Cliff's Notes

OK, One More Time! When Everyone Goes Right, You Go Left!

On Thanksgiving morning last year, the first thing I noticed when I walk down the driveway to get the morning paper was that there were two separate deliveries. This blog post, or news letter to some of you, is about marketing effectiveness. What are people looking at?

OK, back to the deliveries. Why were there two? There were two because of all the printed advertisements,. Why? Because human nature will trump technology, at least for the next few years. That is a bold statement coming form an old guy like me, but if you look at the reality and not the hype you may agree.

How many e-mails do you get per day? 20, 50, 100? How many do you read? How many do you delete? But, when you get home and look at the mail, you look at every single piece before throwing them on the table to sit there looking at you for a few days. Hey, we are all human and share the same traits, we don’t want to physically through something away. Marketing is all about Name Recognition and reputation. How you deliver your message and wrap the package will determine the effectiveness of your program. Also, never advertise discount prices, it does not attract quality patients and effects your PPO reimbursement.

The Web Page … Yes, everybody needs one. Your presence on the web gives a patient the chance to meet you and feel comfortable before they request an appointment. What the patient sees on the web needs to compliment what they hear when they call and see when they walk into your office. Telephone communication skills set the first level of comfort for a patient. Office décor needs to meet all patient expectations to achieve the next level of comfort.   Patient comfort is the first phase in treatment plan acceptance. The real question is how to get people to look at your page. What makes you different from the other 25 offices they see on a Google search.

The Marketing Plan … Marketing budgets should be set at 5% of the previous year’s collections. A marketing plan consists of several programs working together and complimenting each other. Printed advertisements are very effective in creating Name Recognition. Attractive signage (if possible) and coordinated mailings all contribute to establishing your brand. Yes, your Brand! Marketing is all about branding yourself (Name Recognition).

Selective Mailing … The U.S. Postal Service offers selective neighborhood delivery. With this service you can target specific areas that are local to your office. The cost of printing and mailing varies on the number of addresses but sending oversized postcards, every 3 months maybe one of the most effective ways to drive the public to your website. However, don’t think that the phone will ring off the hook, a successful rate of return is only about 3%. This is a marathon not a sprint. But if 1000 mailings done 4 times per year (4000 pc) at a cost of $6k generate 30 phone calls, well, you do the math. The lower range of the average patient value in northern NJ is $700.00/year. If all your marketing is coordinated correctly and the office’s patient communication skills are good, you could realize $21k in revenue for the $6k investment for the first year.

When everyone goes right, you go left … Don’t be afraid to be different. If you look like everyone else you will be lost in the pack. Your message needs to be communicated in the areas your competitors don’t go. Everyone follows the cyber path but how many engage in the old methods? The general public still checks the mail box and they are you target! You want that postcard sitting on the dinning room table for a couple of days. Just a thought.

January 8, 2017 Posted by Cliff's Notes Blog | Uncategorized | Leave a comment

Where Did All The Patients Go? Dentistry Down?

  This is the single biggest question I have been asked in the last 2 months. And if you are in the 80% of the 80/20 rule then it is the same question you have been asking yourself. Yes, dentistry has been down for most of the region and there is no simple answer as to why, but we can speculate.

This year is an election year and regardless of your political beliefs, you have to admit that it has been the most negative one and a half years that we have witnessed in modern memory. You feel depressed, your team feels depressed and your patients feel depressed. Dentistry is not high on their agenda and your chair is the last place they want to be.

The market has changed, the emotional climate that we all live in effects our daily activities and keeps us adjusting our priority lists. Out of Sight, Out of Mind! That may explain what has happened to your daily schedule.

It’s time to re-focus, look at your marketing program and plan a coordinated effort to re-engage “lost patients” and attract new patients. Do you have name recognition? Who are you and what makes you so different? All your competitors are great dentists and they all accommodate insurance plans of some sort. Why should a patient choose you? Marketing 101 “Packaging is 95% of the Sale”, what does your package look like? Does it fit in with the demographic you are marketing to?

Let’s talk about demographics … How does your practice environment relate to your patient base and potential new patients? When I hear an office complaining about not having enough quality patients or patient referrals it usually points to the patient (customer) experience. If you want a general family practice, your external marketing effort should focus on women in the 35-50 year old range. Your practice environment should accommodate their expectations and appeal to their comfort. Marketing research shows that woman make the majority of healthcare decisions within their family structure. They bring hubby and the kids. They also talk about daily experiences and you want that great visit to the dentist to be in that conversation.

To establish a good marketing program that grows the practice the internal marketing program needs to compliment the external one. I have been very impressed with some of the patient referral rewards programs that I have seen. Sometimes it’s not the “thank you” gift but the way it is presented. Stu Lenard, my marketing guru, once said “Retail is Detail” presentation is everything. What does your package look like? Let’s face it, the cost of up-grading your environment is equivalent to 1-2 crowns per month. What’s the ROI? Please contact me with any questions or concerns.

November 10, 2016 Posted by Cliff's Notes Blog | Uncategorized | Leave a comment

In-House Dental Insurance Plans May be Illegal …

The in-house dental insurance plan may be illegal in your state. Here in New Jersey the “good intent” may cost you hundreds of thousands of dollars. The fact is simple, you are offering insurance and you are not a state licensed insurer. BANG! You just broke a whole bunch of laws. Also, the higher your UCR the higher your reimbursement, that is pretty much a fact, but offering a special (i.e. $69.99 Cleaning, X-rays, Exam) may re-adjust your reimbursement to a lower rate and may require you to refund any patient that paid a higher rate during the promotional period and that includes insurance companies.

Healthcare providers are subject to additional consumer protection laws. If you are a PPO provider you are subject to insurance company rules and regulations. However, the rules keep changing. It is almost impossible for a dental office doing less than $1M/year to have the resources to understand and manage the ever changing landscape. Insurance reimbursements are fluid and constantly shifting and require continuous monitoring . Now is the time to think about “Out Sourcing”.

Simple economics … Out sourcing your PPO management program may cost $400.00/month. A team member may cost $600.00+/week. A PPO management company has multiple resources and can react quickly to changes in rates and law.

This past week I attended an outstanding presentation on PPO management and how to navigate and monitor the insurance system. I was amazed at the data the insurance companies compile to determine your reimbursement rate. Do you do “write-offs”? Maybe you should do “insurance adjustments”. Understanding the insurance market and managing it correctly could amount to thousands of dollars per month.

Another thing I noticed was the lack of interest in learning about such an important topic. Most dentist do not understand the insurance market and leave it to the office manager. The office manager does not attend quality seminars and the dentist assumes everything is being done correctly and legally.

Seminar attendance for the new generation of dentists is down and that is not good. They get there information on line but the interaction of a live session really brings things home. For a dentist, practice management sessions are not interesting but they are essential. A good business owner does not have to know how to do something but they need to know what can be and has to be done and then hold team members accountable.

As the cost of operations continue to rise, outsourcing is a very viable option. Outsourcing is nothing more than “shared services” and the only down side is having to pick the best company to work with. Get recommendations and interview several dental orientated companies and calculate the best ROI. The investment in third party specialists can be very rewarding. Would you ask a PPO management company to do a crown prep? Why do you think you can manage PPO’s? After all, you don’t know what you don’t know! Please contact me at any time with any questions or concerns.

October 30, 2016 Posted by Cliff's Notes Blog | Uncategorized | Leave a comment

Survival of the Fittest … Your Patient Base may be a Time Bomb!

Your Patient base is your future. Did you ever really study your “revenue base”? What is the average revenue value of each patient? Looking back at the all the practice valuations that I have done I have seen a range from $650.00/year to $1850.00. Both of those extremes were practices that grossed similar amounts ($1.2M) so why is the higher value more dangerous? The higher value base was one half the size with less than 900 active patients and that leaves the organization more vulnerable to outside economics and changes in the healthcare market.

Average Patient Value … is the average dollar amount that a patient spends annually on dentistry. That should take into account the cost of 2 hygiene appointments and $300.00 in additional work. It doesn’t mater if the patients are private or insurance because your net receipts are used in the calculation. Remember, this is only an average, some patient may need $3000.00 and some just hygiene. The value is easy to find, take the number of active patients (24 months) and divide it into 12 months of receipts. The biggest problem here is that most dental professionals do not know how many active patients they have.

Patient Demographics… is extremely important when managing the growth of a patient base. The average small practice (1-2 doctors) usually has a patient base within 10 years (+ or -) of the doctor. A dentist that is 50 years old will have an average patient base of 40-60. There are always exceptions but this average will hold true 80% of the time. This is a time bomb. As the base gets older it will shrink in size. A strong healthy practice has 1200 active patients per dentist. You want to engage 20-25 new patients per month to off set lost patients and the front end of your demographic model that will be needing less dentistry as they age.

Where is the Pain & Where is the Joy … that your patients are experiencing in their lives? An endodontist told me a great story about what happened in his office. He practices Spa Dentistry and pays attention the “patient experience”. He completed a procedure on a 45 year old woman that was referred to him. When it came time to release the patient, she said “do I really have to go”? When the doc laughed she said it was so quiet and relaxing and now “I have to get home, make dinner and get the kids onto their homework”. You need to relate to your patients world and understand their personal concerns. That’s dentistry beyond the mouth. Be who your patients want you to be.

Healthcare Today … has become a business. The dental practice that defines the “patient experience” as a priority will be rewarded with the greatest gift, a patient referral. Pay attention to growing the base with families, you need to continuously replenish the back end of your of your patient demographic. Please feel free to contact me at any time with any questions or concerns.

October 16, 2016 Posted by Cliff's Notes Blog | Uncategorized | Leave a comment

Survival of the Fittest, The Future of Dentistry, Part II

My last rant about the “Survival of the Fittest” was surprisingly well received . I am not a professional writer, I write like I speak, but I guess the subject on the blog post hit a nerve. The responses and forwards along with transmission contact reports confirm the smaller market’s concern over the rapid advances in technology and their ability to afford it. That is a concern, but no different than any small market (50 or less employees) business in today’s economy. You need to be prepared because the time may come that you may need to decide if you want to be an employer or employee. If ownership/equity is your plan just understand, it’s not easy. But it can be exciting.

You have to like what you do. Most of the dental professionals I deal with love cosmetic and reconstructive dentistry, it’s an art that most people can’t do. They love sitting chairside and working with patients with assorted personalities. But those same great clinicians hate the management end of the business. All the requirements of running a healthcare based business can be overwhelming and quiet often the person sitting on the top of the mountain gets burned out and goes into autopilot. Autopilot can be addicting and dangerous.

Quality Management is the key to a successful organization. Leadership creates the quality. Here lies the problem for the average dentist. A dentist is a doctor, a specialist in oral health just like a cardiologist is a specialist in the functions of the heart. However, doctors are scientists and in most cases not managers but they can be leaders. A leader requires passion and passion is contagious when presented correctly. The development of a quality and well compensated team is the foundation needed to succeed in the future. Putting together a quality team can be difficult and hiring a recruiter or management consultant is not a bad idea. There are several that I think are excellent and I would be happy to share their contact information.

Quality Financial Consultants are essential for any successful business. In a dental practice the owner/decision maker is also the primary revenue generator and they need trusted advise. I always recommend advisors that specialize in the dental/healthcare world mainly because the daily operation of the business is unique. Most financial advisors are CPA’s but not all CPA’s are financial advisors. A good advisor will insist on consulting with you on a quarterly basis and provide tax planning solution within weeks of the end of your Q3. If your advisor is just doing your taxes according to what you give them, its time to start looking for a new “advisor”.

Technology & Diagnostics are requirements to succeed in today’s market. Top quality management and 3rd party consultation are investments in your practice. You need to engage in the digital revolution and “focus on what can go right”. Now is the time to get started. Please feel free to contact me with any questions or concerns.

September 14, 2016 Posted by Cliff's Notes Blog | Uncategorized | Leave a comment

Survival of the Fittest! The Future of Dentistry

Charles Darwin studied evolution and change. I believe he was correct in stating that adaptation to change is the key to survival so it puzzles me when I see people resist it. We all need to embrace the changes in providing healthcare because the advances in technology are speeding up the evolution.

Dentistry (Oral Health) has always been the step-child of medicine and the dentist was never considered a “real doctor” well, that has changed. The advancements in technology has opened the door to a new world of diagnostic capabilities. Dentistry can now detect many systemic conditions before the patient exhibits symptoms. Now think about that from the Insurance company’s view. They are fully aware that early detection and treatment is financially beneficial to them. Early detection leads to cures and that means less professional intervention. Yes, outside of your office it is all about the money.

As we move into 2017, insurance will have a greater impact on our society. No matter which direction politics take us the landscape will continue to evolve at a faster and faster pace. So, how do we survive in this new environment? We embrace the change.

Where will your dental practice be in 3 years? How about 5? I can tell you that if you are still around in 10 years your practice will be nothing you would recognize today. In the next year the 3D printers will be functional in the dental office. Your going to scan your clinical preparations and if you use an outside lab, be able to pint out a temporary crown or appliance the minute you finish the prep. Your diagnostics will all be 3D and you will be looking deeper into the human anatomy than ever before. Radiation will be a thing of the past once the software is available to incorporate ultrasound. And then there are the specialist. The private dental office will have less places to refer to because the specialists will be working in general practices. To survive as the market shifts all clinical procedures will need to be kept in-house.

In 2020 Electronic Health Records (EHR) will be required by all dental professionals. That requires updating software and a plan to integrate digital components and solutions. Saying you have digital radiography is not enough but it is a start. The standard dental practice will need to utilize new technologies to accommodate new diagnostic codes being made available by the ADA and AMA. Also, If you have not started moving towards the “paperless environment” you are working behind the curve. The State of New York already requires E-Scribe and it won’t be long before the other 49 states follow. The train has left the station and it is time to start running and jump on-board.

Now lets talk about the value and “curb appeal” of a practice that is preparing for transition. Young professionals looking to establish their own practice will be more attracted to an organization that is well entrenched in the digital revolution. Today’s graduates do not know how to develop x-ray film and in the very near future they won’t be taught how to use impression materials. They learn the advanced digital formats and when entering residency programs their skills will be honed with digital imaging and diagnostics. The age of dental chairs, lights, compressor, etc. are not the value, as most sellers think. The value is in the ability to practice 21st century dentistry the way new dental professionals are taught and the amount of funds needed for additional investments required to grow a business in the fast paced healthcare revolution.

Please feel free to contact me with any questions or concerns and your comments are always welcome.

September 5, 2016 Posted by Cliff's Notes Blog | Uncategorized | Leave a comment

Do You Know Your Silent Partner?

Yes you have one, maybe several. Any outbound asset that is not directly monitored by daily operations and not subject to checks and balances (digitally) can be a “leak in the ship” and a silent partner.

When a small business like a dental office hears the term “silent partner” they think about embezzlement. Embezzlement does becomes possible without checks and balances but we will leave that discussion for another time. It’s time to look at inventory, work flow, and the all to elusive cash flow.

The Inventory: Inventory time management is one of the most difficult tasks a business has. It is not revenue generating but is an absolute necessity for any on going business. However, you need to take this necessary chore and make it have a positive impact on the overall operation. When you get right down to basics all businesses do the same thing, they buy and sell goods and services.

A very wise man once told me “don’t fall in love with your inventory”. I see clients attend year end trade shows to get great deals on a full year supply of certain products. How wrong is that? By putting large quantities on the shelf you are tying up cash, and cash is why you go to work. If you work with a quality vendor (there’s that word “quality” again) you would already have the price and get next day delivery so buy what you need when you need it. If you buy a quantity of product that last more than 90 days the additional savings need to be a minimum of 10%. Ask your accountant about inventory carrying costs. Automated inventory control is simple and is provided at no cost by quality vendors. Many of my clients use the Aruba Inventory Management System. Good software simplifies the process and the “usage” reports will help you make an informed decision when a “bulk buy” opportunity arises.

The Work Flow: How smooth does production move through your organization? Are you constantly looking over peoples shoulders to make sure they are doing things correctly? As the healthcare world continues to evolve the work flow of any business needs to streamline and automate. This requires change and investment. Utilizing technology and automating systems turns operational time into productive time. As an example, how long does it take your office manager to prepare the morning huddle? Some practice management software (i.e. Dentrex G6) do it automatically saving 15 minutes of business office time. Do that in 4 areas and that is 1 hour. What is the true cost of an employee? Investing a little money in work flow technology can have a huge ROI. Dental offices can now have their large equipment (i.e. compressor, vacuum, X-ray) monitored by software with notification of required maintenance. Hey, your car does it…

The Cash Flow: This is what it is all about. Another term I like to use is “disposable income” because that is what will result with a well organized operation. Cash Flow is the blood of any business. The better the cash flow the healthier the practice. Properly implemented procedure and protocol is essential for the survival of any modern healthcare facility. Please feel free to contact me with any questions or concerns.

August 17, 2016 Posted by Cliff's Notes Blog | Uncategorized | Leave a comment

If You Want People to Help You Make Money, You Have to Let Them Make Money!

 Like many Americans I find myself ordering things on-line and looking for good deals. Amazon continues to amaze me with the quality of there distribution and how they handle returns and complaints. However, they are not always the lowest price. Amazon chose a business model of quality and service and is constantly attempting to improve on their “customer experience”. On the other side of the equation are the big box stores such as Costco, BJ”s, Sam’s Club, etc. that chose quality and price. The low “PRICE” is what determines the level of service.

Ask yourself what your dental practice focuses on. Quality is not the question, its all about the service and the price. The lower your price the less service you can afford to offer or the harder and longer you work. Also, a low price decreases the value of your service. However, on the other hand , if you price your services according to your quality standard of care, your patient base will recognize your value. Most people look for value in the services they buy.

Your clinical skill is your quality and the “patient experience” is your service. I have several clients that are afraid of raising their fees for the fear of loosing patients. Well that may be true of a small percentage but are they the type of patients you want? They are looking at price. By increasing your services and enhancing the patient’s experience, you can increase your fees at a slow rate. Quality patients will recognize your value.

Now for the “making money”…. Quality & Service, when working together, overcome price. However, to make it work you need to share in the cash flow. What that means is providing a reason for team members, vendors, consultants, etc. to provide you with the highest quality of service so that you can maintain the quality of your management and clinical production.

The Team … One of the hardest situations for a manager is how to evaluate a long time employee for a raise. Employees can price themselves out of the market so how do you maintain quality and service when that time arrives? Simple, stop giving raises! Start establishing goals and reward with a % of the increase as a bonus for production. The team is now incentivized to help you make money. That’s how you get people to help you make money.

The Vendors … A well organized business of any size can be a little powerhouse, focus the power. Chose vendors by what they can offer to help you be successful. The quality and service they can provide allows you the opportunity to streamline your organization to maximize production. You need to go into these relationships with your eyes wide open. Its not about the price, that can always be negotiated with an agreement of an on-going relationship, its about the quality of the services being provided. Choosing a vendor is an investment, what’s the ROI?

The Value … I can’t tell you how many clients tell me that they changed accountants because the accountant was too expensive. That may be one of the most foolish statements a business owner can make. What type of services were they getting? Those clients chose price over quality and service. If price takes over the conversation, quality and service will be reduced as will overall revenues. You have no expenses, only investments in quality. What’s the ROI?

Price– Quality– Service … Pick 2 because you can’t have all 3… Quality organizations associate with other quality organizations. I prefer quality. If I can help a client be more successful and do more dentistry, then they will welcome more of my services, everyone wins with quality & service, especially the patient.

August 11, 2016 Posted by Cliff's Notes Blog | Uncategorized | Leave a comment

Everyone Wants a Raise! What happens when a long time employee exceeds their market value?

As a business owner or manager, there are some very difficult decisions that you will have to make through-out your career. Some of the hardest involve your team and their compensation vs production (value).

In a different time an annual wage increase was standard business practice, but in todays economy when operational cost are continually rising, there is not much left over to give to the team, and, you will be expected to give again next year. How can you do it? You can’t keep giving. As an example, a good dental assistant (in northern NJ) will command an hourly wage of $18-$25 per hour. If that quality employee stays with you for 10 years that wage may run as high as $35 per hour and be far above market rates. How do you deal with a team member that has been with you since you bought the practice, is over paid, under produces, but the patient love them? Here comes that difficult decision.

Quality is the key to success and a quality team is one of the most important investments your practice can make. The question is how to compensate them, keep them, and help them “grow” with you and the practice?

There are many creative ways to compensate and retain quality team members. But first you need to up-date and complete your employee management program. Team management is part of both your defensive (risk management) and offensive (production) strategies. We all know the risk management issues, they are the ones that cost you money and everyone is try to sell you. The offensive side relates to production and we don’t talk enough about it.

Some of the most successful practices I deal with offer “employee extra’s”. Everything from bonuses tied to production, medical benefits and 401K programs attract and retain quality team members. If you establish realistic incentives as part of your compensation program you will see production increase. As leader you need to motivate your team and compliments only go so far. People go to work for mostly one reason, to make money. And if you want people to help you make money, you have to let them make money. Let them make extra money by incentive programs.

Talk to your financial advisor about establishing a 401k program, one that requires several years for vesting. Matching funds can be tied to production goals. You may be surprised how this small investment will pay off. Now, every team member has something to lose if production is flat.

There is a great employee management program that was just released. Check out the link and please contact me with any questions or concerns.

http://www.dentalpracticepro.com/

May 7, 2016 Posted by Cliff's Notes Blog | Uncategorized | Leave a comment

Taxes Are UP & Patient Flow Is Down

I remember the first 5 minutes of my first marketing course. The professor started off by saying “marketing 101, packaging is 95% of the sale”. This is a very important concept to consider when addressing declining patient flow and new patient scheduling. The culture of your dental practice is your package and it needs to fit in with the patient base you want to attract.

 Dr. Omar Reed believed that your reception room should be as nice as your patient’s living room. That was 35 years ago and the only thing that changed since then are the decorative styles. Think about it, if your office looks old, no matter how great your dentistry is, the perception is old. If your office is clean, modern and bright the perception is that your clinical skills are also modern and bright. The average patient doesn’t know how good you are, they just know if they like you and feel comfortable. The passion for the patient’s overall health that you and your team exhibit is the bow on your package. When was the last time you repainted the office? What do your floors look like? What does your patient look like? Think about what you want people to think when they walk into your house?

Marketing your practice should be a coordinated effort across all medias. And what the patient sees on your website is what they expect when they walk through the door. I can’t count the number of offices that have great websites or Facebook pages and the physical location is a downgrade.

The patient market that your practice in is also a major factor. When was the last time you did a demographic study of the area you draw your patient base from?

 If you opened your practice 20 years ago and the area had a heavy Italian population, that may be shifting to other cultures. Addressing those cultures may require a different package. Bank of America Practice Solutions and Henry Schein offer real time demographic reports that include age, income, ethnicity, family size, etc. These reports should be considered so that you can realize the maximum ROI for your 2 year marketing program. That’s right, a 2 year plan.. The world is changing too fast to plan anything further out.

 What does your reception room look like? Remember, it is NOT a   waiting room because your patients don’t wait, or do they? When your patients are on line at the super market, they are seeing a flat screen with advertisements and current magazines. What do they see in your office? Sports Illustrated with last year’s Super Bowl round up? All the magazines and wall décor actually compete with your treatment plan acceptance so keep it current and dental health orientated. I see some beautifully decorated offices that keep well within the healthcare theme.

Marketing programs are not an expense, they are an investment, however, for the investment to produce a healthy ROI, you need an organized plan. Maybe it’s time to Brand Yourself and stand out from the crowd?

http://dentalbranding.com/

Please feel free to contact me with any questions or concerns.

April 10, 2016 Posted by Cliff's Notes Blog | Uncategorized | Leave a comment