Cliff's Notes

The Business of Dentistry

A Quality Dental Office & Patient Retention

The patient experience may be the most important marketing tool for practice growth. Unfortunately, most dental practices do not understand how marketing relates to the patient in the chair. Let’s start by agreeing that nobody wants to give up a couple of hours of their lives to sit in a dentist’s chair. Now think about why they choose to sit in your chair and not the one down the street. In today’s market a patient will choose a dentist for a few simple reasons, Insurance, fee schedule, location or recommendation. After they decide on you and the appointment goes smooth, why don’t they continue with re-care? Maybe because you just provided all the services as they expected.

As expected … My wife is a gourmet cook, that may explain why I don’t get on a scale, friends and family love coming to our house because they are Wowed by whatever is put on the table. It’s always different and not what is expected. Your patients expect a certain environment when coming to the office and you provide it. It is nothing special just standard office protocol, friendly and efficient. What were the extras, a goody bag? Why does that patient “want” to come back and refer others? What was the WOW factor?

The “WOW” factor … There was a great seen in the recently cancelled Netflix production of House of Cards. Frank Underwood stopped in at his favorite “Rib Joint”. The best barbeque ribs in the city was at a little broken down shop in a bad part of town. If the ribs were so good why was the shop so broken down? The consumers required to grow the shop chose to be in a different and more comfortable environment. Dr. Omar Reed was a top line dentist lecturing about the patient experience over 30 years ago. His philosophy was that your reception room (not a waiting room because your patients don’t wait) should be nicer then the patient’s living room. It is all about the packaging, delivery and providing the unexpected “environmental” extras.

Unexpected extras … Your patient demographics will determine the level of success your practice achieves. A dental practice’s patient base is usually 10 years plus or minus the dentist’s age. This could be a time bomb for a healthy practice. Practices that are 20 years old tend to be set in their ways and everyday is business as usual. But, that 55 year old dentist is still relating to their own generation and not the one their kids are in. What are the extras that the millennials are not expecting? They are your patient base for the next 20 years. After a dental procedure the dentist should call the patient to make sure they are comfortable for the evening, but maybe they should text and younger patient, you will get an answer not a voice mail. What is the last thing the patient remembers? Check out!

Check out … I never try to reinvent the wheel, I let other people do that and tailor concepts to my situation. This one was great! The office orders a dozen roses every morning. When a female patient is checking out they are given a rose at the same time you are scheduling their next visit. If it is a male patient, offer a rose for them to take home to their spouse, mom, significant other or anyone. That $2.00 flower buys more good will than you can imagine. Make a difference in your patient’s day, do the unexpected and they will remember. Please contact me with any questions or concerns.

 

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June 3, 2018 Posted by | Uncategorized | Leave a comment

What is Your Dental Practice Worth?

What a great question. Every dental practice owner wants to ask that question but rarely do, that is until they want to sell. In the real business world an annual evaluation is always recommended. When should the first evaluation be done? At the end of year one.

Year One … Doing an analysis at this time in your career will identify a basis for production and expenses. It also provides accurate information for insurance, legal and estate planning. It doesn’t matter if you start from scratch, buy an existing practice or enter as an associate.

Entering as an Associate … There is an old saying “a boat is a hole in the water, surrounded by wood into which one pours money”. When entering a practice as an associate its like buying into the boat. What exactly are you walking into? What is the real current value? How much cash value can be assumed if tragedy strikes?

If Tragedy Strikes … Life has a way of creating speed bumps that we have to navigate. Sometimes those bumps are replaced by misfortune and loss. If something happens to the a practice owner that prevents them from being involved with the practice, what happens? An unforeseen event such as accident, health or death has to be planned for. A dental practice that is closed for 30 days loses 30% of its value. A solid transition plan based on current financial and physical values along with detailed implementation instructions should be part of your estate plan. Your dental practice has several areas that has real cash value, each one needs to be identified and vetted.

Areas of concern … If you are a sole practitioner you have insurance covering fire and flood. Do you know what it costs to build an office? Are you aware of the cost of emergency relocation? Can you afford a major loss of income? Your financial and patient information may have been securely backed up but what about the value of your equipment and inventory? What about if you are a partner or vested associate? Is there a buy/sell agreement in place? What is the real cash value of your percentage of ownership? The bottom line is that it is important to do due diligence and to consult with several professionals that are experts in specific areas. By the way, does your commercial lease allow you to do anything? Maybe not.

Expert Consultants … The dental industry is very different than most. Although the “big box” dental centers are opening up all over the country, here in the North East it is still a unique cottage industry as compared to most. There are “dental specific” professional such as CPS’s, Attorneys, Transition Specialists and Estate Planners. These dental industry professionals service hundreds of dental offices, have long proven tract records and in many case have worked with each other and several of your friends. Due diligence is the key. I suggest interviewing several professionals in each area before making a final decision. For more information on professional dental consulting teams please feel free to contact me at any time.

 

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

Do You Participate In PPO Plans “What You Don’t Know!”

This past week, along with 30 practicing dentist, I was wowed by the eye opening information that was supplied by Scott Hironaka from Unitas Consulting. They specialize in dental PPO management and negotiations. Red Alert!! Your practice may be losing hundreds or even thousands of dollars per month because of the contract you signed.

The Contract … Did you read all the fine print? Most people don’t. Do you understand the rights you gave away? Probably not. Every PPO contract allows the insurance company to “rent” your procedure codes to other companies. If you have a patient that has ABC Insurance it does not guaranty that ABC is the carrier. ABC may rent your procedure code to a company you never heard of. The patient’s card still has the ABC logo but the real carrier pays you their reimbursement rate and not the rate that you originally contracted with ABC. Also, if that should happen, all of your reimbursement rates with ABC will automatically change because you accepted it. To make it even more complicated, your procedure codes can be “rented” individually to multilabel carriers. Did you ever wonder why your rates change? Now you have to make that phone call to ABC and get it fixed.

Getting it fixed … Did you ever calculate the expense of trying to fix insurance claims? I’m not just talking about the time it takes on the phone, I’m talking about lost productivity and lost patients. Dental insurance management is a full time job and most dental practice owners don’t understand what it takes to do it right. Ask your insurance coordinator how many phone calls are missed because they are on hold with an insurance company. If you put them on hold they hang up and you have to start all over again. It’s a cycle that repeats everyday in the average practice. There are some things that just can’t be fixed because you didn’t read the fine print but you can challenge.

The fine print … Did you know that if you advertise a special (i.e. exam & x-rays $69.95) that special offer will become your new UCR and if the insurance carrier knows it they will reduce your reimbursement and have the legal right to recover the difference of any dollars sent to you during the promotional period. There is so much you don’t know about dental insurance management. Everyone tries to negotiate better rates but unless you have detailed information on your procedure costs it will be an up hill battle.

Your cost per procedure … Do you know what a certain procedure costs? To negotiate with an insurance company you need to be informed. You have to justify why you need an increase in reimbursements and exactly what codes you are calling about. You can’t ask for an overall increase and you certainly don’t want them to chose the codes. You have to be prepared to focus on specific procedures and you have to be able to document the cost. If you can show (document) the contracted carrier that you cannot provide quality healthcare to their participating patients at the current reimbursement rates, you may have a chance. Remember, insurance carriers want you because you service their revenue base and you may want them to help maintain patient (revenue) flow. So, now there is a common ground.

The common ground … In business, everything is a negotiation. Dental offices fix teeth, professional negotiators negotiate. There is so much that you and your team don’t understand about your business relationships both negative and positive. Professional consult and guidance is essential for success in todays complicated world. You should know, you’re a dental professional.

 

April 29, 2018 Posted by | Uncategorized | Leave a comment

What Effects the Value of Your Practice? You don’t know what you don’t know! Commercial “Professional” Lease Agreements

I recently had an office lease review done for one of my clients and was quite surprised at what was un-covered. The agreement was so top heavy in favor of the landlord that I felt the original professional that reviewed it for the doctor committed malpractice.

Your professional practice … The value of your practice may be a large part of your estate. Imagine this, you have a $1.2M practice that is valued at $875k. All of your ducks are in order including a written quick transition plan that that pro-tects your estate. But, will the lease allow a fast transfer of ownership? What rights does the landlord have to the transition? There is so much in the fine print that unless you are experienced in lease “legalese” there is a good chance there is a paragraph or even a sentence that is missed that directly effects the value of your practice and it’s impact on your estate and your family.

Protecting the value of your practice … So many professionals overlook the fine print when signing documents. We tend to trust our advisors or brokers and there is nothing wrong with that. However, how to those agreement effect other agreements? You want to take on an associate/partner and put there name on the lease for shared liability and the landlord “legally” says no! During day by day operations we negotiate everything from patient payment plans to personal life insurance to a teenagers curfew (those are the tough ones). All agreements must benefit the whole and that’s your job, you are the whole, you are the CEO.

The CEO … It’s time to take full control. Start by understanding the restrictions in all of your signed agreements and how they effect your personal estate. I sug-gest starting with your practice lease agreement and please feel free to contact me with any questions or concerns. Consider attending the free seminar, you don’t know what you don’t know.

Important Commercial Real Estate CE Seminar for Dentists!

Wednesday Evening April 25th … 6:30 PM until 9:00 PM … 2 CE’s

Double Tree by Hilton Hotel, Fort Lee, NJ

If you are buying/building a practice, have a lease that is coming up for renewal or is expiring in 24 months or less, or would like to understand how the lease impacts the sale and valuation of your practice, then you must attend this CE event! 2 CE’s Light meal served 

For Free Attendance use Promo Code: Grassroots!

By Phone: 1.800.459.3413 … By Email: info@cirrusconsultinggroup.com … Online: http://www.cirrusconsultinggroup.com/seminar

 

April 22, 2018 Posted by | Uncategorized | Leave a comment

Dental Business Risk Management

Your exposure to litigation depends on your ability to defend yourself or your team against a legal assault on your practice. The stories I have heard and seen are countless. Patients, team members, pedestrians, tenants, all ages, all demographics, the potential for a legal disaster is only around the corner. The key is to be ready to defend yourself by creating an updated risk management program. You may want to start with a “Patient’s Bill of Rights”.

Patient / Practice Bill of Rights … What is it exactly? A printed statement informing the patient of what they can expect form your office with regard to privacy, professionalism, diagnostic opinion, clinical options, referrals, liabilities and payment options. It also states what the practice expects of the patient such as scheduling, cancellations, payment terms, etc. The “Bill of Rights” should be prepared by a professional familiar with healthcare law. A signed & dated document is gold to any defense team representing a well organized facility. Signed and dated documents are your first line of defense.

Defense Wins Games … When I coached baseball I believed in defense. Offense (your marketing & treatment planning) sells tickets, but your defense will save a close game. You’re your business and clinical teams are the on the front line everyday so training and consistency are critical. Every patient must be processed according to practice protocol. Train your team on people skills so they know what to say and when to ask a supervisor. Prevention is the best form of risk management.

Risk Management … Every business has an offence & defense. In the real world your defense won’t stop litigation, it will only minimize your out of pocket expense. Litigation can come at you from any direction so a professional consultant is strongly recommended. Yes, it will cost you some money but it’s part of your business investment and figured into your quarterly budget. Unfortunately, most people that read this rant won’t want to spend $350.00/hour on legal advise. I can’t tell you how big of a mistake that can be. A couple of thousand dollars now may save a couple hundred thousand down the road if you have to go to court.

Court of Law … A person is innocent until proven guilty but when the plaintive is a general consumer and the defendant (you) is a professional business the rules tend to change. It’s not that the law changes, it opens more doors for the plaintiff’s legal counsel as far a business ethics and the Consumer Protection Act. Most litigation is settled out of court but “settlement” costs money regardless of right or wrong. I know it is hard to believe, but quality documentation can be the difference between a $10,000.00 settlement and $100k. A Risk management program must also include disaster recovery.

Disaster Recovery … What is considered a disaster and I don’t mean a day full of cancelations. A disaster can be a flood, fire or death. The one thing we never really plan for is what happens after we die? Sure, there is money for the family, but what about everything else. Anticipate disasters, they will happen. Please feel free to contact me with any questions or concerns.

April 11, 2018 Posted by | Uncategorized | Leave a comment

Dental Sterilizers & Risk Management

On December 8, 1991 Kimberly Bergalis died, she was 23 years old. She was the first of 6 patients that contracted the Aides virus at a dental office. Dr. David Acer, a Florida dentist who also died of aids, was accused of purposely infecting all 6 patients. Although there was no clinical proof and the Aides virus has not knowingly been transmitted in any dental setting, the race to dental infection control began. At the June 1992 Atlantic City Dental Convention, 6 months after Kimberly’s death, my company sold 32 sterilizer and sold-out on gloves in the first day. Believe it or not, in 1991 very few dentists wore gloves or had real sterilizers, some used toaster ovens.

Sterilizers … (ster·ile: ADJECTIVE .. “free from bacteria or other living microorganisms; totally clean”). The laws of physics states that sterilization occurs when an item is exposed to a consistent 120C degrees for a specific amount of time. There are several different types of sterilization systems available to dentistry, dry heat, steam heat, chemical vapor and gas.

Chemical Vapor … In my opinion chemical vapor sterilization is the best system available to dentistry. This process will not rust or dull instruments and is faster due to the fact that you use a chemical solution instead of distilled water. In today’s market, this system is not practical for a dental office because of the ventilation required and the cost of the chemical sterilant. For a dental practice the wear and tear on instruments can only be avoided by using a dry heat sterilizer.

Dry Heat Sterilizers … Will be the kindest to instruments but they take much longer, 2 hours @ 120C degrees. Carbon steel cutting instrument will not dull and However, autoclavable plastic will melt. Steam sterilizer are much more versatile.

Steam Sterilizers … There are so many different brands and they all do the job if used correctly. Utilizing a pressurized chamber sterilization occurs very quickly but it takes time for the unit to reach pressure an temperature. Manual machines have mechanical timers that alert you to switch the sterilizer to the vent and dry modes. The drawback to a manual machine is that if it is not working correctly and you are not watching the gauges you will never know if proper temperature and pressure are not achieved, . An automatic machine will fill, heat, pressurize, vent and dry on it’s own. If the unit cannot preform the process it will shut down and alert you to the problem. Automatic sterilizers will reduce your liability and be more reliable protecting your patients, team and family.

Liability … Exposure to litigation is the basis of every risk management program. We all have to protect ourselves from the ambulance chasing lawyers. It doesn’t matter if you are right or wrong, your insurance company will settle the case just to make it go away. The sad part is that it will cost you money to defend yourself. An organized risk management program will minimize your out of pocket expense. Now its time to look at you risk management program and how it relates to your sterilization protocol.

Risk Management … When was the last time you looked at your personal security? We’ll look at that in my next rant. Please feel free to contact me with any questions or concerns.

 

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

Dental Instrument Management

Do you know how much you have invested in   hand instruments? I bet you don’t…

Did you ever take inventory of your assets? I can’t recall a dental office ever taking a physical inventory. It is time consuming and expensive but it does give you the real value of your business and a good understanding of how much money is sitting on your shelves and in your draws. Start by reviewing you hand instruments because you may be surprised about how much money you have invested.

Your Investment … I always said that in business you never have expenses, only investments. Hand instruments are the tools of a surgeon and an artist and quality matters. One simple Hygiene setup of good quality instruments runs $150.00 and up. Forceps run over $150.00 each and what about sharp explorers. If you did an inventory of your business, excluding the dental equipment, the hand instruments would be over 15% of your reusable assets. This value deserves attention and maintenance is the key.

Care & Maintenance … How does your team manage your instruments? Most dentists or office managers don’t have a clue. Are they dropping them into a germicidal bath like they’re loading a dishwasher or are they treating them with respect because they are expensive? Quality dentals hand instruments are specially designed for different operative situations. Poorly maintained instrument will loose there shape or sharpness, not preform properly and will need to be replace more often. Understand the instrument management process and the flash points that cause damage like an instrument bath, ultrasonic cleaner and a sterilizer.

The Instrument Bath … When offices ask me about cold sterilization solutions for their instrument baths I explain that there is no such thing. An instrument bath is nothing more than a “holding solution” that prevents cross contamination. The strongest holding solutions are not necessary and may cause lesser quality instrument to degrade but the vapors that leak into the air are still toxic. The instrument bath is a place to store contaminated instruments before the ultrasonic cleaner and it should be covered in a well ventilated area.

The Ultrasonic Cleaner … Rule #1 DO NOT use the machine when a patient with a pacemaker is in the office. Ultrasonic cleaners can protect or damage instruments depending on how they are used. Dumping everything into a basket allows the instruments to bang together causing metal fatigue and dulling. The best way to clean instrument in an ultrasonic is with a cassette system. This is an investment project because most offices do not have the right equipment. If you do not use cassettes, instruments should be rinsed, tied, and placed in the ultrasonic with an enzymatic type solution. After removal they should be rinsed again before placing them in the sterilizer.

The Sterilizer … CDC guide lines are continually changing. The rules for handpieces has change dramatically over the past 2 years but we will discuss that at another time. Instrument guide line now call for the instrument to be completely dry but at the same time they want you to keep the clear part of the pouch up for a better sterilization process. We were always told paper up for better drying. Routinely retrieving wet instrument from a sterilizer signals a problem with your instrument management system and a workflow review should be done.

Workflow Review … The entire clinical team needs to be involved when reviewing instrument management. Please feel free to contact me with any questions or concerns.

 

March 11, 2018 Posted by | Uncategorized | Leave a comment

Embezzlement? Not Me!

 

Embezzlement is live and well and the dental office is no exception. As a matter of fact, most dental office have been embezzled. Some catch it some don’t, I have heard about it and seen it countless number of times over my 40 year career (I started when I was 8). New team members, long time staff, young or old, it doesn’t matter and who’s fault is it? The boss!

 

The Boss … The identification of faults in any business relies on information supplied by reports from different departments. Management’s job (The Boss) is to review these reports and make sure they match. Checks and balances are necessary to insure that all procedures and protocols are operating efficient-ly and “that the check book balances”! Production reports, daily collections, day sheets & deposit slips must all balance with each other. Trusted long time team members as well as new ones must all be subject to checks and balances. A team member should never feel insulted by verification. As Tom Hayden said to Sonny Corleone “it’s only business”.

The Control Freak … We all have or have had the team member that wants to be in control. They develop ownership of their tasks and get agitated when someone else gets involved or asks question. This situation is not healthy for the practice or the employee. Assuming the person is extremely honest, any inconsistency may cast doubt and dam-age a good relationship with management or other team member and disrupt team harmony. That will effect the patient experience and office production. Then there is the other side of the equation, they don’t want you to look.

Receivables & Deposits … Who opens the mail? Who enters payments into your management software? Who fills out the day sheet? Who fills out the deposit slips? Who goes to the bank to make the deposits? If it is the same person and not a family member, a change is needed. Checks and balances, ask your business financial advisor to help set up the system. Let the accountant be the “bad guy” changing the system. My dad once told me that when it comes to business trust two people, God and yourself and watch God.

Payables … Payables involves so much more than just paying bills. Why do you have the bill? Who authorized the services? Where the services requested in the best interest of the organization? Embezzlement isn’t just diverting receivables, it could be theft of goods and services. I could think of a hundred examples like the front desk that has the snow plow company do their home and add it to the office bill. Or, the assistant that places a $2000.00 supply order to get the “Free Kindle” that is shipped with the order and the assistant is checking in the shipment. Did you need the supplies? Were they priced correctly? Nothing is free. Then there is the accounting manager that has been with you for 10 years submitting bills from nonexistent companies and depositing them into a personal account..

Embezzlement … is alive and well in the dentistry. It is all about prevention. Talk to a professional and please feel free to contact me with any questions or concerns.

February 25, 2018 Posted by | Uncategorized | Leave a comment

Dental Material Curing Lights Beyond the Sales Pitch!

No, they are not all the same and yes, they can be expensive. A craftsman (craftsperson for the PC crowd) does their best work with the best tools. Just like handpieces you can use a $50.00 tool or a $1500.00 one, the difference will be the quality and predictability of you restorative procedures. Your perception of quality vs cost starts with the sales pitch.

The Sales Pitch … When I attended Restorative Update 2017 with Dr. Stace Lind last October, my thoughts about curing lights and manufacturer claims were confirmed. Dental light cured materials are chemical compositions and the curing process is a chemical reaction. The laws of physics require a certain amount of exposure time of particular light waves for the chemical reaction to take place quickly. If a manufacturer claims that their system will reduce curing time because it is so powerful, you should think twice. Large manufacturers can make that claim when using their materials because the products are developed and tested using their lights. However, no light curing system cures all materials the same way and excessive curing can cause a burn effect. It is important to know how the materials you are using react to your curing lights.

Curing Lights … There are 4 components that separate a $50.00 system and one that costs $1500.00.

  1. The LED Crystals … They need to be flawless. Just like diamonds there are different qualities. Imperfect crystal will burn hotter in fault areas causing that part of the crystal to burn-out. You will not notice this but the light wave will not be balanced and the output will be diminished.
  2. The Crystal Housing … Quality lights incase the LED crystals in metal col- lars. Electricity powers the crystal and they do get hot internally. Plastic and low quality metals will warp reducing the lights ability to function correctly.
  3. The Glass Light Guide … Again quality is the issue. This is a no brainer, flawless glass rods are a must. If the glass is not pure the best light in the world will not preform. As a side note, keep the business end of the light guide clean.
  4. The Timer … This is the most underrated part of a curing light. You don’t want to under or over cure and when your dealing with seconds, 1 or 2 could make a difference. Let’s be honest, when your light is set at 10 seconds, do know if it is 8 or 12? Reliability costs more.

Testing Your Light … Different lights have different effects on curing dental materials. It is recommended that you have a radiometer to test output but you also should have a computer based comparison study done. The computerized testing & report are free, done on-site, and will help support the quality of your work. Please feel free to contact me at any time with any questions or concerns.

 

February 11, 2018 Posted by | Uncategorized | Leave a comment

Dental Compressors Expensive!

The dental air compressor is the heart of your practice. Like nothing else in you office, if it goes down everything clinical stops. Unlike their counter parts that you can find at The Home Depot, they are expensive and specifically designed for healthcare. Filters and drying chamber are incorporated to pro-vide clean and dry air to help improve clinical procedures with predictable results.

Clean Dry Air … Why are dental compressors so much more expensive than what you see at a retail store. Clean dry air is extremely important when delivering quality dentis-try. When air is compressed the moisture is squeezed out and settles at the bottom of the tank. A purge valve releases the water when a small puddle forms. The remaining mois-ture is captured by a desiccant filter that needs to be changed annually. This is one thing that is never done in any office I walk into, out of sight out of mind. The filter serves another purpose on older systems, they filter out oil vapor.

Oil type compressors … On top of the compressor tank is an electric motor. The motor, just like the one in your car, requires a lubricant to run smooth and reduce friction wear & tear. The oil does burn out and levels should be checked monthly. This is another thing that is never done. Another big issue is that the oil vapor emitted by the motor is in the ambient air can be picked up by the air intake and drawn into the tank. The oil resi-due builds up in the air lines and totally clean dry air is almost impossible. Today, dental designed compressors are oil less.

Oil Less Compressors … New compressor motors are designed to run without oil. A synthetic lubricant is sealed into the race to reduce friction. Although oil less systems are clinically better, they are a little noisier and don’t last as long. Their life expectancy is reduced by about 20% . Replacing an oil type unit with an oil less will not solve the problem of oil vapor in the air lines, once its there its there, but it will reduce the wear on your operatory equipment.

Compressor size … Dental air compressors come in all different sizes. The motors (heads) are rated by hoarse power and the amount of power you need depends on the number of active users. Multiple users with a small compressor will increase the recov-ery time it takes to repressurize the tank causing the heads to run hot and reducing their life span. A larger compressor will hold its pressure longer and more powerful heads will fill the tank faster. A dental compressor, when fully pressurized, hold 100 psi and when bled to 80 psi the heads turn on. The recovery time is the amount of time it take to reach 100 psi. Your compressor is so important that newer systems incorporate software for central operational control.

Central Operational Control … If you read this far down my rant you will now under-stand were we are going. All of your equipment and management systems will talk to each other. Everything will be tied into a central monitoring and management system. Keep this in mind when buying or replacing dental equipment. Including compressors.

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