail” and the detail is what you need to pay attention to. I can’t tell you how many times I have picked up wet newspapers and brought them to the front desk or, while I was waiting, picked up a magazine that was 10 months old. It’s so interesting reading about baseball spring training after the season is over. It looks and feels old and competes with your success.

Competing with yourself … This is not good and it is so avoidable. What magazines are in your reception area? What is playing on the flat screen (I hope it’s a flat screen)? Think about this, your 35-45 year old patient is reading about a great newly designed putter or an outrageous hand bag that sell for $250.00. Then you tell that patient that they “should” have an old restoration replaced. What do think they will do? I think they will say “maybe next time”. If they are watching the travel channel in the reception area, what are they thinking about? It’s not veneers or aligners. Keep the focus on oral and systemic health.

Systemic health … This is the core of the patient experience and the picture you want to portray. Your patients don’t understand that you are a physician and part of their health care team. Your reception area should have heath related magazines and oral health related videos on the flat screen. Keeping the patient focused on health will help them better understand your clinical suggestions. The average patient also respects technology and dental imaging because now you can show them pictures and a picture is worth a thousand words.

The Picture … several years ago I started working with client in an affluent New Jersey town. It was a million dollar location but the practice had not been updated in over 20 years. The dentist is an excellent practitioner with a great personality but the new patient count and re-care system was struggling. Reluctantly, the dentist invested over $100k and renovated the practice (with no down time). They scripted the team, focused them on the patient experience and enjoyed meeting over 100 new patients (that all re-appointed) over a 9 month span. The picture is only getting brighter.

Keep Making it brighter … Gandhi once said “we are the language we speak”. New diagnostic tools are becoming more available to dentists. To remain part of the healthcare revolution that is well underway you need to consider utilizing some of these tools. Technology now allows you to use digital imaging along with your words to explain clinical issues. Technology also allows you to offer your patients an analysis of systemic abnormalities and probabilities. You are not “just” a dentist, you are a physician and a key part of your patient’s healthcare team. Stay current, stay relevant and keep making that picture brighter.

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January 17, 2018 Posted by | Uncategorized | Leave a comment

Time, Technology, Money … 2018(Not Necessarily in That Order)

Many of my clients know my feelings about getting up in the morning. We all get up for one of three reasons, fortune, glory, or the betterment of humanity. Well, it all starts with fortune. Unfortunately there is another saying “it takes money to make money” and that is what prevents most people from trying to reach out and grab the gold ring.

Reaching Out for the Gold Ring … Developing a business plan and trusting yourself with the implementation and the financial investment required is the hardest part. Most of us don’t have the ability to do it all so the investment in a quality team is the first thing to be addressed. Another old saying is “pay peanuts, get monkeys” and that means you will pay more for quality. Most dental practices that have difficulty expanding don’t look at the business foundation and how well it is supported. Without the blocks to build on you will not be able to keep up with the changes over the next decade. The longer you wait to engage, the more expensive it will be. You need to factor in the “learning curve”.

The Learning Curve … It takes a certain amount of time to learn and master a technique or a software program. The new world of dentistry is all about the network and how diagnostic and business management systems integrate. Understanding and utilizing this integration is very important and that means quality in-office training and support.

Training and Support … Yes, it can be expensive but it is essential for your ROI. Unfortunately most dental offices do not realize that some technology integrates better with certain other technologies. Buying a digital radiography system that needs a software bridge to your practice management system creates another step for information to transfer. The Digital trainer may not be familiar with the bridge and that could be a week spot in your production chain. Popular brands usually work well together but a smooth implementation depends on quality training and continued support. Now you have come full circle and need the team to train.

The Team … You need to choose a team leader that could be in command with regard to procedure and protocol. Operational systems need to be maintained for a healthy work flow and maintaining consistency is hard. You can’t keep an eye on everything while you caring for your patients. Morning huddles and monthly team meetings are necessary to keep your team focused and involved.

Focused & Involved … “Involved” is the key word. Always keep your team involved with any changes you plan on making. Before you implement something new (i.e. an impression scanner or software) explain your plan to your team and ask their opinion. Your decision may have been already been made and the order placed, but by consulting (not informing) with your team you can address any fears and concerns that could derail a smooth integration. People don’t like change and some are afraid of a challenge for fear of failing. Bonus systems should be considered as rewards for team performance, that gives everyone a common goal. You can’t keep giving raises, we’ll discuss that next week. Please feel free to contact me at any time with any questions or concerns.

January 7, 2018 Posted by | Uncategorized | Leave a comment

The Word is “Diligence” in 2018 … Eyes Wide Open!!

This will be the last Cliff’s Notes for 2017. Thank you for reading my rants and I hope that somewhere along the line you found something that helped. In the coming year we will all be facing new challenges and some of them we won’t be prepared for. It is im-portant to keep your eye down the field and focused on the goal line. Navigating the maze of changes facing the healthcare industry over the next 2 years (20182020) will be essential to your success.

The Next 2 Years … Why 2 years? In today’s market place technology is fueling technology and it has become impossible to predict what markets will be the flavor of the day. To stay relevant your approach to the market (your patient base de-mographics) needs to be updated. In most cases a business owner (dentist) is too con-sumed with day to day operations to stay focused on changes in their market so they need to invest a little money and consult with experts. A good leader knows when to say “I don’t know”. You need to be a team leader.

Leadership 101 … Leadership is a skill. Some people are born with it and others learn and earn it. Some of the greatest leaders started in the mailroom. My definition of lead-ership is getting your team to do what they don’t want to do and enjoy doing it. Listen to everyone and respect their opinions. You don’t need to agree but you do need to listen. A good leader has to know what can be done but doesn’t have to know how to do it because they have a motivated team along with checks and balances.

A Motivated Team … What motivates people? The most logical answer is money but respect and appreciation rank high on the list. The money your team costs is not an expense, it is an investment. Allowing a competent loyal team member to apply their natural skills to assigned tasks can generate a big return on that investment. Like all investments, there are ups and downs but as long as the upside is recognized and the downside is not chastised but understood as a learning opportunity the ROI will contin-ue to increase.

Natural Skills … When managing a team, recognizing a team members attributes and focusing them on tasks that fit will only enhance your workflow. Getting that person to enjoy the task and understanding why you think that they are the best for the job is the important part so remember to communicate it. Also remember to implement all the checks & balances.

Checks & Balances … “Oh what a tangled web we weave when first we practice to deceive” My dad once told me to trust only 2 people, God and yourself, but watch God. We laughed a lot about that but what he was saying is that mistakes, whether ac-cidental or on purpose, do happen. A system of checks and balances throughout your organization is a priority to protect you, your family and your team. I can’t tell you the number of times I have suspected inconsistencies within a dental team but due to legal considerations I am not permitted to raise suspicion on anyone. However, I can suggest workflow and financial audit trails.

The Challenge … Your 2018 needs to be more organized and controlled than ever before to remain or be more successful. The start is a 1 hour business operational re-view. Please feel free to contact me with any questions or concerns.

  May the New Year bring health and prosperity to your world

December 31, 2017 Posted by | Uncategorized | Leave a comment

Will Your Dental Practice Survive?

 

What a great question. We all dream of long and successful careers but forces beyond our control often derail or demoralize the dream. Just 10 years ago the industry leaders were all preaching “fee for service” and look how fast that changed. Now it is all about managing the patients insurance to maximize benefit expenditures. Regulation, annual registrations, OSHA, HIPAA and more are consuming time and revenue. What is going to happen over the next 10 years, where will your dental practice be? You could be a windshield or a bug.

The Windshield and the Bug … Your driving along the NJ Turnpike and SPLAT! After a moment of silence, you hit your washer switch and the mess is gone. But what just happened, the bug didn’t see you coming and the windshield was put in place to prevent a collision with your face. The healthcare industry is flying down the highway and you don’t want to be the bug. It is time to start thinking, the changes are inevitable.

Changes … The climate has been changing for billions of years. Like a wave it has peaks and valleys and as long as the earth exists I don’t see that changing. The practice of dentistry has also been changing over the years. 20 years ago the federal government enacted the “Clean Water Act” and we couldn’t dump developer and fixer down the drain. For those of us of more tender years, that’s what we used to develop xray film. Today, students graduating dental school don’t know how to develop film or what a PeriPro is. They also never heard of a NuvaLight or the difference between dispersed phase and spherical blend amalgams. Change happens and the last 25 years has been amazing, so where are we going and where are you now?

Where are You Now? … Another great question! The introduction of 3D printers into dentistry is the next step. The software is ready, the equipment is ready, and now the materials are starting to come into the dental market place. In a short while you will be able to “print out” temporary crowns and (invisalign style) aligning brackets. Yesterday’s future is today, it’s time to engage.

It’s Time to Engage … As a modern dentist you need to invest time in learning new techniques and procedures. As a modern business owner you need to reinvest in your business and utilize the new technologies to support clinical advancements. From digital impression scanners to CBT to insurance management, it all starts with your information (computer) network.

Your Information Network … You used to have a computer network but today you need to change that terminology and think of it as an “information network”. The paperless world is here and your network needs to be able to handle and store all the data that will be required to maintain your dental practice records. This will cost money as upgrades and support services become necessary and you have to include these costs into you quarterly and annual budgets. This starts with a comprehensive review of your computer hardware and a discussion of what will be needed over the next 5 years. This is a “today” conversation with an informed professional. How far are you behind the curve. Please feel free to contact me with any questions or concerns.

  

October 29, 2017 Posted by | Uncategorized | Leave a comment

Dental OSA Screening, The Bridge to Primary Care

You have been to all the seminars and the experts told you how much mon-ey you could make fabricating an OSA oral appliance but they don’t bring up the patient deductible that usually leads to a nontreatment plan. The effort in screening and patient rejection made the program irrelevant when mixed in with the rest of the day so after a couple of months you forgot all about it. If this happened to you, you missed the big picture.

The Big Picture … A dental sleep medicine program is part of “Total Systemic Health”. Your patients think of you as just a dentist when you should be part of their personal healthcare team. The screening process for OSA takes about 2 minutes of a hygiene exam and it should be part of your preventive protocol.

Prevention Protocol … Medicine is reactive, dentistry is proactive. The average healthy patient sees their dentist 4 to 6 times more often than they see their primary care provider. People go to their medical doctor when they have symptoms and need to be treated but dentistry is positioned to identify abnormalities before symptoms develop. It’s all about screening. The possibility of early detection has been noted by the insurance industry.

The Insurance Industry … Most large insurance carriers have more money than banks. Delta Insurance is the only one that is dental only, the rest offer medical insurance. If a dental practice can identify abnormal systemic conditions before symptoms develop, treatment would save tens of thousands of dollars per incident and tens of millions annually. You will start to notice that as insurance reimbursements continue to decline, new diagnostic codes will become available for processing. Dental practices will be rewarded for preventive medicine. It all starts with patient screening.

Patient Screening … This is a team task. The screening process is nothing more than asking a few simple question while your team is taking the patients blood pressure. I hope you are check-ing BP because that is the ground floor of any total systemic health program. Questions about head aches, indigestion, snoring, or any aches and pains should be discussed with your patient.

Your Patient … Yes, they are your patients and just like your MD counterparts you need to be able to direct them to other specialist and provide your insight to their primary care providers. In the next few months you will be hearing about salivary tests that can gage the probability of your patient developing all sorts of systemic conditions. Imagine being able to inform a patient that they have a 70% chance of developing heart disease and providing that information to their primary care provider. You could save lives. But OSA screening is also a practice builder.

OSA Practice Building … Medical deductibles are high and dental OSA treatment plans are usually rejected but a condition has been diagnosed. With the patient’s permission the results of the test should be forwarded to their primary provider via registered mail and revisited at their next appointment. The chances are that the CPAP prescribed is not being used opening the door for the oral appliance. Please feel free to contact me for more details on systemic programs.

     

October 24, 2017 Posted by | Uncategorized | Leave a comment

Beware the Tax Man … Q4 is Here!

Did a tax advisor tell you that you made too much money and have to pay the government “real money”. You got got smacked for being successful. Well, this may be your last chance to do it right. Hopefully, you will have to write a check because you had a good year, but who’s name is on the check is the question. If you haven’t scheduled your Q3 review I suggest you do it today. You also need to know how your business will be effected by the impending changes in tax reform.

Tax Reform … It’s coming and you should prepare now for next year or figure out what to do if it is retroactive to the beginning of this year. One thing for certain is that federal money will not be giving freely to states and that means that the states will have to find the lost revenue in other places or begin trimming services. Trimming services is political suicide so don’t expect that to happen. The federal attempt to plugging up some of the holes in the ship (the low hanging fruit) may start with the investment tax credit.

The Investment Tax Credit … Was put in place to stimulate factory production by allowing the buyer to claim several years of depreciation on certain durable goods in a given tax year if those items are used to conduct business . The US congress needs to reauthorize this special rule (IRS Sec. 179) every year and if not done by December 31st the deduction will go away in 2018. Everyone needs to reinvest in their business so it is important that you have this conversation with your tax advisor. The federal government’s tax package will also have a dramatic effect on the States.

The States Low Hanging Fruit … The Consumer Use Tax is a large part of the states lost revenue. In NJ as a general consumer you are required to report all tax liability after exceeding the $500.00 ceiling. That allows for around $7000.00 in out of state purchases. However, a NJ business of any kind is liable after $1.00. The hard part is understanding what is considered non-taxable in the state being as there is no published list. Any seller that collects state sales tax assumes the non-taxable liability. It is important that you discuss the Use Tax requirement with your tax advisor.

Your Tax Advisor … If you are reading this publication the chances are that you own a business or are involved in running one. A quality tax advisor (accountant) is essential in running a business. If your accountant just crunched numbers and tells you what you owe, your probably leaving real money on the table. Quality consultants in all areas of business can be expensive so do your due diligence and ask question. Accountants are not expenses, they are investments and should produce a measurable ROI.

ROI (Return on Investment) … When running a business every thing you do, every check you write, every new patient you spend time with is an investment. The monetary return over an annual time frame needs to be measurable or the investment may not be worth the time or energy. I have seen clients change accounting services because they were too expensive. Maybe they just never utilized services or maybe services were never offered, either way both effect the ROI. One of the most common mistakes a business owner makes is to giving into emotion and the fear of change. A quality leader will invest time in gathering information and making difficult informed decision.

Informed decisions … Making informed decision is essential for success. Please feel free to contact me with any questions or concerns.

 

October 17, 2017 Posted by | Uncategorized | Leave a comment

What are Bioactive Materials and why are they important?

https://www.youtube.com/watch?v=FNehARvvrP4

Larry Clark is Coming to NJ

If you are in the oral healthcare field, You can’t afford to miss this event.

To register call Asteto Dent Labs @ 1-800-447-7750

Bioactive Dental Materials Are The Future!

Larry Clark is one of the top bioactive researchers in the world and he is coming to New Jersey

The bridge between living tooth and a manufactured material has been discovered!

Thursday evening, October 19, 2017, Moonachie, NJ

October 8, 2017 Posted by | Uncategorized | Leave a comment

“Everyone has a plan, Until they get punched in the face!” … Mike Tyson

 

We all have plans to protect ourselves and our families but unfortunately most of us have that plan in our heads or a written plan that is several years old. As we have seen in the south over the last several weeks, things happen and disaster is real!

Disaster comes in all forms … When we think about a disaster we think about storms, fires and floods but what about all of the other scenarios that can develop. As a business owner everything you depend on has a disaster liability. From the electric to turn on your lights to death and disability, there needs to be a written and updated plan. One of the most overlooked and misunderstood disasters is the partnership buy/sell agreement.

The Partnership Buy/Sell Agreement … You may become a partner or take one on for a variety of reasons but is there a planned separation agreement? Taking on a partner is like getting married, everything is community property unless outlined by a legally bind-ing agreement. Unforeseen things happen all the time. What if your partner had a car accident that left your him/her permanently disabled or worst. Do you want their spouse or estate to be become your new partner? Guess what, unless you have an agreement in place they already are. Now you have to buy out the other side while dealing with, understandably, irrational emotions. You have to buy back your business.

Buying Back Your Business … Transitions are never easy. Money and emotions do not mix well. Predetermined values are essential to formulate a buy/sell agreement and funding that agreement should be put securely in place. If you have a business that is valued at $1M, you would need $500k to buy out a partner or an estate. But what about key personnel?

Key Personnel … The ultimate disaster for a business is the death of an owner, principle partner or manager. Replacement of that person can be difficult and expensive. Key per-sonnel insurance policies should also be part of a disaster recovery plan.

Disaster Recovery … I can’t tell you how important it is to prepare for that day that you get punched in the face and have to get up quick. You need professional advice and yes, it will cost a little money. Please feel free to contact me at any time with any concerns.

September 21, 2017 Posted by | Uncategorized | Leave a comment

Cliff’s Notes Team Contacts

Please be advised, I will not be available the week of August 28th. Below is contact information for my support team.

Merchandise Orders

1-800-707-5678 … Andrea  ext. 222-8858 or Kevin Solomon ext. #222-8444

Robin … 1-631-454-3168

 Andrea, Kevin & Robin all know your discount structure from your history.

 Equipment service 1-800-645-6594

You can email our service dispatch at DLHSIFSCService@henryschein.com for a fast response. Make sure your name and office phone number are included with the problem.

Henry Schein Dental Metro Center, Moonachie, NJ   201-440-7004

 

August 24, 2017 Posted by | Uncategorized | Leave a comment

My Feet Hurt! But I’ve Been Sitting all Day? “Dental Office Ergonomics”

It’s 3:00 in the afternoon and your feet and back are starting to hurt, your neck is stiff, and you’re getting a headache. Maybe it’s the stress of running a dental practice or maybe time to look at your working environment as the cause. My advice to my clients is simple, you can try to save money in a lot of places but there are three where price should not matter, your handpiece, your stool, and your overhead light.

Your Handpiece … A craftsman does their best work with the best tools. Your handpiece is your #1 tool. You use it on almost every patient and there is a difference between a $200.00 and a $1200.00 handpiece. Yes, quality handpieces are expensive but so is your time. Quality preforms better and in the long run will cost less but the big advantage is a smooth cut and lower noise. It’s the noise that effects your health. The highspeed squeal is only inches from your ear. We are talking about hearing loss and it is a real problem in dentistry.

Your Stool … This may have been the most misunderstood piece of equipment of the last generation. Back problems, leg problems, foot and neck issues can all be attributed to your stool and positioning. You know who doesn’t have any of these problems? The dentist that works standing up. So, if standing is not an option then you need to look into quality seating and learn about “positioning”. Todays operatory seating is designed to compliment the new patient chairs. The patient’s head position can be adjusted to fit the dentist’s posture when seated correctly in a quality stool. You need to bring the patient to you, not adjust yourself for the patient.

Your Overhead Lighting … This is about your eyes. LED Lighting is the best and there is no excuse not to upgrade your current light to LED with a simple adapter. Your counter tops should be well lit with the same type of light (LED) so eye strain is minimized when looking away from the oral cavity. The focusing and adjusting your eyes have to do during the day will lead to eye muscle fatigue. Got a head ache?

The 80/20 Rule … I can tell you that eight out of ten dentists and hygienists complain to me about aches and pains but they don’t do anything about it. OMG! It’s going to cost some money to make you feel better. So, let’s talk about the cost and you can think about it while your driving home in your $40,000.00 car…..

1) Your Handpiece (air driven) $800.00-$1200.00(depending on brand)

2) Your stool (Drs.) $400.00-$1200.00 … (Asst.) $600.00-$1200.00

3) Overhead light conversion Halogen to LED $350.00 (most brands)

Ask your friends about their chairside health. This is about you and your team and your working environment. A healthy and happy team improves production. A work environment and flow evaluation can be arranged free of charge but to fix any problem you will need to invest in your health. Please feel free to contact me with any questions or concerns.

 

 

August 13, 2017 Posted by | Uncategorized | Leave a comment